Have you ever rolled over in bed and suddenly felt like the room was spinning? You may have experienced benign paroxysmal positional vertigo (BPPV). BPPV is one of the most common causes of vertigo and can make everyday movements, such as getting out of bed, looking up, bending over, or turning your head, difficult.

That being said, BPPV is highly treatable, and physical therapy can usually help to resolve symptoms in just a few visits.

Physical therapists trained in vestibular rehabilitation can evaluate the cause of your dizziness, determine if and which inner ear is involved, and use specific repositioning techniques to treat BPPV.

What Is BPPV?

Benign paroxysmal positional vertigo, or BPPV, is a condition of the inner ear that causes brief episodes of spinning or vertigo when your head changes position.

Inside your inner ear are tiny crystals that help your brain understand where your body is in space and how your head is moving.

Normally, these crystals sit in a specific part of the inner ear. However, sometimes they become displaced and move into one of the semicircular canals.

When this happens, certain head movements can cause the displaced crystals to move through the canal. This sends an inaccurate signal to your brain about your head position, resulting in the sensation of spinning.

What Does BPPV Feel Like?

BPPV typically causes short episodes of vertigo triggered by changes in head position.

Common triggers include:

• Rolling over in bed
• Sitting up or lying down
• Turning your head
• Looking up
• Looking down
• Bending over
• Getting in or out of bed
• Reaching overhead

Some people also experience:

• Nausea
• Loss of balance
• Unsteadiness
• Difficulty walking immediately after an episode
• A sensation that the environment is moving
• Anxiety or fear of triggering another episode

One of the most important characteristics of BPPV is that the spinning sensation is usually brief, often lasting less than a minute once the head is held still.

Why Does BPPV Happen?

Sometimes BPPV develops without an obvious cause. In other cases, it may occur after:

• A head injury or concussion
• A fall
• Prolonged time spent in one position
• An ear or vestibular disorder
• Age-related changes in the inner ear

BPPV becomes more common with age, but it can occur in people of many different ages.

How Is BPPV Diagnosed?

A physical therapist trained in vestibular rehabilitation can perform a clinical evaluation to determine whether your symptoms are consistent with BPPV.

Part of the evaluation may involve moving your head and body into specific positions while observing your symptoms and eye movements.

Your physical therapist will also consider your symptoms, medical history, balance, gait, eye movements, and other potential causes of dizziness.

This is important because not all dizziness or vertigo is BPPV.

How Can Physical Therapy Treat BPPV?

The primary treatment for BPPV is usually a series of specific head and body movements designed to move the displaced crystals out of the semicircular canal and back to their proper location.

These are called canalith repositioning maneuvers.

The Epley Maneuver

This is one of the most well-known treatments for BPPV.  During the maneuver, your physical therapist guides your head and body through a sequence of positions.

The goal is to use gravity to move the displaced crystals through the semicircular canal and out of the area where they are causing symptoms.

Depending on the type and location of your BPPV, your physical therapist may use a different repositioning maneuver.

The appropriate maneuver depends on which semicircular canal is involved and which ear is affected.

This is one reason why having your BPPV evaluated rather than simply performing random “vertigo exercises” from the internet can be helpful.

How Quickly Does BPPV Treatment Work?

One of the advantages of treating BPPV with repositioning maneuvers is that improvement can sometimes happen very quickly.

Some people experience significant improvement after a single treatment session, while others require additional treatment.

Persistent symptoms may occur if:

• The wrong canal was treated
• More than one canal is involved
• The crystals have moved into another part of the vestibular system
• Another vestibular condition is also present
• The BPPV has returned

Your physical therapist can reassess you and modify treatment as needed.

What If I’m Still Dizzy After BPPV Treatment?

It is possible to feel slightly off-balance or sensitive to movement after the spinning episodes have stopped.

This doesn’t necessarily mean that the BPPV treatment didn’t work.

Some people experience lingering motion sensitivity or balance deficits that can be addressed with vestibular rehabilitation.

Vestibular physical therapy can include exercises designed to improve:

• Balance
• Gaze stability
• Coordination
• Visual motion tolerance
• Habituation to movement
• Confidence with walking and everyday activities

Your therapist can determine whether additional vestibular rehabilitation is appropriate based on your symptoms.

Physical Therapy for BPPV

If you’re experiencing positional vertigo, it is helpful to get treatment from a physical therapist as quickly as possible, rather than waiting for the symptoms to go away on their own.

Here at Release Physical Therapy, a physical therapist trained in vestibular rehabilitation can evaluate your symptoms, determine whether BPPV is contributing to your dizziness, identify the affected ear and semicircular canal, and provide an individualized treatment plan.

Schedule an appointment to get started today help resolve those symptoms of dizziness or lightheadedness.