The Single Biggest Mistake People Make When Treating BPPV (And How to Avoid It)

March 2, 2026

If you’ve ever experienced sudden spinning when rolling in bed, looking up, or bending forward, you may have BPPV (benign paroxysmal positional vertigo).

And if you’ve searched online for answers, you’ve probably seen videos showing the Epley maneuver.

Here’s the problem: Many people try to treat BPPV without testing first.

That’s the single biggest mistake we see at Gordon Physical Therapy in Spokane Valley, WA.

Let’s talk about why that matters — and what to do instead.

What Is BPPV?

BPPV stands for benign paroxysmal positional vertigo. It occurs when tiny calcium crystals (otoconia) move into one of the semicircular canals of the inner ear.

When you change head position, those crystals shift — and your brain receives a false signal that you’re spinning.

Common symptoms include:

• Sudden vertigo when getting up from bed

• Spinning when rolling over in bed

• Dizziness when looking up

• Vertigo when bending forward

• Brief episodes of intense spinning (usually under 60 seconds)

The good news?

BPPV is highly treatable!

But only if it’s properly diagnosed first…

The Biggest Mistake: Treating Without Testing

Many people assume: “I feel dizzy when I lie down. I must need the Epley maneuver.”

But here’s what most people don’t realize:

There are different types of BPPV, depending on which canal is involved.

The two most common are:

• Posterior canal BPPV

• Horizontal canal BPPV

Each requires a different treatment maneuver.

If you treat the wrong canal, symptoms often persist — or even feel worse.

Step 1: Properly Test for BPPV

Before treatment, you should perform positional testing to identify:

1. Whether it is actually BPPV
2. Which canal is involved
3. Which side is affected

Two primary diagnostic tests are used:

1. Dix-Hallpike Test

The Dix-Hallpike test is used to diagnose posterior canal BPPV — the most common type.

This test involves turning the head and quickly lying back while observing the eyes.

2. Supine Roll Test

The Supine roll test is used to diagnose horizontal canal BPPV.

This test involves lying on your back and rotating the head side to side while watching for symptoms and eye movements.

Step 2: Watch the Eye Movements (Nystagmus)

This is the step almost everyone misses.

When BPPV is present, the inner ear sends incorrect signals to the brain — and this causes involuntary eye movements called nystagmus.

The direction and type of nystagmus tell us:

• Which canal is involved

• Which ear is affected

• Which treatment maneuver to use

Without observing nystagmus, you’re essentially guessing.

At Gordon Physical Therapy, careful eye movement assessment is one of the most important parts of diagnosing vertigo correctly.

Step 3: Match the Treatment to the Canal

Once the correct canal is identified:

• Posterior canal BPPV → treated with the Epley maneuver

• Horizontal canal BPPV → often treated with the Gufoni maneuver

These maneuvers are designed to reposition the displaced crystals back to where they belong.

When properly matched to the diagnosis, success rates are very high.

When mismatched, symptoms frequently continue.

Why Professional BPPV Evaluation Matters

While YouTube can be helpful for education, BPPV diagnosis is more nuanced than it looks.

At Gordon Physical Therapy in Spokane Valley, we:

• Perform detailed positional testing

• Carefully observe nystagmus

• Identify the exact canal and side involved

• Perform the correct maneuver

• Re-test to confirm resolution

• Screen for non-BPPV causes of vertigo if needed

Many patients come to us after trying maneuvers at home without relief, only to discover they were treating the wrong canal.

Sometimes it’s not BPPV at all.

Proper assessment makes all the difference.

When to Seek Help for Vertigo in Spokane Valley

You should schedule an evaluation if:

• Your vertigo isn’t improving

• You’re unsure which maneuver to perform

• You feel anxious performing testing at home

• Your symptoms don’t fit classic BPPV patterns

• You want faster, more reliable resolution

If you’re in Spokane Valley, WA or the surrounding area and struggling with dizziness, we’d be happy to help.

Early treatment often means faster recovery and less disruption to your daily life.

Watch the Full Video: The Single Biggest Mistake to Avoid

I recently made a YouTube video explaining this exact issue in more detail — including how testing works and why watching eye movements is critical.

You can watch it below this blog post.

If you’re local and would prefer professional evaluation instead of guessing at home, contact Gordon Physical Therapy in Spokane Valley to schedule an appointment.

Need Help With Vertigo?

If you’re experiencing spinning, dizziness, or positional vertigo in Spokane Valley, WA, we specialize in vestibular physical therapy and BPPV treatment.

Contact Gordon Physical Therapy today to schedule an evaluation and get back to feeling steady again!