Vertigo Relief: Epley Manoeuvre & Neck Check (BPPV)
Key insights: 60-second read
- Not all dizziness is true vertigo - symptoms like lightheadedness, unsteadiness, and nausea can actually come from hidden upper neck dysfunction (cervicogenic dizziness).
- Test your neck first before trying the Epley manoeuvre - a simple lacrosse ball release at the base of the skull can reveal whether your symptoms are neck-related.
- Upper neck dysfunction affects head and face function - the top two or three cervical vertebrae have nerves that directly influence dizziness, balance, and even nausea.
- The Epley manoeuvre should be done carefully - keep eyes open, hold each position for 30 seconds or until symptoms resolve, and have someone with you if possible.
- Posture matters for long-term relief - sustained head-forward positions (looking at phones, reading, reclining) may be the underlying cause of recurring symptoms.
The room is spinning. You feel lightheaded, unsteady, maybe nauseous. Your first thought might be vertigo. And you may be right. But before you start the Epley manoeuvre, there is something else you need to check.
As a physiotherapist, I see people every week who have been told they have vertigo, but their symptoms never fully resolve with the standard manoeuvres. Often, hidden upper neck dysfunction is playing a role. The top two or three levels of your neck have a very strong influence over the function of your head. Dizziness, lightheadedness, unsteadiness, and even nausea can all be consequences of that upper neck dysfunction.
This video and article will show you two things. First, how to test whether your symptoms are coming from your neck using nothing more than a lacrosse ball. Second, how to perform the Epley manoeuvre correctly if you do have true vertigo. Plus, why your daily postural habits may be the underlying reason these symptoms keep coming back.
"Before we go down the rabbit hole of showing you how to do the Epley manoeuvre for vertigo, let us double check to see if it isn't something more simple. A lot of people do not realise that the top two or three levels of your neck have a very strong influence over the function of your head."
On this page
The neck test: is your dizziness coming from your upper neck?
Before trying any vertigo-specific exercises, we need to determine whether your symptoms might be coming from your neck. This is called cervicogenic dizziness, and it is surprisingly common.
Step 1: Take stock of your symptoms. Identify a movement or position that triggers your dizziness. For many people, turning their head to one side brings on symptoms.
Step 2: Turn your head to the symptomatic side. Pay attention not just to how it makes you feel, but also how it feels to get there. Do you feel like you can get all the way around to about 90 degrees? Does it feel stiff, taut, or restricted somewhere? Compare this to the other side.
Step 3: Note the difference. If one side feels significantly tighter or more restricted than the other, that is your first clue that neck dysfunction could be contributing to your symptoms.
Clinical insight: The top two or three levels of your cervical spine (C1-C3) have direct neural connections to the vestibular system. Dysfunction in these joints can create symptoms that are nearly identical to inner ear vertigo, including dizziness, nausea, and unsteadiness.
Lacrosse ball release for upper neck dysfunction
This simple self-release technique can help determine whether your upper neck is contributing to your symptoms. All you need is a lacrosse ball, tennis ball, or similar firm ball.
Upper neck release protocol
Placement: Lie on your back. Place the ball right at the base of your skull, at the top of your neck, just off to one side.
Target: You are looking for tissue that feels stiff, tight, restricted, thick, dense, or tender - especially when compared to the same spot on the other side. It does not necessarily matter which side feels symptomatic. The side that feels most restricted is the mechanical handbrake that could be short-circuiting function.
Duration: Spend 30 seconds to 2 minutes on each spot. Breathe deeply to tell your nervous system that this is okay. If symptoms are provoked, stay until they start to settle.
Movement: Once you have softened one spot, move the ball down a little or around to find the next restricted area. Work up and down the upper neck.
Goal: You are trying to influence the joints of your upper neck, which are very close to the nerves that supply and influence the function of your head and face.
If this hidden stiffness or restriction in your neck is related to your symptoms, you should feel an immediate change after this release.
Test-retest: proving the connection
After spending time on the ball, come back up slowly. Stay seated for a moment to get your balance and bearings back. Then immediately turn your head to the side again (the same movement that previously triggered your symptoms).
What to look for:
- Does your neck move better with less restriction in both directions?
- Have your symptoms changed? Hopefully, they have improved or resolved entirely.
If your symptoms have changed, you have just proven that hidden neck dysfunction is factually connected to what you are feeling. If the room is still spinning and your symptoms feel exactly the same despite your neck feeling looser and lighter, then true vertigo is more likely, and the Epley manoeuvre becomes more relevant.
"If it's connected at a basic level, you should ultimately feel like your neck moves better with less restriction in both directions. But then if those symptoms are attached to that dysfunction, hopefully you will see some change in those symptoms straight away."
The Epley manoeuvre for vertigo (right-sided symptoms)
If you have determined that your symptoms are not coming from your neck, or if the neck release did not change your symptoms, the Epley manoeuvre may be appropriate. This technique helps reposition crystals (otoconia) that have become dislodged in your inner ear's semicircular canals.
Epley manoeuvre for right-sided symptoms
Setup: Sit on the edge of a bed, positioned close to the left edge (for right-sided symptoms). Have a pillow placed behind you so that when you lie back, the pillow sits at the top of your shoulders, allowing your head and neck to extend.
Position 1 (starting): Turn your head 45 degrees to the right. Lie back so your head extends over the pillow onto the bed. Hold for 30 seconds or until symptoms subside. Keep your eyes open (someone watching can see nystagmus - rapid eye movements).
Position 2: Rotate your head 45 degrees to the left (facing the opposite direction). Hold for 30 seconds or until symptoms subside.
