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Physiotherapy · UK

Physiotherapy for BPPV - the spinning, stopped properly.

Benign paroxysmal positional vertigo is one of the most fixable causes of dizziness there is - loose inner-ear crystals, moved back where they belong by a guided repositioning manoeuvre. A vestibular-trained physiotherapist, diagnosis at the couch, and often a cure within one to three sessions.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private BPPV physiotherapy costs in the UK.

Indicative ranges across UK vestibular clinics.

In short

£70–£350, usually 1–3 sessions.

Service Indicative range
Initial vestibular assessment (45–60 min) £70–£130
Follow-up session with repeat manoeuvre £50–£90
Typical full course (1–3 sessions) £70–£350
Home-visit vestibular assessment £100–£160
Vestibular rehabilitation course (residual dizziness) £150–£400
Assessment only, with written report £70–£130

Prices vary by city, by the clinic, and by whether you need a single manoeuvre or a longer vestibular rehabilitation course for residual dizziness. Home visits sit at the top of the range.

The problem

A five-minute cure that most people wait months for.

BPPV is where dizziness care quietly under-delivers - tablets prescribed instead of manoeuvres, no one performing the Epley, and months of avoidable spinning. We fix all three before you book.

  • Tablets do not move crystals

    Prochlorperazine and betahistine dull the symptoms at best. BPPV is a mechanical problem - it needs a mechanical fix, at the couch.

  • Someone who does the Epley every week

    Many GPs recognise BPPV but lack the time or setup to perform positional testing and repositioning. A vestibular physiotherapist does it daily.

  • Rule out what BPPV is not, first

    Vertigo with headache, double vision, weakness or hearing loss is a different problem. Screening for those red flags comes before any manoeuvre.

When it helps

When vestibular physiotherapy is the right step.

The situations we see most, plus the one red flag that means urgent medical review rather than a physiotherapy appointment.

  • Spinning when you roll over in bed

    The classic story - brief, intense rotational vertigo lasting seconds to a minute, set off by turning over or lying down.

  • Vertigo on looking up or bending down

    Hanging washing, reaching a top shelf, the hairdresser’s basin - head-position triggers strongly suggest BPPV.

  • Dizziness after a head knock or fall

    BPPV is common after minor head injury, which can shake otoconia loose into the semicircular canals.

  • Dizzy spells after vestibular neuritis

    BPPV frequently follows other inner-ear problems - repositioning treats the positional component.

  • BPPV that has come back

    Recurrence runs at roughly 15–20 percent per year. Retreatment works just as well the second time - it is worth booking promptly.

  • A GP diagnosis, but no one to do the Epley

    Many GPs recognise BPPV but lack the time or setup to perform the manoeuvre - a vestibular physiotherapist fills exactly that gap.

  • Unsteadiness and fear of falling in later life

    BPPV is a leading, fixable cause of falls in older adults - and is under-diagnosed. One manoeuvre can transform confidence.

  • Red flag: vertigo with neurological symptoms

    Vertigo with new headache, double vision, slurred speech, limb weakness or new hearing loss is not BPPV - it needs urgent medical review, not a physio booking.

Treatment options

The test decides the canal - the canal decides the manoeuvre.

What each technique involves - the positional tests that confirm the diagnosis, the repositioning manoeuvres that clear it, and the exercises that mop up what is left.

  • Dix–Hallpike test

    The diagnostic positional test for posterior-canal BPPV - the head is turned and lowered while the physiotherapist watches for the characteristic burst of nystagmus.

  • Supine roll test

    The diagnostic test for horizontal-canal BPPV - head rolled to each side while lying flat. Identifies the affected side and variant, which decides the manoeuvre.

  • Epley manoeuvre

    The first-line canalith repositioning procedure for posterior-canal BPPV. Around 80 percent of people are clear after a single treatment; most others after one or two repeats.

  • Semont manoeuvre

    A brisker alternative for posterior-canal BPPV - a rapid swing from lying on one side to the other. Useful when the Epley is difficult or has not fully worked.

  • BBQ roll and Gufoni manoeuvres

    Repositioning sequences for the less common horizontal-canal BPPV - a 360-degree log roll, or the simpler Gufoni side-lying manoeuvre.

  • Brandt–Daroff exercises

    A home exercise programme of repeated position changes - used when clinic manoeuvres are not tolerated, and to settle residual symptoms between sessions.

  • Vestibular rehabilitation

    Graded gaze-stability and balance exercises for the minority left with lingering unsteadiness or motion sensitivity after the crystals have been cleared.

  • Falls and balance review

    For older adults: a balance and falls-risk assessment alongside repositioning, with home-safety and strength advice built into the discharge plan.

Safety and recovery

What to expect afterwards - honestly.

Canalith repositioning is one of the safest, best-evidenced treatments in medicine. The things worth planning are transport on the first day, the few hours of wobbliness afterwards, and what to do if it recurs.

  • A clinic couch, not a theatre

    This is drug-free, hands-on treatment in an ordinary clinic room. No anaesthetic, no needles, no imaging for classic cases - just positional testing and guided head movements.

  • The testing provokes the vertigo - briefly

    The Dix–Hallpike and the manoeuvres deliberately trigger the spinning for a few seconds. That is how the diagnosis is confirmed. It settles quickly and your physiotherapist supports you throughout.

