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Physiotherapy treatment for Benign Paroxysmal Positional Vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is a condition that causes vertigo, which is a dizzy or lightheaded sensation. Also known as top shelf vertigo, it is related to the position of the head. Certain movements can trigger the dizziness, such as looking up quickly and standing up too quickly after sitting or lying down. The symptoms are caused by a problem in the vestibular system that affects balance. The vestibular system is comprised of the inner ear structures, cerebellum, brainstem, and vestibular nerve. This system controls the integration of stimuli from movement and the senses, as well as how the body visually focuses on things as movement occurs.
Balance Disorder Illustration
In the inner ear, there are multiple canals that are filled with fluid. There are also reservoirs that hold calcium crystals. When these crystals, also known as ear rocks, become dislodged and travel into the canals, an interference with the flow of fluid occurs. This causes the dizziness and balance issues experienced.

Problems in the vestibular system can lead to BPPV and the dislodging of calcium crystals. These can include common ailments such as inner ear inflammation and head trauma as well as less common conditions such as Meniere’s disease. The most commonly occurring symptoms of BPPV are dizziness, nausea, loss of balance, and lightheadedness.

Medication is not a successful treatment for benign paroxysmal positional vertigo and is usually only given in the treatment of primary conditions that are causing the BPPV to occur. To treat this particular condition, it is necessary to relocate the dislodged crystals. This is done through repositioning therapy. The therapy involves a series of movements with the head and body that encourage the crystals to move out of the canal. Common repositioning therapies include Canalith repositioning, Epley maneuvers, and Brant-Daroff maneuvers. A trained physiotherapist will aid in properly executing these movements and provide instructions on performing necessary movements at home. Physiotherapy, if successful, should provide relief within a couple of weeks. If the condition continues, it may be necessary to undergo surgery. The physiotherapist can provide additional information about possible additional treatments that may be necessary.