Benign Positional Paroxysmal Vertigo (BPPV)



Today, we’re gonna talk about vestibular rehab.

If you’ve ever been told by your doctor that you have crystals in your ears, this is a condition called benign positional paroxysmal vertigo or BPPV and is very easily treated.

If you lie down, roll over in bed or get up from bed and it feels like the room is spinning, you get nauseous, or maybe even vomit, it’s because these crystals are loose.

Sometimes, people will just learn to deal with it.

I had a patient come to me who had been dealing with this for five years!

The only reason why she decided to get it treated was that I was seeing her for her back and we couldn’t do treatment for her back, because she didn’t want to lay down flat. After talking to her for a few seconds about why she didn’t want to lay down flat, it was clear she had BPPV. It was very easily treated. We did one treatment for her to resolve her BPPV and she no longer had the dizziness she had been dealing with for five years.

When you go to the doctor, they will most often prescribe some medications, (meclizine, or anti-nausea and motion sickness type medicine). Unfortunately, it will have very little effect on your experience.

So the issue then becomes, what should you do about it?

Many patients have no idea that physical therapists even treat this.

Even I had no idea that this is a condition that PTs treat until I was in school… and my dad is a physical therapist! In PT school, I had the opportunity to shadow at a hearing and balance center. All we did there was treat vertigo and balance issues.

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

During the evaluation with vertigo or BPPV-type diagnosis, not only do we investigate the vestibular system (which are small organs that are embedded in the inner ear or skull area of the inner ear organ), we’ll also assess the balance.

The balance is made up of three components;

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

We assess all three systems to better identify where the biggest deficit or problem is.

Once we do that, we can tailor an exercise program and treatment plan to that specific need so improvement is obtained from the area where there is the most difficult.

Vestibular therapy is it’s not always the most fun therapy to do early in the day. A lot of it involves head movements and changes in head positions, which can often feel like you’ve been on roller coasters all day long, even though you’ve only done a few minutes of exercise.

So, I always educate my patients who suffer from this dizziness to do it at night before going to bed so that as the vestibular system gets irritated and they feel like they’ve been on roller coasters, they can just go to bed, let it calm down and sleep it off until the next day. This condition almost always resolves with 80% effectiveness in 1 or 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 work on improving balance. That way we don’t have to worry about falling.

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

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Nick Hunter, PT, DPT

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