Benign Paroxysmal Positional Vertigo (BPPV) Physiotherapy

Being diagnosed with BPPV can feel like a scary thing. But there’s good news – benign paroxysmal positional vertigo physiotherapy could be the key to getting rid of the dizziness and vertigo that comes with the condition. Think it could work for you? Get in touch today

What is Benign Paroxysmal Positional Vertigo? 

what is benign paroxysmal positional vertigo
benign paroxysmal positional vertigo (bppv)

Benign paroxysmal positional vertigo (BPPV) is a common inner ear disorder that causes brief episodes of dizziness or vertigo. BPPV is usually triggered by changing the position of your head. This change makes tiny calcium carbonate crystals (known as otoconia) dislodge from their usual location in the ear and move into the semicircular canals of the inner ear. 

This disrupts the normal signals to the brain which help you maintain your balance. BPPV is not life-threatening, but it can significantly impact daily activities and your quality of life. 

Benign Paroxysmal Positional Vertigo Symptoms 

BPPV symptoms may include:

  • Dizziness: A spinning sensation that arises suddenly when you move your head 
  • Vertigo: Intense sensation of your surroundings moving or spinning 
  • Nausea: Feeling sick to your stomach, which can lead to vomiting 
  • Loss of Balance: Unsteadiness or difficulty maintaining balance 
  • Nystagmus: Abnormal, jerking eye movements 
  • Lightheadedness: A feeling of faintness or nearly fainting 
  • Headache: Occasionally, a mild to moderate headache 

These symptoms are triggered by changes in head position, like looking up, bending down, or even turning over in bed. 

Benefits of Physiotherapy for BPPV 

the benefits of physiotherapy for bppv
benefits of physiotherapy for bppv

Physio is recommended as an effective treatment for BPPV for several reasons. Here’s why it’s a good idea: 

Relieves Symptoms 

Physiotherapy is highly effective at easing the symptoms associated with BPPV. It’s one of the least invasive methods of treatment, making it a very popular choice. Relieving symptoms with no negative side effects! This quick easing of symptoms can dramatically improve your quality of life. It will also allow you to return to daily activities with minimal disruption. 

Improves Balance 

Improving balance is a critical goal of BPPV physiotherapy. Physiotherapists use very specific techniques to reposition the small crystals in the ear. Moreover, your physio will provide you with balance training exercises to help strengthen the vestibular system, the part of the inner ear responsible for balance. These exercises focus on improving coordination and stability, which reduces the risk of falls and enhances overall mobility. 

Targets Root Cause 

Physiotherapy addresses the root cause of BPPV by using gravity to reposition the displaced calcium carbonate crystals in the inner ear. Through specific manoeuvres, physiotherapists can help move these crystals back to their proper location, effectively alleviating symptoms. 

Non-Invasive Treatment 

Physiotherapy offers a non-invasive treatment option for BPPV, so you won’t need surgery or medication. Techniques like the Epley and Semont manoeuvres use safe, gentle head and body movements and don’t involve any surgery or pharmaceuticals. This makes it an attractive option, especially if you prefer or require non-surgical solutions. 

High Success Rate 

Physiotherapy has a high success rate for treating BPPV. Significantly, many patients experience noticeable relief after just one or a few sessions. Studies have shown that physiotherapy manoeuvres lead to symptom resolution in a majority of cases. This success rate is comparable to, or even better than, other treatment methods. 

Prevent Recurrence 

Physiotherapists teach patients with BPPV how to avoid triggering dizziness. These techniques include proper head movements and sleeping positions. They may also prescribe ongoing exercises to keep the inner ears healthy and monitor patients regularly to make sure symptoms don’t return. 

How Does Physiotherapy for BPPV Work? 

Specific movements of the head can, with the help of gravity, move crystals in the inner ear back into their proper place. Here are some of the most common movements that relieve signs and symptoms of BPPV. 

Epley Manoeuvre 

Purpose: To reposition the ear crystals 

The Epley Manoeuvre is a series of head and body movements designed to move the calcium crystals that cause BPPV back to their correct location. This stops the crystals from interfering with the normal fluid movement within the ear. 

You will sit on the examination table, legs extended, turning your head 45 degrees to the side, and then lying back quickly until your head is hanging over the edge of the table. You’ll hold this position until the vertigo passes (up to 30 seconds). 

