Dizziness and Pain: The Intersection of the Vestibular and Musculoskeletal Systems

In this episode of Talk Dizzy To Me, Dr. Abbie Ross, PT, NCS and Dr. Danielle Tolman PT are joined by Dr. Mickey Shah, PT, D.Sc. NCS, OCS, FAAOMPT, Dip. MDT; Certified Vestibular Rehabilitation Specialist - Emory, AVPT (Pittsburgh) to unpack the connection between pain and dizziness. Together, they explore how the neck plays a critical role in balance, why dizziness isn’t always vestibular, and how clinicians can better assess and treat patients with overlapping symptoms.From real clinical insights to practical strategies, this episode bridges the gap between vestibular therapy, pain science, and musculoskeletal care—making it a must-watch for clinicians and patients alike.Episode Resources: www.EvidenceCEU.comwww.Goodliferehab.comMidwest Vestibular Rehab SymposiumHosted by:🎤 Dr. Abbie Ross, PT, NCS🎤 Dr. Danielle Tolman, PTFor episode recommendations or requests, email us at: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠[email protected]⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Join our online program and community, The Dizzy Reset™. ⁠Use code TALKDIZZYTOME for 40% off your first month!⁠Connect with Us:→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Book a free call with us⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Get free resources straight to your inbox⁠⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠Join our online program and community, The Dizzy Reset™, for FREE⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Watch podcast episodes (and more) on YouTube ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow us on Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow us on TikTok⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow us on Facebook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Disclaimer⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Enjoying the podcast? Leave us a review!⁠→ ⁠Avulux glasses, use code DIZZYRESET for $25 off⁠This episode is for educational purposes only and is not a substitute for medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.Episode Timestamps01:26 From neuro rehab to orthopedic & vestibular care05:18 Why dizziness & pain are not owned by one specialty06:18 Definition of cervicogenic dizziness (updated understanding)06:48 Prevalence: How common is it really?08:14 Cervical spine involvement in dizziness cases10:12 Why movement loss matters more than pain11:36 Real-world complexity: vestibular + cervical overlap14:20 Neck’s role in balance reflexes17:12 Why function matters more than symptoms19:07 Testing beyond standard vestibular exams21:04 Why symptoms alone can mislead treatment22:02 Helping patients understand the neck-dizziness connection24:02 Real-life clinical example explained26:28 Pain science vs dizziness: overlapping principles27:55 Drivers of symptoms: stress, lifestyle, comorbidities29:17 Functional neurological disorders & validation30:41 Nervous system regulation strategies32:09 Practical tools: breathing, guided imagery, small wins33:35 Therapist challenges with patient buy-in35:00 Posture tips that actually work36:54 Simple, effective home exercise strategies38:17 Clinical pearls: what clinicians must remember39:15 Words matter: how language affects recovery40:13 Using reassurance to reduce fear41:35 Why joy and meaningful activity matter in recovery44:06 Empowerment: patients can change and improve

In this episode of Talk Dizzy To Me, Dr. Abbie Ross, PT, NCS is joined by vestibular and neuro experts Dr. Carly Lochala, PT, NCS and Dr. Sara MacDowell, PT to break down facial paralysis, including Bell’s palsy, Ramsay Hunt syndrome, and facial nerve recovery.They dive into how facial paralysis affects not just movement, but also confidence, communication, and daily life... and what both clinicians and patients need to know about assessment, treatment, and recovery.Key Takeaways:- Facial paralysis is commonly caused by Bell’s palsy, but can also result from Ramsay Hunt syndrome, tumors, trauma, or infections- The facial nerve (cranial nerve VII) controls facial expression, taste, tear production, and more- Recovery depends on degree of nerve damage, not just diagnosis- You cannot “exercise” your way out of paralysis early on... the nerve must heal first- Improper exercises or overstimulation can worsen recovery- Facial paralysis has a major psychosocial impact- There are treatment options—even long-term—despite common mythsEpisode Resources:⁠https://facialtherapyspecialists.com/⁠⁠https://www.facialpalsy.org.uk/⁠⁠http://bellspalsy.ws/⁠​​⁠https://facialparalysisfoundation.org/bells-palsy/⁠Webinar: ⁠Sara's WebinarWhere to Find Sara: @dizzydiagnosticsWhere to Find Carly: @balancingactrehabHosted by:🎤 Dr. Abbie Ross, PT, NCS🎤 Dr. Danielle Tolman, PTFor episode recommendations or requests, email us at: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠[email protected]⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Join our online program and community, The Dizzy Reset™. Use code TALKDIZZYTOME for 40% off your first month!Connect with Us:→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠Book a free call with us⁠⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠Get free resources straight to your inbox⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠Join our online program and community, The Dizzy Reset™, for FREE⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠Watch podcast episodes (and more) on YouTube ⁠⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow us on Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow us on TikTok⁠⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow us on Facebook⁠⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠Disclaimer⁠⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠Enjoying the podcast? Leave us a review!→ Avulux glasses, use code DIZZYRESET for $25 offThis episode is for educational purposes only and is not a substitute for medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.

