Of all the conditions treated in a physiotherapy clinic, this one has the most absurd effort-to-outcome ratio.
A person has been dizzy for eight months. They have stopped driving. They hold the wall in the shower. They have had blood tests, a brain scan, and a prescription for a vestibular sedative. They have been told, more than once, that dizziness is part of getting older.
Then someone performs a positioning test that takes ninety seconds, confirms the diagnosis by watching their eyes, performs a repositioning manoeuvre that takes about five minutes, and the dizziness is gone.
This happens regularly. It should not be remarkable, and yet it is.
What BPPV is
BPPV stands for benign paroxysmal positional vertigo. It also goes by positional vertigo, ear crystals, ear rocks, canalithiasis, otoconia displacement, or simply “the spins when I roll over.”
Inside the inner ear, the utricle contains tiny calcium carbonate crystals called otoconia. They sit on a gel membrane and detect linear acceleration and gravity. That is their job and they are good at it.
Occasionally — after a knock to the head, an ear infection, a period of bed rest, or for no identifiable reason — some of these crystals dislodge and drift into one of the semicircular canals, which detect rotation.
Now, when you move your head, the crystals move through the fluid in the canal and generate a rotational signal that does not match what your eyes and body are reporting. Your brain interprets the mismatch as violent spinning.
The signature
BPPV has a very characteristic presentation:
- Vertigo triggered by changes in head position — rolling over in bed, lying down, sitting up, looking up at a high shelf, tipping the head back at the hairdresser
- Episodes lasting seconds to under a minute, not hours
- Intense spinning, not lightheadedness or fogginess
- Often accompanied by nausea
- Nothing between episodes, as long as you keep your head still
If your dizziness lasts hours, is constant, or is not position-triggered, it is probably something else — and that distinction matters.
The scale of the missed diagnosis
BPPV is the most common cause of vertigo, and it becomes more common with age.
Research examining older adults in the community has found substantial rates of unrecognised BPPV — people who had never reported dizziness as a specific complaint, or whose complaint had been attributed to age, blood pressure, or medication. Critically, those with unrecognised BPPV were more likely to have fallen.
That is the point. BPPV is not just unpleasant. It is a fall risk sitting in someone’s inner ear, invisible on every scan they will ever have, correctable in a single appointment.
Diagnosis and treatment
The Dix-Hallpike test is the standard diagnostic manoeuvre for posterior canal BPPV, which accounts for the large majority of cases. The patient is moved from sitting to lying with the head turned and slightly extended. If BPPV is present, after a brief latency the eyes produce a characteristic nystagmus — a specific pattern of eye movement that tells the clinician which canal is affected and which side.
The Epley manoeuvre (canalith repositioning) then uses a sequence of head positions to walk the crystals back out of the canal and into the utricle where they belong. For lateral canal involvement, different manoeuvres apply — which is why identifying the canal correctly matters.
Success rates are high. Many people are resolved in one session, most within two or three. Some recurrence over subsequent years is common, and recurrences are treated the same way.
Vestibular sedative medication, by contrast, suppresses the symptom without moving the crystals, and long-term use can actually impede the brain’s compensation.
At Longevity Physio Studio
We assess dizziness in Eagle Heights, Mt Tamborine, as part of our broader falls and balance work — because dizziness rarely travels alone in the over-65s.
An assessment typically includes positional testing for all canals, oculomotor screening, cervical assessment (the neck contributes to dizziness more often than people expect), balance and gait testing, blood pressure lying and standing to check for orthostatic hypotension, and medication review discussion.
Where the presentation suggests central pathology — persistent dizziness, neurological signs, headache, or atypical eye movements — we refer for medical assessment without delay. Not all dizziness is BPPV, and the ones that aren’t need proper attention.
Book a dizziness assessment
If you get short bursts of spinning when you roll over in bed, lie down, or tip your head back — that is a very specific pattern, and it usually has a very specific fix.
Longevity Physio Studio, Eagle Heights, Mt Tamborine — serving Tamborine Mountain, North Tamborine, Canungra and the Gold Coast hinterland. Book an assessment.
