Feeling “off balance,” lightheaded, or like the room is spinning can be unsettling—and even frightening. Many patients use the words dizziness, vertigo, and disequilibrium interchangeably, but these symptoms each describe different sensations and causes. Understanding the differences is the first step toward effective treatment.
At Cawley Physical Therapy & Rehabilitation, we specialize in evaluating and treating vestibular disorders for patients across Scranton, Wilkes-Barre, Kingston, Pittston, Trucksville, Nanticoke, Mountain Top, Factoryville, and Carbondale, PA. This comprehensive guide breaks down the terminology, explains common causes, and shows how vestibular therapy can restore balance and confidence.
What Is Dizziness?
Dizziness is a broad term used to describe sensations such as being lightheaded, woozy, “spacey,” or faint. Patients often describe it as feeling “off” or as if their head is not clear.
Common Symptoms of Dizziness
- Feeling lightheaded or faint
- Wooziness or mental fog
- Floating or clouded sensation
- Feeling like you might pass out
- Giddiness or unsteadiness
What Causes Dizziness?
Dizziness can stem from a variety of medical conditions, including:
- Low blood pressure
- Dehydration
- Medication side effects
- Anxiety or panic disorders
- Blood sugar changes
- Cardiac conditions
- Inner ear issues
- Vision problems
Because dizziness has many possible causes, a physical therapy evaluation helps determine whether the vestibular system is involved.
What Is Vertigo?
Vertigo is the specific sensation that you or your surroundings are spinning, turning, or tilting. Unlike dizziness, vertigo typically has a clear vestibular (inner ear) cause.
Common Symptoms of Vertigo
- Spinning sensation (true vertigo)
- Nausea or vomiting
- Difficulty focusing vision
- Imbalance or falling to one side
- Motion sensitivity
- Symptoms triggered by head movement
What Causes Vertigo?
The most common causes include:
1. BPPV (Benign Paroxysmal Positional Vertigo)
Caused by tiny calcium crystals becoming displaced inside the inner ear canals.
Symptoms often triggered by:
- Lying down
- Rolling over in bed
- Looking up or down
- Quick head movements
This is treatable with specific PT repositioning maneuvers.
2. Vestibular Neuritis / Labyrinthitis
Inflammation of the vestibular nerve from a viral infection.
3. Meniere’s Disease
Caused by excess fluid in the inner ear.
4. Concussions
Head injuries can disrupt the inner ear or brain’s balance centers.
Vertigo is typically more severe and more easily linked to vestibular dysfunction than general dizziness.
What Is Disequilibrium?
Disequilibrium refers to a sense of imbalance or unsteadiness while standing or walking. Unlike dizziness or vertigo, disequilibrium is not usually associated with spinning or lightheadedness.
Patients often say:
- “My equilibrium is off.”
- “I feel wobbly when walking.”
- “I’m unsteady on my feet.”
- “It feels like the ground is shifting.”
Common Symptoms of Disequilibrium
- Unsteady walking
- Swaying or veering to one side
- Poor coordination
- Increased fall risk
- Difficulty navigating uneven surfaces
What Causes Disequilibrium?
Common causes include:
- Vestibular disorders
- Age-related balance decline
- Muscle weakness
- Neuropathy
- Medication reactions
- Parkinson’s disease or other neurological conditions
- Visual impairments
Disequilibrium strongly affects balance confidence and mobility, and often responds well to vestibular and balance therapy.
Dizziness vs. Vertigo vs. Disequilibrium: How to Tell the Difference
Many patients feel unsure whether they have vertigo or dizziness—and whether their equilibrium is affected. Here is the simplest breakdown:
| Symptom Type | Sensation | Common Causes | Vestibular Involvement? |
| Dizziness | Lightheaded, woozy, faint | Blood pressure, dehydration, medications, anxiety | Sometimes |
| Vertigo | Spinning or rotating sensation | BPPV, vestibular neuritis, inner ear dysfunction | Yes |
| Disequilibrium | Imbalance, unsteadiness when walking | Aging, neuropathy, vestibular disorders, neurological issues | Often |
If you feel unsure which category you fall into, a vestibular physical therapist can clarify your diagnosis through specialized testing.
Why Vestibular Therapy Is Highly Effective
Vestibular rehabilitation therapy (VRT) is a specialized form of physical therapy that retrains the brain and inner ear to work together. It is considered the gold standard for treating many causes of dizziness, vertigo, and disequilibrium.
Benefits of Vestibular Therapy
- Reduces vertigo episodes
- Improves balance
- Restores walking stability
- Reduces motion sensitivity
- Improves coordination
- Helps prevent falls
- Relieves chronic dizziness
- Rebuilds confidence in daily activities
No medication can replace the targeted retraining that vestibular therapy provides.