In this episode of Talk Dizzy To Me, vestibular physical therapists Dr. Abbie Ross, PT, NCS and Dr. Dani Tolman, PT are joined by vestibular PT and social media educator Dr. Amy Moore , PT to break down some of the biggest myths and misconceptions about dizziness, vertigo, and vestibular rehab.If you've ever been told “your tests are normal so nothing is wrong,” “just take meclizine,” or “do the Epley maneuver and it will fix everything,” this episode is for you.Together they discuss what’s myth vs fact in the world of dizziness, why vestibular conditions are often misunderstood, and what patients should actually know about vestibular rehab.Whether you're a patient living with dizziness, a healthcare professional, or simply curious about how the vestibular system works, this episode is for you.Key Takeaways:-Normal tests don’t mean your dizziness is made up-Meclizine should not be used long-term-Good vestibular rehab is much more than physical exercises-A little dizziness during therapy is necessary-Not all dizziness or vertigo is due to BPPV-There's no silver bullet when it comes to chronic dizziness-Movement helps recoveryWhere to find Amy: @thedizzypt_amyHosted by:🎤 Dr. Abbie Ross, PT, NCS🎤 Dr. Danielle Tolman, PTFor episode recommendations or requests, email us at: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠[email protected]⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Connect with Us:→ ⁠⁠⁠⁠⁠⁠⁠⁠Book a free call with us⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠Get free resources straight to your inbox⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠Join our online program and community, The Dizzy Reset™, for FREE⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠Watch podcast episodes (and more) on YouTube ⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠Follow us on Instagram⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠Follow us on TikTok⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠Follow us on Facebook⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠Disclaimer⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠Enjoying the podcast? Leave us a review!Episode Timestamps:04:32 Myth or Fact: If imaging is normal, nothing is wrong06:24 Myth or Fact: Meclizine is not a long-term solution for vertigo08:14 Myth or Fact: Vestibular rehab is only eye and head exercises10:21 Myth or Fact: If exercises make you dizzy, they’re harmful11:49 Myth or Fact: There is no one-size-fits-all treatment for dizziness13:38 Myth or Fact: Anxiety causes dizziness15:29 Myth or Fact: BPPV isn’t always easy to diagnose or treat21:27 Myth or Fact: Rest and avoidance are the best treatment23:50 Myth or Fact: There is a quick fix for chronic dizziness26:58 Myth or Fact: Everyone with dizziness should get a VNG 32:27 Myth or Fact: Waiting until dizziness fully resolves can slow recovery33:36 Myth or Fact: If you’re not better by now, you never will be

In this episode of Talk Dizzy To Me, vestibular physical therapists Dr. Abbie Ross, PT, NCS and Dr. Danielle Tolman, PT sit down with Kayla McCain, who shares her lived experience with Vestibular Migraine and PPPD (Persistent Postural-Perceptual Dizziness).Kayla opens up about what symptoms she experienced, the long road to getting correctly diagnosed, and the strategies that helped her get back to living life again and rebuilding her confidence. Key Takeaways:-Validation and education reduce fear-Vestibular migraine vs. PPPD presentations -Recovery is often multi-factorial-The “dizzy–anxious-dizzy cycle” is real-Small strategies matter in real life-Advocate for yourselfWhere to find Kayla: @true_kaylaismsHosted by:🎤 Dr. Abbie Ross, PT, NCS🎤 Dr. Danielle Tolman, PTFor episode recommendations or requests, email us at: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠[email protected]⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Connect