Vertigo and BPPV: Physical Therapy’s Spin on it
Vertigo is the sensation of motion, when there is none. While there are several causes of dizziness, the most common is Benign Paroxysmal Positional Vertigo, or BPPV. BPPV is a non- life threatening, sudden and brief experience of vertigo, brought on by head positions or movements. Patients with BPPV may report a sensation of “room spinning dizziness” when tilting their head to look up, or rolling over in bed. Luckily, physical therapist utilize Vestibular Therapy to overcome these symptoms and conditions.
BPPV is the result of a mechanical issue in the inner ear. The inner ear is comprised of two types of organs: three semicircular canals, and two otiliths. The semicircular canals sense movement of fluid within the canal and therefore, are sensitive to head movements. The otilith organs (the saccule and utricle) sense gravity via movement of calcium carbonate crystals contained within the membrane. BPPV occurs when the crystals accumulate in one of the semicircular canals, disrupting flow of the fluid. The disruption in the movement of fluid sends a message to the brain that the head is moving, even though it isn’t. This false information from the involved ear is different from the information being received from the other ear. The brain receives conflicting information, and is perceived as a brief spinning sensation.
Most cases of BPPV can be mechanically corrected by a Physical Therapist trained in vestibular therapy in just 1 -3 visits. Therapists may perform a Canalith Repositioning Maneuver (CRM). This is a series of head movements, which utilize gravity to move the crystals out of the canal. Additional techniques and exercises are used to resolve any residual dizziness, which may be present after the mechanical correction of BPPV. Unfortunately, this condition can re-occur up to 50% of the time, within 5 years. If appropriate, the Physical Therapist may provide instructions to perform the CRM independently, however, you are encouraged to contact your healthcare provider should these symptoms recur.
Contact your healthcare provider immediately if there is a change in your hearing or if you experience fainting, headache or neurological symptoms such as numbness, “pins and needles,” trouble speaking or trouble coordinating your movements, as BPPV does not affect these symptoms.
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Annalise Papa, PT, DPT
Annalise Papa completed her undergraduate education at Rutgers University, where she eared her Bachelor’s degree in Exercise Science. She went on to receive a Doctorate in Physical Therapy at Arcadia University. Annalise completed her final clinical rotation working with the director of the Concussion and Vestibular Rehabilitation Program at Strive, and brings a special interest in treating patients with concussion and vestibular diagnoses to the Burlington facility. She also has an interest in treating orthopedic and sports populations, and plans to become certified in MDT.