Have you ever rolled over in bed, looked up to reach a high shelf, or bent down to pick something up and suddenly felt as though the room was spinning? If so, you may have experienced Benign Paroxysmal Positional Vertigo (BPPV), which is the most common cause of vertigo.
Although the sensation can be alarming, BPPV is a benign condition and, in most cases, can be treated effectively by a physiotherapist with specialised training in vestibular rehabilitation.
What is BPPV?
BPPV is a condition that affects the inner ear, which plays an important role in maintaining balance. Inside the inner ear are tiny calcium carbonate crystals (called otoconia) that normally sit within a structure called the utricle. Occasionally, these crystals become dislodged and migrate into one of the fluid-filled semicircular canals.
When you change the position of your head, these misplaced crystals move within the canal, sending incorrect signals to the brain about your head’s movement. This mismatch between what your inner ear, eyes, and body are sensing creates the characteristic spinning sensation known as vertigo.
Episodes of vertigo are usually brief, lasting less than a minute, but they can be intense. Many people also experience nausea, unsteadiness, or a fear of moving their head because they worry about triggering another episode.
Why does BPPV happen?
In many cases, BPPV develops without an obvious cause, particularly in older adults. As we age, the calcium crystals naturally become more likely to detach from their usual position.
However, BPPV can also occur following:
- – A head injury or concussion
- – A viral inner ear infection
- – Prolonged bed rest or inactivity
- – Other disorders affecting the inner ear
- – Occasionally after surgery or dental procedures involving prolonged head positioning
While BPPV is not considered dangerous, the dizziness it causes can increase the risk of falls and significantly affect confidence, mobility, and day-to-day activities.
How can a physiotherapist help?
The good news is that BPPV is highly treatable, and physiotherapists trained in vestibular assessment are well equipped to diagnose and manage the condition.
Your physiotherapist will begin by asking detailed questions about your symptoms before performing specific positional tests to identify which ear and which semicircular canal is affected. Although these tests may briefly reproduce your dizziness, they provide valuable information that guides treatment.
Treatment usually involves a series of gentle repositioning manoeuvres, such as the Epley manoeuvre, designed to guide the displaced crystals back to their correct location within the inner ear. Many people experience significant improvement after just one or two treatment sessions.
If you continue to feel unsteady after the crystals have been repositioned, your physiotherapist may also prescribe balance exercises or vestibular rehabilitation exercises to help your brain adapt and restore normal balance.
When should you seek help?
If you experience repeated episodes of dizziness when changing your head position, it’s worth having the problem assessed. While BPPV is common and usually straightforward to treat, not all dizziness is caused by BPPV. A thorough assessment can help identify the cause of your symptoms and ensure you receive the most appropriate treatment.
Early treatment often leads to faster recovery, allowing you to return to your normal activities with greater confidence and less disruption.
If dizziness is affecting your daily life, our physiotherapy team can assess your symptoms, confirm whether BPPV is the cause, and provide evidence-based treatment to help you get back to feeling steady again.