with Us:→ ⁠⁠⁠⁠⁠⁠⁠Book a free call with us⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠Get free resources straight to your inbox⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠Join The Dizzy Reset™ for FREE⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠Watch podcast episodes (and more) on YouTube ⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠Follow us on Instagram⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠Follow us on TikTok⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠Follow us on Facebook⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠Disclaimer⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠Enjoying the podcast? Leave us a review!Timestamps02:10 Kayla’s background + work 03:03 The beginning: Halloween onset + “felt like a stroke” + terrifying dizziness05:23 ER visit, fever, CT scan, ruled out cancer, sent home with meclizine05:53 Misdiagnoses: anxiety dismissal + MS misdiagnosis (twice) + diagnosis finally at ~7 months06:49 Early clues: menstrual migraine patterns + computer screen symptoms08:43 Life impact: fear, avoiding leaving home, stopping running, weight gain, depression/anxiety09:10 Panic + MRI + “Alice in Wonderland syndrome” episode during a trip11:00 What is Alice in Wonderland syndrome? 11:58 How Kayla describes vestibular migraine13:54 Triggers: hormones, stress, overstimulation, lights/sounds, grocery stores, concerts15:22 Postpartum: aura/floaters, attacks while caring for an infant, fear of falling while holding baby17:13 Trust + parenting: setting limits, positioning for safety, saying “no” when needed19:33 Persistent vs episodic phases + supplements/therapy + later meds after kids20:29 Feeling “seen”: why diagnosis and education changed everything25:08 What helped most: counseling, vestibular therapy, exercise, pacing, rescue meds, acceptance29:51 Practical tips: shopping at low-traffic times, migraine glasses, planned breaks, quiet resets31:24 Resilience through chronic illness32:51 Message for people with vestibular migraine + suspected 3PD: same principles can work again36:13 VM vs 3PD: how symptoms felt different 39:03 3PD treatment journey: sensitive to meds, trying options, continued exercise, gradual dosing approach42:26 Improvements43:54 Advocacy + right provider: feeling heard is half the battle45:19 Don’t give up: treatment options + therapy + counseling + meds (if needed)46:16 Hope in action: Kayla races again47:14 Where to follow Kayla: Instagram @true_true_kaylaisims47:41 Closing thoughts: hope, mindset, and a path forward

Functional Neurological Disorder (FND) is often misunderstood... but it’s real, common, AND treatable. In this episode of Talk Dizzy To Me, vestibular physical therapists Dr. Abbie Ross, PT, NCS and Dr. Carly Lochala, PT, NCS sit down with Dr. Julie Hershberg, PT, NCS to explain what FND is, why it’s been minimized in healthcare, and how it overlaps with dizziness, migraine, dysautonomia/POTS, hypermobility/EDS, and vestibular disorders.They break down brain networks like the default mode network and salience network, discuss common clinical clues (variability, attention-related shifts), and explain how treatment often starts with nervous system regulation, trust-building, and whole-person care—not just exercises.If you’ve been told your symptoms are “all in your head,” this episode is for you.Guest: Dr. Julie Hershberg / Reactive PT Instagram: @reactiveptResources: FND resources hub, reactivept.com/FNDresourcesHosted by:🎤 Dr. Abbie Ross, PT, NCS🎤 Dr. Carly Lochala, PT, NCS For episode recommendations or requests, email us at: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠[email protected]⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Connect with Us:→ ⁠⁠⁠⁠⁠⁠Book a free call with us⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠Get free resources straight to your inbox⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠Join The Dizzy Reset™ for FREE⁠→ ⁠⁠⁠⁠⁠⁠Watch podcast episodes (and more) on YouTube ⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠Follow us on Instagram⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠Follow us on TikTok⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠Follow us on Facebook⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠Disclaimer⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠Enjoying the podcast? Leave us a review!