Vertigo, Dizziness & BPPV: How Physiotherapy Helps
Published
Local Physiotherapist - Lizzie Thornton, Staffordshire Moorlands & Cheshire East
Vertigo and dizziness affect around one in three people over 65 and are a leading contributor to falls. The good news is that many forms of dizziness respond well to physiotherapy — some can be resolved in a single session.
If you or a loved one has experienced a spinning sensation, unsteadiness, or a room that seems to tilt when you turn your head, you are not alone. Dizziness is one of the most common reasons older adults visit their GP, and it is often treatable.
What causes vertigo and dizziness?
Dizziness has many possible causes, and identifying the right one is essential for effective treatment. The most common include:
- BPPV (Benign Paroxysmal Positional Vertigo): Displaced calcium crystals in the inner ear cause brief, intense spinning sensations when you change head position — rolling over in bed, looking up, or bending down.
- Vestibular neuritis or labyrinthitis: Inflammation of the inner ear, often after a viral infection, causing persistent dizziness and imbalance.
- Cervicogenic dizziness: Dizziness related to neck problems, often accompanied by stiffness or pain.
- Medication side effects: Some blood pressure tablets, antidepressants or sedatives can cause lightheadedness.
- Orthostatic hypotension: A drop in blood pressure when standing up, causing a brief dizzy spell.
- Neurological conditions: Stroke, Parkinson's disease or multiple sclerosis can affect balance and cause dizziness.
Because the causes are so varied, a medical assessment is important before starting physiotherapy. Your GP can rule out serious causes and refer you for the right treatment.
What is BPPV and why is it so common?
BPPV is the single most common cause of vertigo, particularly in adults over 50. Inside your inner ear are three fluid-filled canals that sense head movement. Tiny calcium carbonate crystals (otoliths) normally sit in a nearby structure called the utricle. If some of these crystals become dislodged and drift into one of the canals, they send false signals to your brain — creating a spinning sensation when you move your head in certain ways.
The hallmark of BPPV is brief episodes of vertigo lasting less than a minute, triggered by specific head movements. It is not dangerous in itself, but the sudden spinning can cause falls, especially in older adults.
How physiotherapy treats BPPV
BPPV is one of the most satisfying conditions to treat because it often resolves completely with a simple, non-invasive manoeuvre performed by a trained physiotherapist.
The most common technique is the Epley manoeuvre, which involves a series of guided head and body movements that use gravity to move the displaced crystals back out of the canal and into the utricle where they belong. The procedure takes about 15 minutes and can eliminate symptoms in a single session for many patients.
Other repositioning manoeuvres — such as the Semont or Gufoni techniques — may be used depending on which canal is affected. Your physiotherapist will first perform the Dix-Hallpike test to determine exactly which ear and which canal is involved.
After successful treatment, some people experience mild residual dizziness for a few days. Balance exercises can help speed up full recovery.
Vestibular rehabilitation for ongoing dizziness
Not all dizziness is BPPV. If your vertigo stems from vestibular neuritis, labyrinthitis, or age-related inner ear changes, a course of vestibular rehabilitation therapy (VRT) can help your brain compensate for the inner ear deficit.
VRT uses specific exercises to:
- Improve gaze stability: Training your eyes to stay focused on a target while your head moves, reducing the sensation that the world is jumping.
- Retrain balance: Gradually challenging your balance system with exercises that progress from sitting to standing to walking.
- Reduce motion sensitivity: Gradual exposure to movements that trigger dizziness, helping your brain habituate and reduce symptoms.
- Improve walking confidence: Rebuilding the ability to walk outdoors, on uneven surfaces, and in busy environments.
Vestibular rehabilitation is progressive — exercises start gently and become more challenging as your system adapts. Most people see meaningful improvement within 4 to 6 weeks of consistent practice.
The link between dizziness and falls
Dizziness is a major fall risk factor, especially for older adults. When the balance system is unreliable, the brain receives conflicting signals, making it harder to stay steady. People who feel dizzy often become less active to avoid triggering symptoms — which leads to muscle weakness and deconditioning, further increasing fall risk.
This is why treating dizziness is about more than comfort. It is a key part of falls prevention. By resolving the underlying vestibular problem and rebuilding balance and strength, physiotherapy can break the cycle of dizziness, inactivity and falls.
What to expect at your first session
Your physiotherapist will begin with a thorough assessment, including:
- Questions about your symptoms — when they started, what triggers them, how long they last
- A review of your medical history and medications
- Balance and walking tests
- Positional testing (such as the Dix-Hallpike) to check for BPPV
- Eye movement assessment, as abnormal eye movements (nystagmus) can indicate vestibular problems
If BPPV is confirmed, treatment can often begin immediately. For other vestibular conditions, you will be given a tailored exercise programme to practise at home, with regular reviews to progress the exercises as you improve.
When to seek urgent medical attention
While most dizziness is benign, certain symptoms need urgent medical review. See a doctor immediately if dizziness is accompanied by:
- Sudden severe headache
- Double vision or loss of vision
- Slurred speech or facial drooping
- Weakness or numbness in an arm or leg
- Difficulty walking or sudden falls
- Chest pain or irregular heartbeat
- Loss of consciousness
These could indicate a stroke or other serious neurological condition and require emergency assessment.
Frequently asked questions
Can physiotherapy help with vertigo?
Yes. Physiotherapists trained in vestibular rehabilitation can assess the cause of vertigo and provide targeted treatment. For BPPV, specific repositioning manoeuvres can resolve symptoms in a single session. For other causes, balance retraining and gaze stabilisation exercises can reduce dizziness and fall risk.
What is BPPV and how is it treated?
Benign Paroxysmal Positional Vertigo (BPPV) is caused by displaced calcium crystals in the inner ear that trigger brief spinning sensations with head movements. It is treated with canalith repositioning manoeuvres such as the Epley manoeuvre, which guide the crystals back to their correct position.
Should I see a doctor before physiotherapy for dizziness?
Yes. Sudden or severe dizziness should be assessed by a doctor first to rule out serious causes. Once cleared, vestibular physiotherapy can address balance, dizziness and deconditioning. Your physiotherapist will refer you back to your GP if symptoms suggest something other than a vestibular problem.
Struggling with dizziness or balance?
Our physiotherapists can assess your dizziness, identify the cause, and provide targeted vestibular rehabilitation at home. Explore our falls prevention programme, or find a physio near you to arrange a visit.
About Lizzie Thornton
Lizzie Thornton is a specialist community physiotherapist with over 15 years of experience in vestibular rehabilitation, falls prevention and post-illness recovery. She is HCPC registered and a member of the Chartered Society of Physiotherapy. Lizzie provides home physiotherapy visits across Staffordshire Moorlands and Cheshire East.