Vertigo has a way of arriving without warning. You roll over in bed or look up at a shelf, and the room spins. The good news is that the most common cause is mechanical, it is diagnosable in a single appointment, and a trained physiotherapist can usually treat it in a handful of sessions. Here is how that works, and how to tell when dizziness needs a different kind of attention.
Vertigo is a symptom, not a diagnosis
True vertigo is the sensation that you or the room is spinning. It is different from feeling faint or light-headed, which points to other causes such as blood pressure. Getting this distinction right matters, because the treatment depends entirely on what is producing the sensation. That is the first thing a vestibular physiotherapist works out.
BPPV: the most common culprit
Benign paroxysmal positional vertigo, or BPPV, causes short, intense bursts of spinning triggered by position changes: rolling in bed, lying down, tipping your head back. Inside your inner ear are tiny calcium carbonate crystals that normally sit in one chamber and help you sense gravity. In BPPV, some of them escape into the semicircular canals, the fluid-filled loops that sense head rotation. Every time you move your head, the loose crystals swirl the fluid and your ear sends the brain a false signal that you are spinning.
It sounds obscure, but it is remarkably common, especially after age 50, after a knock to the head, or sometimes after a long stint at the dentist or hairdresser with your head tipped back.
What the Epley manoeuvre actually does
The fix is mechanical too. The Epley manoeuvre is a guided sequence of head and body positions that uses gravity to steer the loose crystals out of the canal and back into the chamber where they belong. It takes a few minutes. Research consistently puts the success rate around 80 per cent after one to three treatments, which makes it one of the most effective procedures anywhere in musculoskeletal care.
A word of caution about YouTube: the manoeuvre only works if it is performed for the correct ear and the correct canal, and that requires positional testing to establish. We regularly see people who have made themselves worse doing a home version on the wrong side. Get diagnosed first. After that, if it recurs, your physio may teach you a safe home routine.
When it is not BPPV
Not all dizziness is crystals. Vestibular neuritis, usually after a virus, inflames the balance nerve and causes days of constant vertigo rather than short bursts. Vestibular migraine, Meniere's disease and dizziness driven by the neck each behave differently again. These conditions are managed with vestibular rehabilitation: a program of gaze stabilisation, balance and habituation exercises that retrains the brain to trust its balance signals again. It is slower than an Epley fix, usually a matter of weeks, but the evidence for it is strong.
What a vestibular physio appointment looks like
Expect a detailed history first, because the pattern of your dizziness tells most of the story. Then positional testing to reproduce the symptoms briefly and identify which ear and canal are involved, along with balance and eye movement assessment. If it is BPPV, treatment usually starts the same day. If it is something else, you leave with a diagnosis, a plan and your first exercises. You can read more about the service on our vestibular physiotherapy page, or meet our vestibular physiotherapists.
When dizziness is an emergency
A small number of dizzy presentations need a hospital, not a physio. Call 000 or go to an emergency department if vertigo arrives with any of these: sudden severe headache, double vision, slurred speech, difficulty swallowing, numbness or weakness in the face or limbs, or trouble walking that is far out of proportion to the spinning. These can signal a problem with blood supply to the brain and are not things to wait out.
Getting help on the Sunshine Coast
If spinning, rocking or unsteadiness is interfering with your week, you do not need a referral to be assessed. Book online with one of our vestibular physiotherapists, or call (07) 5478 2333 for Mooloolaba or (07) 5441 4768 for Nambour. Most BPPV cases we see are dramatically better within one to three visits, and it is genuinely one of the most satisfying things we treat.
