Vertigo (BPPV): How Physiotherapy Stops the Spinning

The Vertigo That Tablets Cannot Fix

One of the most satisfying conditions I treat is also one of the most under-recognised: BPPV — benign paroxysmal positional vertigo. It is the single most common cause of true spinning vertigo, and most people are handed a strip of tablets that barely touch it. The real fix is mechanical, and it is fast.

How To Know It Is Probably BPPV

BPPV has a very recognisable signature: brief, intense spinning triggered by a change in head position — rolling over in bed, lying down, looking up to a shelf, or bending forward. Each spell lasts seconds to under a minute and then settles. There is no hearing loss and no ringing. If that sounds like you, the odds are high it is BPPV.

What Is Actually Happening Inside Your Ear

Deep in your inner ear are tiny calcium crystals that help you sense movement. In BPPV, some crystals come loose and drift into a balance canal where they do not belong. Now, every time you move your head, they slosh around and send your brain a false, violent message that the world is spinning. Nothing is damaged — the crystals are simply in the wrong place.

The Fix: Repositioning Manoeuvres

Because it is a mechanical problem, it has a mechanical solution. A canalith repositioning manoeuvre — the best known is the Epley manoeuvre — uses a precise sequence of head and body positions to guide the loose crystals out of the canal and back into the chamber where they cause no trouble. Done correctly, it resolves a large majority of cases in one or two sessions. This is one of the rare treatments in medicine that can feel almost like a switch being flicked.

Why You Should Not Just Copy a Video

There are different forms of BPPV affecting different canals and different sides, and the manoeuvre must match the exact type — the wrong one can make things worse. That is why the first session should be supervised. In a vestibular physiotherapy consultation I take you through the diagnostic positions, identify the side and canal, and then guide you through the correct manoeuvre step by step. Once it is confirmed, I teach you a home version so you can manage any recurrence yourself.

How This Works Over Video

Vertigo patients are often the most relieved to avoid travel — the last thing you want when the room is spinning is a car ride to a clinic. Over a video call I can observe your eye movements and symptoms during the test positions, confirm the pattern, and direct each step of the manoeuvre safely with a family member assisting if needed.

When Dizziness Needs a Doctor First

Not all dizziness is BPPV. Seek urgent medical care if your dizziness comes with a severe headache, double vision, slurred speech, weakness or numbness in the face or limbs, fainting, or trouble walking — these point to other causes that need immediate attention, not a physiotherapy manoeuvre.

Stop the Spinning

If positional spinning is disrupting your sleep and your days, you do not have to simply wait it out on tablets. Tell me your symptoms in the 2-minute intake form and book a consultation — if it is BPPV, this is often one of the quickest wins in all of physiotherapy.