Dizziness is a symptom rather than a diagnosis, and similar symptoms can have very different causes. Vestibular problems may arise from the inner ear, the vestibular nerve or the parts of the brain involved in processing balance and movement. They can affect much more than simply feeling dizzy, influencing walking, driving, exercise, work and confidence in busy or unfamiliar environments. At NeuroPhysio, we look at the full pattern of symptoms and the factors that may be contributing. Understanding what is happening is an important first step in deciding whether vestibular physiotherapy, further medical investigation or another form of specialist support is most appropriate.
Vestibular symptoms can be difficult to describe and do not always feel like a spinning sensation. Some people feel unsteady or disoriented, while others notice problems mainly when moving, turning their head or entering visually busy environments.
You may experience spinning, light-headedness, disorientation or a sensation that you or your surroundings are moving when you yourself are still.
Some people feel unsteady when walking, turning, changing direction or moving across uneven or darker environments.
Vestibular problems can also cause blurred or unstable vision during movement, motion sensitivity or difficulty coping with screens, supermarkets, crowds and traffic.
There are many different causes of dizziness and imbalance, and identifying the underlying condition is important because treatment varies considerably. A manoeuvre that may be highly effective for positional vertigo, for example, is very different from the rehabilitation required following vestibular nerve injury or for persistent visually induced dizziness. Conditions we commonly assess or support include:
Benign Paroxysmal Positional Vertigo causes brief episodes of vertigo triggered by particular head movements, such as rolling in bed, looking up or bending down.
Vestibular neuritis affects the vestibular nerve on one side and can cause a sudden episode of vertigo and imbalance, followed in some cases by ongoing dizziness or visual instability.
Labyrinthitis can cause vertigo and imbalance alongside changes in hearing. Medical assessment is particularly important where hearing loss occurs suddenly.
Reduced vestibular function on one or both sides can affect balance and the ability to keep vision stable while moving.
Vestibular migraine can cause episodes of dizziness, vertigo, motion sensitivity or visual sensitivity, sometimes without headache.
PPPD causes persistent dizziness or unsteadiness that is often worse when upright, moving or in visually complex environments.
Ménière’s disease is associated with recurrent vertigo and fluctuating hearing symptoms and usually requires medical or audiovestibular management.
Vestibular function can change with age and may contribute to unsteadiness, gait problems and falls alongside other balance factors.
Following concussion or brain injury, dizziness may involve vestibular, visual, cervical, exercise-related or wider neurological factors rather than a single cause.
Some vestibular disorders originate within the inner ear or vestibular nerve. These are often described as peripheral vestibular disorders and include conditions such as BPPV and vestibular neuritis. Other dizziness and balance problems arise from areas of the brain involved in processing vestibular information. These may occur following stroke, brain injury or other neurological conditions and are described as central vestibular disorders. Some people have more than one contributing factor. Our neurological background allows us to consider dizziness alongside changes in walking, vision, coordination, sensation and other areas of neurological function.
The pattern of your symptoms can provide important clues about what may be contributing to them. We consider when symptoms began, what they feel like, how long they last, what triggers them and whether they occur alongside hearing changes, headaches, visual symptoms or other neurological features.
Depending on your presentation, further medical or specialist investigation may be needed before rehabilitation is appropriate. This could include input from a GP, neurologist, ENT specialist or audiovestibular service. Where vestibular rehabilitation is appropriate, our dedicated service explains in more detail how treatment can help.
Vestibular symptoms can occur alongside neurological conditions such as stroke, acquired brain injury, multiple sclerosis, Parkinson’s disease and Functional Neurological Disorder. In these situations, dizziness or imbalance may not be explained by the vestibular system alone. Walking, coordination, vision, sensation, strength, fatigue and confidence can all influence how someone feels and functions. Our specialist neurological physiotherapists assess these factors together so that rehabilitation is based on the whole clinical picture rather than treating dizziness as an isolated symptom.
Some vestibular conditions respond well to physiotherapy, while others require medical, ENT or audiovestibular management, and some need a combination. For example, BPPV may respond to a specific repositioning manoeuvre by a physiotherapist, while conditions involving hearing changes or more complex neurological symptoms may require further investigation before rehabilitation begins. Every episode of dizziness or vestibular symptoms is not necessarily appropriate for physiotherapy. Where another form of assessment is needed, we will explain this and recommend the most appropriate next step.
We welcome referrals from neurologists, GPs, ENT and audio-vestibular specialists, rehabilitation consultants, case managers, solicitors, insurers and allied health professionals. Referrals are particularly appropriate where dizziness or balance problems occur alongside a more complex neurological presentation or following concussion or acquired brain injury. Where needed, we can provide clear clinical reporting outlining the presentation, rehabilitation goals, proposed treatment and response to intervention, while communicating with the wider multidisciplinary team.
A vestibular disorder affects the systems responsible for balance, spatial orientation and keeping vision stable when the head moves. Problems can arise within the inner ear, vestibular nerve or areas of the brain involved in processing balance information.
Not exactly. Dizziness is a broad term that can describe several different sensations. Vertigo describes the false sensation that you or your surroundings are moving or spinning. Understanding exactly what you experience can help identify the possible cause.
BPPV is a common cause of brief vertigo triggered by particular changes in head position. It can often be diagnosed using positional tests and treated with a specific repositioning manoeuvre.
Yes. Some vestibular conditions can make visually complex or moving environments particularly difficult to tolerate. People may notice dizziness or disorientation in supermarkets, crowds, traffic or other environments containing significant visual movement.
Yes. Vestibular migraine can cause episodes of dizziness, vertigo or motion sensitivity, and headache does not have to occur during every episode.
Persistent Postural-Perceptual Dizziness is a recognised condition involving persistent dizziness, unsteadiness or non-spinning vertigo. Symptoms are typically worse when upright, moving or exposed to complex visual environments.
Yes. Dizziness, balance problems and visual motion sensitivity are common after concussion. Because post-concussion symptoms can have several different causes, a detailed assessment is important before deciding which rehabilitation approach is most appropriate.
No. Treatment depends on the diagnosis. Some conditions require medical or audiovestibular management, some respond well to specific physical treatments such as repositioning manoeuvres, and others benefit from a combination of medical management and vestibular rehabilitation.
Not always. If you already have a diagnosis, we will review this as part of your assessment. If the cause of your symptoms remains unclear, we can assess whether your presentation appears appropriate for physiotherapy and advise if further medical, neurological or audiovestibular investigation should take place.
If dizziness, vertigo or balance problems are affecting your everyday life, a specialist assessment can help clarify what may be contributing and what the most appropriate next step might be. Where vestibular rehabilitation is suitable, we can then build treatment around your symptoms, goals and the activities you want to return to.
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