How Physios & Chiros can help with BPPV (vertigo symptoms)

"“This morning I woke up terrified because when I rolled over in bed, the world started spinning

Julie Cai

November 15, 2022

"“This morning I woke up terrified because when I rolled over in bed, the world started spinning around me. What’s wrong with me?”


You are experiencing what is known as vertigo - which is a type of dizziness that is often described as feeling that you are spinning, or that the world is spinning around you, particularly if you change position. There are multiple causes of vertigo, although the most common we come across in our Marrickville clinic is BPPV - otherwise known as Benign Positional Paroxysmal Vertigo. This disorder is caused by problems in the inner ear, particularly the ear crystals residing in the vestibular system which gives you your sense of balance. In this post we will discuss the symptoms, causes, treatment and how Physio or Chiro can help.  


What is Benign Positional Paroxysmal Vertigo (BPPV)?


BPPV is caused by calcium carbonate crystals (otoliths) in the semicircular canals of the inner ear. The crystals are actually debris that have migrated from another part of the inner ear. They can incorrectly move into either of the three semicircular canals which monitor certain directions of balance.

When you turn your head into the direction monitored by one of the semicircular canals, the crystals move which cause a momentary disturbance in the fluid movement within the canal resulting in vertigo. As the movement stops and the crystals settle, the vertigo dissipates within 30-60 seconds. This can also be accompanied with a longer period of queasiness of discomfort.


So what are the symptoms of BPPV?

People suffering from BPPV often report:

  • Trouble getting out of bed in the morning, but feel okay getting out on the opposite side of the bed
  • Dizziness when looking up or down, or tilting to one side
  • Holding their head still relives the dizziness
  • Sudden head motion
  • Nausea
  • Light-headedness
  • Eyes drifting & flicking uncontrollably (nystagmus)


BPPV can also be made worse by:

  • Changes in barometric pressure - patients often feel symptoms approximately two days before rain
  • Lack of sleep
  • Stress

Diagnosis of BPPV

BPPV can be largely diagnosed by the Dix-Hallpike or supine roll test, which involves positioning the individual backwards, turning the head and observing eye movements called nystagmus. The specific semicircular canal that is affected is determined by the type of eye movement caused (upward/downward/rotary). This then informs the particular maneuver required to treat the affected ear canal accordingly.


Treatment of BPPV

Treatment for true BPPV is often highly effective, and generally requires only a few sessions to be completely resolved. The treatment involves different positioning sequences to move the particles out of the semicircular canals to another area where they do no harm, and can then be normally absorbed and excreted.

The positioning sequence required will depend on the semicircular canal affected. The posterior semicircular canal is the most commonly affected which requires the Epley Maneuver. The lateral canal requires the Lempert (BBQ) Maneuver, while the superior or anterior canals require the Deep Head Hanging Maneuver. Every positional change can cause momentary vertigo, however significant improvement is often experienced immediately after. Therefore it is important to consult an experienced health professional who can help determine which maneuver you require and ensure you are performing it correctly. These can then be done as home exercises.

There is also a newer exercise called the Half Somersault that causes less severe vertigo, but sometimes takes more repetitions. This can also be done at home.

It is important to note that there are also different types of vertigo which may be misdiagnosed. Watch this space for further posts on different types of Vertigo, particularly vestibular neuritis, labyrinthitis, Meniere’s disease, vestibular migraine, benign recurrent vertigo and others.


Our Physio and Chiro at our Marrickville clinic located in Sydney’s Inner West are experienced in assessing and treating BPPV. If you have any further questions about how we can help your vertigo, head over to our Contact Us page, or book in now to make an appointment.


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