Vertigo and dizziness: the physiotherapy treatment most people don't know about

BPPV (Benign Paroxysmal Positional Vertigo) accounts for about 50% of all vertigo cases. It happens when tiny calcium crystals in the inner ear become dislodged and float into the semicircular canals, sending false motion signals to your brain.

The triggers are distinctive: turning over in bed, looking up to hang clothes or reach a high shelf, bending down to pick something up, or tilting your head back at the salon. Episodes last seconds to a minute but can be intense and frightening.

The standard treatment in India is medication: Vertin (betahistine), Stugeron (cinnarizine), or Stemetil (prochlorperazine). These manage nausea but do not fix the underlying problem. The crystals are still floating where they should not be.

The actual fix is a repositioning manoeuvre performed by a trained physiotherapist. It takes about 15 minutes and has an 80 to 90% success rate in one or two sessions.

The physiotherapist first performs a diagnostic test called the Dix-Hallpike test to confirm BPPV and identify which ear and which canal is affected. This involves moving your head into specific positions and observing your eye movements.

The treatment, called the Epley manoeuvre (or Semont manoeuvre depending on the canal), physically guides the dislodged crystals back to where they belong. It involves a specific sequence of head and body positions, held for about 30 seconds each.

Most patients feel significant or complete relief immediately after the manoeuvre. Some experience mild residual unsteadiness for a day or two. A small number need a second session if symptoms partially persist.

Your physiotherapist also teaches you a home version (modified Epley) so you can manage any recurrences yourself without needing a clinic visit.

Vestibular neuritis or labyrinthitis is inner ear inflammation that causes prolonged dizziness lasting days to weeks. After the acute phase, vestibular rehabilitation exercises (gaze stabilization, habituation, balance retraining) speed recovery significantly.

Cervicogenic dizziness is linked to neck problems, common in people with cervical spondylosis. When neck stiffness or muscle tension affects the blood flow or sensory signals from the neck, it can cause a vague dizziness or unsteadiness. Neck physiotherapy resolves this.

Age-related balance decline happens as the vestibular system weakens. You may not have classic vertigo but feel increasingly unsteady. Vestibular and balance exercises maintain and improve function.

Persistent postural-perceptual dizziness (PPPD) is chronic dizziness without a structural cause, often triggered by an initial vertigo episode that has resolved but left the brain in a heightened state of vigilance. Vestibular rehabilitation with graded exposure helps.

See a physiotherapist if your dizziness is triggered by specific head positions, comes in brief episodes of seconds to minutes, makes you feel unsteady but is not constant, or if you have already been told it is BPPV but are only receiving medication.

See a doctor first if your dizziness started suddenly with hearing loss, you have severe persistent vertigo with vomiting lasting more than a day, you have a new headache with dizziness, you notice weakness or numbness on one side of the body, or you have double vision with dizziness.

Many patients bounce between ENT and neurology without improvement because BPPV does not show up on MRI, CT, or blood tests. It is diagnosed through a physical examination and treated with a physical technique. This is why the right referral matters.

BPPV recurs in about 30 to 50% of patients, usually within the first year. If you have learned the home Epley manoeuvre from your physiotherapist, you can often manage recurrences yourself within minutes.

Vitamin D deficiency is linked to BPPV recurrence. Given how common vitamin D deficiency is in India, especially among women, getting your levels checked and supplementing if low is a worthwhile preventive step.

Regular vestibular and balance exercises can reduce recurrence risk. These are simple movements that take a few minutes daily and help keep the vestibular system calibrated.