Background

Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular disorders and is characterised by brief episodes of vertigo triggered by changes in head position. The condition occurs due to displacement of otoconia within the semicircular canals, resulting in abnormal stimulation of the vestibular system. Although BPPV is not life-threatening, recurrent vertigo episodes significantly affect functional independence, balance ability, psychological well-being, and quality of life. Physiotherapy-based interventions, particularly canalith repositioning manoeuvres (CRMs), vestibular rehabilitation therapy (VRT), balance training, and exercise-based approaches, have become important components of BPPV management. However, variations exist regarding the effectiveness of different physiotherapy approaches and their additional benefits when combined with conventional repositioning techniques.

Objective

This systematic review aimed to evaluate the effectiveness of physiotherapy interventions in reducing vertigo symptoms and improving functional outcomes among patients with benign paroxysmal positional vertigo. The review specifically assessed the effectiveness of canalith repositioning manoeuvres, vestibular rehabilitation, home-based exercise programmes, balance training, cervical stabilization exercises, and complementary physiotherapy approaches in improving dizziness, balance, recurrence rates, and functional performance.

Methods

A systematic review approach was used to analyse randomized controlled trials and controlled clinical studies investigating physiotherapy interventions for patients diagnosed with BPPV. Ten studies published between 2012 and 2026 were selected based on relevance to the research question. The included studies involved interventions such as Epley manoeuvre, Brandt-Daroff exercises, vestibular rehabilitation therapy, cervical stabilization exercises, temporomandibular joint mobilisation, yoga-based rehabilitation, and combined therapeutic approaches. Outcomes assessed across studies included the Dizziness Handicap Inventory (DHI), vertigo severity, recurrence rate, postural stability, balance performance, functional mobility, and fall risk.

Results

The selected studies demonstrated that physiotherapy interventions significantly improved vertigo-related symptoms and functional outcomes in individuals with BPPV. Canalith repositioning procedures consistently showed effectiveness in resolving positional vertigo, while vestibular rehabilitation provided additional improvements in dizziness-related disability, balance, and functional mobility. Combined approaches, including canalith repositioning with cervical stabilization exercises or vestibular rehabilitation, demonstrated greater improvements compared with repositioning alone. Home-based Self-Epley manoeuvres and Brandt-Daroff exercises both reduced vertigo severity, although no significant difference was observed between them. Additional interventions such as TMJ mobilisation and yoga showed benefits in selected functional outcomes, although their effects on dizziness reduction require further investigation.

Conclusion

Physiotherapy is an effective intervention strategy for reducing vertigo symptoms and improving functional outcomes in patients with BPPV. Canalith repositioning manoeuvres remain the primary treatment approach, while vestibular rehabilitation and targeted exercise interventions provide additional benefits by improving balance, reducing dizziness-related disability, and lowering fall risk. Future research should focus on larger multicentre trials to determine optimal physiotherapy protocols and long-term effectiveness.

Keywords: Benign paroxysmal positional vertigo; Physiotherapy; Vestibular rehabilitation; Canalith repositioning manoeuvre; Epley manoeuvre; Dizziness; Balance; Vertigo management.