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, PTFor episode recommendations or requests, email us at: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠[email protected]⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Partnered with:→ Our online program and community, The Dizzy Reset™, ⁠use code TALKDIZZYTOME for 40% off your first payment⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠Avulux glasses, use code DIZZYRESET for $25 off⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠Just Ingredients, use code TALKDIZZYTOME for 5% off⁠Connect with Us:→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Book a free call with us⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Get free resources straight to your inbox⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠→ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Join our online program and community, 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 to Talk Dizzy To Me00:15 – Introducing Dr. Kristin Steenerson01:10 – What is 3PD/PPPD?01:37 – Diagnostic criteria: persistent, postural, perceptual dizziness02:47 – Common triggers and risk factors04:52 – Why some providers question the diagnosis06:34 – Hypervigilance and lack of biomarkers08:20 – Why symptoms can continue after the original issue resolves09:35 – Education, reassurance, and moving from “detective mode” to rehab11:24 – Brain health habits: sleep, food, exercise, hydration, stress12:16 – Why symptom tracking can sometimes backfire15:38 – Why grocery stores, airports, screens, and busy spaces trigger symptoms17:47 – Fear, memory, and the brain’s threat response19:39 – Avoidance vs gradual exposure21:03 – Neurology evaluation and ruling out other causes23:24 – What vestibular testing can and cannot show25:14 – The gap in measuring perception26:34 – fMRI research and brain network changes in 3PD29:51 – Vestibular therapy for 3PD31:00 – Medication options and why SSRIs/SNRIs may help35:38 – 3PD vs vestibular migraine41:05 – What progress looks like in recovery43:49 – Permission to do hard things without fear of damage44:47 – Community support and celebrating wins45:42 – Future research: medications, CGRP, TMS, neuromodulation48:54 – Mic drop takeaway for clinicians and patients