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Benign Paroxysmal Positional Vertigo, or BPPV, is one of the most common causes of vertigo—a sensation of spinning or dizziness. Although it can be a temporary and benign condition, BPPV can significantly impact one’s quality of life. Aside from dizziness, it can cause discomfort, anxiety, and difficulties with balance and coordination. However, with proper diagnosis and treatment, individuals with BPPV can find relief and regain their balance.


Although I am a physical therapist by profession, I am not your physical therapist.  This information is for educational purposes only, it does not constitute medical advice and does not establish any kind of therapist-patient relationship with me. I am not liable or responsible for any damages resulting from or related to your use of this information. Always consult with your healthcare provider prior to beginning any new exercise regime.

What is BPPV?

BPPV occurs when tiny calcium carbonate crystals, known as otoconia, dislodge from their usual position within the inner ear and migrate into one of the semicircular canals. These canals detect rotational movements of the head, and when otoconia disrupt their normal function, they send false signals to the brain about head position and movement, resulting in vertigo.

The hallmark symptom of BPPV is brief episodes of vertigo triggered by changes in head position, such as rolling over in bed, tilting the head back, or looking up. These episodes typically last less than a minute and may accompany nausea, imbalance, and a sensation of spinning.

Other Types of Vertigo

Vertigo in its definition is a symptom that is described as a spinning sensation. In understanding vertigo and its management, it’s essential to recognize that various underlying conditions can trigger this disorienting sensation. While Benign Paroxysmal Positional Vertigo (BPPV) is the most common culprit, other causes of vertigo exist.

It is vital to get a proper diagnosis from a healthcare provider for effective treatment. Vertigo symptoms can also be caused by things such as a stroke, cardiovascular issues, migraines, or other inner ear issues like Meniere’s or vestibular neuronitis.

Statistics Regarding BPPV

  • Prevalence: Clinical estimates suggest that BPPV comprises approximately 20-30% of all cases of vertigo and dizziness encountered in clinical practice. It is notably regarded as the leading cause of peripheral vertigo, particularly among older adults.
  • Age Distribution: While BPPV can affect individuals of any age, it is more commonly diagnosed in older adults, with the prevalence increasing with age. It is most frequently observed in individuals over the age of 50, and its incidence tends to rise with advancing age.
  • Gender: BPPV appears to affect women more frequently than men, with some studies suggesting that women are up to two to three times more likely to develop BPPV than men. The reasons for this gender disparity are not entirely clear but may be related to hormonal factors or anatomical differences in the inner ear.
  • Recurrence Rate: BPPV has a relatively high rate of recurrence, with approximately 15-50% of patients experiencing a recurrence of symptoms within five years of initial diagnosis and treatment. Recurrence rates may vary depending on factors such as age, comorbidities, and adherence to self-management strategies.
  • Impact on Quality of Life: BPPV can have a significant impact on an individual’s quality of life, leading to symptoms such as vertigo, dizziness, imbalance, nausea, and anxiety. These symptoms can interfere with daily activities, work, and social functioning, resulting in decreased mobility, increased risk of falls, and reduced overall well-being.
  • Healthcare Utilization: BPPV accounts for a notable portion of healthcare utilization related to vertigo and dizziness, including visits to primary care physicians, otolaryngologists, and emergency departments. It is a leading cause of referrals to vestibular rehabilitation specialists and physical therapists for evaluation and management.
  • Underdiagnosis and Undertreatment: Despite its prevalence and impact, BPPV is believed to be underdiagnosed and undertreated in clinical practice. Many individuals with BPPV may not seek medical attention, dismiss their symptoms as benign or transient, or receive an incorrect diagnosis, leading to delays in appropriate management and potential exacerbation of symptoms.

Early recognition, accurate diagnosis, and effective management strategies, including canalith repositioning maneuvers and vestibular rehabilitation therapy, are essential for optimizing outcomes and minimizing the burden of BPPV on affected individuals and healthcare systems.

How Physical Therapy Helps

Physical therapy plays a crucial role in managing BPPV and its associated symptoms. The primary goal of physical therapy for BPPV is to reposition the displaced otoconia within the inner ear canals. This will restore normal vestibular function and alleviate vertigo.

Canalith Repositioning Maneuvers

Canalith repositioning maneuvers, also known as particle repositioning maneuvers, are specific exercises designed to move the displaced otoconia out of the semicircular canals and into an area of the inner ear where they will not cause symptoms. The most common maneuver used to treat BPPV is the Epley maneuver, although other variations, such as the Semont and Gans maneuvers.

During these maneuvers, a physical therapist guides the patient through a series of head and body movements designed to facilitate the movement of the otoconia. These movements may induce temporary feelings of dizziness or vertigo but are generally well-tolerated and provide significant relief from symptoms.

Vestibular Rehabilitation Therapy (VRT)

In addition to recommending canalith repositioning maneuvers, physical therapists may suggest vestibular rehabilitation therapy (VRT) especially for those who continue to experience persistent imbalance and dizziness despite undergoing repositioning maneuvers. VRT is a specialized form of physical therapy that emphasizes exercises and activities aimed at improving vestibular function and facilitating central nervous system compensation for vestibular deficits.

VRT programs are customized to address each individual’s specific needs and may comprise a variety of exercises, including balance exercises, gaze stabilization exercises, habituation exercises, and general conditioning exercises. By systematically exposing the vestibular system to controlled movements and stimuli, VRT helps individuals become less sensitive to vertigo triggers and enhances overall balance and stability.

Get Evaluated and Treated Today

BPPV can be a challenging condition to live with, but with the appropriate treatment and guidance from a physical therapist, individuals with BPPV can experience significant improvement in their symptoms and regain their sense of balance and well-being. Canalith repositioning maneuvers and vestibular rehabilitation therapy are valuable tools in the management of BPPV, offering effective and non-invasive solutions for those affected by this common vestibular disorder. If you suspect you may have BPPV or are experiencing symptoms of vertigo, consult with a healthcare professional, who can provide a proper diagnosis and recommend appropriate treatment options, including physical therapy interventions.