Dizziness

Dizziness is a broad term covering several different sensations — lightheadedness, unsteadiness, a floating feeling, or a spinning sensation known as vertigo — and it can arise from a number of different systems in the body, including the inner ear, the cardiovascular system, and the neck. Because these different causes need quite different management, working out what’s actually driving your dizziness is the essential first step, and this is exactly where a physiotherapy assessment can help.

One of the most common and effectively treatable causes, particularly in middle-aged and older adults, is cervicogenic dizziness — dizziness driven by stiff, poorly-moving joints in the upper neck. The neck contains a dense concentration of nerve endings that feed information to the brain about head position and movement; when these joints aren’t moving properly, the signals they send can become unreliable, and the brain interprets this mismatch as unsteadiness or dizziness.

What causes dizziness

Cervicogenic dizziness typically develops from stiffness or dysfunction in the upper cervical joints, often related to poor posture, previous neck injury (including whiplash), or general age-related stiffening of the neck. Other common causes of dizziness include inner ear conditions such as benign paroxysmal positional vertigo (BPPV), where small crystals within the inner ear become dislodged and trigger brief, intense spinning with certain head movements; vestibular neuritis or labyrinthitis, involving inflammation of the inner ear’s balance structures; and cardiovascular causes such as postural hypotension, a temporary drop in blood pressure when standing up quickly. Because several of these can coexist, or produce similar symptoms, distinguishing between them is an important part of an accurate assessment.

When to see a physiotherapist

Dizziness without any of the features below is often a reasonable thing to have assessed by a physiotherapist as a first step, particularly if it’s related to neck movement, prolonged sitting, or changes in position. However, dizziness accompanied by slurred speech, facial drooping, sudden severe headache, chest pain, double vision, or weakness or numbness on one side of the body needs urgent medical attention, as these can indicate a more serious neurological or cardiovascular cause rather than a musculoskeletal one. Dizziness following a head injury, or accompanied by hearing loss or ringing in the ears, is also worth having assessed by your GP alongside any physiotherapy input.

A physiotherapy assessment for dizziness typically involves careful questioning about when symptoms occur, what triggers or eases them, and how long episodes last, alongside physical tests of neck movement, joint mobility and balance. This helps build a picture of which system is most likely involved before treatment begins, since treating the wrong cause — for example, focusing on the neck when an inner ear condition is actually driving symptoms — won’t help and can delay the right care.

Physiotherapy treatment for dizziness

Where the assessment points to the neck as a contributing factor, treatment focuses on restoring normal movement and reducing the confusing signals reaching the brain from the cervical joints. Andrew’s approach typically combines:

• Manual therapy and joint mobilisation to restore normal movement in the upper cervical spine, easing the stiffness that’s disrupting the accurate signals the neck should be sending to the brain.
• Exercise rehabilitation — targeted exercises to retrain balance and the coordination between the neck, eyes and inner ear, which reduces both current symptoms and the likelihood of dizziness recurring.

Where the assessment suggests a different underlying cause — an inner ear condition, for example — Andrew will explain this and, where appropriate, refer you on to the right practitioner rather than treating a cause that physiotherapy isn’t well placed to address directly.

What to expect from treatment

Andrew’s assessment involves specific tests of neck movement and balance to help identify how much the cervical spine is contributing to your symptoms, alongside screening for the red flags above and for signs pointing toward an inner ear cause instead. This typically includes assessing neck range of motion and joint mobility, reproducing symptoms with specific neck positions to see whether they match a cervicogenic pattern, and simple balance testing to establish a baseline to measure progress against.

Many people notice an improvement in their sense of stability within the first few sessions once appropriate treatment begins, though the exercise component — retraining balance and coordination — is what tends to make the improvement last. Because dizziness can be an unsettling symptom regardless of its cause, Andrew will also take the time to explain what he thinks is driving your particular presentation, since understanding the “why” often reduces the anxiety that dizziness itself can provoke.

Managing dizziness day to day

Alongside in-clinic treatment, simple practical adjustments can help in the meantime — standing up more slowly and pausing briefly before walking off, avoiding sudden neck movements during a flare, and maintaining good posture through the day to reduce cumulative strain on the neck. If dizziness is affecting your confidence with everyday activities like driving or walking on uneven ground, it’s worth mentioning this to Andrew, since balance-specific exercises can be tailored to address exactly those situations.