Medically reviewed by Subrat Bahinipati, PT, DPT — Co-founder, Synergy Therapeutic Group
Vertigo is the sensation that you or your surroundings are spinning, tilting, or moving when you are still — typically caused by a problem in the inner ear or vestibular system.
It affects approximately 40% of adults at some point, with the most common cause being benign paroxysmal positional vertigo (BPPV), which is highly treatable. The most common signs are spinning sensations triggered by head movements, imbalance, nausea, and a feeling of unsteadiness that makes driving or stairs feel unsafe.
Unlike conventional approaches that often default to vestibular suppressant medication, Synergy Therapeutic Group treats vertigo by precisely identifying which vestibular structure is involved — then using evidence-based repositioning maneuvers (Epley and variations) and targeted vestibular rehabilitation to resolve the underlying cause, often in 1-3 visits.
If the world is spinning, tilting, or your balance has become unreliable — your body is sending a signal, not declaring a verdict. Vestibular therapy retrains the system.
Vertigo and dizziness are among the most disorienting symptoms a person can experience. Patients describe feeling like the room is spinning, the floor is tilting, they’re going to fall, or their head feels disconnected from their body. The medical workup often turns up labels — BPPV, vestibular neuritis, Meniere’s disease, persistent postural-perceptual dizziness, cervicogenic dizziness — but the patient is often left with medication and a vague reassurance that “it should pass.” For many, it doesn’t pass on its own. It needs targeted vestibular therapy.
What the balance system actually is
Your sense of balance comes from three systems working together: the inner ear (vestibular system), the eyes (visual system), and the body’s sense of where it is in space (proprioception). When one of those systems is impaired — by a virus, a head injury, age-related decline, BPPV crystals out of place, neck dysfunction, or other causes — the brain receives conflicting signals and produces dizziness or imbalance.
The good news: the brain is highly plastic, and the balance system responds to focused retraining. The work has a name — vestibular rehabilitation therapy — and it is one of the most evidence-based areas in all of physical therapy.
Common patterns we treat
- BPPV (benign paroxysmal positional vertigo) — when crystals in the inner ear shift out of place, causing brief but intense vertigo with head movement. Often resolves with specific repositioning maneuvers.
- Vestibular neuritis or labyrinthitis — after a viral illness, the inner ear may stop working symmetrically with the other side. Therapy retrains the brain to compensate.
- Post-concussion dizziness — common after head injury, requires multi-system work on vestibular, visual, and cognitive recovery.
- Cervicogenic dizziness — when the upper neck is the driver of the dizziness. Frequently missed.
- Persistent postural-perceptual dizziness (PPPD) — the brain has become hyper-vigilant to balance signals. Retraining works.
- Meniere’s disease — episodic vertigo with hearing changes. Therapy helps function between episodes.
- Age-related balance decline — multifactorial, very responsive to focused work.
How vestibular therapy works at Synergy
An evaluation looks at how each system in your balance is functioning. We assess eye movements (the vestibulo-ocular reflex), positional testing for BPPV, postural stability with eyes open and closed, gait, neck mobility, and the integration of all the systems together. Based on what we find, we build a treatment plan.
For BPPV, we use specific repositioning maneuvers (such as the Epley maneuver) — many patients see significant improvement in a single session. For broader vestibular hypofunction or PPPD, the work involves graded exposure exercises that retrain the brain to interpret balance signals correctly. For cervicogenic dizziness, we treat the neck directly. For post-concussion patients, we coordinate with the broader concussion care team.
Throughout, we educate patients on what is happening in their body. Understanding the system is part of the recovery — because much of the disability from chronic dizziness is the anxiety and avoidance that builds up around it.
Another vertigo and balance story
Vertigo and balance issues can take many forms — and respond to vestibular therapy in different ways depending on what is driving them. Here is another patient story:
Conditions that often accompany dizziness
- Chronic neck pain — the upper cervical spine is directly connected to the balance system
- Headaches and migraines — vestibular migraine is a real condition
- Chronic pain — pain and dizziness often coexist
- Vestibular therapy — our dedicated treatment approach
Recommended Reading
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Frequently asked questions
What is the Epley maneuver and does it really work?
The Epley maneuver is a specific sequence of head positions that moves displaced inner-ear crystals out of the semicircular canal where they are causing vertigo. For BPPV, it works in many patients in a single session, sometimes with one or two repeat sessions. It is one of the most evidence-based interventions in all of physical therapy.
Can stress cause vertigo?
Stress does not directly cause vertigo, but it can trigger or worsen episodes in people with an underlying vestibular condition. The nervous system\’s threat response amplifies balance-system sensitivity. Patients whose vertigo is heavily stress-influenced often need nervous-system regulation alongside vestibular therapy.
Why do I feel dizzy when I roll over in bed or look up?
That pattern — brief, intense vertigo triggered by specific head positions — is the classic presentation of BPPV. It is caused by displaced calcium crystals in the inner ear and is one of the most treatable forms of dizziness. A few sessions of vestibular therapy resolve it for most patients.
How long does it take for BPPV to go away?
With treatment, often a single session to a few weeks. Without treatment, BPPV can resolve on its own in weeks to months, but it can also persist or recur. Patients who get treated typically recover faster and have fewer recurrences.
Can vertigo come back after it goes away?
Yes — BPPV in particular has a known recurrence rate, particularly with age, head trauma, or after illness. Recurrence does not mean the original treatment failed; it means the same condition has flared again. The treatment is the same, and we teach patients to recognize early signs.
This page was medically reviewed by Subrat Bahinipati, PT, DPT, who has practiced physical therapy for more than 32 years and specializes in chronic and complex musculoskeletal conditions. He is the co-founder of Synergy Therapeutic Group in Carbondale, Illinois.
Is BPPV curable?
Yes — BPPV (the most common cause of vertigo) is highly treatable. The Epley maneuver — moving your head through specific positions to reposition the loose crystals in your inner ear — resolves about 80–90% of cases in 1–3 sessions. We perform it carefully based on which ear and which canal is affected. Doing it wrong (or generic YouTube versions) often does not work.
Can vertigo come back after treatment?
About half the time, yes — BPPV recurs. Usually within months to years of the initial episode. The good news: once you have had it treated, you know what works. We teach you the home version of the Epley maneuver so you can self-treat at the first sign of recurrence — most people resolve recurrences in a day.
What causes dizziness besides BPPV?
Several things: vestibular neuritis (inner ear inflammation), Meniere disease, cervicogenic dizziness (from neck), medications, dehydration, anxiety, and low blood pressure. Not all dizziness is vertigo — true vertigo is the spinning sensation. We assess what is actually happening before treating, because the wrong treatment for the wrong cause wastes weeks.