Feeling dizzy, unsteady or like the room is spinning? You’re not alone and you’re not imagining it. Dizziness is one of the most common reasons adults over 45 visit their GP, yet it’s also one of the most misunderstood.
This guide explains what might be causing your symptoms, what the research says about treatment options and how the team at Sundial Clinics in Brighton can help you feel steady again.
First: What Do We Actually Mean by “Dizziness”?
The word “dizziness” is a catch-all that our patients here at Sundial use to describe several very different sensations. Before anything else, it helps to work out which one you’re experiencing because the cause and the solution can be quite different.
Vertigo is the sensation that you or the room is spinning or tilting. It can come on suddenly and feel genuinely alarming.
Lightheadedness is more of a floaty, woozy feeling, as though you might faint. It’s often related to blood pressure changes or dehydration.
Unsteadiness or imbalance is the feeling of being off-kilter, particularly when walking, standing up or moving your head quickly.
Disequilibrium is a broader sense of instability without a clear spinning sensation, often described as “not feeling right on your feet.”
Getting clear on what you’re experiencing is the first step. The next is working out where it’s coming from. There are three main systems involved.
The Three Systems That Keep You Balanced
Your sense of balance depends on three systems working in harmony:
- Your inner ear (vestibular system): tiny fluid-filled canals detect movement, acceleration and head position. When these send the wrong signals, dizziness follows.
- Your eyes (visual system): your brain constantly cross-references visual information to confirm where your body is in space.
- Your joints and muscles (proprioceptive system): particularly in your feet, ankles and spine, these send the brain continuous feedback about posture and movement.
When any one of these systems misfires, or when the brain struggles to integrate conflicting signals from all three, you feel dizzy or unsteady. Understanding which system is involved points directly to the right kind of help.
The Inner Ear: BPPV and Vestibular Disorders
BPPV Explained: How We Help Patients Stop the Room Spinning
Benign Paroxysmal Positional Vertigo (BPPV) is the single most common cause of vertigo, accounting for around 20–30% of all dizziness presentations in primary care (Bhattacharyya et al., 2017). Despite the alarming symptoms, it has a clear mechanical explanation and, reassuringly, a highly effective treatment.
Inside your inner ear, tiny calcium carbonate crystals called otoconia sit on a sensory membrane. Occasionally, through a knock to the head, a bout of illness or simply due to age-related changes, these crystals become dislodged and migrate into one of the semicircular canals. There, they disrupt normal fluid movement, sending the brain false signals about head position. The result is sudden, intense, brief vertigo, typically lasting less than a minute, triggered by specific movements such as rolling over in bed, tilting the head back or bending forward.
Common BPPV symptoms
- A sudden spinning sensation when you change position
- Nausea, and occasionally vomiting
- A feeling that settles quickly once you stay still
- Symptoms that come and go, sometimes for weeks
The Epley Manoeuvre: What It Is and How It’s Used to Treat BPPV
The Epley manoeuvre is a series of guided head and body movements designed to move the displaced crystals out of the semicircular canal and back to where they belong. It sounds simple, but it requires precise positioning and takes only a few minutes.
The evidence for it is compelling. A Cochrane systematic review (Hilton & Pinder, 2014) found the Epley manoeuvre to be a safe and effective treatment for posterior canal BPPV, with significantly higher rates of symptom resolution compared with no treatment or sham procedures. In clinical practice, many patients experience complete or near-complete relief after just one or two sessions. Some require a short course of vestibular rehabilitation exercises to fully restore confidence and balance.
At Sundial Clinics, our chiropractors and physiotherapists are trained in the Epley manoeuvre and associated repositioning techniques. If BPPV is what’s causing your vertigo, there’s a very good chance we can help you feel significantly better, often within a session or two.
Living with BPPV: Symptoms, Triggers and Treatment Options
For those who’ve been living with BPPV for some time, daily life can become carefully managed around triggers: sleeping on one side only, avoiding certain movements, dreading hairwashes or the dentist’s chair. This kind of restricted living is common, understandable and, in most cases, entirely avoidable.
BPPV can recur, particularly in older adults, and a small number of people have repeated episodes over months or years. The inner ear naturally becomes less efficient with age. This contributes to the increased balance problems many people notice from their mid-50s onwards. The good news is that each episode is treatable, and vestibular rehabilitation between episodes can reduce the impact on day-to-day function.
Triggers most often reported by patients include these activities.
