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How Physical Therapists Treat Benign Paroxysmal Positional Vertigo (BPPV)

Some physical therapists are specially trained to treat benign paroxysmal positional vertigo (BPPV)—a condition that causes dizziness when you change position or move your head. The cause of BPPV, which is the most common cause of vertigo, is a dysfunction in the vestibular system in the inner ear. Although the condition can range from mild to severely debilitating, in some cases, the condition is effectively treated in a single physical therapy session.

If your primary care physician suspects that your symptoms may be due to BPPV, he or she may refer you to either a physical therapist or occupational therapist trained in vestibular rehabilitation treatment techniques. The therapist will determine which type of BPPV—canalithiasis or cupulolithiasis—is causing your symptoms and then treat them using the appropriate procedures.

Understanding the Cause of BPPV

Some of the calcium carbonate crystals that are located in the utricle (a fluid-filled sac) within the inner ear can become dislodged and fall into one of the three inner ear canals. If too many of these tiny crystals accumulate in an ear canal where they don't belong, they interfere with the normal movement of fluid in the canal.

When the fluid moves, it sends messages to the brain that your head is moving when it's really still. Since the messages the nerve cells in the inner ear are sending don't match the messages your eyes are sending to the brain at the same time, your brain interprets the difference as a spinning sensation. What happens is you think the room is moving when it's not.

Identifying the Location of the Problem

A physical therapist trained in treating BPPV will move your head into different positions to trigger a vertigo attack. This is the method used to identify in which ear the crystals are dislodged. Making the crystals move causes your eyes to move abnormally in a particular way, which tells the therapist in which ear canal the loose crystals are located. The therapist then uses specific maneuvers to guide the crystals back to where they belong.

Treating the Different Types of BPPV

  • Canalithiasis

Canalithiasis is a type of BPPV where the loose crystals move freely in the fluid in one or more ear canal. Moving your head sets the crystals in motion, triggering vertigo. The sensation generally lasts for about 60 seconds and passes once the fluid settles and the crystals stop moving.

If your physical therapist identifies your BPPV as canalithiasis, he or she will use a series of simple head maneuvers, known as the canalith repositioning procedure (or Epley maneuver), to treat the condition. If dislodged crystals are present in more than one canal, the therapist will treat one canal at a time.

Even if treatment stops the spinning sensation, your therapist may instruct you in home exercise techniques if you still feel a little unsteady. Usually, however, the canalith repositioning maneuver relieves vertigo in 80 percent of affected individuals after just one or two treatments.

  • Cupulolithiasis

Cupulolithiasis is the other type of BPPV in which the crystals don't move, but instead get stuck on nerves that sense the fluid movement. Vertigo associated with this type of BPPV lasts longer than canalithiasis. If you have this type of BPPV, the therapist must first dislodge the crystals using a procedure known as the liberatory maneuvers. He or she will then use the canalith repositioning technique to guide the crystals out of the canal and back down into the utricle.

To learn more about benign paroxysmal positional vertigo, contact a physical therapist from an establishment like Bonita Community Health Center.