Planet Ice Physiotherapy
2300 Rocket Way, Coquitlam, B.C. V3K 6Z2 Ph: (604) 552-8898 Fax: (604) 552-8028
What Is Benign Paroxysmal Positional Vertigo (BPPV)?
About twenty percent of dizziness is caused by a condition called benign paroxysmal positional vertigo (BPPV). This is a mechanical disorder of the vestibular system whereby “ear crystals” (otoconia) become dislodged and free-floating. When these ear crystals (calcium crystals attached to a gelatinous substance that lie over a nerve) get detached and float loosely, certain head movements set off connections between the vestibular system and our ocular system. This results in nystagmus, a rhythmic torsion-like twitching of our eyeballs, accompanied by a spinning sensation or the feeling of being dizzy. Patients also may complain of problems getting out of bed and rolling over in bed.
A head injury is a common cause of BPPV in people under the age of 50. More often, especially in the elderly, BPPV is idiopathic, meaning that the cause is unknown.
How Can a Trained Physical Therapist Treat BPPV?
The head motion that stimulates BPPV is determined by which canal contains the floating ear rock. A trained physical therapist can determine which canal is affected by administering certain tests. Once the affected canal is identified, the physical therapist can perform a canal repositioning procedure (CRP). With a CRP, the therapist moves the patient’s head into certain positions to help direct the ear rock to its original and proper location.
By way of illustration, think about that simple game you played as a child, where you tried to maneuver a tiny ball through a maze simply by tilting the game in your hands. These controlled and gentle movements allowed you to progress the tiny ball along the path-like maze to the goal position.
Once a CRP is performed, the therapist will issue precautions to allow the ear rock to settle back into place permanently.
How Do We Strengthen the Vestibular System?
Even after a CRP is successful, a patient may sometimes still feel off- balance and/or dizzy. Specific exercises can help strengthen the vestibular system and relieve these symptoms. For example, a patient’s gaze stabilization may be impaired. This means that person’s eyes are “slipping off” the object in view. It may happen so quickly that it is below the patient’s conscious level.
The best treatment for BPPV is with specialized physical therapy, called Vestibular Rehabilitation Therapy (VRT). After evaluation, the physical therapist will design a personalized program employing certain exercises, which basically retrain the brain. They include:
If you suffer from a vestibular system disorder such as BPPV, there are many other strengthening exercises using simple stimulation, such as sitting and bouncing on a large physical therapy ball, walking and turning the head, walking on different surfaces with your eyes opened or closed. An experienced and creative therapist will suggest several ways to stimulate and improve the function of your vestibular system to best improve your balance and/or reduce dizziness while guarding for safety.
Our bodies are in constant motion. Think of how much we are moving when we simply walk down the street. Not only are we progressing forward, we are moving up and down as we push off from our toes and shift from one leg to the other. Despite this changing activity, our visual world remains stable.
Remember how old home movies looked when the camera operator walked while filming? The recorded images were so shaky, that some people became dizzy by watching them. It is our vestibular system that prevents the same thing from happening to our visual world when we move.
What Is Our Vestibular System?
Our vestibular system is located in our inner ears.
It helps with our balance, orientation in space, and eye movements.
It keeps our visual world stable; it keeps us steady.
One function of the vestibular system is to help us perceive linear movement.
This means that the vestibular system helps us sense when we are moving up,
down, back or forth, for instance in a fast-moving vehicle or in an elevator.
Another function is to help us perceive rotational (spinning) motion.
In each ear’s vestibular system, there are three semicircular canals that begin and end from a tiny vestibule (small space or cavity). Each canal acts like a carpenter’s level and is oriented at different angles that respond to different planes of movements. The canals help our eye muscles remain at our focal point, even when our head is moving.
If the vestibular system is not functioning properly, symptoms can include dizziness, vertigo (a sensation of spinning or swaying), imbalance, spatial disorientation, lightheadedness, and motion sickness. Vestibular-system distress manifests itself in several conditions and has many causes: viral infection, bacterial infection, allergies, certain medications, aging, and trauma.
More than two million people per year visit their doctor with symptoms of a vestibular balance disorder. This is particularly true of the elderly.