- Sudden changes in head position
- Lying flat or rolling in bed
- Looking up (e.g. putting something on a high shelf)
- Bending forward (gardening, picking up objects)
If you recognise yourself in this list, it’s worth speaking to one of our chiropractors rather than simply adapting around the problem.
The Spine: Cervicogenic Dizziness and the Neck-Balance Connection
Cervicogenic Dizziness: The Often-Overlooked Cause of Chronic Balance Problems
Here’s something that surprises many patients: your neck is deeply involved in balance. The upper cervical spine, particularly the top two vertebrae, C1 and C2, is densely packed with proprioceptive nerve endings that send constant positional information to the brain. When this system is disrupted through injury, poor posture, osteoarthritis or muscle tension, the brain receives conflicting or inaccurate signals and dizziness can result.
This is called cervicogenic dizziness, and it is significantly under-recognised. It’s often described as a vague, constant unsteadiness rather than true spinning vertigo, frequently accompanied by neck pain or stiffness, and often worse after prolonged sitting, looking at a screen or sustained postures.
Reid et al. (2014) published a randomised controlled trial in the journal Manual Therapy demonstrating that manual therapy directed at the upper cervical spine produced significant improvements in dizziness, neck pain and disability in patients with cervicogenic dizziness with results maintained at twelve-week follow-up. L’Heureux-Lebeau et al. (2014) similarly found that musculoskeletal dysfunction of the cervical spine was a common finding in patients presenting with dizziness and that appropriate treatment of the neck could meaningfully reduce vestibular symptoms.
The Neck-Balance Connection: What Your Cervical Spine Has to Do with Stability
The proprioceptive system in the neck is one of the most neurologically rich areas of the body. The muscles, joints, and ligaments of the upper cervical spine contain a high density of mechanoreceptors. These are specialised sensory cells that detect position and movement and relay this information to the brain’s balance centres in real time.
When cervical proprioception is disrupted through whiplash, osteoarthritis, sustained forward head posture or muscle guarding, the brain’s internal map of where your head is in space becomes unreliable. This can manifest as dizziness, visual disturbance, difficulty concentrating or a general feeling of being “off”.
This is why many patients with chronic neck problems also report balance difficulties and why treating the neck can, in some cases, resolve dizziness that has been attributed to other causes.
Can a Back Problem Cause Dizziness? What the Research Says
From a chiropractic perspective, what’s most relevant here is the effect that restricted movement and altered joint mechanics in the upper cervical spine can have on the surrounding nervous tissue and proprioceptive signalling.
A 2016 systematic review by Lystad et al. in the Journal of Manipulative and Physiological Therapeutics reviewed the evidence for manual therapy in the treatment of cervicogenic dizziness and found promising results, with the authors noting that manipulative and mobilisation techniques (like those we use at Sundial) applied to the cervical spine appeared to reduce dizziness symptoms in several well-designed studies.
It’s important to note that chiropractic care is not appropriate for all causes of dizziness. A thorough assessment is always the first step to rule out serious or red-flag causes, identify the most likely source of the problem, and plan the most appropriate treatment. At Sundial Clinics, that’s always where we start.
Could Your Dizziness Be Coming from Your Neck? Signs to Watch For
Cervicogenic dizziness is more likely to be involved if you notice:
- Dizziness that seems worse after sitting at a desk or screen for long periods
- Dizziness that comes on when you move your neck, rather than just your head
- A history of neck pain, stiffness, whiplash or cervical osteoarthritis
- Dizziness accompanied by tension headaches, particularly at the base of the skull
- Symptoms that feel better after movement, a warm shower, or light exercise
- No clear inner ear diagnosis despite investigations
None of these is conclusive on its own, but together they build a picture that’s worth exploring with a clinician.
Proprioception and Balance: How Your Body Knows Where It Is in Space
Proprioception is the body’s internal GPS. Sensors in your muscles, joints, and connective tissue continuously report position, movement, and load to the brain, which uses this information alongside visual and vestibular input to maintain posture and coordinate movement.
As we age, proprioceptive acuity naturally declines. The receptor cells become less sensitive, nerve conduction slows slightly and the brain has to work harder to maintain stability. This is a normal part of ageing, but it can be significantly worsened by inactivity, chronic pain, previous injuries or a sedentary lifestyle.
The hopeful message is that proprioception can be trained. Balance and stability exercises that challenge the body’s positional sensors, particularly in unstable or dynamic environments, have been shown to improve balance function, reduce fall risk, and restore confidence in movement in older adults (Sherrington et al., 2019).
