What is BPPV and How Can PT Help it?

By Nick Mazzone PT, DPT, CSCS

What is BPPV?

Benign Paroxysmal Positional Vertigo (BPPV) is a disorder of the vestibular system in the inner ear. This system is responsible for coordinating head and eye movements and plays a large role in balance. Dysfunction occurs when calcium carbonate crystals break loose and fall from their original resting position in the utricle (see photo below) into one of the semicircular canals, which typically sense movements of the head. Once this occurs, the brain receives a signal that the head is moving, even though this is not the case. This false signal causes uncoordinated movements of the eyes when the head is moved into a specific position (depending on which canal the crystals lands in). This leads to the sensation that the room is spinning around you, which is known as vertigo. In BPPV, the symptoms typically go away within 30 seconds or so.


What causes BPPV?

 In more than half of all BPPV cases, the exact cause is unknown (AKA idiopathic). Head trauma, infections, and issues with blood flow are some of the known causes of the condition. Sometimes something as simple as a sinus infection can cause symptoms of vertigo due to congestion in the middle ear, which may place pressure on the structures of the inner ear causing dysfunction.

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How do we treat BPPV?

 Physical therapists are trained to treat the symptoms of vertigo by using positional maneuvers that are aimed at returning the dislodged calcium carbonate crystals to their original resting position. The most common intervention used to treat BPPV is known as the Epley maneuver. This technique consists of passive movement of the patient’s head into multiple provocative positions. This maneuver will cause your symptoms, so be ready to feel the vertigo come on.  Once the symptoms subside in that particular position, it is said that the crystals have moved on to a different portion of the canals. The head is then repositioned to catch up with the new position of the crystal. At the end of the technique, the crystals should return to their original position in the utricle. Patients are typically symptom free after 1-2 sessions when the Epley is performed. Your physician or physical therapist will explain to you that you should not drive after this treatment and should plan ahead to secure yourself a ride home. You may also be given a home exercise program to help take care of any remaining symptoms.

BPPV Epley.jpg


Check out this video that shows an alternative exercise for treating BPPV that can be performed at home. It is particularly helpful for those who have periodically recurring symptoms and would like to expand their treatment options.

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Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.



 Main photo retrieved from http://www.acceleratedhealthcentre.com/concussion

Photo of Epley maneuver retrieved from https://www.healthdiseases.org/epley-maneuver/

Photo of inner ear congestion retrieved from http://www.greathillsent.com/blog/date/2013-12-01.html

Photo of anatomy of the outer, middle, and inner ear retrieved from https://www.medcor.com/anatomy-of-the-ear/

Photo of vestibular organs retrieved from https://virginiavisiontherapycenter.com/signs-and-causes-of-vestibular-dysfunction/

Vestibular Rehabilitation for BPPV (n.d.). Retrieved from https://wwspt.com/pt-treatments/vestibular-rehabilitation/benign-paroxysmal-positional-vertigo/