Dizzy? Don’t Wait. Why Early Treatment for Dizziness MATTERS.

Written by: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist, AIB-VRC

Owner: Healthy Aging Physical Therapy

I’ve been meaning to write this for a while.

As a physical therapist, I’ve met so many patients - especially older adults - who are frustrated, scared, and worn out from trying to get help for their dizziness. Many have already been to the ER or seen their primary care doctor. They’ve had bloodwork, imaging, and hours spent waiting, only to leave with a discharge summary (and costly bill…) that says "vertigo" and a prescription for meclizine (which, by the way, is often the worst thing you can do for vertigo!). 

Dizziness can be hard to describe, hard to diagnose, and hard to treat without the right tools. And most healthcare providers, despite their best intentions, do not have the training to effectively treat dizziness. Causes of dizziness in older adults can range from simple ‘plumming’ issues like Benign Paroxysmal Positional Vertigo (BPPV) to complex, multifactorial dizziness that can really limit an individual's ability to live their lives the way they want to and can lead to a cascade of other problems, both physical and emotional, down the road. Fortunately, truly dangerous causes of vertigo are actually pretty rare, and vestibular therapists like myself are trained to screen for them - and can do so, right at home. 

Last week, I completed an advanced Vestibular Rehabilitation course through the University of Pittsburgh’s Department of Physical Therapy - a detailed update on the science of dizziness, its causes, and effective treatments. It gave me the final nudge to write this, because the truth is:

Dizziness is common - but TREATABLE!

What is the Most Common Cause of Dizziness?

You may be surprised to learn that one of the most common causes of dizziness in older adults is BPPV (benign paroxysmal positional vertigo) - and it’s often misdiagnosed or missed altogether.

In fact:

• Dizziness is one of the top 3 reasons older adults seek emergency care.

• It accounts for ~10% of all ER visits in people over 65.

• Approximately 40% of dizziness in older adults can be attributed to BPPV - and many go undiagnosed for years.

BPPV is caused by tiny calcium carbonate crystals in your inner ear - called otoconia - that get dislodged and move into the wrong part of your vestibular system. This sends confusing signals to your brain, causing that awful spinning sensation when you move your head a certain way.

But here’s the key:
BPPV is both benign and highly treatable. (Really  - it’s in the name!)

Using a gentle series of head movements called canalith repositioning maneuvers, we can move the crystals back to where they belong, most often in just 1 or 2 sessions.

What If It’s Not BPPV?

That’s okay too. Vestibular therapists are trained to assess and treat a wide range of dizziness causes - including vestibular hypofunction, central dizziness, post-concussion syndrome, cervicogenic dizziness, and more.

Treatment often includes a combination of:

• Vestibular exercises designed to retrain the brain and inner ear to work together again. These may include gaze stabilization exercises (teaching your eyes to stay steady while your head moves), habituation exercises (gradual exposure to movements that trigger symptoms to reduce sensitivity), and substitution strategies that help your body use other senses like vision or proprioception to compensate for balance loss.

• Balance training that challenges your body safely to improve stability, confidence, and coordination. This may include:

• Standing on uneven surfaces

• Practicing turning or head movements during walking

• Dual-task activities to mimic real-world situations (like walking while talking or carrying something)

• Education is one of the most powerful parts of therapy. As vestibular specialists, we help you:

• Understand why you're dizzy

• Identify what makes your symptoms worse

• Learn how to gradually return to daily activities

• Build confidence to move again (because the fear of dizziness can often be just as limiting as the dizziness itself)

We also spend time helping you avoid common pitfalls - like over-relying on meclizine or stopping movement altogether, which can actually make symptoms worse over time.

We don’t just guess - we test.
Using clinical tools and evidence-based screening, we assess your vestibular system, visual tracking, balance strategies, gait, and postural control. From there, we create a personalized plan that meets your needs and goals.

Vestibular rehabilitation therapy (VRT) is the gold standard for managing most non-life-threatening vestibular disorders, and it has strong research support behind it.

Isn’t Dizziness Just a Normal Part of Getting Older?

One of the most harmful misconceptions I hear from patients is they brush off dizziness as part of aging, or are told by well-meaning healthcare providers to simply drink more water.  But dizziness is not a normal part of aging, and when it goes untreated, it can trigger a cascade of issues that affect nearly every aspect of a person’s health. People often start avoiding certain movements or situations that provoke symptoms, which leads to reduced physical activity, progressive muscle weakness, and worsening balance. This in turn increases the risk of falls, leads to  social withdrawal, and contributes to emotional challenges like anxiety and depression.