Age and Lifestyle: Why Dizziness Becomes More Common After 45
Why Balance Gets Harder With Age and What You Can Do About It
Balance is a skill, and like all skills, it requires regular use to remain sharp. From our mid-40s onwards, several age-related changes begin to stack up.
- The vestibular hair cells in the inner ear gradually reduce in number and sensitivity
- Proprioceptive nerve endings become less acute
- Vision, particularly depth perception, declines
- Muscle strength and reaction speed reduce
- Medications become more common, many of which affect balance
The World Health Organisation estimates that falls are the second leading cause of accidental injury deaths globally and that adults over 65 are most at risk (WHO, 2021). The encouraging news is that balance decline is not inevitable, and targeted exercise and treatment can make a substantial difference.
A landmark Cochrane review by Sherrington et al. (2019), analysing data from 108 randomised controlled trials with over 23,000 participants, found that exercise programmes, particularly those emphasising balance and functional movement, reduced falls in older adults by around 23%. This is a meaningful, real-world result.
At Sundial Clinics, we regularly support patients in Brighton and Hove and across the Sussex region who want to stay active as they get older. Whether you’re a keen golfer, an enthusiastic walker on the South Downs, a gardener or someone who simply wants to feel steady on their feet, there are practical steps we can help you take.
Falls, Dizziness, and Older Adults: A Proactive Approach to Staying Steady
One in three adults over 65 falls each year. For many, the first fall or even the fear of falling marks a turning point: a reluctance to go out, to exercise, to engage in the activities that give life its richness. This is called fear of falling and research shows it can itself increase fall risk by causing people to move less, become deconditioned and lose the very balance skills they’re trying to protect (Scheffer et al., 2008).
The most effective response is proactive rather than reactive. If you’ve had a fall, felt unsteady, or noticed that your balance isn’t what it was, a proper assessment (rather than simply being more careful) is the most useful thing you can do.
An assessment at Sundial Clinics will look at your posture, cervical spine mobility, proprioception, footwear and movement patterns. Then we’ll put together a practical, personalised plan.
Desk Workers and Dizziness: Is Your Posture Messing With Your Balance?
Working from home has quietly reshaped the musculoskeletal problems we see in our clinic. Hours spent at a screen, often with the head carried forward of the shoulders, the upper back rounded, the neck under sustained tension, creates the perfect conditions for cervicogenic dizziness.
Forward head posture increases the effective load on the cervical spine significantly (Hansraj, 2014), compresses the joints of the upper neck, and reduces the quality of proprioceptive signalling from the muscles and joints that keep your sense of balance calibrated. Many patients who present with dizziness are also reporting screen-related neck pain and the two are often related.
If you’re working from home and you’ve noticed dizziness alongside neck discomfort, it’s worth having your posture assessed.
Sports, Concussion, and Balance Problems: What Athletes Should Know
Post-concussion dizziness and balance impairment is a well-established clinical entity, and not just in contact sport. Cyclists, golfers, runners and recreational sports players can all sustain minor head injuries, sometimes without recognising them as such, that affect vestibular function and proprioception.
Giza & Hovda (2014) describe the neurophysiological cascade that follows concussion and explains why dizziness and balance impairment can persist for weeks or months after a seemingly minor head knock. Vestibular rehabilitation, including gaze stabilisation exercises, balance retraining and carefully progressed return-to-sport protocols, has good evidence for accelerating recovery.
If you’ve had a head injury and are still experiencing balance problems or dizziness, please don’t wait for it to “just sort itself out.” Early, appropriate management makes a difference.
Exercise and Self-Help: What You Can Do at Home
Targeted exercises work best and will depend on the causes of your dizziness. That’s why a clinical assessment from one of our chiropractors or physio’s specialising in neurological and vestibular rehab is a good idea. These exercises should be introduced gradually and if any exercise makes your symptoms worse, stop and seek advice.
Five Gentle Exercises to Improve Your Balance at Home
- Single-leg stand Stand near a wall or sturdy chair. Lift one foot slightly off the floor and hold for 20–30 seconds. Progress by closing your eyes once confident. Aim for three repetitions each side, twice daily.
- Heel-to-toe walk (tandem walking) Walk in a straight line placing the heel of one foot directly in front of the toes of the other, as if on a tightrope. Ten steps forward, ten back. Progress to doing this with your eyes closed.
- Sit-to-stand From a chair with arms, stand up slowly and sit back down without using your hands. Repeat 10–15 times. This builds leg strength and hip stability critical for balance.
- Side steps with resistance Step sideways along a clear space, keeping your weight low and controlled. This challenges the hip abductors and lateral stability systems that contribute to balance.
