Planet Ice Physiotherapy

Physiotherapy and Rehabilitation Clinic

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: 

  • Gaze stabilization or vestibular ocular reflex (VOR ) exercises require the person to move her head while fixating her eyes on a static visual target, like a small circle on the wall. It is very important that the target remains stationary. Over time, the person will be able to move her head faster and keep the visual target clear and stable. This will improve balance and dizziness.   


  • Balance exercises can be performed by standing on a compliant surface like thick foam with the eyes closed. This forces the body to eliminate information coming naturally from the joints and from the visual systems, and to hone in on the information coming only from the vestibular system. There are many exercises to strengthen balance: negotiating over obstacles of various heights; narrowing someone’s base of support by bringing feet closer together; lifting alternating legs; using controlled movement while shifting the weight from one leg to the other; walking and having the person turn his/her head in different directions; or ambulating on different surfaces, such as cobblestone, grass, sand, or foam. A step strategy is used when there is a large disturbance, such as a big push, which requires the individual to take a step to recover balance.

  • Habituation exercises can also help reduce dizziness by desensitizing the person to the causative motion. For example, a person may become dizzy when he gets out of bed in the morning. As an exercise, the person will lie on his bed and quickly sit up. He will stay in that position until his dizziness goes away completely or returns to his baseline, the level of dizziness before starting the exercise. Then the person will quickly lie down on the bed again and wait until the dizziness returns to his baseline. This motion is done three to five times, a couple of times a day.  Eventually, the person’s vestibular system gets accustomed or desensitized to this movement and he no longer becomes dizzy when getting out of bed. 


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.


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 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.