Physio treatment for BPPV and Vertigo

What is BPPV?

Benign paroxysmal positional vertigo or BPPV is the most common source of dizziness, vertigo, unsteadiness, and nausea when you move your head.

BPPV occurs when otoconia located in the vestibular system of your inner ear becomes dislodged. Otoconia are microscopic crystal-like structures that we use to sense the speed and position of our body. If these find themselves in the fluid within your inner ear canal, they produce vertigo, among other symptoms.

The fluid in our inner ear canals plays a major role in how we orientate ourselves. As we move our heads, the canals positioned at different angles that hold this fluid relay information about the speed, distance, and direction of movement. So if the otoconia are dislodged, they end up sending incorrect messages to the brain.

This is what produces a feeling of disorientation. The body is now trying to make sense of new information which does not align with other means of orientation.

What are the symptoms of BPPV? 

The most common symptom of BPPV is vertigo. Vertigo is sometimes (incorrectly) used to describe the sensations associated with a fear of heights. While the experience someone with a fear of heights may have when looking down from a high place does share some similarities with vertigo, the two are completely distinct in both cause and overall effect.

Vertigo is when the mismatch between signals to your brain creates the false impression that you are moving or spinning. While this feeling is nothing more than an illusion, the impact on everyday life is far from it.

Other symptoms you may experience include:

• dizziness
• lightheadedness
• imbalance
• nausea
• intermittent hearing loss
• headaches

The frequency, duration, and intensity of symptoms can differ significantly from person to person. They can range from a daily occurrence to intermittently for weeks or months at a time only to suddenly cease. Likewise, it may only be felt as a subtle phenomenon or can be overwhelming, making even everyday tasks difficult to complete. 

What can trigger the symptoms of BPPV?

Common triggers include rolling over in bed, getting out of bed, and lifting your head to look up. Thankfully, BPPV is generally an easily treated disorder.

BPPV can sometimes feel like an unwelcome visitor that strikes out of nowhere, but there are specific triggers you should be aware of. Understanding these triggers can help you navigate your daily activities with greater ease and confidence. These seemingly routine movements can unexpectedly disturb the calcium crystals in your inner ear, leading to sudden vertigo and dizziness. Some common triggers to avoid include:

Rolling Over in Bed

One of the most common triggers of BPPV is rolling over in bed. Even when lying down, sudden movements can displace the calcium crystals in your inner ear. To handle this trigger, be mindful of your movements while lying down. If possible, try to move more slowly and deliberately if you need to be comfortable.

Quickly Standing

The act of sitting up and standing can set off vertigo episodes. Unfortunately, this means BPPV can also be triggered when you get out of bed in the morning, get up off the couch, or even when you stand up out of your chair at work.

Lifting Your Head to Look Up:

Looking up to admire the sky or reaching for something high can unexpectedly trigger BPPV symptoms. When you lift your head, it can disturb the delicate balance of the crystals in your inner ear, causing a feeling of disorientation. Make an effort to avoid sudden, excessive neck extensions instead, opting for slow and controlled head movements whenever possible.

What causes benign paroxysmal positional vertigo?

While most common in people over the age of 50, BPPV can occur in anyone of any age.

BPPV can result from:

• acquiring a head injury
• the natural degeneration within the inner ear that comes with ageing
• damage resulting from an inner ear disorder

Some research has indicated a strong connection between BPPV and migraines. People who suffer from migraines are three times more likely to develop BPPV compared to those who do not.

How can I relieve the symptoms of BPPV?

Sleep with a Slightly Raised Head:

We all know the importance of a good night’s sleep. That said, a small adjustment to your head position while in bed could make a big difference. 

Elevating your head slightly while sleeping can reduce the likelihood of triggering vertigo episodes during the night. You can achieve this as easily as using two or more pillows to prop up your head comfortably.

Take It Slow Getting Out of Bed:

Mornings can be particularly challenging for those with BPPV. To avoid sudden dizziness when you get out of bed, take your time. Sit on the edge of the bed for about a minute before standing up. 

Taking a moment before you rush off to start the day is good for your general wellbeing, and this brief pause allows your body to adjust and find its balance.

Mind Your Movements:

Incorporate caution into your daily activities to minimise the risk of triggering BPPV symptoms. Try to avoid bending down abruptly to pick up objects, as this sudden movement can disturb the fluid in your inner ear. 

When moving your head, opt for slow, controlled movements to maintain balance.

Be Conscious of Neck Extensions:

While going about your daily tasks, be mindful of extending your neck too far forward or backward, as this may exacerbate symptoms. By keeping your neck movements within a comfortable and neutral range, you can minimise discomfort and instability.

Medication:

In the short term, motion sickness medications can provide relief from any nagging nausea you may be experiencing from BPPV. These medications are designed to control the queasy feeling and reduce the severity of vertigo episodes.

However, it’s essential to keep in mind that these medications are not a long-term solution and should only be used under the guidance of a medical professional. Consult with your healthcare provider to determine if these medications are suitable for your specific condition.

How can BPPV be treated?

As soon as you notice symptoms like dizziness, nausea, and vertigo, it’s crucial to seek treatment promptly. Ignoring the signs may not only worsen your condition but also increase the risk of dangerous falls and injuries. Early intervention will give you a better chance of getting back on your feet sooner and resuming your daily activities with confidence. 

See a Physiotherapist

When it comes to treating the symptoms of BPPV, a physiotherapist can be your best ally. At City Physio, our team is well-versed in diagnosing and treating various musculoskeletal and balance-related issues. Our physiotherapists will conduct a thorough assessment to confirm if the source of your symptoms is BPPV, and tailor a treatment plan to suit your specific needs.

The exercises we’ll provide are safe and pain-free manoeuvres that support repositioning dislodged otoconia back to where they can function properly. Just like any other treatment exercise, consistency is key. Your commitment to performing the prescribed exercises diligently will yield better and faster results. It’s normal to experience some discomfort during the first few sessions, but we’re here to support you through every step of your journey. As you persist, you’ll notice a gradual improvement in your symptoms.

We will also conduct a thorough assessment of your head and neck joint movement. This helps us identify and provide treatment for any other factors which may be contributing to your symptoms.

Surgery

While exercises our physiotherapists provide are the cornerstone of managing and treating BPPV, In rare and extreme cases surgical intervention may be considered. One surgical option involves blocking the affected canal entirely, preventing the dislodged crystals from interfering with your balance system. This surgical procedure targets the root cause of the problem without compromising the overall function of your vital vestibular system. However, it’s crucial to note that surgical procedures are typically reserved for severe cases and should be thoroughly discussed with medical professionals.

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