- Standing on an uneven surface Standing on a folded towel or cushion while performing everyday tasks (brushing teeth, reading) challenges your proprioceptive system gently. Progress to single-leg standing on the surface.
Gaze Stabilisation Exercises: A Simple Tool for Vestibular Rehab
Gaze stabilisation exercises train the vestibulo-ocular reflex, which is the brain’s ability to keep vision steady while the head moves. Disruption of this reflex is common in vestibular disorders and contributes to visual blurring, nausea and dizziness during movement.
A basic version: hold a letter or small target at arm’s length, focus on it and slowly move your head from side to side while keeping your eyes fixed on the target. Start with 30 seconds and gradually increase duration. McDonnell & Hillier’s (2015) Cochrane review found vestibular rehabilitation, including gaze stabilisation training, to be more effective than no treatment or medical management alone for chronic vestibular dysfunction.
How Improving Your Core Strength Can Reduce Dizziness
Core stability underpins balance. The deep trunk muscles, particularly transversus abdominis, the multifidus and the pelvic floor, form a stable base from which efficient movement and postural control originate. Weakness in these muscles can result in compensatory postural patterns, increased load on the cervical spine, and reduced proprioceptive efficiency.
We love exercises on a gym ball because it wobbles and makes your core muscles and balance apparatus work harder. If you are already a patient here at Sundial Clinics in Brighton, ask us to show you some easy exercises to get you started.
Pilates-based rehabilitation, which forms part of many physiotherapy programmes, has been shown to improve balance, functional mobility and fall risk in older adults (Barker et al., 2015). Even simple, daily core activation exercises can contribute to improved stability and reduced dizziness symptoms over time.
Red Flags: When Dizziness Needs Urgent Attention
Most dizziness is benign and treatable. But there are certain symptoms that require urgent medical evaluation. Please seek immediate help if dizziness is accompanied by any of the following:
- Sudden severe headache unlike any you’ve had before
- Weakness, numbness, or tingling in the face, arms, or legs
- Sudden difficulty speaking, swallowing, or understanding speech
- Double vision or sudden vision loss
- Loss of coordination or inability to walk
- Chest pain or palpitations
- Loss of consciousness
These could indicate a stroke, TIA (transient ischaemic attack) or another serious neurological event. Call 999 or go to your nearest A&E immediately.
At Sundial Clinics, all new patients with dizziness or balance problems are screened for red flag symptoms before any treatment begins. If we have any concern at all, we will refer you promptly to the appropriate specialist.
What to Expect at Your First Appointment for Balance Problems
If you’ve been putting off seeking help because you’re not sure it’s “serious enough” or because you’re worried about what you’ll be told, here’s what actually happens at an initial appointment at Sundial Clinics.
- A thorough history. We’ll ask you to describe your symptoms in detail: when they started, what triggers them, whether they’re getting better or worse, what makes them better or worse and what impact they’re having on your daily life. There are no wrong answers.
- Screening for red flags. We’ll check for any symptoms that would indicate a need for urgent medical referral.
- Positional testing. Depending on your history, we may perform the Dix-Hallpike test to assess for BPPV or other positional assessments to identify vestibular involvement.
- Cervical assessment. We’ll examine the mobility, alignment and muscular patterns of your neck and upper back and assess proprioceptive function.
- Balance and postural assessment. We may observe how you stand, walk, and move and test balance under different conditions.
- A clear explanation and plan. At the end of your appointment, we’ll tell you what we think is going on, what we recommend and what you can realistically expect. We’ll never push you towards treatment you don’t need or want.
If you’re based in Brighton, Hove, Lewes, Worthing or anywhere across East or West Sussex, the team at Sundial Clinics would be happy to help.
You don’t need a GP referral to book an appointment (you can make one online here). Our chiropractors and physiotherapists will carry out a thorough assessment, explain what they find, and work with you on a realistic, evidence-based plan.
We’re experienced in helping adults who are worried about dizziness, vertigo, and balance problems and we know how much these symptoms can affect daily life. You deserve clear answers and a practical path forward.
Frequently Asked Questions
Q: What is the most common cause of dizziness?
A: Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes. It occurs when tiny calcium crystals in the inner ear become dislodged and send false signals to the brain about your body’s position. It typically triggers brief but intense spinning sensations when you move your head.
Q: How do I know if my dizziness is coming from my ears or my brain?
