by Boris Katz PT, MBA
Do you frequently feel dizzy? Does the condition get worse when you turn your head or when you lie down? Do you feel like the room is spinning? Does your vertigo come in sudden short spells?
You might be experiencing a condition called Benign Paroxismal Positional Vertigo (BPPV). BPPV is a mechanical problem of the inner ear. In this condition calcium carbonate crystals become dislodged and end up in one or more semicircular canals (where they are not supposed to be).
Semicircular canals of the inner ear are lined with cilia (microscopic hairs) and filled with liquid substance, known as endolymph. Every time the head moves, the endolymph moves the cilia. This works as a motion sensor, as the movements of the cilia are communicated to the brain. In BPPV, crystal debris move in the semicircular canals with gravity and send an error message to the brain that the head is moving. This message does not match with what the eyes are seeing and what the muscles and joints are feeling. This mismatched information is perceived by the brain as the spinning sensation, causing vertigo, which normally lasts for up to one minute.
What will the physical therapist do for you?
On your first visit, physical therapist will check if you have BPPV by doing Dix Hall Pike test – taking you from a seated position to a lying down position with your head brought back and rotated to the side.
You might experience dizziness and some nausea from this maneuver. You will be prepared by a therapist on what he is about to do and what your reaction might be. This test will assist therapist to identify the side where the problem in the inner ear is present. After Dix Hall Pike test, therapist will perform an Epley Maneuver (illustration below). There will be a different home exercise program designed for each patient with this maneuver or a similar one, depending on the type of BPPV patient has.
There is a strong evidence supporting effectiveness of Epley’s Maneuver and other Canalith Repositioning Techniques for BPPV. Dorigueto R. and colleagues studied 100 patients with BPPV treated with Canalith Repositioning Technique and found only 4% of patients had a return of nystagmus and vertigo after 1 year. 70% showed no recurrence of BPPV.
Patient will require an average of 2-3 visits in the office combined with a home exercise program for BPPV to be corrected. For best results patient should continue therapy for 2-3 more weeks to follow up Canalith Repositioning Technique with vestibular exercises. Physical therapy will treat the cause of vertigo, while vertigo medications will treat the symptoms and will usually not address the underlying cause. Physical therapy is a cost –effective way to treat a very debilitating condition quickly and effectively. Your treatment will be fully covered by your insurance under physical therapy benefits. At Light Touch Rehabilitation, our physical therapists and chiropractors are trained in treatment for vertigo and vestibular rehabilitation.
Brodovsky Janine R. et Al. “Vestibular Rehabilitation for unilateral peripheral vestibular dysfunction” Physical Therapy March 2013 Vol. 93
Dorigueto, Ricardo S, et Al. “ Benign paroxysmal positional vertigo recurrence and persistence” Braz J. Otorhinolaryngol (2009) vol 75; no.4
Denton D. “ Hands on Guide to Vestibular Rehabilitation: Clinical Decision Making to treat Vertigo, Dizziness and Balance Disorders”Continuing Education course, December 2017.