BPPV | VERTIGO | DIZZINESS
Our multidisciplinary team of highly skilled Chiropractors & Chartered Physiotherapists can help assess, diagnose and manage vertigo, dizziness and balance disorders.
At Watt Health, our experienced Chiropractors and Chartered Physiotherapists provide assessment and tailored treatment for dizziness and balance-related conditions, including Benign Paroxysmal Positional Vertigo (BPPV), cervicogenic dizziness and vestibular dysfunction.
Experiencing a spinning sensation when turning over in bed? Feeling unsteady when walking, looking upwards or moving your head? Vertigo and dizziness can be distressing, unpredictable and disruptive to everyday life.
THE ANATOMY
Understanding the Vestibular System, Inner Ear & Cervical Spine
Your balance depends on the complex interaction of three principal systems:
1. The Vestibular System (Inner Ear)
Deep within the inner ear lies the vestibular system, responsible for detecting head movement and helping maintain balance.
It consists of three semicircular canals, which detect rotational head movement, and two otolith organs (the utricle and saccule), which detect linear acceleration and head position relative to gravity.
Small calcium carbonate crystals, known as otoconia, normally sit within the otolith organs. If these crystals become displaced into a semicircular canal, they can interfere with normal movement detection and trigger BPPV.
2. The Cervical Spine (Neck)
Your neck contains specialised joints, muscles and sensory receptors that continuously communicate information about the upper cervical spine, contribute to proprioception — your body’s awareness of its position in space.
Altered cervical sensory input may contribute to dizziness, imbalance and spatial disorientation in some patients, a condition commonly described as cervicogenic dizziness.
3. The Visual & Neurological Systems
Your eyes, brain and nervous system continuously process information from the vestibular system and cervical spine to maintain stable vision, balance and coordinated movement.
When information from these systems becomes disrupted or conflicting, symptoms such as vertigo, light-headedness, unsteadiness or motion sensitivity can develop.
Understanding which system is responsible is essential, as not all dizziness is caused by the inner ear, and not all dizziness should be treated with the Epley manoeuvre.
CAUSES OF DIZZINESS & VERTIGO
Dizziness is a symptom rather than a single medical diagnosis. Several different conditions can produce similar sensations, making accurate clinical assessment particularly important.
1. Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is one of the most common causes of vertigo.
It occurs when tiny calcium carbonate crystals become displaced from their normal location in the inner ear and enter one of the semicircular canals.
This can cause brief but intense episodes of spinning vertigo, usually triggered by specific head movements such as turning over in bed, looking upwards or lying down.
BPPV frequently responds well to canalith repositioning techniques such as the Epley manoeuvre, which aim to return the displaced crystals to an area where they no longer trigger symptoms.
2. Cervicogenic Dizziness (Neck-Related Dizziness)
Cervicogenic dizziness describes dizziness or unsteadiness potentially associated with dysfunction of the cervical spine.
It may occur alongside neck pain, restricted movement, muscular tension, whiplash-associated disorders or altered cervical proprioception.
Unlike classical BPPV, patients often describe a sensation of imbalance, disorientation or unsteadiness rather than brief episodes of intense spinning.
Diagnosis requires careful examination and exclusion of other potential vestibular, neurological and medical causes.
Appropriate management may include Chiropractic assessment, gentle cervical manual therapy, neck rehabilitation and sensorimotor exercises.
3. Vestibular Dysfunction & Balance Disorders
Vestibular disorders can interfere with how the brain receives and processes information about movement and balance.
Conditions such as unilateral vestibular hypofunction, vestibular neuritis and other vestibular disorders may produce ongoing dizziness, imbalance, visual disturbance or sensitivity to head movement.
Where appropriate, vestibular rehabilitation physiotherapy uses targeted exercises to improve gaze stability, balance and tolerance to movement.
Other possible causes of dizziness include vestibular migraine, Ménière’s disease, medication effects, blood pressure changes and neurological conditions. These require appropriate assessment and, where necessary, medical referral.
WHY AM I DIZZY?
Everyday Activities That Can Trigger Vertigo & Dizziness
Vertigo and dizziness can occur during surprisingly simple movements, often making routine activities uncomfortable or anxiety-provoking.
Common triggers include:
For Patients With Positional Vertigo (BPPV):
Turning over in bed, particularly onto one side
Lying down or getting out of bed
Looking upwards towards a shelf or ceiling
Bending forwards to tie shoelaces
Tilting the head backwards when washing hair
Sudden changes in head position
For Patients With Persistent Dizziness or Vestibular Dysfunction:
Walking through supermarkets or busy environments
Moving the head quickly from side to side
Looking at moving objects or scrolling on screens
Walking on uneven surfaces
Travelling in cars or other moving vehicles
Exercising, particularly when changing direction
For Patients With Suspected Cervicogenic Dizziness:
Rotating or extending the neck
Maintaining prolonged desk or computer postures
Moving the head while experiencing neck stiffness
Driving and repeatedly checking blind spots
Performing movements that aggravate existing neck pain
These symptoms can overlap between different conditions. An accurate diagnosis is therefore essential before beginning treatment.