BPPV, or Benign Paroxysmal Positional Vertigo, is a common cause of vertigo, or a false sense of spinning. It is fairly common among adults, with increased incidence as you age. It usually comes on without an apparent reason, however can occur after a head trauma or after spending time in a head tipped back position (such as in a dentist chair). Usually you will first notice symptoms when turning over in bed or when sitting up from bed in the morning.
The spinning sensation occurs due to a mechanical problem in the peripheral vestibular system of the inner ear. This system has calcium crystals called otoconia that sit on a gel-like substance and are sensitive to gravity, as well as three semicircular canals filled with fluid that are oriented in three different planes. In a normal vestibular system, the fluid in the canals moves when your head moves. This displaces hair cells and sends a message to the brain to tell it that your head is moving. Sometimes the otoconia crystals become dislodged into the fluid and give your brain a false signal that your head is moving when it’s not. This results in a spinning sensation, or vertigo.
There can be many different causes of vertigo but with vertigo due to BPPV, the spinning sensation will occur with position changes, lasts less than a minute, and improves if the head is kept still. Many people will figure out how to change how they are moving in order to avoid bringing on the symptoms and may only feel a mild sense of disequilibrium or nothing at all between spells. In the most severe cases of BPPV, it may cause nausea or vomiting and impact your ability to work or drive.
It is important to note that if you experience constant dizziness unrelated to positional changes it is not likely BPPV. Alert your physical therapist or primary MD right away if you are experiencing any symptoms such as double vision, new onset of headaches, ringing in your ears, difficulty speaking or swallowing, difficulty coordinating movements, falling, passing out, or numbness/tingling as these symptoms will help to accurately diagnose your condition and direct you to the appropriate medical management or treatment.
BPPV can be very successfully treated by a physical therapist who specializes in the treatment of vestibular conditions. Your physical therapist will ask questions about how the dizziness started, the specific symptoms that you are experiencing, and what makes it worse or better. They will then perform a thorough evaluation to rule out other more serious causes of dizziness and to check for nystagmus, or eye movement, with positional changes. If they determine that you do have BPPV, they will instruct you in how to perform a maneuver to “dump” the otoconia crystals out of the semicircular canals. Usually the BPPV is completely resolved within 1-3 treatment sessions. If you have any residual feeling of unsteadiness or any neck pain from guarding your movements, your physical therapist can work with you to address these issues as well.
If your not sure why you are losing your balance, check out this great blog post to figure out if this might work!
As always, please contact us if you feel you want a physical therapist to help evaluate your condition.