Benign Positional Paroxysmal Vertigo (BPPV)



Let’s talk about vestibular rehab.

Have you ever been told by your doctor that you have crystals in your ears? This is referred to as a condition called benign positional paroxysmal vertigo, or BPPV and is very easily treated.

It’s characterized specifically by a room spinning sensation upon lying down, rolling over in bed or getting up out of bed, due to these crystals being loose. It can even cause nausea and vomiting! If it’s your first time experiencing the spinning sensation you will be terrified because you feel like you’re on a roller coaster without a safety harness.

Sometimes, people just learn to deal with it.

We recently had a patient come to our clinic who had been dealing with this for FIVE years!

The ironic part? We weren’t even seeing her for her vertigo! She came to our clinic seeking help for her back pain, but didn’t want to lie down flat for her treatment. After speaking with her briefly about why she did not want to lie flat, it was clear that she was suffering from BPPV.

We did one treatment to resolve her BPPV and she no longer had to tolerate the dizziness that she had been dealing with for five years.

Often, when people are seen by their primary physicians for problems such as this, they’re prescribed some type of medication (meclizine, or anti-nausea and motion sickness type medicine). Unfortunately, it will have very little effect on your experience and ultimately just mask the issue at hand temporarily.

So what can be done about this?

Many people suffering from BPPV aren’t even aware that physical therapists can treat this.

We get referrals quite a bit from doctors who will prescribe vestibular therapy.

During an evaluation with a vertigo or BPPV- type diagnosis, not only do we investigate the vestibular system (the small organ embedded in the inner ear), we’ll also assess balance.

Balance is made up of three components:

  • 1. Your vision
  • 2. Your vestibular function and equilibrium
  • 3. Your muscle stretch reflexes in the muscles

At PPT, we assess all three systems to better identify where the biggest deficit or problem lies.

Once we do that, we can easily tailor an exercise program and treatment plan for that specific need, so improvement is obtained from the area most affected.

But to be honest, vestibular rehab is not always the most fun therapy to do early in the day. A lot of it involves head movements and changes in the heads position, which can often feel like you’ve been on a roller coaster for a majority of the day; even though you’ve only done a few minutes of exercise!

We love to educate our patients who suffer from dizziness to do this therapy at night before going to bed. This allows their irritated vestibular system to calm down while they sleep until the next day. This condition almost always resolves with 80% effectiveness in 1 to 2 treatments.

Very commonly BPPV is treated within one to three sessions and the dizziness is gone.

BUT… the balance issues remain.

After we take care of the dizziness (vertigo), we then move on to improving balance. That way we don’t have to worry about falling.

Just think of all you will be enjoying when your life is no longer limited by the restrictions of balance and vertigo issues.

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Nick Hunter, PT, DPT
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