⁠⁠Timestamps 00:00 Welcome to Talk Dizzy To Me (intro)01:42 What is Functional Neurological Disorder (FND)? How to explain it to patients02:08 FND as a brain network dysfunction (function vs structure)03:32 Why education improves outcomes in vestibular care + FND04:02 Why FND has been misunderstood/minimized in healthcare04:12 From “hysteria” and “conversion disorder” to modern neuroscience06:05 Harmful stigma: being told symptoms are “fake” + medical trauma08:19 What to look for when you suspect FND (clinical clues)09:13 Variability, attention-related shifts, symptoms “moving”10:35 Screening for other diagnoses + doing a thorough neuro screen11:04 Common comorbidities missed: migraine, EDS/hypermobility, POTS/dysautonomia, vestibular disorders12:53 What you’ll hear in the subjective history that suggests FND15:13 Why “one test” (like Hoover) isn’t enough + signs vary by symptom type16:54 Diagnostic criteria: what exists, what’s lacking, what needs improvement19:12 Risk factors & triggers: sex differences, pain, sleep, physical injury/illness21:01 Dizziness in FND: how common is it + vestibular system connection21:59 Autonomic + sensory overlap (vestibular sympathetic reflex, otolith sensitivity)24:44 Treatment approach: why there’s no one-size-fits-all protocol25:38 Whole-person assessment + “pie chart” contributors + education foundation29:00 Building trust, validation, and safety (especially after medical trauma)31:18 Why play, fun, and salience matter for nervous system regulation + motor learning32:45 Default mode network vs salience network explained simply37:48 Social media + FND: what we think vs what research shows41:26 Adapting vestibular rehab when FND is part of the picture44:26 Safety + motor symptoms: when you prioritize regulation over exercise48:18 Sensory inventory & building a regulation toolkit (OT-informed strategies)51:00 Not everyone needs “calm”—some people need safe movement to regulate52:18 “Mic drop” messages for people who feel stuck55:21 Where to find Dr. Julie Hirschberg’s FND resources

In this episode of Talk Dizzy To Me, vestibular physical therapists Dr. Abbie Ross, PT, NCS and Dr. Danielle Tolman sit down with Laura Ehlers to share a powerful, real-life story of chronic dizziness, plus the long road to obtaining answers in a healthcare system that often defaults to “it’s BPPV” or “it’s anxiety.”Laura walks us through how her symptoms evolved after being hit in the head and what her life looks like living with dizziness. She also shares the layered diagnoses that often show up together in complex dizziness cases—vestibular migraine, PPPD (Persistent Postural-Perceptual Dizziness), dysautonomia/POTS (Postural Tachycardia Syndrome), and hypermobility/EDS (Ehlers-Danlos Syndrome), as well as the strategies that have helped her rebuild capacity.You’ll hear practical, experience-based advice on:- How to advocate for yourself when you’re not being believed- Why the right healthcare provider can be a game-changer- Medication realities: from sensitivities to finding what worksGuest: Laura Ehlers Instagram: @laurasnaturallifeHosted by:🎤 Dr. Abbie Ross, PT, NCS🎤 Dr. Danielle Tolman, PT For episode recommendations or requests, email us at: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠[email protected]⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Connect