Beyond BPPV: What Happens When the Vertigo Doesn’t Go Away?

Most clinicians know Benign Paroxysmal Positional Vertigo (BPPV) as the classic “ear crystal”problem. Tiny calcium carbonate particles normally sit on the utricle, but when they slip into one of the semicircular canals, they trigger nystagmus and that unmistakable 30-second burst of spinning. It’s unsettling but usually treatable with repositioning maneuvers like the Epley. As a vestibular physical therapist, I treat BPPV often—and it’s usually only part of the story. BPPV can show up alongside vestibular neuritis, Ménière’s disease, concussion, and very frequently, vestibular migraine. When BPPV is the sole issue, symptoms typically resolve in 1–3 sessions. But when a patient’s dizziness, imbalance, head pressure, or tinnitus lingers after the crystals are back where they belong, we have to look deeper: lifestyle, stress, sleep, nutrition, exercise, and nervous-system regulation all play a role.

This is where Zero Balancing changed everything for my practice.

Adding ZB to my vestibular rehab toolbox filled a gap I didn’t realize I had. For patients with recurring dizziness not caused by BPPV, a few sessions of Zero Balancing often created the shift they needed. Those “complex” vestibular cases started improving more quickly and more consistently.

Learning Zero Balancing early in my vestibular career reshaped how I treat—and teach. If you’re curious about expanding your own hands-on skills to support patients with stubborn dizziness or any stress-related physical dysfunction, I’d love to have you join me.