Your physiotherapist will then have you turn your head 90 degrees while still lying down, roll your body to follow, and slowly sit up. They will help you with every movement. 

Semont Manoeuvre 

Purpose: To relocate debris in the ear canal 

The Semont Manoeuvre involves rapid movements to dislodge and reposition the otoconia from the semicircular canals. It’s a little different from the Epley Manoeuvre and may be more effective for some patients. The Semont Manoeuvre is also known as the liberatory manoeuvre. 

You’ll sit facing your physiotherapist, with your legs hanging off the table. Your physio will have you turn your head 45 degrees to the side that causes the worst vertigo. They’ll then lower you quickly down to the table on that side, and you’ll look up at the ceiling for about 30 seconds. 

The physio will then move you up and down to the other side, in one swift movement. On this side, you’ll be looking at the table instead of the ceiling. After about 30 seconds, the physiotherapist will help you sit up again.  

Brandt-Daroff Exercises 

Purpose: Reduces dizziness through repetition 

Brandt-Daroff exercises for BPPV are habituation exercises designed to help your brain adapt to the abnormal signals caused by the displaced otoconia. These habituation exercises involve repeated movements that provoke mild vertigo, which helps to reduce your brain’s sensitivity over time. You can do these exercises at home. 


  1. Sit on the edge of a bed or couch. 
  2. Turn your head at a 45° angle to one side. 
  3. Lie down quickly onto one side, keeping your head at an angle and looking up. 
  4. Stay in this position for 30 seconds, or until the vertigo stops. 
  5. Sit up slowly and return to the starting position. 
  6. Repeat the movement on the other side. 

Perform this sequence 5 to 10 times, three times a day. 

Are There Risks of Physiotherapy for BPPV? 

Temporary Increased Dizziness 

Patients may experience a temporary increase in dizziness immediately following physiotherapy. It typically lasts for a few minutes to a few hours after treatment. 

Resting and avoiding sudden head movements can help manage this temporary dizziness. Your physiotherapist may also provide guidance on how to minimise this effect. 


The movements used to treat BPPV can bring on a nauseous response. This may happen because of the motion of your head and the rebalancing process in your inner ear. It generally gets better as your body adjusts to the changes in your inner ear. 

Drink small amounts of water, eat light meals, and use over-the-counter anti-nausea medications to help alleviate nausea. 

Who Shouldn’t Have BPPV Physiotherapy? 

Physiotherapy for BPPV may not be suitable for people who:

  • Have neck or back problems that prevent safe head movements
  • Experience severe cardiovascular issues that could be aggravated by the movement 
  • Are unable to follow instructions due to cognitive impairments 
  • Have recently had head or neck surgery 

Always consult a qualified healthcare provider to determine if physiotherapy for BPPV is safe for you before booking an appointment for treatment. 

Post-Physio Self-Care Tips for BPPV 

Do Your BPPV Vertigo Exercises As Prescribed 

Your physio will send you home with exercises for BPPV vertigo. Don’t neglect these – they are an important part of managing the condition after physical therapy. 

Performing these exercises over time can help prevent BPPV from happening again. Your physio will give you detailed instructions, usually with a print-out or digital copy of the exercises, so you have a range of exercises to perform over time. Your physio may also send you links to helpful exercise videos

Monitor Symptoms 

If you start to experience BPPV symptoms again, book another appointment as soon as possible. If your symptoms keep coming back very soon after treatment, consult with your physio about possible reasons for this. 

Schedule Follow-Up Visits 

Even if your symptoms don’t come back, it’s a good idea to schedule a follow-up visit as a preventative measure. Regular physio sessions can help to keep your ear crystals in their correct position and prevent the unpleasant symptoms from coming back.

Benign Paroxysmal Positional Vertigo Physiotherapy FAQs

A BPPV physiotherapy session typically lasts between 30 and 60 minutes. This includes assessment, treatment manoeuvres, and post-treatment guidance.

Most patients with BPPV experience significant improvement after 1 to 3 physiotherapy sessions. The exact number of sessions needed can vary based on the severity of symptoms and individual response to treatment.

You should try to avoid driving immediately after BPPV physiotherapy. The treatment can temporarily increase dizziness and disorientation, which may impair your ability to drive safely. Wait until these symptoms subside before driving, or ask someone to come along and drive you home afterwards.

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