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Is your world spinning? You might have Benign Paroxysmal Positional Vertigo

Published: September 28, 2020

What is Benign Paroxysmal Positional Vertigo (BPPV)?

BPPV is a common condition where you experience dizziness, vertigo or other sensations that might feel like the world is spinning around you as you move your body and head in to different positions.

Have you ever had a brief ‘dizzy spell’ when rolling over in bed, or from getting up too quickly when you are lying down? Perhaps you feel dizzy when looking up to rinse your hair, or even when looking down to tie your shoes – you may be suffering from BPPV.

Pleasingly, BPPV is for the most part a temporary condition but if left untreated it can continue to bother people for months, or in some cases years.

Many conditions can cause symptoms like dizziness and vertigo so finding a physiotherapist who is skilled in the assessment and treatment of BPPV is important as it is a highly manageable condition and is by far the most common cause of dizziness and vertigo.


Common symptoms of BPPV

If you have BPPV, you may experience symptoms like dizziness or vertigo when you perform certain movements that involve your head rotating or looking up or down, such as:

  • Getting up from resting in bed
  • Laying down to rest in bed or when rolling over
  • Bending down to tie your shoe laces or picking objects up from the floor
  • Looking up towards the ceiling or high cupboards
  • Checking your blind spot whilst driving or turning your head whilst reversing your car

Symptoms such as dizziness or vertigo generally occur quickly with BPPV when the head is placed in a triggering position. Most people find the spinning sensation lasts less than 10-seconds if they keep still (even if they feel like the environment around them is still moving due to vertigo).

Nausea is not an unusual feeling to experience with BPPV and in severe cases you may experience vomiting due to the unpleasant sensation of vertigo.

Another common symptom of BPPV, which can be harder to detect, is called nystagmus. This is where your eyes move rapidly back and forth in different directions whilst your head is in certain positions. Detecting nystagmus is an important part of diagnosing BPPV and it helps to select the most appropriate type of treatment. This is something your physiotherapist should be looking out for when performing an assessment.


Causes of BPPV

In a lot of cases of BPPV, a primary cause is never found. As research continues to evolve there are however many common causes believed to be linked with BPPV such as:

  • Ear infections
  • Head injuries
  • Ageing/maturation of the inner ear structures
  • Viral infections
  • Migraines
  • Osteoporosis/osteopenia
  • Meniere’s disease and labyrinthitis

BPPV is also two times more likely to occur in women than in males and importantly, it is not always associated with age.


Why do you experience dizziness/vertigo with BPPV?

The ears are a complex anatomical structure but housed within them are three small structures called semi-circular canals. These canals are filled with fluid and are orientated at different angles to each other. The role of these canals is to provide the brain with information on how fast and in which direction we are moving our head.

With BPPV, microscopic calcium crystals that are attached to a membrane deep within the inner ear structures detach and float freely through the fluid filled canals where they do not normally belong. As these crystals move through the canals at a slower speed than that which we move our head, it creates a false stimulus and provides the brain with conflicting information, making us feel like we are moving when we are not.


How can physiotherapy help?

Your physiotherapist can diagnose BPPV by performing a range of simple movement-based tests to identify what symptoms you are experiencing and with which head movements. Testing occurs in different positions whilst you are seated and lying down and will help to identify which side is affected.

If you test positive for BPPV your physiotherapist can perform a simple technique involving different head and body movements that takes less than a couple of minutes to help treat your BPPV. The aim of these techniques is to move the microscopic calcium crystals through the canals in the inner ear back to where they belong. The treatment techniques used for BPPV are not only painless but highly effective if done correctly and your physiotherapist will talk you through each step to ensure you are comfortable and to make sure you understand what is going on.

Most people will experience quick resolution of symptoms after one session, but sometimes BPPV can take 2-3 sessions to resolve completely.

Your physiotherapist will also discuss with you any precautions you need to take following treatment and can also assist you with self-management techniques if you feel comfortable to do these at home.

If you are experiencing dizziness, spinning, vertigo or feeling nauseous when moving your head in different positions you may be suffering from BPPV. Book in for a Free Initial Assessment with Kyle Saunders at Back In Motion Kingston and he will be sure to go through a detailed assessment to identify the cause of your symptoms and to provide you with effective treatment options so you can go about your day comfortably again.


Written by Kyle Saunders (MPhysio, BExSc, APAM)