with Us:→ ⁠⁠⁠⁠⁠Book a free call with us⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠Get free resources straight to your inbox⁠⁠⁠⁠→ ⁠⁠⁠⁠Join The Dizzy Reset™ for FREE→ ⁠⁠⁠⁠⁠Watch podcast episodes (and more) on YouTube ⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠Follow us on Instagram⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠Follow us on TikTok⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠Follow us on Facebook⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠Disclaimer⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠Enjoying the podcast? Leave us a review!⁠01:11 Laura’s background: chronic migraine, holistic health, and early dizziness tools02:37 Early warning signs: highway driving issues, tunnel vision, “is it anxiety?”03:05 Vision therapy → severe spinning vertigo onset04:33 Current symptoms: nonstop rocking/boat sensation + visual flow triggers04:59 Life impact: driving intolerance, travel limits, parenting challenges06:27 The advocacy problem: being believed, speaking the “right language”07:52 Misconceptions in healthcare: “If Epley didn’t work, you’re anxious”09:47 Resources that helped: clinicians online + vestibular education on social media10:42 Why primary care matters: getting treated even without a supportive specialist11:09 Diagnoses explained: vestibular migraine + PPPD + dysautonomia/POTS spectrum12:07 Layering issues: infections, mold gene, mast cell activity13:06 Clinician perspective: frustration when patients get conflicting medical input14:31 Hope vs acceptance: living in the chronic illness “seesaw”15:59 Biggest mindset tool: document wins to prove progress is happening17:35 “Early whispers” of symptoms20:58 What helped most: rehab principles + sensory integration focus21:20 Proprioception strategies: weighted inputs, holds, stomps, boots, blanket22:46 Hyperbaric oxygen: regaining ability to read23:15 Scaling exposure: “one sidewalk square at a time”24:14 Breakthrough: walking on grass increased capacity25:14 Histamine/mast cell stabilization: Zyrtec and sleep/sensory benefits26:35 EDS/hypermobility: why screening matters in the “triad” conversation28:40 Daily habits: caffeine consistency, electrolytes, potassium vs sodium insight29:10 Nervous system work: somatic therapy + staying committed to movement31:10 Mindset during flares: you’re not at square one; you’re stepping off the path36:19 Encouragement for beginners: slow progress still adds up37:45 Identity shift: grief + reinventing life (reading, painting, new interests)39:06 Community: why 1:1 connections can beat unmoderated groups41:30 Medication journey: fear, hesitancy, and why meds became a useful tool44:55 Rescue meds (Ativan): pre-treating to participate in life moments45:54 Micro-dosing approach: ultra-low starts + pharmacist check-ins46:52 LDN + Zyrtec wins; sensitivity to other meds48:40 Mic drop moments: what clinicians must understand + patient hope message

If you’re a physical therapist treating dizziness (or a patient trying to understand what’s going on), this episode is packed with practical, clinic-ready guidance. Dr. Abbie Ross, PT, NCS and Dr. Dani Tolman, PT welcome Dr. Sara MacDowell, PT & Dr. Sydney Duhe, PT from Dizzy Diagnostics to break down real-world vestibular cases—including BPPV with lingering symptoms, acute vertigo after the ER (vestibular neuritis / hypofunction), and the common overlap of vestibular migraine (VM) + Persistent Postural-Perceptual Dizziness (PPPD) with visual motion sensitivity.You’ll learn how to think beyond textbook presentations, how to avoid missing multi-canal or bilateral BPPV, how to build patient buy-in with education, and how to dose and progress VOR/gaze stabilization and visual desensitization exercises for busy environments like grocery stores.Episode Resources:-Follow Dizzy Diagnostics on Instagram: @DizzyDiagnostics-Advanced Neurotherapy Education (ANTE): advancedneurotherapyed.com⁠⁠Hosted by:🎤 Dr. Abbie Ross, PT, NCS🎤 Dr. Danielle Tolman, PT For episode recommendations or requests, email us at: ⁠⁠⁠⁠⁠⁠⁠⁠[email protected]⁠⁠⁠⁠⁠⁠⁠⁠Connect with Us:→ ⁠⁠⁠Book a free call with us⁠⁠⁠→ ⁠⁠⁠Get free resources straight to your inbox⁠⁠→ ⁠⁠Join The Dizzy Reset⁠→ ⁠⁠⁠Watch podcast episodes (and more) on YouTube ⁠⁠⁠→ ⁠⁠⁠Follow us on Instagram⁠⁠⁠→ ⁠⁠⁠Follow us on TikTok⁠⁠⁠→ ⁠⁠⁠Follow us on Facebook⁠⁠⁠→ ⁠⁠⁠Disclaimer⁠⁠⁠→ ⁠⁠⁠Enjoying the podcast? Leave us a review!