In fact, dizziness and anxiety are closely linked; research shows that the brain regions responsible for balance and emotional regulation are deeply connected. So yes, while dizziness can make you feel anxious, anxiety can actually make you feel dizzy! It’s a real, bi-directional cycle that many people find themselves stuck inW.

That’s why early treatment is so critical. A 2023 study of over 800,000 adults found that individuals who received physical therapy within three months of reporting dizziness were 86% less likely to fall in the following year. That’s an extraordinary impact, and a clear message that getting help early matters. Don’t wait to see if it goes away. There’s effective treatment available, and it can make all the difference.

The Benefits of At-Home Vestibular Care

When you're experiencing dizziness, just getting to a clinic can feel overwhelming, dangerous or impossible. You may be facing challenges like driving, navigating stairs, fatigue, or simply not having someone available to accompany you. BPPV treatment may leave you feeling dizzy for an hour or so after they are complete, so getting home from the clinic may be an unexpected challenge as well.  That’s why we bring expert vestibular care directly to you. At Healthy Aging Physical Therapy, we provide outpatient-at-home vestibular rehabilitation—a safe, effective, and personalized approach that addresses dizziness, vertigo, and balance issues in the comfort of your own home. Our team includes certified vestibular and concussion specialists, Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist,  and Jessie Jamieson, PTA, both trained through the American Institute of Balance. When dizziness is your primary concern, you’ll be evaluated by one of our vestibular-trained clinicians to ensure an accurate diagnosis and targeted treatment plan from the start.

You may also receive care by a member of our larger, collaborative team of physical and occupational therapists who have  advanced training in fall prevention, Parkinson’s Disease, orthopedic rehabilitation, chronic pain, arthritis, and post-injury recovery. That means you won’t just be treated for your dizziness - you’ll be cared for as a whole person. With at-home vestibular care from a specialized and holistic team, you can feel secure knowing you're in good hands every step of the way.

Ready to Get Steady?

Dizziness doesn't have to take away your confidence, your safety, or your ability to live life on your terms. With the right treatment, delivered by a specialized team in the comfort of your own home, you can get back to doing the things you love without the fear of falling.

At Healthy Aging Physical Therapy, we provide outpatient-at-home vestibular rehabilitation covered by Medicare Part B, BCBS and most Medicare Advantage Plans. That means you get the same expert care you'd receive in a clinic, without ever having to leave home. From your first evaluation to personalized vestibular and balance therapy, you’ll be supported every step of the way by a team who understands the unique needs of older adults.

To request a Vestibular Therapy Consultation, you can:

📞 Call us at (617) 398 - 4508
📠 Ask your doctor to fax us referral to (781) 262 3337
🌐 Or click the button below to register as a new patient and we’ll call you from there to schedule your appointment.

References

• Marmor et al. (2023). Use of Physical Therapy and Subsequent Falls Among Patients With Dizziness in the US.
   JAMA Otolaryngol Head Neck Surg. https://doi.org/10.1001/jamaoto.2023.2840

• Pauwels et al. (2023). Gait and Falls in BPPV: A Systematic Review and Meta-analysis.
   J Neurol Phys Ther. https://doi.org/10.1097/NPT.0000000000000438

• Dunlap et al. (2021). Fear Avoidance Beliefs and Disability in Vestibular Disorders.
   Phys Ther. https://doi.org/10.1093/ptj/pzab147

• Metz & Bryce (2024). Including BPPV Screening in Falls Clinics.
   J Laryngol Otol. https://doi.org/10.1017/S0022215123002049

• Agrawal et al. (2009). Vestibular Dysfunction and Fall Risk in US Adults.
   Arch Intern Med. https://doi.org/10.1001/archinternmed.2009.66

• McDonnell MN & Hillier SL. (2015). Vestibular rehabilitation for unilateral peripheral vestibular dysfunction.
   Cochrane Database Syst Rev. (1):CD005397.
   https://doi.org/10.1002/14651858.CD005397.pub4

• Bhattacharyya N et al. (2008). Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (BPPV).
   Otolaryngol Head Neck Surg.
   https://doi.org/10.1016/j.otohns.2008.08.022

• Oghalai JS et al. (2000). The Dizziness Handicap Inventory: BPPV and Older Adults.
   Otolaryngol Head Neck Surg.
   (Referenced for prevalence data; original article not available online, but frequently cited in clinical literature)