Vertigo · Imbalance · PPPD · Visual vertigo
When the world won't hold still: help for chronic dizziness and vertigo.
Dizziness is one of the most common reasons people see a doctor, and one of the most frustrating when it doesn't go away. We focus on detailed testing of the eyes, inner ear and balance systems to understand what is driving your symptoms, then retrain those systems step by step.
Look closer. Recover forward.
Sounds familiar?
- Spinning, rocking or swaying sensations
- Feeling unsteady when you walk, especially in the dark or on uneven ground
- Symptoms that get worse in stores, crowds, traffic or when scrolling
- Dizziness with quick head turns, bending or rolling over in bed
- Feeling like you're on a boat even when standing still
- Avoiding driving, shopping or busy places because of how they make you feel
- Fatigue and fog after a day of "working hard just to stay balanced"
You're not imagining it, and you're not alone. These symptoms are real, and many of the systems behind them can be measured.
Why symptoms can persist
Balance depends on three streams of information that your brain blends together: your inner ear (vestibular system), your eyes, and position sense from your body. After an inner-ear infection, a concussion, a migraine or another trigger, the brain normally recalibrates. Sometimes that recalibration is incomplete.
When that happens, the brain may lean too heavily on vision or stay on high alert for motion. Busy visual environments, head movement and even standing upright can then keep symptoms going long after the original trigger has settled. The Bárány Society describes one well-studied pattern, persistent postural-perceptual dizziness (PPPD), as a chronic functional vestibular disorder: a real problem with how balance signals are processed, not a structural injury and not "just anxiety."
Because dizziness has many possible causes, from benign positional vertigo to migraine to blood-pressure regulation, the first job is to sort out which systems are involved.
What we'll evaluate
Testing is chosen for you based on your history and what you can comfortably tolerate, with rest breaks built in.
Positional testing
Checks for benign paroxysmal positional vertigo (BPPV), a common and very treatable cause of brief spinning.
Eye movements and gaze stability
Video-based eye tracking of how your eyes and inner ear work together when your head moves.
Vestibular reflexes
Head-movement tests of each balance organ and how well your vision stays clear during motion.
Balance and gait
Computerized balance testing under changing visual and surface conditions, plus walking and fall-risk measures.
Visual motion sensitivity
How you respond to moving or complex visual scenes, the kind found in stores and traffic.
Autonomic screen
Heart rate and blood pressure on standing, since lightheadedness can come from blood-flow regulation rather than the inner ear.
Our assessments guide rehabilitation and don't replace medical diagnosis. More about our testing
How care will work
Vestibular rehabilitation is well supported by clinical practice guidelines for people with inner-ear (vestibular) weakness. Depending on your testing, your program may include gaze-stabilization exercises, gradual exposure to the movements and visual environments that provoke symptoms, balance and walking training, and repositioning maneuvers when positional vertigo is found.
We dose everything to your tolerance. Exercises may stir up mild, short-lived symptoms, and that is often part of the brain recalibrating, but they should never leave you wiped out for days. We also explain what is happening along the way, because understanding your dizziness helps reduce the fear and avoidance that can keep it going.
Intensive program
Several shorter sessions per day, with planned rest, over a block of consecutive days. Designed for people traveling in or who want focused care in less time.
Outpatient program
Regular visits over several weeks with a home program in between. A good fit if you live nearby or prefer a gentler pace.
What to expect
- Before your visitWe review your records and prior testing, then talk on a short fit call so you know whether we're a good match before you book.
- EvaluationAn in-depth neurological exam and objective testing, paced to your tolerance.
- Report of findingsA plain-language explanation of what we found and what we recommend, with a written summary.
- Your programIntensive or outpatient rehabilitation, dosed and progressed as you respond.
- Re-test & home planWe repeat key measures to check progress and send you home with a program you can keep using.
Progress is tracked with repeated balance and eye-movement measures and with the activities you want back, like driving, grocery shopping or walking outdoors.
When to seek urgent care
Call 911 for sudden dizziness with weakness, numbness, facial droop, trouble speaking, double vision, a severe headache, sudden hearing loss or trouble walking. These can be signs of a stroke. If you think you are having a medical emergency, call 911.
This page is educational and is not medical advice. Please talk with your physician about your symptoms. We work alongside your medical team and never ask you to stop medications or replace medical care.
Frequently asked questions
What's the difference between dizziness and vertigo?
Vertigo is a false sense of movement, often spinning. Dizziness is a broader term that can also mean lightheadedness, unsteadiness or a rocking feeling. Describing exactly what you feel, and when, helps point to which system is involved.
What is PPPD?
Persistent postural-perceptual dizziness is a long-lasting, non-spinning dizziness or unsteadiness that is worse when upright, with motion and in busy visual environments. It usually follows another trigger, such as an inner-ear problem, concussion or migraine, and it is recognized by international diagnostic criteria.
Will the exercises make me dizzier?
They may cause mild, temporary symptoms because they gently challenge the systems that need to recalibrate. We dose them carefully and progress slowly so you can keep functioning day to day.
Can vestibular rehabilitation help if I've been dizzy for years?
Clinical guidelines support vestibular rehabilitation for chronic as well as recent vestibular problems. Whether it is right for you depends on what your evaluation shows, and we'll be honest about that.
Is my dizziness caused by anxiety?
Dizziness and anxiety often feed each other, but that doesn't mean the dizziness is imaginary. We measure how your balance systems are working and address both the physical and the fear-avoidance sides of the cycle, in coordination with mental-health providers when helpful.
Do you work with ENT and audiology specialists?
Yes. We'll review prior hearing and balance testing and coordinate with ENT, audiology and your other physicians, and we'll refer you if we find something that needs their care.
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Look closer. Recover forward.
Related conditions
Many people have more than one of these. We look at how the systems interact.
Migraine & headache
Frequent migraine, vestibular migraine or post-traumatic headache alongside dizziness or visual strain.
Concussion & TBI
Headaches, fog, light sensitivity or dizziness that linger months or years after a concussion or mild TBI.
Dysautonomia & POTS
Racing heart on standing, lightheadedness, fatigue and exercise intolerance with POTS or dysautonomia.
Selected research
These sources describe the conditions and rehabilitation principles discussed on this page. They are not studies of our clinic, which is not yet open.
- Staab JP, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the Bárány Society. J Vestib Res. 2017;27(4):191-208. doi.org/10.3233/VES-170622 (opens in a new tab)
- Hall CD, et al. Vestibular rehabilitation for peripheral vestibular hypofunction: an updated clinical practice guideline. J Neurol Phys Ther. 2022;46(2):118-177. doi.org/10.1097/NPT.0000000000000382 (opens in a new tab)