Benign paroxysmal positional vertigo (BPPV)

BPPV occurs when calcium carbonate crystals in the inner ear become dislodged, causing vertigo with certain head movements. Physiotherapists diagnose BPPV using tests like the Dix-Hallpike manoeuvre and treat it with the Canalith Repositioning Manoeuvre (e.g., Epley manoeuvre) to relocate the crystals. Follow-up care includes additional balance and habituation exercises if needed, ensuring effective symptom management and improved quality of life. More information

The role of physiotherapy in rehabilitation of BPPV

Diagnosis and assessment:

 The physiotherapist will first confirm the diagnosis of BPPV using specific tests, such as the Dix-Hallpike manoeuvre, to identify which ear and which canal are affected.

Canalith repositioning manoeuvre:

The primary treatment involves performing specific manoeuvres, such as the Epley manoeuvre, to move the dislodged calcium crystals out of the semicircular canals where they cause vertigo and back to their proper location in the inner ear.

Brandt-Daroff exercises:

You may be advised to perform Brandt-Daroff exercises. These may cause dizziness initially, which can cause anxiety and discomfort, so it is recommended to seek advice from a health care professional before performing them.

Your physio will ask you to:

  • Sit upright on the edge of the bed.
  • Turn your head slightly (45 degrees) to the left.
  • Keep your head in the same position as you lie down quickly on the right side.
  • Ensure the back of the head rests on the bed. Wait 20–30 seconds or until the dizziness stops.
  • Sit upright. Wait 20–30 seconds for any dizziness to settle.
  • Repeat on the other side.
  • Turn the head slightly to the right before lying down quickly on the left side.
  • Do this five times on each side (takes about 10 minutes). Repeat three times a day.

Follow-up and monitoring:

The physiotherapist will monitor the patient’s progress, ensuring that the manoeuvres are effective and addressing any residual symptoms or balance issues. They may also perform additional manoeuvres if needed.

Balance and Habituation Exercises:

If necessary, the physiotherapist may introduce balance training and habituation exercises to help the patient adapt to any remaining dizziness and improve overall stability and confidence in movement.Overall, the physiotherapist helps patients manage BPPV effectively, reducing symptoms and improving their quality of life through targeted, evidence-based interventions.

Where to next?

Pollinate Health offers a vertigo and dizziness physiotherapy service. Book with us today.