The Basics of BPPV: Positional Vertigo

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Summer is here and that brings more outside time and fair weather. Activities like gardening and yard work are frequent, and sports like golf, tennis and swimming encourage us to spend time outside enjoying all that Vancouver has to offer. But have you ever found yourself moving into a position where you are bending over, looking high up or tilting your head to one side and suddenly the outside world appears to be moving?  It can be a very unsettling feeling, even if it doesn’t last long.

 

Vertigo is the sensation of the outside world spinning.  It is a symptom, but not a diagnosis.  The incidence is quite common, as much as 1 in 15 adults will have an episode of vertigo in their life, according to an Ear Nose and Throat Doctor teaching at Columbia University.  One of the causes of vertigo that we see at Treloar Physiotherapy is a condition called Benign Positional Paroxysmal Vertigo (BPPV).  It is important to note that BPPV is not the only cause of vertigo, but it is the most common.  Here is some basic information about BPPV:

What is it?

  • BPPV is a problem that occurs in the vestibular system that causes a sensation of spinning for short periods of time when the head is moved into certain positions.
  • The crystals that are located in sacs within the inner ear break free, moving into one of the semi-circular canals of the inner ear.
  • When your head moves, the crystals float through the canal and continue to move even after you stop moving. This creates a temporary spinning sensation (vertigo) that comes on with specific head movements.

What causes it?

  • In most cases, we do not know what causes the crystals to break free and move into the semi-circular canals.
  • Very few cases occur because of a physical blow to the head (ie something that ‘knocks’ the crystals loose).

What movements trigger the vertigo symptoms?

  • Big movements that involve bending over and looking down – emptying the dishwasher, weeding the garden, bending low to pick up something under the bed, tying shoes, putting the golf ball on the tee (!).
  • Looking up at something high – getting ready to prune the tree, changing a light bulb (we don’t do this as often anymore thanks to LEDs!), a high tennis serve toss, looking up/leaning head back while washing your hair.
  • Changes of position – moving from lying down to sitting up or vice versa (ie in/out of bed, getting up/down off an exercise mat) or turning your head/rolling to one side while lying down.

How long does the vertigo last?

  • With BPPV, the vertigo sensation itself typically lasts less than 1 minute, and not more than 2 minutes (it can often feel much longer in the moment!). The symptoms will recur as the head and body move into the provoking positions.
  • There can also be a sensation of imbalance while moving/walking or mild nausea when someone is suffering with BPPV and this can occur more frequently.

How do you treat BPPV?

  • BPPV can be treated very effectively with a re-positioning maneuver – essentially using gravity and the position of your head to move the crystals out of the affected canal and back to their normal resting position. When this happens, and the crystals are ‘back in their home’ the vertigo symptoms go away.

Many people use the internet to look up home treatment for BPPV and often read about the ‘Epley Technique’.  This is the most commonly performed re-positioning maneuver for BPPV; but it does not treat all types of BPPV.  The Epley is only effective for one type of BPPV. The key to effective treatment involves: figuring out which ear has the problem (it is usually only one ear), determining what canal the crystals are stuck in, and effectively applying the correct treatment technique.  If the wrong technique is used, or done incorrectly you will not likely cause damage, but you can make yourself feel pretty rotten and it will not solve the problem.

 

A physiotherapist who has studied vestibular rehabilitation will take you through an assessment that will involve the following:

  • A thorough history of your symptoms and current challenges.
  • A safety screen to rule out more serious causes of vertigo.
  • A physical assessment to determine if BPPV is the cause of the vertigo and how to best treat it.

 

Often treatment can be done in the same session.  Assessment and treatment for BPPV does involve reproducing the symptoms of vertigo – but it’s worth it when the vertigo is gone.  Don’t let vertigo get in the way of enjoying the activities that you enjoy, especially in the summer season!

Call one of our clinics or book online (www.treloarphysio.com) to make an appointment with one of our physiotherapists trained in vestibular rehabilitation.

Written by Stacy Benmore (Physiotherapist, Treloar Physiotherapy Kerrisdale).