Vertigo (BPPV) & Physiotherapy

By Senior Physiotherapist Robert Barker.

What is BPPV?

Benign Paroxysmal Positional Vertigo (BPPV) is a vestibular dysfunction in the inner ear associated with dizziness, nausea and the sensation of the room spinning. Episodes occur intermittently when you turn your head in certain positions, usually rotating or looking down, with symptoms settling within a few minutes.

BPPV occurs when particles, which sit within the inner ear (Utricle) which become dislodged and move into the semicircular canals, where they can either float in the fluid (endolymph) or become imbedded on the canal walls. These particles are calcium carbonate crystals, which can slowly dissolve by themselves or need some help via treatment to dislodge them from the walls and move them out of the canals.    

Why does it feel like the room is spinning?

There are 3 semicircular canals which contain fluid in them and very small sensory like hairs which stick out from the canal walls. These hairs detect the speed and direction of fluid motion when we move our head, and relay signals to the brain. This is how we recognise when our head not strait, or when where moving. When a dislodged particle gets stuck in one of the canals the normal flow of fluid is altered and often increased as the particle move more with gravity. This gives the incorrect signal to brain as the fluid is now moving when our head is still, thus sending a signal to the brain which we feel as the room spinning when it is not. 

Who gets BPPV?

BPPV can occur at any age, but it is more common in older adults as the vestibular system starts to degenerate. Other causes have been linked to:

• head trauma
• Inner ear infections
• Prolonged head positions (usually extension)
• Migraines
• Diabetes
• Reduced blood flow

Most episodes of BPPV occur spontaneously, with no specific incident. People often describe rolling over in bed, or getting up from lying own with a sudden onset dizziness.

How can Physiotherapy help?

There are specific vestibular tests which we can do to determine whether your systems are due to BPPV or something else. These tests often involve certain head manoeuvres involving one of the semicircular canals to see if the fluid flow is disrupted. A positive test will replicate your vertigo symptoms and cause very recognisable rapid eye movements, called “nystagmus”. As the brain thinks we are moving, the signals to the eyes get confused and they start to move in certain directions specific to the type (based on which of the three canals are effected) of BPPV.     

Once we know which of the canals the particles are lodged in, we can treat it. Most cases of BPPV can be treated with Physiotherapy, which includes different head positioning manoeuvres often repeated a few times. These manoeuvres help dislodge the calcium carbonate particles from the walls and then aim to gradually guide them through gravity and flow of the fluid out of the canal, back to the inner ear (Utricle). Some of the more common techniques or manoeuvres used are the Epley, The Lempert (BBQ roll), and the Carol Foster method (Half somersault).

Studies have shown that the vast majority of patient’s symptoms can be treated effectively within 3 sessions and with the prescription of daily home exercises.

Other causes of Vertigo/dizziness.

If we assess your symptoms as not BPPV related we will conduct a thorough neurological and cervical spine exam to identify the cause, and refer you to the right medical professional if required. 

There are many causes of dizziness and feelings of nauseousness, most non-serious. However, if your experiencing dizziness not associate with head movements, that is constant (not settling with a few minutes), vision disturbances, hearing loss, black outs, severe pain/headaches, difficulty speaking (slurred or broken speech), difficulty swallowing, or any signs of facial numbness or pins and needles, then consult your regular GP immediately as this could be a sign of something more serious. 

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