A: Inner ear dizziness (vestibular) usually produces a distinct spinning sensation (vertigo), often triggered by head movement, and may be accompanied by nausea or hearing changes. Brain-related dizziness tends to feel more like unsteadiness or light-headedness and may come with other neurological symptoms such as double vision, slurred speech, or weakness. A GP or specialist can confirm the source with the appropriate tests.
Q: Can a problem with my spine or neck cause dizziness?
A: Yes. Cervicogenic dizziness originates from the neck (cervical spine) and is often linked to poor posture, muscle tension, or joint dysfunction. The neck’s proprioceptors — sensors that tell your brain where your body is in space — can send conflicting signals when the cervical spine is not functioning correctly, resulting in dizziness or a feeling of spatial disorientation.
Q: When should I see a doctor about dizziness?
A: You should seek prompt medical attention if your dizziness is sudden and severe, is accompanied by chest pain, shortness of breath, a severe headache, facial drooping, vision changes, or slurred speech — these can be signs of a more serious condition. Even recurring mild dizziness that affects your daily life warrants a professional assessment.
Q: Can anxiety or stress cause dizziness?
A: Absolutely. The brain plays a central role in processing balance information, and when it is under stress, it can misinterpret or become hypersensitive to normal sensory signals. Persistent Postural-Perceptual Dizziness (PPPD) is a well-recognised condition where psychological factors such as anxiety contribute directly to chronic dizziness.
Q: Is dizziness more common as we age?
A: Yes. Age-related changes to the inner ear, reduced blood pressure regulation, medication side effects, and decreased proprioception all make dizziness more prevalent in older adults. It is also a leading cause of falls in the elderly, so it should never be dismissed as simply “one of those things.”
Q: Can dizziness be treated without medication?
A: Often, yes. BPPV, for example, is frequently resolved with the Epley manoeuvre — a series of guided head movements performed by a trained practitioner. Vestibular rehabilitation exercises, physiotherapy for the cervical spine, and lifestyle adjustments (hydration, posture, stress management) can all be highly effective depending on the underlying cause.
Q: How long does dizziness usually last?
A: This depends entirely on the cause. BPPV episodes may last seconds to minutes. Vestibular neuritis can cause dizziness for days to weeks. Chronic conditions such as Ménière’s disease or PPPD may involve ongoing symptoms that require longer-term management. Most causes are treatable, so a prolonged episode should always be investigated.
About Matthew Bennett, Chiropractor Brighton
Matthew Bennett is the founder and principal chiropractor at Sundial Clinics Brighton, established in 1991. With over 35 years of clinical experience, Matthew qualified from the Anglo-European College of Chiropractic in 1987 and served as President of the British Chiropractic Association for four years. As a Fellow of the Royal College of Chiropractors and former team chiropractor for Brighton and Hove Albion FC and the British Alpine Ski Team, Matthew combines evidence-based chiropractic treatment with sports performance expertise. His authority in musculoskeletal health has been recognised through national media appearances, expert witness roles and contributions to professional publications. Matthew’s commitment to clinical excellence ensures patients receive the most effective chiropractic care in Brighton.
Peer-Reviewed References
Barker, A.L. et al. (2015). Effects of Pilates exercise for improving balance in older adults: A systematic review with meta-analysis. Archives of Physical Medicine and Rehabilitation, 96(4), 715–723.
Bhattacharyya, N. et al. (2017). Clinical practice guideline: Benign paroxysmal positional vertigo (update). Otolaryngology–Head and Neck Surgery, 156(3_suppl), S1–S47.
Giza, C.C. & Hovda, D.A. (2014). The new neurometabolic cascade of concussion. Neurosurgery, 75(S4), S24–S33.
Hansraj, K.K. (2014). Assessment of stresses in the cervical spine caused by posture and position of the head. Surgical Technology International, 25, 277–279.
Hilton, M.P. & Pinder, D.K. (2014). The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews, Issue 12.
L’Heureux-Lebeau, B. et al. (2014). Evaluation of paraclinical tests in the diagnosis of cervicogenic dizziness. Otology & Neurotology, 35(10), 1858–1865.
Lystad, R.P. et al. (2011). Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review. Chiropractic & Manual Therapies, 19(1), 21.
McDonnell, M.N. & Hillier, S.L. (2015). Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews, Issue 1.
Reid, S.A. et al. (2014). Manual therapy and exercise for cervicogenic dizziness: a single-blind, randomised controlled trial. Manual Therapy, 19(5), 469–475.
Scheffer, A.C. et al. (2008). Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age and Ageing, 37(1), 19–24.
Sherrington, C. et al. (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, Issue 1.
World Health Organisation (2021). Falls fact sheet.