Why Am I Dizzy?

Dizziness is an umbrella term that often varies between patients. The nature of dizziness requires interpretation. Simply labeling yourself as dizzy provides little diagnostic information. Often, we correlate dizziness to the vestibular system. Medical jargon aside, think of your vestibular system as your inner ear. The inner ear is a complex system that provides spatial information about speed, direction, acceleration, deceleration, pitch, and yaw. An easy example is sensing movement within an elevator. Your vision tells you you’re not moving, but the inner ear, along with your muscular system, sense the upward or downward movement of the elevator.

You may describe dizziness as a spinning, while others feel simply ‘off.’ Dizziness can range from a feeling of lightheadedness to severe vertigo to what our patients relate to a ‘drunken gait.’ All of these descriptors equate to different etiologies.

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The Inner Ear

The inner ear consists of three semicircular canals (shown above) and two not-pictured organs: the utricle and saccule. Each semicircular canal lies in a separate plane of motion to provide 3-Dimensional, 360 degree information about movement. The canals are lined with hair cells, each with an individual crystal attached to the end. The canals are filled with a fluid (endolymph) that moves within the canal to deflect hair cells, which signals information to the brain.

Positional Dizziness

Some of the most common forms of dizziness accompany positional changes. Again, simply labeling your dizziness as positional requires us to dig deeper. Positional dizziness is typically related to one of two conditions: orthostatic hypotension or benign positional paroxysmal vertigo (BPPV).

Orthostatic Hypotension

Orthostatic hypotension is common, particularly with individuals who have low blood pressure. Symptoms are often experienced when transitioning between gravity-dependent positions. For example, standing too fast or transitioning from lying to sitting. As we transition to a gravity-dependent position blood is pulled downwards, causing a protective response to the brain to faint. Luckily, most patients can stabilize their blood pressure before hitting the deck, while in more severe cases individuals may actually faint. Symptoms are verbalized as a ‘fade-to-black’ or ‘light headedness.’ Generally, patients who experience orthostatic hypotension will stand or sit for a few seconds, allowing their blood pressure to stabilize.

Benign Positional Paroxysmal Vertigo (BPPV)

BPPV is a severe, sudden onset, and often debilitating attack of vertigo. Symptoms typically present with rolling in bed, bending, or pitching the head up or down. At an anatomical level, crystals within the inner ear become dislodged in the semicircular canals. As our head position changes the pull of gravity can cause dislodged crystals to move and relay false information to the brain. Once provoked, symptoms are often short lived and last less than one minute. Patients often use ‘every time’ language. For example, “every time I bend over or roll in bed I experience severe dizziness.” Luckily, most cases of BPPV episodes can be corrected in a few days by performing a repositioning technique known as the Epley Maneuver. Often, the Epley Maneuver is performed by a physical therapist, neurologist, or audiologist.


As previously stated, our inner ear is responsible for relaying information about direction and speed. The entire system is hardwired into our central nervous system and allows for maintenance of balance. The information relayed from the inner ear is transmitted to the brain for interpretation. The brain interprets the information from the inner ear and allows for changes in muscle tone and eye movements that allow us to maintain balance and track objects. A finely tuned inner ear allows you to smoothly track objects during movement. Often, imbalance and unsteadiness are a result of an inner ear that may not be relaying accurate information. Symptoms from patients are often verbalized as feeling ‘off’ or the persistent need to drag a finger or two along the wall for balance. Luckily, a individualized vestibular rehabilitation program can help re-calibrate your inner ear. Specific exercises that train your inner ear and eye movements can effectively eliminate symptoms; however, unlike BPPV, treatment effects are seen over the course of 8-12 weeks, not a few days.

For some, a quick Epley Maneuver can provide lasting relief in a short period of time. For others, a program emphasizing balance, visual stabilization, coordination, and strength can effectively improve balance and reduce fall risk.

If you are suffering from dizziness in your daily life, click the link below to schedule your free discovery visit with a physical therapist at Buffalo Rehab Group.