Understanding Vertigo: What It Is, Why It Happens, and How It’s Treated
By Dr. David Lavin, PT, DPT, CMP, TPI CGFI
If you’ve ever rolled over in bed and suddenly felt like the whole room was spinning, you know how disorienting vertigo can be. It can come out of nowhere, leave you nauseated and unsteady, and make you afraid to move your head. The good news is that vertigo is often very treatable, but effective treatment starts with understanding what’s actually causing it.
Not All Vertigo Is the Same
Here’s something a lot of people don’t realize. “Vertigo” isn’t a diagnosis. It’s a symptom, and it can come from several very different sources. The spinning you feel when you roll over in bed is often BPPV, or benign paroxysmal positional vertigo, which happens when tiny calcium crystals in your inner ear end up where they don’t belong. But dizziness can also stem from an irritated vestibular system that needs to be retrained, from problems in the upper neck, or from a combination of factors.
This matters because the treatment for each is different. Doing the right maneuver for the wrong problem doesn’t help, which is why self-treatment so often falls short. Before any treatment begins, I use standardized clinical tests to determine what’s actually driving your symptoms and which side is involved. Everything after that follows from what I find.
Canalith Repositioning: Effective, but the Details Matter
For true BPPV, treatment is often quick and remarkably effective. Canalith repositioning maneuvers, the Epley being the best known, guide those displaced crystals back to where they belong, frequently with noticeable relief in just one or two sessions.
You may have seen these maneuvers online, and might have even tried the Epley on your own at home. The catch is that the maneuver has small intricacies that make a big difference. The angle of your head, the direction you’re turned, how long you hold each position, and knowing which ear and which canal is affected all determine whether the treatment works or barely moves the needle. The Epley is also just one option. Depending on which canal the crystals have settled in, a different maneuver may actually be the right one, and using the wrong technique is a common reason home attempts fall flat. So if you’ve tried the Epley maneuver on your own and felt like it didn’t work, there’s a good chance it wasn’t that the treatment failed, but that a small detail wasn’t quite right, or a different maneuver was needed. That’s the value of having it done correctly the first time, and then being taught a home version you can actually trust.
When Repositioning Isn’t the Whole Answer
Sometimes the crystals are only part of the story. When the vestibular system itself is oversensitive, I use habituation exercises, which are carefully dosed movements that help your nervous system calm down and adapt to the positions that currently trigger symptoms. When the upper cervical spine is contributing, hands-on manual therapy to the neck can be an important piece of the puzzle. And when someone has been dizzy long enough that their confidence and steadiness have suffered, I combine these approaches with balance training so you’re not just symptom-free, but genuinely secure on your feet again.
I can layer these approaches together and adjust in real time based on how your body responds, rather than forcing your symptoms into a single one-size-fits-all protocol.
The Advantage of Being Treated at Home
There’s also a practical benefit to addressing vertigo in your own space. We can assess and treat you exactly where your symptoms tend to occur, like the side of the bed where you roll over each morning, and I bring a professional portable treatment table so you can be positioned safely and comfortably throughout. For someone who’s actively dizzy, being evaluated and treated at home, without the added challenge of getting to a clinic, simply makes the whole process easier.
You Don’t Have to Just Wait for It to Pass
A lot of people assume vertigo is something you simply endure until it fades. Often it isn’t. With the right assessment and the right treatment, many people feel dramatically better quickly, and they learn what to do if it ever returns.
If you’re in Fernandina Beach, Amelia Island, Yulee, or the surrounding Nassau County area and you’re dealing with dizziness or vertigo, I’d be glad to help you understand what’s going on and get you moving confidently again.
Dr. David Lavin is a Doctor of Physical Therapy serving Fernandina Beach, Amelia Island, Yulee, and the surrounding Nassau County area. To schedule a consultation, contact THRĪV here.
