Vertigo and BPPV: Exercises That Actually Stop the Spinning
What Is BPPV?
Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo. It causes brief spinning sensations triggered by head movements like:
Each episode typically lasts less than a minute but feels much longer. It's frightening but not dangerous.
What Causes BPPV?
Your inner ear contains tiny calcium crystals called otoconia. In BPPV, these crystals become dislodged and float into the semicircular canals—fluid-filled tubes that sense rotation.
When you move your head, the floating crystals trigger false rotation signals, causing vertigo.
Risk factors:
How to Know If It's BPPV
BPPV has distinctive features:
It does NOT cause:
If you have these other symptoms, see a doctor for other causes.
The Dix-Hallpike Test
This test identifies BPPV and determines which ear is affected.
How it's done:
1. Sit on a bed with legs extended
2. Turn head 45° to one side
3. Lie back quickly with head hanging over edge
4. Watch for vertigo and eye movements
5. Repeat on other side
Positive test: Vertigo and rotational nystagmus (eyes beating toward the ground or toward the affected ear).
Note which side triggers symptoms—you'll treat that ear.
The Epley Maneuver (Posterior Canal)
The most common type of BPPV affects the posterior canal. The Epley maneuver repositions the crystals.
Steps (for RIGHT ear):
1. Start: Sit on bed with legs extended
2. Position 1: Turn head 45° to the RIGHT
- Lie back quickly so head hangs over edge
- Wait 30 seconds (vertigo may occur—this is normal)
3. Position 2: Turn head 90° to the LEFT (now facing 45° left)
- Wait 30 seconds
4. Position 3: Roll body onto LEFT side while turning head another 90° (now facing down at 45°)
- Wait 30 seconds
5. Position 4: Sit up slowly while keeping head tilted down
- Wait 1 minute
For LEFT ear, reverse all directions.
Success rate: 80% resolve with 1-3 treatments.
Semont Maneuver (Alternative)
Another effective technique for posterior canal BPPV.
Steps (for RIGHT ear):
1. Sit on edge of bed
2. Turn head 45° to the LEFT
3. Quickly lie down on RIGHT side (affected ear down)
- Wait 30 seconds
4. Quickly move to lying on LEFT side (don't change head position)
- Your nose should now face the bed
- Wait 30 seconds
5. Slowly sit up
For LEFT ear, reverse all directions.
BBQ Roll (Horizontal Canal)
About 10% of BPPV affects the horizontal (lateral) canal. This type causes symptoms when lying down and turning side to side.
Steps (for RIGHT ear):
1. Lie on your back, head neutral
2. Turn head 90° to the LEFT (away from affected ear)
- Wait 30 seconds
3. Roll body to the LEFT (onto left side), keeping head turned
- Wait 30 seconds
4. Turn head 90° more (now facing down)
- Wait 30 seconds
5. Roll onto your stomach with head turned
- Wait 30 seconds
6. Continue rolling and return to starting position
Essentially: Roll 360° toward the unaffected ear in 90° increments.
Brandt-Daroff Exercises
If maneuvers don't fully resolve symptoms, or for maintenance:
1. Start sitting on edge of bed
2. Quickly lie on one side (nose pointing slightly up)
3. Wait 30 seconds or until dizziness stops
4. Return to sitting, wait 30 seconds
5. Quickly lie on other side
6. Wait 30 seconds or until dizziness stops
7. Return to sitting
Do: 5 repetitions, 3 times daily, for 2 weeks.
These work through habituation—teaching your brain to ignore the abnormal signals.
After Treatment
24-48 hours after Epley:
Note: Some research suggests these precautions aren't necessary, but many clinicians still recommend them.
What If It Comes Back?
BPPV recurs in about 50% of people within 5 years. If it returns:
When to See a Doctor
Get evaluated if:
A vestibular therapist or ENT specialist can perform maneuvers more precisely and identify less common canal variants.
The Bottom Line
BPPV is the most common cause of vertigo and is very treatable. The repositioning maneuvers (Epley, Semont, BBQ Roll) work by moving displaced crystals out of the semicircular canals.
Key points:
The spinning may be terrifying, but BPPV is benign. With the right maneuver, relief often comes within minutes.
Foundational Rehab provides guidance for balance and vestibular conditions alongside our musculoskeletal programs.