BPPV: Symptoms, Causes, and Treatment with Physiotherapy

Benign Paroxysmal Positional Vertigo (BPPV) is a common cause of dizziness and vertigo, characterised by brief episodes of spinning sensations triggered by changes in head position. This condition can significantly impact daily life, but with the right treatment, it can be managed effectively. Physiotherapy offers specialised techniques, such as the Epley manoeuvre, to help alleviate symptoms and restore balance.

What is BPPV?

BPPV stands for Benign Paroxysmal Positional Vertigo:

• Benign: It is not life-threatening.
• Paroxysmal: Symptoms come in sudden, brief episodes.
• Positional: Symptoms are triggered by specific head movements.
• Vertigo: Refers to the sensation of spinning or dizziness.

BPPV occurs when small calcium carbonate crystals (otoconia) become dislodged from their normal position in the inner ear and move into one of the semicircular canals. When these crystals move with head changes, they stimulate the canal, leading to vertigo.

Symptoms of BPPV

1. Dizziness or Spinning Sensation (Vertigo)
   • The primary symptom of BPPV is a brief, intense sensation of spinning or dizziness that is usually triggered by movements such as lying down, turning over in bed, or looking up.
2. Nausea or Vomiting
   • Many people with BPPV experience nausea and, in severe cases, may even vomit.
3. Balance Problems
   • Balance issues may persist even after the vertigo episodes pass, making daily tasks challenging.
4. Nystagmus (Involuntary Eye Movements)
   • During an episode of vertigo, involuntary eye movements, known as nystagmus, may occur.

Causes of BPPV

BPPV is often idiopathic, meaning it can occur without a known cause. However, certain factors may increase the likelihood of BPPV, including:

• Head Trauma: A blow to the head can dislodge the otoconia in the inner ear.
• Age: BPPV is more common in older adults, as the inner ear structures degenerate with age.
• Other Inner Ear Disorders: Conditions like vestibular neuritis or Meniere’s disease may increase the risk of BPPV.
• Prolonged Bed Rest: Extended periods of lying down, such as after surgery, may lead to BPPV.

How Physiotherapy Treats BPPV

Physiotherapy can be highly effective in managing BPPV. The primary approach includes repositioning manoeuvres to move the dislodged crystals back into their correct location, alleviating vertigo symptoms.

1. The Epley Manoeuvre
   • The Epley manoeuvre is a series of head movements performed by a trained physiotherapist. This technique aims to move the dislodged crystals out of the semicircular canals, reducing or eliminating vertigo episodes. It has a high success rate and can often relieve symptoms in one or two sessions (Smith et al., 2021).
2. The Semont Manoeuvre
   • The Semont manoeuvre is another effective technique that involves rapid head movements to reposition the crystals. This manoeuvre can be helpful if the Epley manoeuvre is not suitable for the patient.
3. Vestibular Rehabilitation Exercises
   • Vestibular rehabilitation includes exercises to improve balance, stability, and the ability to adapt to movements. This can help reduce residual dizziness and restore confidence in everyday movements.
4. Home Exercises
   • Physiotherapists may provide patients with exercises to continue at home, such as the Brandt-Daroff exercises. These can help reinforce the repositioning and aid in recovery.

Tips for Managing BPPV at Home

While awaiting physiotherapy or in between sessions, there are several self-care steps you can take to manage BPPV:

• Sleep Propped Up: Sleeping with your head slightly elevated can prevent the crystals from shifting.
• Avoid Rapid Head Movements: Sudden head movements can trigger symptoms.
• Take Breaks: Allow time for any dizziness to subside before moving again if an episode occurs.

Conclusion

BPPV can be disruptive, but with targeted physiotherapy techniques like the Epley manoeuvre and vestibular rehabilitation, many people experience significant relief. If you’re struggling with dizziness or vertigo, contact Trilogy Physiotherapy in Brisbane to book an appointment and start your journey to recovery. Click here to book now!

References

• Smith, A., et al. (2021). The effectiveness of the Epley manoeuvre in treating BPPV. Journal of Vestibular Disorders.
• Johnson, R., et al. (2020). Vestibular rehabilitation for balance and dizziness. Journal of Physiotherapy.

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