What is Persistent Postural-Perceptual Dizziness (PPPD)?
Persistent Postural-Perceptual Dizziness (PPPD) is a common long-term vestibular condition that causes ongoing dizziness, unsteadiness and sensitivity to movement. Unlike conditions such as BPPV, PPPD is not caused by damage to the inner ear itself, but by the way the brain processes balance and sensory information following an initial trigger.
PPPD often develops after an event such as vestibular neuritis, BPPV, vestibular migraine, concussion, panic attacks or another illness that caused dizziness. Although the original condition may have resolved, the brain continues to rely excessively on visual information and protective movement strategies, leading to persistent symptoms.
People with PPPD often describe feeling constantly off balance rather than experiencing true spinning vertigo. Symptoms are usually worse when standing, walking, moving through busy environments or watching moving objects.
The good news is that PPPD is highly treatable with the right combination of education, vestibular rehabilitation and graded exposure.
How Can Physiotherapy Help?
Specialist vestibular physiotherapy is one of the most effective treatments for PPPD. Rehabilitation aims to retrain the brain's balance system, reduce sensitivity to movement and gradually restore confidence in everyday activities.
At Greenacre Physio, treatment may include:
- Comprehensive vestibular assessment
- Education about PPPD and symptom mechanisms
- Vestibular rehabilitation exercises
- Balance and gait retraining
- Gaze stabilisation exercises
- Gradual exposure to movement and visually busy environments
- Habituation exercises to reduce motion sensitivity
- Breathing and relaxation strategies where appropriate
- Falls prevention advice
- Personalised home exercise programmes
Our rehabilitation programme is carefully paced to challenge your balance system without overwhelming your symptoms, allowing steady and sustainable progress.
Why Choose Greenacre Physio?
Vestibular rehabilitation is one of Greenacre Physio's specialist areas. Our clinicians have extensive experience diagnosing and treating people with persistent dizziness through specialist NHS vestibular and neurological services, as well as private practice.
We understand that PPPD can be frustrating because routine medical tests are often normal despite symptoms having a significant impact on daily life. We take time to explain your diagnosis, reassure you about your symptoms and provide an evidence-based rehabilitation programme designed to help you regain confidence and independence.
Appointments are available at our Essex and Cambridge clinics, as well as through home visits and virtual consultations.
What to Expect
Your first appointment will include a detailed discussion about your symptoms, medical history and the situations that make your dizziness worse. We will perform a comprehensive vestibular assessment to identify the underlying cause of your symptoms and determine whether PPPD is the most likely diagnosis.
Following your assessment, we will explain how PPPD develops and create a personalised rehabilitation programme. Treatment focuses on gradually retraining your balance system through targeted exercises and functional activities, with regular reviews to ensure your rehabilitation continues to progress.
Frequently Asked Questions
Is PPPD caused by anxiety?
No. PPPD is a recognised neurological and vestibular condition. While anxiety can increase symptoms, it is not simply a psychological condition. PPPD develops because of changes in how the brain processes balance and movement following an initial trigger.
Can PPPD be cured?
Most people experience significant improvement with specialist vestibular rehabilitation. Recovery takes time and requires consistent practice, but many people return to normal or near-normal levels of activity.
Why do supermarkets and busy environments make me feel worse?
Busy visual environments place greater demands on the brain's balance system. People with PPPD often become overly reliant on visual information, making places such as supermarkets, shopping centres or busy streets particularly challenging. Vestibular rehabilitation helps reduce this sensitivity over time.
Do I need a referral?
No. You can self-refer directly to Greenacre Physio. We also accept referrals from GPs, neurologists, ENT consultants, audiologists and other healthcare professionals.
Book an Appointment
If you have persistent dizziness, feel constantly unsteady or have been diagnosed with PPPD, we're here to help. Book an appointment at one of our Essex or Cambridge clinics, arrange a home visit, or schedule a virtual consultation with one of our experienced vestibular physiotherapists.
Common PPPD Symptoms We Treat
- Persistent dizziness
- Feeling off balance or unsteady
- Motion sensitivity
- Symptoms worse when standing or walking
- Difficulty in supermarkets or busy environments
- Visual motion sensitivity
- Fear of falling
- Reduced confidence leaving the house
- Difficulty returning to work or driving
- Persistent dizziness following vestibular illness or concussion
Why Choose Greenacre Physio for PPPD?
Persistent Postural-Perceptual Dizziness can feel overwhelming, particularly when routine scans and medical tests appear normal. At Greenacre Physio, we understand that your symptoms are real and can have a significant impact on work, social activities and quality of life.
Our clinicians have specialist experience in vestibular rehabilitation through NHS vestibular and neurological services, treating people with both acute and persistent dizziness. We use evidence-based rehabilitation to retrain your brain's balance system, reduce motion sensitivity and gradually rebuild your confidence. Whether your symptoms began after a vestibular illness, concussion or another balance disorder, we will work with you to help you return to the activities that matter most.