⁠Timestamps00:15 - Meet the guests: Sydney & Sarah (Dizzy Diagnostics) + their vestibular journeys05:18 - Case 1: BPPV treated… but lingering dizziness/imbalance remains06:39 - “First check: is BPPV truly resolved?” (all canals + short arm considerations)07:36 - Fear avoidance + habituation: getting patients moving again safely09:56 - Look beyond BPPV: hypofunction, migraine, cervicogenic contributors12:45 - Multi-canal BPPV: why it’s tricky + how to prioritize treatment14:36 - Treating multiple canals in one session19:49 - Do you always schedule a follow-up after “straightforward” BPPV?21:46 - Teaching self-treatment + “seeing is believing” re-check visits24:08 - Case 2: ER “vertigo,” meclizine, lingering unsteadiness weeks later25:35 - Full vestibular exam even with “negative imaging” 27:26 - What you expect in unilateral hypofunction: oculomotor, HIT/VHIT, balance, gait29:14 - Treatment: education first, then VOR + balance + functional head movement32:03 - Anxiety/fear avoidance: reframing dizziness as a “learning opportunity”33:59 - Time-crunched HEP: “stacking” exercises into daily life 36:47 - VOR progression: dosing, symptom monitoring, advancing complexity39:10 - The future of gaze stability: more specific dosing, unilateral work, wearables42:37 - Case 3: Mid-30s postpartum, floaty dizziness + visual motion sensitivity (VM + PPPD/3PD)44:03 - VM education: migraine features without head pain; hormonal shifts as triggers45:28 - PPPD/3PD overlap + early prevention 51:49 - Treating visual motion sensitivity: patterns, videos, salience, real-world exposure58:00 - Where to find Dizzy Diagnostics + resources

In this special episode of Talk Dizzy to Me, vestibular physical therapists Dr. Abbie Ross, PT, NCS and Dr. Dani Tolman, PT sit down with two giants in the vestibular field: Jeff Walter, PT, DPT, NCS and Helena Esmonde, PT, DPT, NCS (Vestibular First).Jeff tries to stump the group with vestibular questions covering:-The history of John Epley and his contributions to the field-Alexander’s law, Brun’s nystagmus, and the origin of the word nystagmus-A precise definition of vertigo-Advanced use of the bow and lean test for horizontal canal BPPV-What happens when BPPV maneuvers go “wrong” (short arm, conversion, retesting)-Practical use of the Rinne test, recruitment, and tuning forks in vestibular practice-How to interpret CT scans that “show” superior canal dehiscence (SCD)-A rare case of cough-induced nystagmus -The reality that some dizzy patients don’t fit neatly into any diagnosis—and why that’s okayWhether you’re a vestibular therapist, audiologist, ENT provider, or someone with dizziness hungry for answers, this episode is packed with clinical pearls, red flags, and pattern recognition tips for vertigo, BPPV, nystagmus, and beyond.Episode Resources:Jeff Walter, PT, DPT, NCS-https://www.vestibular.today-MedBridge Courses: https://www.medbridge.com/educate/instructors/jeff-walter-dpt-ncsHelena Esmonde, PT, DPT, NCS-https://vestibularfirst.com-Journal Club: https://vestibularfirst.com/education/journal-club/-Educational Resources/Handouts: https://vestibularfirst.com/education/resources/-Vestibular First 's Journal Club- Clinical Pearls from an Unusual Case of Vertigo: https://youtu.be/ASjx5Yet1So?si=3qu5LkiD_pEDagHqFor more FREE resources, click ⁠⁠⁠here⁠.