Dizziness and Vertigo 101: BPPV


  • Understanding dizziness and vertigo
  • How your physiotherapist can work to alleviate symptoms
  • The science behind Benign Paroxysmal Positional Vertigo

What is BPPV?

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of dizziness. It’s the cause of 20-30% of vertigo cases and is present in both women and men of all ages. It can occur spontaneously, or as a result of head trauma or inner ear infection. BPPV is a dysfunction of the peripheral vestibular system in your inner ear and can be very successfully treated by non-invasive physiotherapy treatment.

What does BPPV feel like?

People who have this problem will often wake up with, or have rapid onset dizziness with the following characteristics:

  • Episodic symptoms: typically occurring for short periods of time, worsened with movement and eased if staying still.
  • Episodes lasting for 30 seconds to a minute.
  • The Spins. Can feel like the room is spinning very fast. May set you off balance and induce nausea or even vomiting.
  • Lingering Imbalances. After a few days/weeks, typically the episodes will decrease, but there can be residual unsteadiness when walking, standing, twisting or turning.

What is happening in the inner ear with BPPV?

The balance system of the inner ear has many parts. Generally speaking, there is a ‘little rock’ of crystals called the Otolith, that sits atop a gelatinous structure called the Utricle. When you speed up or slow down, the Otolith weighs on the Utricle and signals this acceleration/deceleration.

Right next to this area is a network of tubes called the Semicircular Canals. These are fluid-filled canals with cilia sensors in them, similar to an intestinal structure. When you twist and turn, the fluid sloshes around stimulating these sensors to communicate to your brain that you are doing so.

The problem arises when the Otolith dislodges from the Utricle and makes its way into the semicircular canals. A small twist can cause a strong stimulation of the canals resulting in dizziness.

Depending on where the Otolith is, and if it gets stuck, the symptoms can last anywhere between days and months. However, there are a series of positional movements and exercises that can dislodge the Otolith from the canals.

What can physiotherapy do for BPPV?

If you are suffering from the above concerns, physiotherapy can be very helpful in facilitating recovery. Research has shown that up to 93% of people see improvement after one or two treatments. A physiotherapist can:

  • Fully assess if BPPV is the problem.
  • Identify any red flags and recommend whether further investigation/physician consult would be best.
  • Perform treatment to remove the Otolith from the canal.
  • Educate with home care exercises and self management for possible future episodes.

While BPPV is one of the most common types of dizziness, there’s much more to explore regarding the subject of vertigo. Check back for more posts about inner ear dysfunction. 

*Please note this post is meant to educate regarding the presence and treatment of BPPV. If you have significant concerns regarding the state of your dizziness, and it is coupled with symptoms such as pain, vision/hearing disturbance, numbness, and/or difficulty speaking, it is recommended to see a physician immediately.


Hilton, MP et al. The Epley manoeuvre for benign paroxysmal positional vertigo. Cochrane database of Systemic Reviews. 2010
Francesc R et al. Management of benign paroxysmal positional vertigo of lateral semicircular canal by Gufoni’s manoeuvre. Am. J. Otolaryngol. 2009, 30, 106-111.

Image Credit:

Image 1: http://healthliving.today/vertigo/

Image 2: https://ataplacecalledvertigo.files.wordpress.com/2012/10/inner_ear-1732.jpg


Further Reading:

For more information about the inner workings of your brain, click here .

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