Finding Balance: 3 Effective Vestibular Treatment for BPPV

Finding Balance: 3 Effective Vestibular Treatment for BPPV

When it comes to maintaining our balance and spatial orientation, the vestibular system plays a crucial role. However, for some individuals, a condition called Benign Paroxysmal Positional Vertigo (BPPV) can disrupt this delicate system, leading to bouts of dizziness and vertigo. 

Thankfully, advancements in medical science have created treatment options to alleviate the symptoms of BPPV. In this blog post, we’ll explore what BPPV is, its symptoms, and the vestibular physiotherapy treatments available to restore your balance and quality of life.

The vestibular system controls our sense of balance. Benign Paroxysmal Positional Vertigo (BPPV) is a common disorder of the vestibular system.  BPPV occurs when tiny calcium crystals, called otoliths, become dislodged from their usual position in the utricle and move into one of the semicircular canals. The role of these otoliths are to send signals to the brain about the position of your head.  When they are dislodged and sent out of place, the signals they send to the brain get mixed up.

Most often with BPPV, the displaced otoliths will send abnormal signals to the brain when your head is moved in certain positions, such as rolling over in bed or looking up. With these movements, you can feel symptoms such as vertigo, dizziness, and nausea.

Most commonly, people with BPPV experience brief episodes of intense vertigo, often described as a spinning sensation. These episodes may last for a few seconds to a minute, and are usually triggered by specific head movements. Other common symptoms include dizziness, unsteadiness, and a feeling of being lightheaded. 

While BPPV is not life-threatening, it can significantly impact an individual’s quality of life, leading to difficulties with daily activities.  And being dizzy means you’re at an increased risk of falls.

Fortunately, treatments exist for managing BPPV and its symptoms. These treatments aim to put the otoliths (the dislodged calcium crystals) back to their original position, so they send the correct signals to your brain again.  This means your vestibular system will be back to its regular function.

Vertigo courtesy of River East Physiotherapy & Sports Fitness Clinic (Read the caption)

Treatments for BPPV

Do not do vestibular treatments at home unless you’ve been directed to do so by your physiotherapist. Whether these treatments are right for you depend on what your physiotherapist’s findings are from your vestibular assessment.  Your physiotherapist will also need to teach you how to do them and make sure you’ve learned them correctly.  If you can’t do them effectively, you risk making your condition worse.

Below are descriptions of some of the treatments a vestibular therapist may do with you in the clinic.  Again, don’t do these at home unless your vestibular physiotherapist has told you to do so!  We don’t want you to feel worse.

1.) Canalith Repositioning Procedures (Epley Maneuver)

The Epley maneuver involves your physiotherapist guiding you through a series of specific head and body movements, lying down, sitting up and gently rolling. The goal is to guide the dislodged crystals out of the semicircular canal and back into the utricle, where they belong. 

When done correctly, the Epley maneuver is relatively safe technique and can often provide immediate relief from vertigo and dizziness.

2.) Semont-Toupet Maneuver

The Semont-Toupet maneuver is a different type of canalith repositioning procedure used to treat BPPV. It involves a different sequence of head and body movements designed to move the displaced otoliths out of the affected semicircular canal. 

This maneuver is particularly effective for certain types of BPPV and can offer quick symptom relief.

3.) Brandt-Daroff Exercises

Brandt-Daroff exercises are a set of specific movements and positional changes. These exercises aim to get the vestibular system used to the dislodged otoliths/crystals (“habituation”). When your body gets habituated to the crystals in their new location, the intensity and frequency of vertigo episodes can decrease over time. 

Brandt-Daroff exercises can be a useful supplement to canalith repositioning procedures.

The role of a Physiotherapist in vestibular treatment for BPPV

For managing vestibular conditions such as Benign Paroxysmal Positional Vertigo (BPPV), the help of a well-trained physiotherapist is invaluable. As specialists in movement and function, physiotherapists with vestibular training play a crucial role in assessing and treating vestibular disorders, including BPPV. 

In this this section, we’ll explore how a physiotherapist can provide effective vestibular treatment for BPPV.

1.) Comprehensive Assessment

The first step in managing BPPV is a thorough evaluation by a physiotherapist. During the assessment, the physiotherapist will ask about your medical history, ask about your symptoms, and do a series of tests to determine how your vestibular system is functioning. These tests may include the Dix-Hallpike maneuver, which helps identify which semicircular canal is affected, and where the displaced otoliths (crystals) have ended up.

2.) Diagnosis

Accurate diagnosis is vital in vestibular treatment, as it guides the physiotherapist in designing an appropriate and personalized management plan. By pinpointing the specific type and location of BPPV, the physiotherapist can determine which canalith repositioning procedure or exercises are most suitable for the individual. This tailored approach ensures that the patient receives the best possible outcome from the treatment.

