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When the world goes round and round

It is estimated that every year at least 9 out of 100 people are affected by a room spinning sensation, lightheadedness, or dizziness as a result of Benign Paroxysmal Positional Vertigo, or more commonly, BPPV. Usually the vertigo sensation is created by head position changes such as rolling in bed, looking upward, or bending forward at the waist. While this vertigo usually lasts one minute or less, it’s very disrupting and many people report modifications or limitations of their normal movements in order to avoid provoking it. Furthermore, BPPV is associated with an increased risk of falls, decreased quality of life, and depression. The good news is that there is strong evidence to show that physical therapy exercises and maneuvers can resolve the symptoms of BPPV and help people get back to a normal life.

What is BPPV?

In a previous column that I’ve wrote, I discussed the balance systems humans use to keep upright and prevent a fall. The root cause of BPPV can be found in one of these systems, the inner ear or vestibular system. One of the features of the inner ear is 3 small, fluid-filled semicircular canals that respond to directional changes of the head. As your head moves, the fluid within the canals sweeps across tiny sensory hair cells embedded within the walls of the canals. This fluid movement is transmitted to the brain where the information from the vestibular system is used to aid in maintaining balance. Have you ever wondered why it’s hard to stand upright after jumping off a merry-go-round? The motion of the playground equipment creates fluid movement within your inner ear and your brain perceives this as motion even if you’re standing upright (or attempting to).

During BPPV, however, a piece often called “ear rocks” break off from within the canals of your ear and move to another part of the inner ear. This throws off the dynamics of the inner ear and sends the wrong signals to your brain. Much like jumping off the merry-go-round, your brain perceives a movement that’s not there and the result is vertigo, or the sensation of spinning.

How is BPPV treated?

While most BPPV occurs in one specific canal of the inner ear, it is important that your treating physical therapist perform a multitude of tests to identify which specific section of the inner ear is causing symptoms. It’s also important to rule out other possible causes of vertigo. After confirming the location of the symptom generator, your physical therapist will have you perform a very simple, but specific series of head and neck maneuvers. The maneuver is designed to move the “ear rocks” back into an appropriate area of the inner ear. Often times you’ll work as a team to move your head through a series of 4 positions with a 30 to 60 seconds hold of each. There are, however, different maneuvers for different vertigo generators.

Furthermore, your physical therapist may send you home with a series of home exercises to perform as a conjunction to your treatment. Most BPPV is treated successfully with use of physical therapy. What’s very impressive about these treatments is the quick response. Often times people have a rapid resolution of their dizziness. If you find yourself suffering from symptoms similar to BPPV, talk to your primary care provider or physical therapist. A few quick maneuvers may provide you with the relief you seek.

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