⁠⁠Hosted by:🎤 Dr. Abbie Ross, PT, NCS🎤 Dr. Danielle Tolman, PT For episode recommendations or requests, email us at: ⁠⁠⁠⁠⁠⁠⁠⁠[email protected]⁠⁠⁠⁠⁠⁠⁠⁠Connect with Us:→ ⁠⁠⁠Book a free call with us⁠⁠⁠→ ⁠⁠⁠Get free resources straight to your inbox⁠⁠→ ⁠⁠Join The Dizzy Reset⁠→ ⁠⁠⁠Watch podcast episodes (and more) on YouTube ⁠⁠⁠→ ⁠⁠⁠Follow us on Instagram⁠⁠⁠→ ⁠⁠⁠Follow us on TikTok⁠⁠⁠→ ⁠⁠⁠Follow us on Facebook⁠⁠⁠→ ⁠⁠⁠Disclaimer⁠⁠⁠→ ⁠⁠⁠Enjoying the podcast? Leave us a review!Timestamps00:00 – Intro00:15 – Meet the Hosts & Guests02:09 – Education Resources & Journal Club03:08 – History Lesson: Dr. John Epley06:21 – Alexander’s Law Explained09:39 – Gustav Alexander’s Shocking Death11:10 – Origin of the Term “Nystagmus”13:31 – Brun’s Nystagmus & CPA Tumors15:10 – Defining Vertigo (ICVD-Based)18:22 – Bow & Lean Test: Angles, Mechanics & Clinical Pearls23:24 – Short Arm / Anterior Arm BPPV & Tricks to Get Crystals Moving27:34 – Retesting Posterior Canal BPPV: When You Re-Create the Problem32:23 – Short Arm Debris & “Wimpy” Persistent Torsion35:08 – Maneuver Names, Variations & Confusion in the Literature38:53 – Tuning Forks in Vestibular & ENT Practice45:19 – CT & Superior Canal Dehiscence: Might vs Definitely49:22 – Cough-Induced Nystagmus51:39 – Pattern Recognition, Edge Cases & Not Knowing Everything56:15 – Reassuring Patients & “Doing the Next Right Thing”

Vestibular physical therapists Abbie Ross, PT, DPT, NCS, and Danielle Tolman, PT, DPT, sit down with Rob Landel, PT, DPT, FAPTA, to unpack cervicogenic dizziness (CGD) — what it is and isn’t, how to tell neck-driven dizziness apart from inner ear causes, and the clinical tools that actually make a difference.They dive into the head–neck differentiation test, cervical joint position error (JPE) testing with a laser, and why CGD rarely causes vertigo or spinning. You’ll also hear how concussion, whiplash, BPPV, and migraine can overlap with neck-related dizziness — plus practical insights on manual traction, cervical strength and endurance training, “pain-first” strategies, and when a short-term collar might help (despite its bad reputation).Episode Resources:Website: skillworks.bizEmail: [email protected] For more FREE resources, click ⁠⁠⁠here⁠.⁠⁠Hosted by:🎤 Dr. Abbie Ross, PT, NCS🎤 Dr. Danielle Tolman, PT For episode recommendations or requests, email us at: ⁠⁠⁠⁠⁠⁠⁠⁠[email protected]⁠⁠⁠⁠⁠⁠⁠⁠Connect with Us:→ ⁠⁠⁠Book a free call with us⁠⁠⁠→ ⁠⁠⁠Get free resources straight to your inbox⁠⁠→ ⁠⁠Join The Dizzy Reset⁠→ ⁠⁠⁠Watch podcast episodes (and more) on YouTube ⁠⁠⁠→ ⁠⁠⁠Follow us on Instagram⁠⁠⁠→ ⁠⁠⁠Follow us on TikTok⁠⁠⁠→ ⁠⁠⁠Follow us on Facebook⁠⁠⁠→ ⁠⁠⁠Disclaimer⁠⁠⁠→ ⁠⁠⁠Enjoying the podcast? Leave us a review!Timestamps:00:00 – Welcome & show open00:45 – Dr. Lindell’s background & early vestibular days03:01 – How far vestibular rehab has come03:58 – Defining CGD clinically05:26 – Symptoms CGD 06:26 – CGD with vestibular or central issues; trauma link 07:25 – Secondary CGD from guarding & “moving in blocks”08:31 – Is CGD over- or under-diagnosed?12:11 – BPPV + trauma: when to probe the neck14:10 – Migraine, vestibular migraine, cervicogenic headache—untangling overlap16:26 – How neck input feeds spatial orientation19:43 – Mismatch analogy: why CGD feels like seasickness21:10 – History taking: get precise about “dizzy”22:38 – Traumatic vs. atraumatic onset; red flags & neuro screen26:28 – Exam flow once central/peripheral causes are ruled down27:22 – Head–Neck Differentiation Test (separating head vs. neck motion)30:17 – Cervical Relocation / Joint Position Error (JPE) Test with laser33:27 – Testing extension: stabilizing neck vs. moving head in block35:03 – Treatment blueprint: mobility, pain, motor control, strength/endurance37:26 – Laser tracing progressions 38:20 – Timelines: why strength/endurance take the longest46:18 – Why one therapist managing vestibular + MSK is ideal49:18 – Evidence & experience with traction/manipulation for CGD50:43 – “Heavy-headedness”53:22 – Fatigue → increased sway; training normalizes it54:48 – Wrap-up & future part 2 ideas

