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Physical Therapy for BPPV

March 31, 2014

Physical Therapy for BPPV
--Amanda Stinson, PT

What is vertigo?
At least 10 percent of all ER visits are related to dizziness or vertigo.  Step one for treating these patients is distinguishing between dizziness and vertigo.  Unlike dizziness, vertigo is the false sense of movement (usually that either you are spinning or your environment is spinning around you).  Vertigo is the result of a disruption of your vestibular system.  Since your vestibular system plays an important role in your ability to balance, a disruption in the system can lead to falls and consequent injuries.

What is BPPV?
Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo.  Studies have shown that 2.4% of individuals will experience BPPV at least once in their lifetime.  BPPV is vertigo that is triggered by changes in the position of your head.  Episodes of vertigo are brief (typically less than one minute) and can occur when you look up, bend over, roll over in bed, or transition from laying down to sitting up.  You may also experience nausea along with the vertigo.  The good news is that BPPV is the most successfully treated cause of vertigo!

What causes BPPV and how do physical therapists test for it?
Vestibular organs housed in your inner ear detect changes in head position.  BPPV occurs when otoconia (small calcium crystals) from the vestibule make their way into one of the semicircular canals.  This usually happens spontaneously, but may also be the result of a head injury.  These canals have connections to the muscles that move our eyes.  Physical therapists are able to detect the presence of BPPV by watching your eyes as you move as your body changes position.  When BPPV is present, a nystagmus (rapid involuntary eye movement) will occur at the same time as you feel the vertigo. 

How do physical therapists treat BPPV?
Physical therapists must first determine which ear is affected and then which canal within that ear is the source of the problem.  Physical therapists can then use their knowledge of the anatomy of the inner ear in order to help guide the crystals out of the semicircular canals and back to their proper place within the vestibule.  In most cases, vertigo can be completely resolved within 1-2 treatments of physical therapy!

References: 

1) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117684/  

2) http://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo

3) http://www.med.upenn.edu/solomon/images/BPPV.pdf

4) http://www.emedicinehealth.com/benign_positional_vertigo/article_em.htm
 

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