3.) Canalith Repositioning Procedures

As experts in vestibular treatment, physiotherapists are trained in performing canalith repositioning procedures, such as the Epley maneuver and the Semont-Toupet maneuver. These maneuvers involve a series of precise head and body movements to guide the displaced calcium crystals back to their original position in the utricle. The physiotherapist will carefully guide you through these maneuvers in the clinic, ensuring that the procedure is safe and effective.

4.) Home Exercise Programs

In addition to in-clinic maneuvers, physiotherapists can create custom-designed home exercise programs for patients with BPPV. These exercises, such as Brandt-Daroff exercises, aim to “habituate” the vestibular system to the presence of the dislodged crystals. This reduces the patient’s symptoms.  

By providing clear instructions and support, the physiotherapist empowers the patient to take an active role in their recovery and self-manage their symptoms.

5.) Balance Training

BPPV can lead to a loss of balance and increased risk of falls, making balance training a crucial aspect of vestibular treatment. Physiotherapists can incorporate specific balance exercises into the treatment plan, improving the patient’s postural stability and reducing the fear of falling. As balance improves, patients can regain confidence in their daily activities and enjoy an improved quality of life.

6.) Progressive Exercises

Vestibular rehabilitation is a specialized area within physiotherapy that addresses a wide range of vestibular disorders, including BPPV. Through a series of progressive exercises and techniques, vestibular rehabilitation promotes central nervous system compensation, allowing the brain to adapt to the vestibular dysfunction and minimize symptoms over time.

7.) Patient Education and Empowerment

Education plays a vital role in vestibular treatment, and physiotherapists excel in providing patients with valuable information about BPPV and its management. They explain the condition, its triggers, and the importance of adherence to the prescribed treatment plan. Empowered with knowledge, patients can better understand their symptoms and make informed decisions to promote their recovery.

8.) Long-Term Management

For some individuals, BPPV may recur or persist despite successful treatment. In such cases, physiotherapists can provide ongoing support and management. By closely monitoring the patient’s progress, they can adjust the treatment plan as needed to address any new symptoms or challenges that arise.

When diagnosed with Benign Paroxysmal Positional Vertigo (BPPV), a vestibular physiotherapist can be a patient’s beacon of hope. Their expertise in treatments such as canalith repositioning procedures, home exercise programs, balance training, and vestibular rehabilitation, is critical for providing relief to individuals suffering from this condition. The physiotherapist’s comprehensive assessment, diagnosis, and patient education contribute significantly to successful outcomes in managing BPPV.  Physiotherapists help patients reclaim their balance and improve their quality of life. 

If you experience symptoms of BPPV, do not hesitate to seek the guidance of a vestibular physiotherapist to embark on your journey towards finding equilibrium and regaining control over your life.


Frequently Asked Questions

While some cases of BPPV may resolve on their own over time, it is highly recommended to seek treatment from a physiotherapist trained in vestibular therapy.  

BPPV can’t really be “cured”, but a physiotherapist can often make the symptoms disappear.  Once the crystals in your inner ear have been knocked out of place once, even if your physiotherapist successfully guides them back in place for you, they’re more likely to get knocked out again in the future.  In some ways, BPPV is like cancer (but not life-threatening!): once you’ve had it, even if you treat it effectively, there’s always a chance it can come back in the future and you’ll need more treatment.

Lack of sleep is unlikely to cause vertigo directly. 

However, a lack of sleep can contribute to a variety of health issues, including dizziness and lightheadedness. Inadequate sleep can also exacerbate existing vestibular symptoms, or make these conditions more noticeable. 

So make sure to address both sleep deprivation and any underlying vestibular conditions, to best manage your symptoms.

No, vertigo from BPPV is typically not permanent. With proper diagnosis and treatment, the vertigo from BPPV can be effectively managed, and usually eliminated. 

When done by your physiotherapist, canalith repositioning procedures, such as the Epley or Semont-Toupet maneuvers, are highly successful at relieving vertigo.  

For people whose vertigo does recur, they can usually find further relief with follow-up appointments with their vestibular physiotherapist.  The physiotherapist can provide additional treatment in-clinic and prescribe custom exercises to address symptoms at home.

About Andrea Grant

As a Director of River East Physiotherapy and Sports Fitness Clinics, Andrea Grant oversees all programs and patient care.  She is a Registered Physiotherapist, and she also holds a Master of Science in Physical Therapy, a Master of Arts in Public Administration, and a Certified Management Consultant designation.  Ms. Grant draws on this unique blend of credentials in healthcare and management to ensure an excellent patient experience at River East Physiotherapy.

Medical Disclaimer:

The information presented in this blog post is for educational purposes and should not be interpreted as medical advice. If you are seeking medical advice, treatment or a diagnosis, consult with a medical professional such as one suggested on this website. The Clinic Accelerator Inc. and the author of this page are not liable for the associated risks of using or acting upon the information contained in this article.

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