What is BPPV and What Can I Do About It?

As a physical therapist, I surprise a lot of people when I tell them I often treat patients with vestibular disorders, or symptoms of dizziness. I’ve had patients complain that they have fallen multiple times, gotten sick to their stomach, or couldn’t even get out of bed because their dizziness is so severe. One of the most common causes of dizziness I see in my practice as a physical therapist is BPPV. 

BPPV stands for “benign paroxysmal positional vertigo.” Whoa, what does that even mean?! Let’s break it down: 

Benign = it’s not harmful or causing damage to your body 

Paroxysmal = sudden, brief attacks that come and go 

Positional = being in a certain position will cause the attack 

Vertigo = dizziness specifically involving a spinning sensation 

BPPV affects your vestibular system, which is a small yet powerful system that is located in your inner ear. You have a set of these organs on each side, just like your ears. The purpose of this system is to provide information to your brain about which direction you are moving, and how quickly. 

 Image from www.ccjm.org/content/89/11/653

Small crystals (calcium carbonate, to be specific) or “ear stones” are a normal part of your vestibular system. They are normally located in the parts of your inner ear called the “utricle” and the “saccule.” They help your brain understand which direction your head is moving. 

Sometimes, these crystals can travel out of their usual locations and into a different part of the inner ear, called the “Semicircular canals.” There are 3 different canals, named “posterior,” “anterior,” and “horizontal.” When the crystals make their way into any one of these semicircular canals, your brain is still receiving signals from them about what direction your head is moving. The problem is that they are in the wrong part of your inner ear, and so their signals aren’t making sense to your brain. This causes you to feel dizzy. Symptoms can range from fairly mild, all the way up to so extreme that it causes you to vomit or even fall over. This is BPPV. 

Unfortunately, there isn’t much you can do in terms of prevention for BPPV. It is more likely to occur in ages 40 and older, and it is slightly more common in females than in males. Research has not been able to find any particular cause for BPPV to occur. Most of my patients tell me they first noticed symptoms when they rolled over to get out of bed in the morning, when they bent over to pick something up from the floor, or when they quickly turned their head to one side.  

The good news is that physical therapy can resolve this issue, and usually pretty quickly. How? As physical therapists, we can perform some tests in the clinic to determine which ear is the problem, and which canal the crystals have become dislodged into. From there, we can help you perform specific maneuvers and positions to “whoosh” the crystals back where they belong, which usually immediately resolves your symptoms. We teach our patients how to do these maneuvers safely at home, too, and incorporate some vestibular training and exercises to help sharpen the system back up. 

The internet has helped to spread this information, including the maneuvers you can try at home, which is great! Unfortunately, these videos don’t all work for everyone who has BPPV. Why? Remember when I said there are 3 different semicircular canals? Well, the crystals can float to any one (or even more than one) of these canals. You also have an identical set of these canals, on both your left and right side. So, you may watch a video that helps to whoosh crystals from the posterior semicircular canal, for example, back to where they belong. However, if the crystals in your ear have migrated into, say the horizontal canal, this particular maneuver is unlikely to help your symptoms, because it isn’t moving your head in the correct directions. Likewise, if the video is treating the left ear, and your right ear is the one with the issue, it will probably not help you. Oftentimes I see patients that have multiple canals with crystals that need to be relocated, so we have to do a combination of maneuvers to resolve all of their symptoms BPPV-related.

If you haven't gathered, my strongest recommendation if you believe you are experiencing symptoms of BPPV is to get evaluated by a physical therapist! 

Once the BPPV is resolved, it’s best practice to work on strengthening your vestibular system back up. Similar to your muscles, if your vestibular system isn’t being utilized much, it will get weaker. When you feel dizzy, your body’s natural reaction is to slow your movements down and also limit how much you move your head, in order to help so you don’t feel so dizzy. This makes complete sense, as it keeps you safe. However, if this continues on, your vestibular system will start to weaken since it’s not being used, which will ultimately make your symptoms even worse. 

Vestibular training exercises involve movements of your head, your eyes, or both. The purpose of these types of exercises is to strengthen the connections between your eyes, your brain, and your vestibular organs so that you feel more steady. This training can help you feel more like yourself, so you can get back to your normal activities without worrying that you will become dizzy. You can watch one example of a vestibular exercise by clicking HERE to watch on Instagram, or click HERE to watch it on Facebook. 

If you are currently experiencing symptoms of BPPV, you will want to hold off on attempting any vestibular exercises, because these can make your dizziness worse. Instead, you’ll want to be evaluated by a physical therapist that treats vestibular disorders. You can find a PT near you by using this “Find a PT” search tool from the American Physical Therapy Association. In the meantime, make sure you read about "The Thumb Trick" - it can really be a lifesaver when you are dealing with acute dizzy symptoms. You can watch a video about it by clicking HERE, or you can read my blog post about The Thumb Trick by clicking HERE. 

If you believe you are currently experiencing BPPV-related symptoms, here is a summary of what to do and how to keep yourself safe:

1.  Make an appointment to be evaluated by a physical therapist ASAP.

2.  Take caution and go slow when changing positions such as rolling over, sitting up or lying down. Try to avoid turning your head quickly or bending over, as these movements can exacerbate BPPV symptoms.

3.  Learn "The Thumb Trick" and use it whenever you start to feel dizzy.