In this Talk Dizzy to Me episode, vestibular physical therapists Dr. Abbie Ross, PT, NCS and Dr. Dani Tolman, PT sit down with Dr. Mike Studer, DPT, MHS, NCS, CEEAA, CWT, CSST, CSRP, CBFP, FAPTA to unpack neuroplasticity—what it is, how it works, and how to apply it in vestibular rehabilitation. We cover dual tasking, prediction error, fear-avoidant vs. fear-adapted movement, motivational interviewing, and patient-directed dosage using the OPTIMAL theory of motor learning. Mike shares practical clinic and real-life examples (driving, grocery stores, cooking), mic-drop lines you’ll quote to patients, and how to talk to insurers using objective measures.If busy visuals or movement bother you, consider listening on Apple Podcasts/Spotify.-Neuroplasticity = learning. It’s not just more pathways; it’s stronger, faster, better-fed pathways that consolidate during sleep.-Dose the meaningful. Intensity, repetitions, salience, and task specificity drive consolidation (“put a post-it on that memory”).-Exposure works. Habituation/adaptation creates prediction error (“that wasn’t as bad as I expected”), reinforcing change via dopamine.-Fear shows up in movement. Beyond fear-avoidant behavior, watch for fear-adapted movement (reduced head turns, co-contraction, slow/over-intentional strategies).-Dual tasking is two goals, not ‘think-and-move’ toward one goal. Use cognitive+motor or visual+motor loads that are personally salient.-Autonomy accelerates progress. Let patients choose dosage (keep, dial down, or push), using motivational interviewing and OPTIMAL theory.-No expiration date. Neuroplastic change remains possible well beyond 1 year—set expectations and use objective measures to justify care.Episode Resources:Email: [email protected]: mikestuder.comInstagram: @MikeStuderDPTBook: The Brain That Chooses ItselfFor more FREE resources, click ⁠⁠⁠here⁠.⁠⁠Hosted by:🎤 Dr. Abbie Ross, PT, NCS🎤 Dr. Danielle Tolman, PT For episode recommendations or requests, email us at: ⁠⁠⁠⁠⁠⁠⁠⁠[email protected]⁠⁠⁠⁠⁠⁠⁠⁠Connect with Us:→ ⁠⁠⁠Book a free call with us⁠⁠⁠→ ⁠⁠⁠Get free resources straight to your inbox⁠⁠→ ⁠⁠Join The Dizzy Reset⁠→ ⁠⁠⁠Watch podcast episodes (and more) on YouTube ⁠⁠⁠→ ⁠⁠⁠Follow us on Instagram⁠⁠⁠→ ⁠⁠⁠Follow us on TikTok⁠⁠⁠→ ⁠⁠⁠Follow us on Facebook⁠⁠⁠→ ⁠⁠⁠Disclaimer⁠⁠⁠→ ⁠⁠⁠Enjoying the podcast? Leave us a review!Time Stamps:03:29 Neuroplasticity defined05:21 Core principles: intensity, repetitions, salience, task specificity, sleep consolidatio09:35 Zooming into vestibular reha10:06 VR as proof of neuroplasticity; predictive processing11:32 Habituation/adaptation as exposure-based therapy; links to pain & psycholog13:32 Fear, expectations, and patient education14:28 Therapeutic alliance: precision starts with the person17:42 Treating fear: exposure-response prevention & prediction error (dopamine wins)20:05 Dosage variables + motivational interviewing + OPTIMAL theory21:27 Threat perception, amygdala, and “roadblocking” fear pathways24:13 Fear-avoidant vs. fear-adapted movement (new concept in progress)26:11 Cognitive load, exhaustion, and dual-task intolerance29:32 Building alliance between sessions (check-ins)30:00 What dual tasking is (and isn’t): two separate goals31:32 Clinic examples: cognitive+motor; visual+motor with busy backgrounds34:51 Real life: driving with kids, grocery stores, cooking; task switching vs. dual tasking38:40 Overtraining in clinic to empower life outside39:10 Progression: patient-controlled dosage (autonomy)43:27 Neuroplasticity at any age; caveats for degenerative conditions45:26 “Road crew at night” metaphor; why sleep matters47:13 The “1-year” myth; talking to insurers with objective measures49:27 Mic-drop lines⁠⁠