What is PPPD, and how does physical therapy retrain chronic rocking and swaying?

What causes PPPD?

After a triggering event, the brain switches to a high-alert balance strategy: stiffening posture, scanning the surroundings and relying heavily on vision. That is useful during an acute problem. In PPPD, the strategy stays switched on after the trigger has healed, so normal motion and busy scenes keep feeling threatening².

How is PPPD diagnosed?

Diagnosis is based on symptoms that meet published criteria, not on a single test¹. We use infrared video goggles to make sure no active BPPV or other inner ear problem remains, and BioSway testing often shows heavy reliance on vision. Your physician may also review medicines, mood and sleep.

How does physical therapy treat PPPD?

• Habituation: graded exposure to visual motion, busy patterns and head movement, starting below your symptom threshold
• Balance retraining: practicing relaxed, natural postures and walking without stiffening
• Gradual return to avoided places: stores, driving and crowds
• Education: understanding PPPD reduces the alarm that feeds it

Medicines such as SSRIs or SNRIs, and cognitive behavioral therapy, provided by other clinicians, can be combined with therapy².

Where can I get PPPD treatment in Alpharetta, Cumming or Suwanee?

We treat PPPD at our Cumming and Alpharetta clinics in 60-minute, one-on-one visits. Patients come from Johns Creek, Milton, Duluth, Suwanee and Forsyth County. Progress is usually gradual over several weeks, and we measure it with repeat BioSway testing.

Where can I get help in Alpharetta, Cumming and nearby?

Dr. Manan Patel, PT, DPT, TPS and our team of physical therapists see patients from Alpharetta, Johns Creek, Milton, Roswell, Cumming, Suwanee, Sugar Hill, Buford, Duluth and Forsyth County at two North Atlanta clinics. Every visit is 60 minutes, one-on-one, and urgent appointments are available within 48 hours. We are in-network with Traditional Medicare, BCBS / Anthem and Tricare, and offer a $129 rate per visit for self-pay and out-of-network plans. Not sure where to start? Take the free symptom self-check, or visit our Alpharetta clinic or Cumming clinic page.

Related care

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References

1. Staab JP, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD). Journal of Vestibular Research. 2017.
2. Popkirov S, Staab JP, Stone J. Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness. Practical Neurology. 2018.

Answered by Dr. Manan Patel, PT, DPT, TPSDoctor of Physical Therapy, Certified Vestibular Specialist and one of the few certified Therapeutic Pain Specialists in North Atlanta, with 15+ years of outpatient care. About Dr. Patel

This answer is general education, not a diagnosis or a substitute for an examination. If you have new or worsening symptoms, contact your doctor. Call 911 for sudden severe dizziness with trouble speaking, weakness, numbness, double vision or a severe headache.