Benign paroxysmal positional vertigo is a vestibular disorder that is triggered by the displacement of calcium carbonate crystals in the inner ear. These crystals are called canaliths or otoconia, and they help your body detect movement and understand its position.

When they are moved out of place, they send incorrect signals to the brain, causing symptoms like vertigo or dizziness. Other symptoms of BPPV include:

• Nausea
• Vomiting
• Imbalance
• Nystagmus (involuntary eye movements)
• Disorientation 
• Neck pain
• Musculoskeletal pain
• Headache 

Symptoms of benign paroxysmal positional vertigo can vary from person to person, and may vary in intensity per episode. Some individuals may also experience BPPV more frequently than others.

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BPPV can often occur without a known direct cause. Some possible contributors to the condition include age, head injuries, changes from surgery, or sudden head movements that may lead to displacement of canaliths.

BPPV is also thought to be associated with certain medical conditions or injuries such as the following:

• Meniere’s Disease: A disorder of the inner ear that causes episodes of vertigo, tinnitus, and hearing loss.
• Labyrinthitis: The labyrinth of the inner ear can become inflamed, often due to infection, and can cause BPPV.
• Vestibular Neuritis: Involves inflammation of the vestibular nerve in the inner ear, which carries balance signals to the brain.
• Head Trauma: Injury such as whiplash or concussions can disrupt the balance in the inner ear.
• Age-Related Vestibular Degeneration: Degeneration of the inner ear due to aging can cause a higher likelihood of canalith displacement.

Physical therapy is an effective treatment for benign paroxysmal positional vertigo and can help those who experience symptoms frequently manage the condition more effectively.

When treating BPPV, canalith repositioning maneuvers are used to encourage canaliths to return to the inner ear.

Canalith repositioning maneuvers involve a series of head movements that are safe to do with the help of a provider or even at home. For some patients, however, these can be difficult to perform alone, such as for those with low mobility.

Physical therapists can also teach brandt-daroff exercises, which are similar repositioning maneuvers designed for those who have more frequent experiences with BPPV. The point of these exercises is to encourage proper placement of canaliths. By performing these often, patients can potentially avoid BPPV episodes.

In addition to maneuvers that treat or prevent BPPV episodes, physical therapists can also provide what’s called vestibular rehabilitation therapy.

This form of therapy helps individuals prepare for BPPV flare-ups by improving body strength, stability, balance, and overall preparedness for symptoms of dizziness or vertigo.

Additionally, physical therapists can help address other symptoms of BPPV such as neck or musculoskeletal pain through additional treatments. At Hive Therapy and Wellness, we may use a combination of any of the following treatments to support patients with BPPV:

• Dry Needling
• Cupping
• Manual Therapy 
• Spinal Manipulation 
• Electrical Muscle Stimulation
• Tissue Scraping 
• Exercise Prescription
• Behavioral Modifications
• Therapeutic Modalities
• Neuromuscular Re-education
• Biofeedback (part of neuromuscular)
• Therapeutic Activity