One of the most common causes of vertigo where you will feel a sudden sensation that you’re spinning or that environment around you is spinning — is Benign Paroxysmal Positional Vertigo (BPPV). BPPV produces short bursts of mild to severe dizziness. Specific alterations of your head’s position generally induce this condition.

And, we know how dizziness can affect your quality of life. It can be critical, especially when you experience imbalance, making you fall and lead to a serious injury.

So, it is vital to discover more about BPPV and understand a physiotherapist’s role in vestibular rehabilitation therapy on this condition.

What is Benign Paroxysmal Positional Vertigo (BPPV)?

Benign Paroxysmal Positional Vertigo (BPPV) is among the common cause of having vertigo. In this case, you will feel that you are spinning or your environment is spinning. When you move your head – tip your heads up, lie down or sit up on your bed, you will experience sudden, severe, and short dizziness or vertigo. But, there are times that you may experience mild dizziness.

Its occurrence may vary; for some, it may go away on its own, but there are chances that it may reoccur. Although this is not a sign of a serious health problem, it can be bothersome, so you must have yourself checked when you find that your vertigo affects your daily life.

How Does Vestibular Physiotherapy Help Benign Paroxysmal Positional Vertigo (BPPV)?

You will feel like your head is spinning or your world is spinning around.

In addition, BPPV can be frightening to older people (over 65 years old) since it causes imbalance, leading to falls which can be the leading cause of fracture in their age range.

What are the symptoms of BBPV?

The symptoms of BPPV may vary from one person to another, but among the common symptoms are:

  • Mild to Intense Dizziness
  • Vertigo – you feel that you are like spinning or the world around you is spinning
  • Lightheadedness
  • Imbalance or unsteadiness
  • Nausea
  • Vomiting

As mentioned earlier, its occurrence may vary. Its episode may last within a minute or two. It can disappear within six weeks, but it comes back either for a long or shorter period.

What causes BPPV?

How Does Vestibular Physiotherapy Help Benign Paroxysmal Positional Vertigo (BPPV)?

How Does Vestibular Physiotherapy Help Benign Paroxysmal Positional Vertigo (BPPV)?

A condition in the inner ear causes benign paroxysmal positional vertigo (BPPV). There are tiny calcium “stones” or calcium carbonate crystals, known as otoconia, inside your inner ear canals that assist you in maintaining your equilibrium. These stones typically move about when you move in a specific way, such as standing up or turning your head. These stones can sometimes migrate into the semicircular canal of your inner ear. So, when they move into and become stuck within the semicircular canals, BPPV occurs as you move your head in specific directions. The stones induce dizziness because they activate sensors in the semicircular canal.

Otoconia or calcium carbonate crystals in the utricle may loosen up due to injury, trauma, aging, or infection. Naturally, they will dissolve in the utricle. However, when they moved into the semicircular canals, they will not dissolve. So, why can it cause dizziness as we move our heads?  As the head’s position changes, the otoconia in the semicircular canal will roll around and pushes the tiny hair-like processes or cilia. The cilia are responsible for transmitting information about our balance. So, this is why when otoconia roll around and push the cilia, vertigo occurs. In short, it happens when tiny calcium crystals in the inner ear become dislodged from their usual position.


Changes in our heads position or movements can trigger an episode of BPPV, which can include the following:

  • When you roll over or sit up on the bed
  • You try to bend forward to look down
  • Titling your head backward or turning around

It can happen in a single ear in many cases, but it may also affect both ears.

What are the risk factors?

Although BPPV may happen without reason, it can be due to aging – which is possible because of wear and tear. However, it may also occur due to head trauma, such as a vehicle collision or a concussion.

However, did you know that it may happen due to the following?

  • Having an inner ear disorder such as Meniere’s disease
  • High-intensity exercises
  • Keeping your head in the same position for a long time, like being on a hospital bed or bed rest for long periods.
  • Driving or cycling over rough trails

How is Benign Paroxysmal Positional Vertigo diagnosed?

BPPV will be diagnosed based on the following:

  • Medical History
  • Results of your Physical Examination
  • Results of the Balance Tests
  • Your story on when and where the symptoms occur
  • Results of Dix-Hallpike test – looking for ‘Jumping of the eyes’ or nystagmus (normally present on people with BPPV)

How Vestibular Rehabilitation Therapy does help BPPV?

