PPPD Explained: When the Dizziness Doesn’t Go Away

In this episode of Talk Dizzy To Me, vestibular physical therapists Dr. Abbie Ross, PT, NCS and Dr. Danielle Tolman, PT sit down with neurologist Dr. Kristin Steenerson to unpack Persistent Postural Perceptual Dizziness, also known as 3PD or PPPD. If you feel dizzy, floaty, rocking, disoriented, or visually overwhelmed most days — especially in places like grocery stores, airports, busy restaurants, or while scrolling screens — this episode explains what may be happening in the brain and nervous system. Dr. Steenerson breaks down the diagnostic criteria for 3PD, why symptoms can continue even after the original vestibular problem improves, how 3PD overlaps with vestibular migraine, and why treatment often requires a combination of education, vestibular therapy, medication, cognitive strategies, lifestyle support, and gradual exposure. This conversation also addresses why 3PD is sometimes misunderstood, how hypervigilance plays a role, and why there is real hope for recovery and improved quality of life. Hosted by: 🎤 Dr. Abbie Ross, PT, NCS 🎤 Dr. Danielle Tolman, PT For 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! https://tdr.balancingactrehab.com/inv... Connect with Us: → ⁠⁠⁠Book a free call with us⁠⁠⁠: https://calendly.com/balancingactreha... → ⁠⁠⁠Get free resources straight to your inbox⁠⁠: https://www.balancingactrehab.com/sub... → ⁠⁠Join our online program and community, The Dizzy Reset™: https://www.balancingactrehab.com/group → ⁠⁠⁠Follow us on Instagram⁠⁠⁠:   / balancingactrehab   → ⁠⁠⁠Follow us on TikTok⁠⁠⁠:   / balancingactrehab   → ⁠⁠⁠Follow us on Facebook⁠⁠⁠:   / balancingactrehab   → ⁠⁠⁠Disclaimer⁠⁠⁠: https://www.balancingactrehab.com/dis... → ⁠⁠⁠Enjoying the podcast? Leave us a review: https://www.google.com/maps/place//da... → ⁠⁠⁠Avulux glasses, use code DIZZYRESET for $25 off: https://avulux.com/DIZZYRESET This episode is for educational purposes only and is not a substitute for medical advice. Always consult a qualified healthcare provider for diagnosis and treatment. The views expressed by guests are their own and do not necessarily reflect those of the host(s). Timestamps: 00:00 – Welcome to Talk Dizzy To Me 00:15 – Introducing Dr. Kristin Steenerson 01:10 – What is 3PD/PPPD? 01:37 – Diagnostic criteria: persistent, postural, perceptual dizziness 02:47 – Common triggers and risk factors 04:52 – Why some providers question the diagnosis 06:34 – Hypervigilance and lack of biomarkers 08:20 – Why symptoms can continue after the original issue resolves 09:35 – Education, reassurance, and moving from “detective mode” to rehab 11:24 – Brain health habits: sleep, food, exercise, hydration, stress 12:16 – Why symptom tracking can sometimes backfire 15:38 – Why grocery stores, airports, screens, and busy spaces trigger symptoms 17:47 – Fear, memory, and the brain’s threat response 19:39 – Avoidance vs gradual exposure 21:03 – Neurology evaluation and ruling out other causes 23:24 – What vestibular testing can and cannot show 25:14 – The gap in measuring perception 26:34 – fMRI research and brain network changes in 3PD 29:51 – Vestibular therapy for 3PD 31:00 – Medication options and why SSRIs/SNRIs may help 35:38 – 3PD vs vestibular migraine 41:05 – What progress looks like in recovery 43:49 – Permission to do hard things without fear of damage 44:47 – Community support and celebrating wins 45:42 – Future research: medications, CGRP, TMS, neuromodulation 48:54 – Mic drop takeaway for clinicians and patients