Vertigo: How Physiotherapy Can Stop Your World Spinning!

Do you ever experience dizziness or vertigo, or feel like your world is spinning?

Is your dizziness, or vertigo brought on by movements of your head?

You may have a condition called ‘Benign Paroxysmal Positional Vertigo’ or BPPV.

 

What is BPPV?

Benign Paroxysmal Position Vertigo (BPPV) is the most common inner ear problem and cause of vertigo. The description of BPPV is in its name.

“Benign” = it is not life-threatening despite, at times, the alarming intensity & severity of symptoms.

“Paroxysmal” = it comes on suddenly and then eases in brief distinct spells.

“Positional” = it is triggered by certain head positions or movements.

“Vertigo” = the sense of spinning motion often associated with the distinct attacks.

What causes BPPV?

BPPV is caused by displaced crystals that have become unstuck from their normal settled location in the inner ear and are now free floating around delicate sensors in the wrong part of the inner ear. When the crystals are in the normal part of our inner ear they help us with balance and motion perception. They can create intense false messages of spinning when they are moving freely in the canals. These symptoms are caused by these crystals disturbing the sensors in these sensitive canals.

The most intense part of the BPPV symptoms are directly related to how long it takes the crystals to settle after you move or change head position. As the crystals move/settle, your brain is being given false messages that you are spinning around!

What are the common symptoms of BPPV?

Although everyone will experience BPPV differently, the most common symptoms are distinct triggered spells of vertigo or spinning sensations that are most often accompanied by nausea (occasionally vomiting) and/or a severe sense of disorientation in space. These symptoms will last most intensely for seconds to minutes however can leave some people feeling a persistent sense of vaguer dizziness thereafter. In some people, BPPV can present more as an isolated sense of instability brought on by position change e.g. sitting up, looking up, bending over and reaching.

BPPV does not cause constant severe dizziness that is unaffected by position or movement.

It can not affect your hearing or produce fainting.

It will decrease in severity over time.

What caused my BPPV?

The vast majority of cases of BPPV occur for no reason however it can occasionally be associated with trauma, migraine, other inner ear problems, diabetes, osteoporosis, and prolonged time lying in bed.

How is BPPV diagnosed?

Medical imaging (e.g. scans, X-rays) cannot show or confirm BPPV however simple physical testing can help to confirm the diagnosis. The physical testing requires you to move your head into a specific position that makes the crystals move. This provokes a characteristic eye movement that your doctor of physio will be able to see and characterise to confirm the diagnosis.

You can also experience vertigo that is caused by dysfunction of your neck which is termed ‘Cervicogenic Vertigo’. This type of vertigo is also treatable with physiotherapy but isn’t discussed in this post.

Can BPPV be treated?

Yes!

The good news is, the vast majority of cases can be corrected with a simple re-positioning manoeuvre.  You may need between 1-3 treatments to resolve the issue. These re-positioning techniques are designed to guide the crystals back to their original location in the inner ear.

These manoeuvres can be performed at home, however should first be assessed by a professional to accurately diagnose your type of BPPV as this changes the treatment technique. Your GP may refer you to a physiotherapist once a diagnosis of BPPV is made, although a referral is not necessary to see your physio.

 

Is there any down side to BPPV re-positioning treatments?

During the actual BPPV treatment there can be some momentary distress from vertigo, nausea and feelings of disorientation characteristic of your usual BPPV episodes. Following the treatment, some people report their symptoms start too clear almost immediately. However, frequently people will report some degree of persistent motion sickness-type symptoms and mild instability that can take a few hours to resolve to more rarely a few days to gradually go away.

Can BPPV go away on its own?

There is evidence that left untreated, BPPV can go away within weeks. Although, remember that while the crystal is out of place, in addition to feeling sick and sensitive to motion, your unsteadiness can make you at increased risk for falling so be careful.

How long will it take before I feel better?

 

Even after successful treatment of BPPV some people can feel some mild residual sensitivities to movement and generalised unsteadiness that can take a few days to a few weeks to gradually resolve. It is important to follow up with your therapist if your symptoms of dizziness/instability do not resolve in a timely manner (days to couple weeks).

Is there anything I should or shouldn’t do to help my BPPV?

You need to take precautions that you don’t fall as your balance will be “off”. Until the BPPV has been successfully treated you will feel increased sensitivity to movement. After your BPPV has resolved, it is important to resume normal activities that you can safely tolerate as the gradual exposure to motion and movement will help to speed up your recovery.

Can BPPV come back and/or can I prevent it?

Unfortunately, BPPV is a condition that can re-occur. This may be caused by some secondary factors (e.g. trauma, other inner ear or medical conditions). Medical research has not found any way to prevent recurrences of BPPV. However if it does come back or recur it is as treatable with as high success rates.

 

References

Discover a Life Rebalanced

http://www.health.vic.gov.au/edfactsheets/downloads/vertigo-bppv.pdf

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/benign-paroxysmal-positional-vertigo-bppv

https://audiology.asn.au/public/1/files/Fact%20Sheets/BPPV%20Fact%20Sheet%20with%20diagram.pdf