# Dizziness and vertigo Dizziness is feeling light-headed, woozy or off balance, and vertigo is the feeling that you or the room is spinning. Causes we often treat include crystals loose in the inner ear (BPPV), an inner-ear infection or inflammation, a stiff or injured neck, and balance changes with age. We find the likely cause, then treat it with head movements and exercises matched to that cause. ## Symptoms - A spinning feeling when you roll over in bed, lie down or look up - Feeling woozy or off balance - Unsteady walking, especially in the dark or on uneven ground - Nausea that comes with the dizziness - Trouble keeping your vision steady when your head moves - Dizziness that comes with neck pain or stiffness - Feeling worse in a car, in busy places or on screens ## Assessment We start by asking what the dizziness feels like, what brings it on, how long each spell lasts, and how it started. If the dizziness began after a blow to the head, we also check for a concussion. See [concussion rehabilitation](https://backinactionphysiotherapy.com/services/concussion-rehabilitation). Then we check: - how steady you are standing and walking - your eye movements, with your head still and moving - positional tests, moving you from sitting to lying with your head turned, to look for loose crystals - your neck, and whether moving it brings on dizziness Some dizziness comes from the brain itself: vestibular migraine, a stroke, multiple sclerosis and other neurological conditions. These need a careful assessment and a rehabilitation plan, and if they have not been diagnosed, a referral to your doctor or the emergency department first. Dizziness can also come from blood pressure, the heart, medicines or other medical problems. If your symptoms do not fit an inner-ear, balance or neck pattern, we ask you to see a doctor or nurse practitioner. ## Treatment Treatment depends on the cause: - **Crystals loose in the inner ear (BPPV):** tiny calcium crystals drift into one of the inner ear's balance canals. Then lying down or rolling over sets off a short spin. We treat this with a set series of head and body positions that guide the crystals back out of the canal (repositioning manoeuvres). - **Inner-ear infection or inflammation (vestibular neuritis):** the balance nerve of one inner ear becomes inflamed, often after a virus. Once the worst spinning has passed, we use balance work and gaze exercises, where you keep your eyes on a target as your head moves. - **Other inner-ear disorders:** labyrinthitis, Ménière's disease and vestibular hypofunction (an inner ear that has stopped working well) are treated the same way, with gaze and balance exercises matched to the tests, alongside your doctor's care. - **Dizziness from the neck:** the neck tells the brain where your head is, and a stiff, sore neck can blur those signals. We treat the neck with [manual therapy](https://backinactionphysiotherapy.com/services/manual-therapy) and exercise. - **Balance problems in older adults:** balance can slip with age, time in bed, or changes in eyesight or feeling in the feet. We set strength and balance exercises to help lower the chance of a fall. - **Motion sensitivity:** some people feel dizzy or sick in a car, on a gondola, in busy places or on screens (visually induced dizziness), and some are left with a constant swaying or rocking feeling for months (persistent postural-perceptual dizziness, PPPD). We use short, repeated doses of the movement that bothers you (habituation exercises). Each dose should make your symptoms no more than a little worse. Most of this is [vestibular rehabilitation therapy](https://backinactionphysiotherapy.com/services/vestibular-rehabilitation-therapy): exercise-based treatment for the inner ear and balance system. ## Getting back to sport Before you return to the hill or trail, your balance and vision need to keep up with quick head turns. We test these, then build drills such as head turns while you balance, quick direction changes, and work on uneven ground. Flat light on the ski hill takes away the visual cues you use for balance. We add drills with your eyes closed or your vision busy. Start back on easier terrain, in good light. The same training helps with everyday balance, such as walking on snow and ice. ## When to come in Book an assessment if lying down or looking up sets off a spin, or you still feel unsteady after an inner-ear illness. Come in too if dizziness comes with neck pain, your balance has slipped, or movement around you makes you queasy. Go to the emergency department right away, or call 911, if any of these happen: - a sudden, severe headache or neck pain - double vision or loss of vision - trouble speaking or swallowing - weakness or numbness on one side of the face or body - sudden trouble walking or standing, or a clumsy arm or leg - chest pain, a racing or irregular heartbeat, or fainting - new, severe dizziness with hearing loss ## Who treats it - [Therese Leigh, Physiotherapist, BSc Physiotherapy, MHA, Dip Sport Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/therese-leigh) - [Mike Conway, Physiotherapist, M. PT Sports, M. PT Manips, M. PT Studies, BSc Kin, CHT, GunnIMS, FCAMPT, CSCS](https://backinactionphysiotherapy.com/team/mike-conway) - [Bianca Matheson, Physiotherapist, BSc PT, Grad Dip PT Manips, Dip Sports Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/bianca-matheson) - [Jian Soares, Physiotherapist, M ClinPhys, BSc PT, FCAMPT](https://backinactionphysiotherapy.com/team/jian-soares) - [Julie Charette, Physiotherapist, BSc PT, Cert. MDT](https://backinactionphysiotherapy.com/team/julie-charette) - [Emilie Noble, Physiotherapist, MSc PT, BSc Kines, AN-IMS](https://backinactionphysiotherapy.com/team/emilie-noble) - [Cameron Gant, Physiotherapist, BSc Physiotherapy, PG Cert Sports Physio](https://backinactionphysiotherapy.com/team/cameron-gant) - [Nicole Klopfer, Physiotherapist, B Physiotherapy (Hons) (UMelb), M Physiotherapy (Manips) (UWA), PGrad Cert Cont & PF Rehab (UMelb), GunnIMS](https://backinactionphysiotherapy.com/team/nicole-klopfer) ## Services - [Physiotherapy](https://backinactionphysiotherapy.com/services/physiotherapy) - [Vestibular Rehabilitation Therapy](https://backinactionphysiotherapy.com/services/vestibular-rehabilitation-therapy) - [Concussion Rehabilitation](https://backinactionphysiotherapy.com/services/concussion-rehabilitation) - [Manual Therapy](https://backinactionphysiotherapy.com/services/manual-therapy) ## Frequently asked questions ### Why does the room spin when I roll over in bed? Often, loose crystals. A short spin when you roll over, lie down or look up is the typical pattern of crystals loose in the inner ear (BPPV). It is one of the most common causes of vertigo. The spin usually lasts less than a minute, though you may feel queasy or unsteady for longer. Positional tests in the clinic can show whether BPPV is the cause. ### Can dizziness come from my neck? Sometimes. Dizziness from the neck usually feels like unsteadiness or a light head rather than a spin. It tends to come with neck pain or stiffness, and can follow whiplash or long hours in one position. Other causes can feel much the same, so we test the inner ear and your balance as well as the neck before deciding. ### Should I see a doctor before booking? Not always. If the dizziness follows a clear pattern, such as a spin when you roll over in bed, we can assess it first. See a doctor or nurse practitioner if it is new and has no clear trigger, or if you have heart or blood pressure problems. Go to the emergency department right away, or call 911, if it comes with a sudden severe headache, trouble speaking or walking, or weakness on one side. ### Can BPPV come back? Yes, it can. The crystals can come loose again, sometimes long after the first spell. If the spin returns, we test again and use the head movements that match the inner-ear canal involved. We can show you the signs to watch for, so you know when to book. *This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.*