Labyrinth Physical Therapy & Wellness

Persistent Postural-Perceptual Dizziness (PPPD)

Do you feel dizzy or unsteady almost every day—even though the original problem may be gone?

PPPD is a chronic dizziness disorder that can cause persistent sensations of rocking, swaying, imbalance or disorientation.

Symptoms are often worse when standing, walking, moving or being surrounded by complex visual environments.

PPPD is not imaginary, and it isn't simply “anxiety.” It reflects changes in how the nervous system processes and responds to balance, visual and movement information.

Common Symptoms of PPPD

People with PPPD often describe:

Rocking or swaying
Feeling as though they are walking on a boat
Persistent non-spinning dizziness
Feeling disconnected or disoriented
Difficulty walking in stores
Dizziness in crowds
Sensitivity to patterned floors
Symptoms while scrolling on a phone or computer
Difficulty watching moving objects
Increased symptoms while standing or walking
Symptoms that improve when lying down or remaining still
Fear or apprehension about movements that may provoke dizziness

How Does PPPD Begin?

PPPD often develops after something initially disrupts the balance system.

This may include:

BPPV
Vestibular neuritis
Vestibular migraine
Concussion
Illness
A fall or episode of severe vertigo
Another medical or vestibular event

The original problem may improve, but the brain can remain overly dependent on visual information or overly protective about movement.

Treatment for PPPD

Successful treatment generally focuses on helping the nervous system become less sensitive to movement and sensory information.

Vestibular rehabilitation may include:

Gradual exposure to head movement
Walking and balance training
Visual-motion exercises
Habituation
Dual-task activities
Aerobic exercise
Progressive return to normal environments
Strategies for decreasing movement avoidance

The exercises need to be appropriately dosed. Simply pushing through severe symptoms is not the goal.

Why Specialized Evaluation Matters

Persistent dizziness can have many causes.

Before treating PPPD, we want to understand what started your symptoms and determine whether there are remaining vestibular, neurologic, visual or musculoskeletal problems contributing to them.

PPPD may also occur alongside another diagnosis, such as vestibular migraine.

Get Back to Moving Normally

PPPD can make your world feel smaller as you begin avoiding stores, crowds, exercise, driving or other activities.

Treatment is designed to gradually reverse that pattern.