  • Nausea and brief unsteadiness afterwards

    Feeling washed out, mildly nauseous or unsteady for a few hours after a repositioning manoeuvre is common and normal. Plan a quiet rest of the day.

  • Do not drive immediately afterwards

    Have someone drive you to and from the first session. You must not drive while liable to sudden dizzy spells - and should tell the DVLA if vertigo affects your driving.

  • Neck and back considerations

    The manoeuvres involve neck extension and rotation. Significant neck disease, recent neck surgery or severe back problems are screened for first - modified positions exist for most.

  • Canal conversion is possible, and fixable

    Occasionally a manoeuvre moves crystals into a different canal, changing the symptom pattern. Repeat testing picks this up and a different manoeuvre clears it.

  • Recurrence is common - and quick to retreat

    Around 15–20 percent of people have a recurrence within a year. It is not a failure of treatment; the same manoeuvres work again, usually in a single visit.

  • Residual dizziness has its own treatment

    A minority feel vaguely off-balance for days to weeks after successful repositioning. Vestibular rehabilitation exercises speed this up - it is not a sign the BPPV is back.

  • Red flags after treatment

    New severe headache, double vision, slurred speech, limb weakness, new hearing loss or vertigo lasting hours rather than seconds need same-day medical review or A&E, not a routine physio call.

Reading your assessment report

Your assessment report in four parts. Read the last one first.

Whichever manoeuvre was used - Epley, Semont or a horizontal-canal roll - the report your physiotherapist sends you keeps to the same shape.

A UK vestibular physiotherapist reviewing a patient’s assessment report and treatment plan

A quiet reminder

Vestibular language is precise and can read coldly - ask your care team to explain anything that is unclear.

Ask your care team to explain anything that is unclear.

  1. 01 Header

    Diagnosis, canal and side

    What positional testing showed - which canal is affected (usually posterior), which side, and the nystagmus pattern that confirmed it.

  2. 02 Technique

    Tests performed and manoeuvres used

    The Dix–Hallpike and roll-test findings, which repositioning manoeuvre was performed (Epley, Semont, BBQ roll) and how you tolerated it.

  3. 03 Findings

    Response and home programme

    Whether repeat testing was clear by the end of the session, any Brandt–Daroff or vestibular rehabilitation exercises prescribed, and the review plan.

  4. 04 Impression

    Outcome, recurrence advice, safety-netting

    Read this first: whether you are discharged, what recurrence feels like and how to rebook fast, driving advice, and the red flags that mean medical review instead.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Physiotherapy is commonly covered with a GP or specialist referral, though most policies cap the number of sessions per year.

Frequently asked

Everything we get asked about BPPV physiotherapy.

Quick answers on the Epley manoeuvre, recurrence, safety, cost and the NHS route.

  • What actually is BPPV?

    Benign paroxysmal positional vertigo - brief, intense spinning triggered by head-position changes such as rolling over in bed or looking up. It happens when tiny calcium crystals (otoconia) come loose and drift into a semicircular canal of the inner ear, usually the posterior canal, sending false movement signals to the brain. It is benign, common, and very treatable.

  • How is BPPV diagnosed - will I need a scan?

    No scan is needed for classic cases. Diagnosis is made at the couch: the Dix–Hallpike test for the posterior canal and the supine roll test for the horizontal canal reproduce the vertigo and show a characteristic eye-movement pattern. Imaging is only considered when the story or the testing does not fit BPPV.

  • How does the Epley manoeuvre work?

    It is a guided sequence of four or five head and body positions that uses gravity to roll the loose crystals out of the semicircular canal and back into the chamber where they belong. It takes a few minutes, provokes brief vertigo at each step, and clears roughly 80 percent of posterior-canal BPPV after a single treatment.

  • How many sessions will I need?

    Usually one to three. Many people are cured at the first visit; a repeat manoeuvre a week or so later clears most of the rest. Horizontal-canal BPPV or lingering unsteadiness can add a few vestibular rehabilitation sessions. A typical private course costs £70–£350 in total.

  • Is the treatment safe? What are the side effects?

    Very safe. The manoeuvres deliberately provoke brief vertigo, and mild nausea or unsteadiness for a few hours afterwards is common. Neck problems are screened first and positions modified where needed. Occasionally crystals shift into another canal - repeat testing spots it and a different manoeuvre fixes it.

  • Will the BPPV come back?

    It can - recurrence is around 15–20 percent per year. That is not a failure of treatment. The same manoeuvres work again, typically in a single visit, and your discharge plan tells you exactly what recurrence feels like and how to rebook quickly.

  • How much does private vestibular physiotherapy cost in the UK?

    An initial vestibular assessment of 45–60 minutes is typically £70–£130, follow-ups £50–£90, and a home visit £100–£160. Because most cases resolve in one to three sessions, the total is usually £70–£350.

  • Can I get this on the NHS instead?

    Yes - NHS vestibular physiotherapy and balance clinics exist, and some GPs perform the Epley themselves. In practice referral routes are slow in many areas and GP appointments rarely allow time for positional testing, which is why people with disabling daily vertigo often choose a private vestibular physiotherapist and are seen within days.

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