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Chronic and Constant Dizziness (PPPD)

Persistent Postural-Perceptual Dizziness (PPPD) or Chronic Dizziness

  • Are you frustrated or tired of feeling dizzy or unsteady all the time?
  • Does your dizziness stop you from being yourself and from living your normal life?
  • Do you feel unsteady and feel like your brain doesn’t know where your body is?
  • Have you been feeling dizzy or unsteady for months or even years?
  • Do you avoid places like supermarkets because of your dizziness?
  • Does looking at patterned carpets, moving screens or busy environments make you feel dizzy?
  • Do you feel like no one understands where your dizziness is coming from and why it’s happening?

What is PPPD?

At Active, we see many people who have chronic dizziness or PPPD and they often find it hard to describe their symptoms. People often feel ‘off’ or not like themselves. They find their symptoms get worse when they’re tired, or when they pay more attention to the symptoms, and get better when they’re distracted. Chronic dizziness and PPPD are actually very common. In fact, as many as 30% of patients with vertigo end up having a residual motion sensitivity that requires habituation training.

PPPD can be very frustrating and you may feel like it’s taking over your life. Dizziness can have many causes. In an effort to determine the cause of your dizziness, you may have seen a number of health care professionals. In addition, the symptoms of PPPD can be vague and hard to describe, so the condition might not have been correctly diagnosed for some time. We understand your frustration and know that, even if various test results come back clear, your problems are very real.

Due to the prolonged nature of PPPD, and the impact of the symptoms on daily life, many people may experience anxiety or avoidance of things that trigger their dizziness. This can include crowded places or even going outside. This can become a vicious cycle, which can be broken with appropriate help and support.

While PPPD is a complex condition, with appropriate diagnosis and rehabilitation, the symptoms of PPPD and other chronic dizziness can be alleviated.

Common Symptoms

  • Non-spinning vertigo (feeling as if you’re swaying or rocking, even though you’re sitting or standing still)
  • Unsteadiness (feeling as if you’re about to fall)
  • Light-headedness (feeling woozy or as if you’re going to pass out)
  • Mild dissociation (feeling ‘spaced out’ or as if you’re floating)
  • Symptoms are usually worse when:
    • standing or sitting upright
    • moving your head or body
    • seeing movement, such as when you’re scrolling on a phone, watching TV, looking at traffic or seeing many people walking around
    • seeing complex patterns, such as a busy carpet, wallpaper, or a supermarket aisle
    • walking or riding in a car
  • Neck stiffness
  • Unsteady walking or stiffened walking patterns (gait disorders)
  • Fatigue (tiredness) and/or cognitive fog
  • Fear of falling

What Causes PPPD?

PPPD is usually triggered by an initial acute episode of vertigo, dizziness or unsteadiness. This first episode may be caused by many different things that upset the balance system, including:

  • A vestibular problem such as vestibular migraine, vestibular neuritis or benign paroxysmal positional vertigo (BPPV)
  • A fall
  • Medications or surgeries resulting in dizziness or imbalance 
  • Cardiac or nervous system problems such as stroke or heart attack 
  • Vestibular migraine
  • Panic attacks with dizziness
  • Dysautonomia (disease of the autonomic nervous system – which controls the body’s involuntary processes, such as heart rate, blood pressure, digestion and so on)

Instead of making a complete recovery from an acute episode, the brain re-wires itself, becoming overloaded and sensitive to movement and other stimuli.

How can we Help?

PPPD may coexist with other vestibular conditions, including vertigo, which may make it difficult to diagnose. Physiotherapists with advanced training in vestibular conditions, have expert knowledge in determining the diagnosis of PPPD, and in analysing what’s contributing to your problems.

Once you have a diagnosis, the first step in treatment is helping you understand what triggers your symptoms and how your brain is responding to normal signals as if you were in danger. Knowing what is going on will help you feel more in control and able to take part in your rehabilitation.

You will then commence Vestibular Rehabilitation with a physiotherapist who understands, and is experienced in, working with people who have PPPD. Vestibular rehabilitation is an exercise-based treatment program for dizziness. The goal is to help your brain re-learn how to balance and how to respond correctly to signals from your visual and vestibular systems. Your vestibular physiotherapist can help you set treatment goals and design a customized program to meet your needs. If you start doing too much, too soon, it can make your symptoms worse. The vestibular therapist will track your progress and support you through the ups and downs of recovery. The frequency, duration and complexity of the exercises will be gradually increased based on your response. Due to the chronic nature of the condition, and the length of time it usually takes for people to get a correct diagnosis, rehabilitation for PPPD can continue for several months

What Should I Expect From my Appointment?

  • Detailed Interview: This helps us to gain a full understanding of your symptoms, medical history and what you hope to achieve from our intervention.
  • Support: We understand how frightening it is to experience vertigo, dizziness and imbalance so we will take care to address all of your needs to help you feel safe to participate in the assessment and treatments.
  • Physical Assessment: We take a considered approach to assessing your body, head and eye movements and vestibular reflexes, using the latest technology. This enables us to accurately assess your function and develop a customised treatment plan for you.
  • Education: We believe that your understanding of the findings, condition and aims of treatment is important to your outcome, so we will spend time explaining key points.
  • Targeted Treatments: We use specialised treatment methods, such as repositioning techniques, to manage your symptoms.  In some cases, this can lead to immediate improvement in your symptoms and movement. 
  • Progressive Exercise Program: We teach you specially designed exercises and movements to retrain your brain, to enable independence and safely build confidence, capacity, coordination and balance, in line with your lifestyle goals.
  • Communication and Collaboration with your General Practitioner and/or Specialist doctors to keep them informed of your progress and to support your care. 

Where can I see my Physiotherapist?

On this page

In Clinic

Online Video Appointments

Web & Mobile App

Private Gymnasium