Dizziness and Vertigo: How Physiotherapy Treats BPPV

If you've ever rolled over in bed and felt the room suddenly spin, you'll know how alarming it can be. It usually lasts less than a minute, but the intensity of it is enough to make people worry something is seriously wrong. In many cases, the cause is a surprisingly mechanical problem inside the inner ear called Benign Paroxysmal Positional Vertigo, or BPPV — and it's one of the few causes of dizziness that physiotherapy can often resolve completely, sometimes in a single visit.

We see BPPV regularly at Method Physiotherapy, often in people who've already been to A&E or their GP and been told to "give it time." The good news is that time isn't usually what's needed. A specific, well-understood repositioning technique is.

What's actually happening in your ear

Your inner ear contains small crystals of calcium carbonate, called otoconia, sitting within a structure that helps your brain sense head position. In BPPV, some of these crystals become dislodged and drift into one of the semicircular canals — the fluid-filled loops that detect rotational movement. When you tip your head a certain way, the loose crystals shift and send a false signal to your brain that you're spinning, even though you're not.

That's why BPPV has such a distinctive pattern. It's triggered by specific movements — rolling over in bed, looking up to a high shelf, bending down to tie your shoes — and each episode is brief, typically 20 to 60 seconds, settling once the crystals stop moving. It's unpleasant and disorienting, but it isn't dangerous, and it doesn't mean there's anything wrong with your brain or your balance system in the long term.

It can happen after a knock to the head, a bout of ear infection, or with no obvious trigger at all. It also becomes more common as we get older, though we see it across a wide age range.

How a physiotherapist confirms the diagnosis

Because several conditions can cause dizziness — inner ear infections, migraine-related vertigo, blood pressure changes, or issues with the neck — the first step is always a proper assessment rather than jumping straight to treatment.

A physiotherapist trained in vestibular assessment will take a detailed history, asking about exactly when the dizziness occurs, how long it lasts, and what brings it on. Then they'll use a test called the Dix-Hallpike manoeuvre, where your head is guided into a specific position while your eyes are observed closely. In true BPPV, this triggers a characteristic pattern of eye movement, called nystagmus, along with your usual dizziness. This eye movement pattern also tells the physio which of the three canals is affected and on which side, which matters for choosing the right treatment.

This kind of careful, hands-on assessment is a core part of general physiotherapy practice — using clinical tests to pinpoint a mechanical cause before deciding on treatment, rather than treating symptoms in isolation.

The treatment: the Epley manoeuvre

Once the affected canal is identified, treatment usually involves a repositioning technique called the Epley manoeuvre (or a variant, depending on which canal is involved). It's a sequence of head and body movements, guided by the physiotherapist, that uses gravity to gently walk the displaced crystals back out of the semicircular canal and into a part of the inner ear where they no longer cause problems.

Each position is held for around 30 to 60 seconds while the crystals settle, before moving to the next step. It can bring on a brief, intense wave of dizziness during the procedure, which understandably makes people apprehensive beforehand — but it typically passes quickly, and many patients notice a marked improvement immediately afterwards.

Research and clinical experience both point to this being highly effective, often resolving symptoms within one to three sessions. It's one of those rare situations in physiotherapy where the fix is genuinely mechanical, direct, and fast, rather than a longer rehabilitation process.

What to expect afterwards, and when to get help

After treatment, we usually advise keeping your head relatively upright for the rest of the day and avoiding lying flat, though guidance varies slightly depending on presentation. Some mild unsteadiness for a day or two afterwards is normal as your brain readjusts, even after successful treatment. A follow-up session confirms the crystals haven't drifted back, and occasionally a second round of repositioning is needed.

It's worth flagging that not all dizziness is BPPV, and part of a good assessment is ruling out other causes, or identifying when a neck issue is contributing to your symptoms — something that often overlaps with the kind of postural and joint problems we address through pain relief for back, neck and joint pain. If your dizziness comes with symptoms like slurred speech, double vision, weakness, or a severe headache, that needs urgent medical attention rather than physiotherapy.

If you've been living with positional dizziness and putting up with it, it really is worth getting it properly assessed. BPPV is uncomfortable but very treatable, and there's no need to simply wait it out. Get in touch to book an assessment at our Vauxhall clinic, and we'll work out what's causing your symptoms and get you moving confidently again.