Position 3: Roll onto your left side (bend your right knee to help rotate). Keep your head and neck in the same position as Position 2. Hold for 30 seconds or until symptoms subside.
Position 4 (finishing): Return to a seated position, sitting off the side of the bed. Hold for 30 seconds or until symptoms feel normalised.
The essence of the Epley manoeuvre is that by putting your head in different positions, you are trying to reposition those crystals through the canals back to where they should be. It may exacerbate your symptoms temporarily, but they should settle when each position is held long enough.
Epley manoeuvre for left-sided symptoms
If your symptoms are worse on the left side, simply reverse the instructions:
- Sit close to the right edge of the bed
- Turn your head 45 degrees to the left to start
- Rotate to the right for the second position
- Roll onto your right side
- Return to seated
Important safety information
Keep your eyes open during the manoeuvre, especially if someone is with you. Nystagmus (rapid eye movements) is a key sign of vertigo and helps confirm the diagnosis.
Hold each position until symptoms resolve - this may be longer than 30 seconds for some people. Do not rush.
Do not stand up immediately if nausea is part of your symptoms. Make sure you feel levelheaded and back to normal before standing and walking around.
If you are unsure, seek professional help. Speak to a physiotherapist, doctor, or someone trained in these techniques who can guide you through it and manage your symptoms in the moment.
Why your neck posture matters for long-term relief
You can do the neck release. You can perform the Epley manoeuvre. But if you keep putting your head and neck into the same problematic shapes every day, your symptoms may keep coming back.
Everything happens for a reason, musculoskeletally. If you have developed an inner ear issue or a neck problem, both have to be there for a reason. Based on clinical experience, the biggest, most common, most overlooked cause is the shapes and positions you put your head and neck into the most throughout the day.
Common problematic postures include:
- Looking down at your phone
- Looking down to read (books, puzzles, arts and crafts)
- Reclining back into a chair with your head forward
- Watching television with your head propped in an awkward position
If you take the time to do these exercises but do not pay attention to getting back into more symmetrical, upright, anatomically correct postures, a lot of this work could be for nothing long term.
"If you take your time to do these exercises and they help you, you do not want to just get yourself back into certain shapes every day and ask these things to come back or to hang around longer than they should."
Video transcript with timestamps (click to jump)
One key insight from this video
"A lot of people do not realise that the top two or three levels of your neck have a very strong influence over the function of your head. Dizziness, lightheadedness, feeling unsteady can actually be a consequence of upper neck dysfunction. Before trying the Epley manoeuvre, use a lacrosse ball at the base of your skull to test whether your symptoms are coming from your neck."
Frequently asked questions about vertigo and neck dysfunction
How do I know if my dizziness is from my neck or my inner ear?
The lacrosse ball test described in this video is a simple way to find out. If releasing tight spots at the base of your skull significantly changes your symptoms, your neck is likely involved. True inner ear vertigo (BPPV) typically does not respond to neck release. However, it is possible to have both conditions simultaneously. A physiotherapist or doctor can perform specific tests to differentiate between the two.
How often can I do the Epley manoeuvre?
You can repeat the Epley manoeuvre as needed, but it is generally not recommended to do it more than once per day. Each time you do it, your symptoms should become less severe. If you have performed the manoeuvre correctly 2-3 times over a few days with no improvement, consult a healthcare professional. It is possible you have a different type of vertigo (e.g., affecting a different canal) that requires a different manoeuvre.
Can I do the Epley manoeuvre on myself?
Yes, many people successfully perform the Epley manoeuvre at home. However, if you are unsure, if your symptoms are severe, or if you have other medical conditions, it is safer to have a trained professional (physiotherapist or doctor) perform it with you. They can also confirm which ear is affected and which specific manoeuvre is appropriate for your type of vertigo.
What should I do after the Epley manoeuvre?
After successful repositioning, many practitioners recommend avoiding certain head positions for 24-48 hours (e.g., lying flat, looking up at high shelves, or tipping your head far back). However, evidence on post-manoeuvre restrictions is mixed. More importantly, pay attention to your daily head and neck postures to prevent recurrence. Avoid sustained head-forward positions (looking at phones, reading, reclining awkwardly).
Can poor posture really cause vertigo-type symptoms?
Yes, it can. Sustained head-forward postures can create stiffness and dysfunction in the upper cervical spine (C1-C3). These vertebrae have direct neural connections to the vestibular system and can refer symptoms that mimic inner ear vertigo. This is called cervicogenic dizziness. While it may not cause true BPPV (crystals in the ear), it can certainly cause dizziness, lightheadedness, unsteadiness, and nausea.
Vertigo and vertigo-type symptoms are genuinely awful. The room spinning. The nausea. The feeling that you cannot trust your own balance. I understand how distressing this can be.
The good news is that many people can improve with the right approach. But the right approach starts with the right diagnosis. Is it your inner ear? Is it your neck? Is it both? The lacrosse ball test gives you a simple, safe way to begin answering that question.
If you have tried the Epley manoeuvre and it has not helped, or if your symptoms keep coming back no matter what you do, consider that your neck might be playing a role. And consider that your daily postural habits might be the underlying reason these symptoms are recurring.
I help people with dizziness, vertigo, and neck-related symptoms in Port Macquarie and via telehealth. If you would like a proper assessment to determine the root cause of your symptoms, I am here to help.
- Grant
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If you would like help making sense of your aches, pains, or ongoing symptoms, you can book with Grant either in Port Macquarie or via telehealth.
Disclaimer: This information is for educational purposes and does not replace individualised medical advice. The Epley manoeuvre can worsen symptoms in some conditions. If you have severe symptoms, neck instability, or other medical concerns, consult a qualified healthcare professional before attempting these techniques. Individual responses vary.
