Understanding Vertigo and the Epley’s Manoeuvre
We have discussed the process of Benign Paroxysmal Positional Vertigo (BPPV) and how Chiropractic can be utilised in its management in a previous blog post. So, the plan for this blog is not to go over old ground, instead I want to focus on the Epley’s manoeuvre because I felt I didn’t do this part of the blog justice. If you’ve ever had vertigo, you’ll know how unsettling it can be — even simple movements like turning over in bed can suddenly feel overwhelming. The good news is that one of the most common causes of vertigo is very treatable, often with a simple technique called the Epley’s manoeuvre.
What Is Vertigo?
As we discussed in our previous blog, vertigo isn’t just feeling “a bit dizzy.” It’s the sensation that you or your surroundings are moving or spinning, even when you’re perfectly still.
BPPV happens when tiny calcium crystals inside the inner ear move into the wrong place. These crystals normally help your body sense movement, but when they shift, they send confusing signals to the brain — triggering sudden dizziness, nausea, or unsteadiness, especially with head movements.
What Is the Epley’s Manoeuvre?
The Epley’s manoeuvre is a gentle series of head and body movements designed to guide those misplaced crystals back to where they belong. Once the crystals are back in the correct position, the vertigo often settles — sometimes immediately, sometimes over a few days.
It’s commonly performed by a healthcare professional, such as me here in the Spriggs Chiropractic clinic, but in some cases, patients are taught how to do it safely at home. I will give you fair warning, the Epley’s manoeuvre can trigger nausea and even cause you to vomit immediately after completing the movements. This is something that some of my patients’ have experienced when performing the Epley’s in clinic, so have a bin or bucket next to you, just in case.
The Epley’s Manoeuvre: The Four Stages
Here’s a simple breakdown of how it works:
Stage 1: Starting Position
You begin by sitting upright on a bed, with your legs extended. Your head is turned about 45˚ towards one of your shoulders. It doesn’t matter which one at this stage in practice, however, some people may be aware of which ear is the trouble marker, so turn your had towards that side if you know ahead of time. If you don’t know ahead of time, this first two stages of the manoeuvre will trigger the onset of a vertigo episode when you turn towards the affected side.
Stage 2: Lying Back
You are to gently lie back quickly, with your head still turned and slightly tilted backward over the edge of the bed. You’ll stay here for about 30 seconds. You can use a pillow behind your upper back and shoulders to help with tilting your head backwards, whilst keeping the 45˚ turned position of your head.
What you might feel:
This is often when vertigo occurs — it can feel intense, but it usually settles quickly.
Stage 3: Head Turn
Without lifting your head, it’s slowly turned 90 degrees to the opposite side and held for another 30 seconds.
Why this works:
Gravity helps move the crystals along the inner ear canals.
Stage 4: Rolling Onto Your Side
Next, turn your body towards the side you are now facing, however, when turning your body, you must maintain this 45˚ head position so you’re lying on your side with your nose angled slightly toward the bed or whatever surface you are performing this on. Stay in this position for another 30 seconds, you slowly sit back up.
The goal:
The crystals are guided back into their proper chamber, where they stop causing symptoms.
How Effective Is It?
The Epley’s manoeuvre is highly effective, with many people experiencing significant relief after just one or two sessions. Some may need it repeated, and symptoms can occasionally return — but it remains one of the safest and most reliable treatments for BPPV. Wolf and colleagues found in their study that some patients experienced resolution of their symptoms within 72 hours and 74% of patients felt improvement within one week1. Deva found similar results as Wolf with 92% of patients experiencing resolution of their symptoms immediately after performing Epley’s2. Again, it is worth noting that some patients do experience episodes of their BPPV in the future, but once you have experienced the Epley’s manoeuvre, you will build the confidence to mange them when the occur.
A Reassuring Final Thought
Vertigo can feel alarming, but for many people, it’s caused by a mechanical problem with a mechanical solution. The Epley’s manoeuvre is a great example of how simple, targeted movement can restore balance and confidence.
If you’re experiencing ongoing dizziness, it’s important to get assessed by a healthcare professional to ensure the manoeuvre is right for you.
Your world doesn’t have to keep spinning — help is often just a few gentle movements away.
By Mark Spriggs DC, MChiro, MSc, PGCert, FRCC
References:
- Wolf et al (1999). Epley’s manoeuvre for benign paroxysmal positional vertigo: a prospective study. Clin Otolaryngol Allied Sci Fec; 24(1): 43-46. doi: 10.1046/j.1365-2273.1999.00202.x.
- Deva (2024). Epley’s Manoeuvre vs. Semont’s Maneuver in Post-Canal Benign Paroxysmal Positional Vertigo: A Comparative Study in a Tertiary Centre. Indian J Otolaryngol Head Neck Surgery. Oct;76(5): 3854-3859. doi: 10.1007/s12070-024-04721-9.