How a Physical Therapist Evaluates Dizziness, Vertigo, and Disequilibrium
A vestibular evaluation is comprehensive and includes:
Medical History + Symptom Review
Your PT will clarify whether your symptoms are spinning, lightheadedness, or balance-related.
Balance and Gait Assessment
To evaluate fall risk, postural control, and disequilibrium.
Oculomotor Testing
Your eye movements provide a window into how your vestibular system is functioning.
Positional Tests (like the Dix-Hallpike Test)
Used to diagnose BPPV.
Motion Sensitivity Testing
Determines which movements trigger symptoms.
Strength and Flexibility Assessment
Weak lower-body muscles often contribute to disequilibrium.
Evaluating these systems together allows your therapist to pinpoint the cause and create an individualized plan.
Vestibular Therapy Treatment Techniques
Vestibular therapy uses evidence-based techniques to treat a variety of inner ear–related symptoms.
Canalith Repositioning Maneuvers (for BPPV)
If vertigo is caused by BPPV, your therapist may use maneuvers such as:
- Epley maneuver
- Semont maneuver
- Gufoni maneuver
- BBQ roll
These movements guide displaced crystals out of the semicircular canals. Many patients feel relief within 1–3 visits.
Gaze Stabilization Exercises
Designed to reduce dizziness when moving your head.
Common exercises include:
VOR (Vestibulo-Ocular Reflex) Training
Holding your gaze on a target while moving your head side to side or up and down.
These exercises help retrain how your eyes and inner ear communicate.
Balance and Gait Training (for Disequilibrium)
Your PT may use:
- Narrow base standing
- Foam or unstable surfaces
- Tandem walking
- Head-turn while walking
- Dynamic stepping drills
These improve real-world balance and reduce fall risk.
Habituation Exercises
For motion sensitivity (e.g., dizziness when turning your head), your PT gradually exposes you to the movements that trigger symptoms until your brain adapts.
Strengthening and Postural Training
Weak hips, core muscles, and lower legs can worsen disequilibrium. Strengthening improves stability and reduces the effort needed to maintain balance.
When to Seek Help from a Vestibular Therapist
You should schedule an evaluation if you experience:
- Recurrent episodes of vertigo
- Feeling like your “equilibrium is off”
- Persistent lightheadedness
- Wobbling or unsteady walking
- Room-spinning sensations
- Dizziness that worsens with head movement
- Difficulty focusing vision while moving
- Fear of falling
- Symptoms lasting longer than 48 hours
Early intervention leads to significantly better outcomes—especially with BPPV or vestibular neuritis.
Get Relief with Vestibular Therapy at Cawley PT
If you’re experiencing dizziness, vertigo, or disequilibrium, the right treatment can restore your balance, improve your confidence, and help you return to normal activities.
At Cawley Physical Therapy & Rehabilitation, we treat vestibular conditions every day—and our individualized care plans get results.
Start your FREE consultation today:
Contact Cawley PT →
Frequently Asked Questions (FAQ)
What is the main difference between dizziness and vertigo?
Dizziness is typically a feeling of lightheadedness or wooziness, while vertigo is the sensation that you or your surroundings are spinning. Vertigo usually has an inner ear cause and often involves nausea or imbalance, while dizziness may stem from cardiovascular, neurological, or vestibular issues.
Why does my equilibrium feel “off” even when I’m not dizzy?
Feeling like your equilibrium is off—known as disequilibrium—often results from balance system disruptions involving the inner ear, visual system, or lower-body strength. It may also stem from neuropathy, medications, or age-related changes. Vestibular therapy can help determine the cause and restore stability.
Can vestibular therapy help with chronic dizziness?
Yes. Vestibular therapy is one of the most effective treatments for long-lasting dizziness caused by inner ear or balance system dysfunction. By retraining how your eyes, brain, and inner ear coordinate, therapy can significantly reduce symptoms and help you return to normal daily activities.
How long does it take for vestibular therapy to work?
Most patients experience improvement within 2–4 weeks, depending on the cause of their symptoms. Conditions like BPPV may resolve in as little as one session, while chronic dizziness or disequilibrium may require a longer treatment plan. Consistency with home exercises improves results.
Is vertigo dangerous or a sign of a serious problem?
Vertigo is uncomfortable but not usually dangerous. However, sudden severe vertigo, neurological symptoms, fainting, or persistent imbalance may indicate a more serious issue and should be evaluated promptly. A vestibular therapist can help determine whether your symptoms are inner ear–related or require further medical assessment.