Vestibular rehabilitation therapy is a form of physiotherapy that uses a special exercise-based program designed to reduce dizziness issues and improve a patient’s balance. Head motions, which are crucial in retraining the vestibular system, are included in this therapy. Depending also on the symptoms of BPPV, treatment may vary. It may consist of habituation exercise or balance training.

In terms of BPPV, it involves a repositioning maneuver or a canal repositioning exercise that will help to reposition those tiny calcium crystals.

In addition, the therapy may include balance training, home exercises, and changes in your diet and lifestyle.

So, does Vestibular Rehabilitation Therapy is effective in Helping Benign Paroxysmal Positional Vertigo (BPPV)?

A 2017 article published in the International Journal of Immunopathology and Pharmacology systematically reviewed the evidence about vestibular rehabilitation (VR) therapy’s effect on BPPV. It shows that it can help patients with BPPV in terms of the following:

  • Improve the balance control and quality of life.
  • It also helps visual stabilization with head movements, which can improve vestibular-visual interaction during head movement.
  • It can expand static and dynamic posture stability.

Also, this review proves that there should be a hierarchy of interventions for people with BPPV.

It should start with Canalith Repositioning Procedure or CRP and follow by post-treatment exercises.

In addition, the review showed that both CRP and VR have a synergistic effect since they can help improve the symptoms in a short time. In individuals with comorbidities such as cervical or thoracic spine disorders that contraindicate CRP, VR can have a crucial role in reducing the uptake of anti-vertigo medications. However, VR does not lower recurrence rates, most likely because it does not affect BPPV’s pathophysiological processes, although it does improve the pleasantness of BPPV episodes.

The review also suggested the need for further studies to identify a specific VR protocol and type of outcomes. Also, it needs further studies to a much larger population to confirm the results. The review also proposed that BPPV requires a multidisciplinary approach in treatment in which there must be a collaboration between the patient’s otolaryngologist, physiatrist, orthopedics, and physiotherapists.

What other conditions do Vestibular Therapy can help?

Vestibular rehabilitation is not only for adult patients, but it can also help children to decrease dizziness due to various types of inner ear disorders – which includes benign paroxysmal positional vertigo (BPPV) and also other neurologic conditions.

Before starting your VR therapy, you must consult your physician to diagnose your condition and refer to a vestibular therapist.

Aside from BPPV, this therapy can help in the following conditions:

  • Labyrinthitis
  • Vestibular neuritis
  • Vestibular hypofunction
  • Bilateral vestibulopathy
  • Vestibular schwannoma
  • Meniere’s disease
  • Vestibular migraine
  • Traumatic brain injury
  • Concussion
  • Functional movement disorder
  • Stroke
  • Cerebellar disorders
  • Multiple sclerosis
  • Progressive supranuclear palsy (PSP)
  • Persistent postural perceptual dizziness (PPPD)

Where can I find a vestibular rehabilitation therapist in Coquitlam, BC?

At Evergreen Rehab & Wellness – Coquitlam, we have a licensed and skilled physiotherapist who can help you with BPPV through vestibular rehabilitation. Each session will start a thorough assessment to collect a detailed history of your condition. It will also include the current issues you experience, such as a history of your fall or current lifestyle. It will also have various types of tests to observe your visual and vestibular system.

Depending on your assessment results and symptoms that you experience, our Physiotherapist in Coquitlam will provide a custom treatment plan suitable for your condition. It may involve in-clinic sessions and techniques. Also, they will provide you with home exercises assignment and lifestyle changes.

They can also help you understand fully your condition and how to deal with it. Also, what is crucial in undergoing VR? Doing and completing the home exercises are vital to the success of the therapy, and our therapist will help you how to accomplish it.

So, if you are struggling with vertigo, let our Physiotherapist in Coquitlam help you.

The Final Note

Also, remember that when you feel suddenly dizzy or have a previous case of BPPV, remember to be extra careful. Don’t do some movements that will trigger your vertigo. And, if you feel suddenly to be dizzy, take a rest or sit down for a moment because you might lose control.  

But, when you experience dizziness with severe headaches, hard to talk, you can’t see, double vision, changes in your hearing, you are falling or can’t walk -it’s time to call your doctor. BPPV may be a common and not a severe condition, but remember that it can make you fall, which can lead to injury – it’s time to talk to your physician and therapists.

In addition, please remember that even if you have successful treatment of BPPV, it may still reoccur, so it’s vital that you talk with your physician and your therapist. They can help you on how to manage your episode of vertigo when it reoccurs.

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