Effective Management of Vertigo with Physical Therapy

Brett Minter, PT

May 2009

Benign Paroxysmal Positional Vertigo (BPPV) is a life altering disorder that causes grief and stress within our population.  BPPV is an inner ear disorder that results in dizziness and vertigo (sensation of spinning or the world spinning around you) with certain head movements due to the collection of particles within a part of the inner ear.  Typically, a person with BPPV will complain of brief episodes of vertigo caused by a sudden change in head posture.  Commonly, these positions involve looking up, bending over, or rolling in bed.  The vertigo is typically brief (5-15 seconds) but can last up to 1-2 minutes.  Symptoms of BPPV can include dizziness or vertigo, light-headedness, and nausea. 

 BPPV is commonly seen in the elderly population, but can be seen in any age group following mild or moderate head trauma.  A diagnosis of BPPV is based on a patient’s history, symptomology, physical examination and the results of vestibular function tests.  When testing for BPPV the physical therapist will look for characteristic jumping of the eyes in a head hanging position. 

 Once it is determined that a person has BPPV there are several treatment options.  A person can wait for remission.  This is not a good option because the time for remission ranges from a few days to months or not at all.  During this time period the person will develop secondary problems from lack of mobility.  Medications are prescribed for this condition to manage nausea.  Vestibular suppressants can reduce symptoms of dizziness, however, this suppresses the vestibular system and causes unwanted balance problems.   The most effective treatment for BPPV is the particle repositioning head maneuvers performed in the physical therapy office.  These maneuvers act to move the detached particles within the inner ear to their original resting place.  The repositioning head maneuvers are very effective with an approximate cure rate of 80-90%.  The recurrence rate for BPPV after these maneuvers is minimal. 

 The treatment of BPPV in a physical therapy practice can be very successful.  The physical therapist must understand how to sort out the various pathologies that may cause dizziness or vertigo.  Once this is accomplished then knowledge of the manual skills required to fix the problem may be implemented.  This will then save the patient unneeded diagnostic tests, hospitalizations and medication.

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