Balance, nerves and dizziness
BPPV and repositioning treatment
The spinning that starts when you roll over in bed. It is caused by loose crystals in the inner ear and it is frequently fixed in a single appointment.
Benign paroxysmal positional vertigo is the most satisfying condition in this building. Small calcium crystals that belong in one part of the inner ear have moved into another, where head position makes them move and produces a brief, intense sensation of spinning. Rolling over in bed, lying back at the dentist, and looking up at a high shelf are the classic triggers.
It is diagnosed by a positional test that reproduces the vertigo and shows a characteristic eye movement, and it is treated by a sequence of head positions that moves the crystals back where they belong. A large majority of cases resolve within one to three treatments.
Why this page exists as a warning as well as a service
BPPV is common, dramatic, and frightening — people genuinely believe something serious is happening — and it is resolved in a very small number of visits. Those three facts together create an opportunity that a certain kind of clinic takes.
If you are diagnosed with positional vertigo and booked a course of twelve appointments, you are being sold eleven you do not need. We will treat it in the appointment you arrived for, check it at a follow-up, and discharge you.
And if it has not responded after three repositioning treatments, the answer is not more of the same. It means the diagnosis is wrong, and you need a physician rather than a fourth attempt.
What the appointment involves
A positional test — usually the Dix-Hallpike — which will briefly reproduce your vertigo. This is unpleasant for about thirty seconds and it is the diagnosis. We will warn you before rather than after.
Then the repositioning manoeuvre, which is a sequence of head and body positions held for a short time each. Also briefly unpleasant.
Then a rest, and frequently the whole thing is over. We will give you what to do if it returns, because in a minority of people it does, and knowing how to recognise it saves another appointment.
What we check before treating
Neck range, because the positions involved require it and some people cannot safely be put into them — we have alternatives.
And the red flags, because not everything that spins is BPPV. New double vision, speech or swallowing difficulty, new weakness or numbness, or vertigo that is constant rather than positional and brief needs assessment elsewhere.
We do not sell blocks of visits in advance. We do not sell blocks of visits in advance. A prepaid package of twelve sessions gives the clinic a reason to use all twelve and gives you a reason to attend appointments you no longer need, and it converts the single most useful sentence in this trade — you are better, stop coming — into a refund conversation. You pay per visit, and the visit you do not need is the one we cancel.
Included as standard
How we treat this
Treatment in the appointment you booked
Not a course. If it is BPPV, we treat it that day rather than scheduling twelve.
A warning before the unpleasant part
The positional test reproduces your vertigo for about thirty seconds. You will be told beforehand rather than surprised.
A follow-up to confirm, then discharge
One check that it has stayed away. That is the whole course for most people.
An exit rule stated up front
If three repositioning treatments have not resolved it, the diagnosis is wrong and you need a physician, not a fourth.
Neck range checked first
The positions require it, and where somebody cannot be safely placed in them there are alternatives.
What to do if it comes back
It recurs in a minority of people. Recognising it saves an appointment and we will show you how.
When to make an appointment
Signs this is worth an assessment
- The room spins for less than a minute when you roll over in bed.
- Tipping your head back — at a hairdresser, a dentist, a high shelf — sets it off.
- It is intense but brief, and settles if you stay still.
- It started suddenly, often on waking.
- You have started sleeping propped up to avoid triggering it.
- It followed a head injury or a period in bed with an illness.
BPPV — how long a course usually takes
- Most cases resolve within one to three repositioning treatments. If yours has not moved after three, the diagnosis is wrong and you need a physician rather than more of the same.1 – 3 visits
This is a typical number of visits for this problem, not a quote and not a promise. You get an estimate specific to you, in writing, at the first appointment, and we reassess against the same measurements at visit four rather than at visit ten — so a course that is not working gets changed or stopped instead of extended. What each visit costs is published on the pricing page: $190 for the initial evaluation and $140 for a treatment visit if you are paying yourself, or your plan's copay if you are not. We do not sell blocks of visits in advance.
Questions we are actually asked
BPPV — frequently asked
How many treatments does BPPV need?
Most cases resolve within one to three repositioning treatments, and frequently in the first appointment. If it has not responded after three, the diagnosis is probably wrong and you need a physician rather than a fourth attempt — we will say so rather than continuing.
Is the Epley manoeuvre uncomfortable?
Briefly, yes. Both the positional test that diagnoses it and the manoeuvre that treats it will provoke the spinning for a short period, typically under a minute each. We warn you beforehand rather than after, and the discomfort is short and self-limiting.
Can I do the Epley manoeuvre myself at home?
Sometimes, once the correct ear and canal have been identified, and that identification is the part that needs a clinician. Doing the wrong manoeuvre for the wrong canal can move the crystals somewhere less convenient. If it recurs after a confirmed diagnosis, we will teach you the home version.
Will it come back?
In a minority of people, yes, sometimes years later. Recurrence is not a sign that the treatment failed, and knowing how to recognise it means one appointment rather than a fresh round of investigation.
My clinic booked me twelve sessions for vertigo. Is that normal?
For positional vertigo it is not justified. It is common, dramatic and quickly resolved, which is exactly the combination that gets over-treated. If a positional test confirms BPPV, the honest course is a treatment, a check and a discharge.
Related conditions
Often seen alongside this
Vertigo & dizziness
Most dizziness that responds to physical therapy comes from the inner ear, and most of that is treatable in very few visits.
3 – 8 visits
Balance & falls
Falling is not a consequence of age. It is a consequence of specific, measurable and largely trainable deficits, and we measure them.
12 – 24 visits
Neuropathy
When sensation is unreliable, balance has to be rebuilt on the senses that still work. That is trainable even when the nerve is not.
10 – 20 visits
Older adults
Strength training works at eighty. It works at ninety. The dose that works is heavier than almost anybody is offered.
12 – 24 visitsSixty minutes, one to one, with the therapist you chose
Book an appointment
The booking page shows each therapist's own diary rather than a generic grid, so a slot you can see is a slot that is genuinely free. Most people do not need a doctor's referral to start — New York's direct access law runs to ten visits or thirty days — though Workers' Compensation, No-Fault and Medicare each need one from the first visit. If you are not sure which of those you are, telephone and we will work it out before you book.