The Thinking Practitioner

🎙 Dizziness Roundtable (with Ruth Werner)

Ruth Werner returns to The Thinking Practitioner for a roundtable discussion with Til and Whitney on one of the most overlooked topics in manual therapy: balance challenges. Ruth is the author of A Massage Therapist’s Guide to Pathology (now in its 7th edition), a long-time educator, and host of the podcast I Have a Client Who. In this wide-ranging conversation with Til and Whitney, Ruth brings her characteristic clarity to a complex subject — helping us understand what’s really happening when clients feel dizzy, wobbly, or unsteady.

Balance difficulties show up constantly in clinical practice, yet most of us never learned how to think about them. Clients get dizzy turning over on the table. They feel lightheaded sitting up from prone. They mention casually that they’re “always a little unsteady” after sessions — and we realize we’ve never asked the right questions. This episode gives MTs a framework for understanding, responding to, and even helping with balance challenges — while knowing when to refer out.

✨ Topics discussed include: Ruth, Til, and Whitney unpack the sensory triad behind balance (vision, proprioception, and the vestibular system), explore common conditions like BPPV and POTS, and discuss what the research actually shows about massage and balance — including some encouraging findings about foot work and gait in older adults.

• What we really mean by “balance” — and why Ruth finds the word frustratingly vague
• The difference between vertigo (spinning) and dizziness (lightheadedness)
• Why position changes on the table can trigger symptoms — and what to do about it
• BPPV, the Epley maneuver, and “rocks in our head” (otoliths)
• POTS, blood pressure medications, and the challenge of sitting up
• Hypermobility, Ehlers-Danlos syndrome, and their links to balance issues
• Red flags: progressive changes, asymmetry, and when to refer
• Research on massage, foot work, and balance in older adults
• Why there’s no “dizziness muscle” — and what we can do instead
• Fall risk, deconditioning, and the cascade of consequences
• Vestibular physical therapy and other referral options

✨ Resources:
• Ruth Werner’s website: https://ruthwerner.com/
• Ruth’s podcast I Have a Client Who: https://www.abmp.com/podcasts?defined_term=353
• A Massage Therapist’s Guide to Pathology, 7th Edition: https://booksofdiscovery.com/
• Sefton et al. (2012) – Six weeks of massage therapy produces changes in balance: https://pmc.ncbi.nlm.nih.gov/articles/PMC3457720/
• Tarkhasi et al. (2025) – Corrective exercises with massage improve balance and gait: https://pubmed.ncbi.nlm.nih.gov/39550789/

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• Academy of Clinical Massage – Grab Whitney’s free Assessment Cheat Sheet at https://academyofclinicalmassage.com/cheatsheet

✨ Watch the video / connect with us:
• YouTube: https://www.youtube.com/@AdvancedTrainings/podcasts
• Til Luchau – https://advanced-trainings.com | https://facebook.com/advancedtrainings | https://instagram.com/til.luchau
• Whitney Lowe – https://academyofclinicalmassage.com | https://facebook.com/WhitneyLowe | https://twitter.com/whitneylowe

📧 Email us: info@thethinkingpractitioner.com

The Thinking Practitioner Podcast is intended for professional practitioners of manual and movement therapies — bodywork, massage therapy, structural integration, physical therapy, osteopathy, and similar professions. It is not medical or treatment advice.