In an earlier post, we reviewed how the body uses three systems to process information keeping us upright and balanced. If that process is disrupted, one gets a sensation of spinning, called vertigo, or dizziness, which can cover many descriptions similar to feeling “off kilter”, imbalanced, disoriented, or lightheaded. Here, we will briefly explore the five most common causes of dizziness or vertigo that we treat.  See Post: Do You Suffer From Dizziness or Do You Have Poor Balance? Here’s Why & What To Do

Medical Emergencies

But first things first! It is important to rule out an urgent medical problem. Know the F.A.S.T. warning signs for a stroke from the American Stroke Association and the most common signs of a heart attack from the American Heart Association. With these and other urgent medical conditions, symptoms other than dizziness will be present that must be addressed emergently.   

1. BPPV – Benign Paroxysmal Positional Vertigo

BPPV or Benign Paroxysmal Positional Vertigo is the most common and quite disturbing type of vertigo. This occurs when “canaliths” or calcium carbonate crystals break free inside the canals of the inner ear, resulting in conflicting signals being sent to the brain. As these crystals fall with head movements, one experiences a sensation of whirling or spinning that we call vertigo. This can be disorienting enough to cause a loss of balance and possibly a fall.

BPPV Vertigo occurs when “canaliths” or calcium carbonate crystals break free inside the canals of the inner ear
BPPV Vertigo occurs when “canaliths” or calcium carbonate crystals break free inside the canals of the inner ear

Unfortunately, this condition is not readily identified by many healthcare professionals, leading to unnecessary testing and referrals to specialists. This can lead to weeks, and sometimes months of dealing with the problem before it is properly addressed.  We treat BPPV by relocating the crystals to their correct placement in the inner ear simply by placing your head in a sequence of positions, depending on which canal is affected. Yes, treatment for BPPV can be that simple! We have therapists at both our Bethany and Sherwood locations that will see you quickly, within 48 hours, and often the same day you call. We don’t want you to wait if you have this condition.  For more detailed information about BPPV, visit the Benign Paroxysmal Positional Vertigo page on VEDA’s website. 

2. Cervicogenic Dizziness

Cervical dizziness, or cervicogenic dizziness, is caused by a variety of neck problems resulting in the sensation of “feeling off”, “heavy-headed”, unstable, imbalanced, or “floating”. These are terms our patients frequently use. Sometimes this will be accompanied by headaches, neck stiffness, or neck pain. There is no formal test that can confirm this condition. Rather, it is diagnosed after a careful history and examination of both the cervical spine and the vestibular system. 

Cervical dizziness, or cervicogenic dizziness, is caused by a variety of neck problems
Cervical dizziness, or cervicogenic dizziness, is caused by a variety of neck problems

Once properly diagnosed, treatment will provide relief almost immediately. Mobilizing the muscles and joints of the neck are the first steps, then follow-up with corrective exercises addressing posture, stretching, and mobility compliments the care we provide. Working as a team allows you to obtain results quickly.  For more information on cervicogenic or cervical dizziness, read this article from the Cleveland Clinic or this one from our friends at VEDA Our therapists at both our Bethany and Sherwood locations are well versed in identifying and treating cervicogenic dizziness. We have appointments within 48 hours so you can be seen quickly and start feeling relief. 

3. Central Dizziness

Central dizziness, also known as Central Vestibular Disorders, categorizes as a group of conditions that create the perception of dizziness, vertigo, or unsteadiness from a problem in the brain and brainstem.  woman experiencing vertigo and dizziness concept imageThe symptoms can present similar to those arising from the inner ear. The cause is different, however, because the brain and brainstem inaccurately process the information taken in from our visual system, our somatosensory system (our sense of touch and body’s perception of movement), and the vestibular organs of the inner ear. Think of it as your brain being unable to complete a very complex math problem and the result is dizziness (wrong answer!) versus stability (the right answer!)  Successful treatment requires a specific approach depending on the exact diagnosis. This is where our vestibular therapists can help you. We help identify the cause of your problem and help you find a solution through a graduated treatment program to reduce or eliminate your symptoms.   For more in-depth information and details on many of the specific diagnoses related to this disorder,  VEDA has a great article here

4. Concussion

A concussion, more accurately identified as mild traumatic brain injury, or mTBI, occurs when there is physical injury to the brain from a force causing the brain to quickly accelerate and decelerate within the skull. Many people think of concussions occurring primarily in football, but concussions happen in the general population from falls, whiplash, and auto accidents The injury occurs on a physical and physiologic level. Physically this happens with bruising, twisting, or shearing of the nerves and their connections in the brain. Physiologically, the chemical and metabolic processes that keep our body systems in balance are disrupted. Once this occurs, symptoms of dizziness and disorientation, among others, present.  For balance and orientation, we start to over-rely on vision to keep us upright leading to physical stress on the eyes, head, and neck. Internally we don’t utilize the other systems as well causing further challenges when we do try to use them. Physical therapy for concussion is part of a comprehensive treatment approach to allow a return to normal physical functioning.  You can read more about concussions from a number of reputable sources. Just click on the links below to go directly to their page to learn more. Contact us today to learn how our therapists are specifically trained to treat concussion symptoms and help you feel yourself again. Mayo Clinic  The CDC  WebMD  Johns Hopkins and VEDA

5. Imbalance and Falls

While it doesn’t appear to be an obvious choice for this list, people will often report a primary complaint of dizziness while their problem is actually having poor balance. This can occur for all of the reasons listed above, or because of the following reasons: 

  • Decreased strength in the leg, pelvis, back, and abdominal muscles
  • Tight muscles in the legs restrict their ability to move freely
  • Poor agility, or put another way, being unable to move quickly to recover balance
  • Fear of falling. Having fallen once leads to over-protection, actually increasing the risk for an additional fall. 
  • Inactivity. The old adage of “if you don’t use it, you lose it” applies here. An insightful person once asked, “If you do something every day, what day are you going to wake up and not be able to do it?” Think about that!

And of course, there are a number of medical conditions that contribute to dizziness as well that should be considered. Here are just a few:

  • Dehydration
  • Hypoglycemia / low blood sugar
  • Medications side effects
  • Anemia
  • Hypotension / low blood pressure
  • Hypertension / high blood pressure
  • Stroke or TIA
  • Cardiac conditions


central dizziness head spinning dizzy Vestibular RehabilitationListen to our expert physical therapist, Matt Whitaker, PT, discuss Vestibular Rehabilitation: What Works and What Doesn’t as a guest on VEDA’s ICU podcast series.

VEDA is the authoritative resource for patients for all things vestibular, providing education to understand these challenging conditions.


Thank you for reading the Top 5 Causes of Dizziness and Vertigo. We hope it has helped you understand a little more about what causes dizziness. To learn more about other conditions and how we treat dizziness, please visit our Vertigo page.      

For a thorough evaluation and individualized treatment, contact our Sherwood clinic or our Bethany clinic today, and be seen in less than 48 hours.

Check out what injuries we commonly treat and what to expect during an appointment.