Bucks County Womens Journal

People who have vertigo and are suffering from symptoms of dizziness, nausea, loss of balance, and vomiting may not know that there is a one-time treatment that can cure those symptoms and allow them to return to a normal life. Physical therapists expertly trained in vestibular therapy can perform a single maneuver on patients experiencing these symptoms that 80% of the time will eliminate the vertigo.

Benign Paroxysmal Positional Vertigo, or BPPV, is a peripheral vestibular disorder involving the inner ear that causes spells of vertigo that typically last less than one minute, when the head is in certain positions.
The onset of vertigo can cause dizziness, making the patient feel off balance, and sometimes can induce nausea and vomiting. Common everyday tasks, like doing situps, reaching for a kitchen cabinet, or bending over to pick something up can cause an episode.

This can mean patients avoid doing things they love, like working out. For elderly patients, untreated vertigo can mean a loss of mobility and independence because they may be afraid that moving around could cause them to fall. For this reason, it is very important that patients be treated immediately.

In an amazing process, a physical therapist will lay someone down on the exam table, roll them, and, when they sit up, their symptoms are gone. Often, regular therapy can take six weeks to be effective. The physical therapy treatment for vertigo is very effective, very quick, and involves no drugs.

BPPV can be attributed to several causes, but, in approximately 58% of cases, the exact cause in unknown. Head trauma accounts for 6-18%, while infection, inflammation, or ischemia accounts for 3-9%. The risk for BPPV increases with age. Eighty-five percent of adults over 65 years of age have BPPV.

A trained therapist using the Dix-Hallpike test, confirms the diagnosis of BPPV. In this test, the patient turns the head 45 degrees to one side and is quickly laid down with the head hanging over the edge of a table. While this test is being performed, the patient wears infrared goggles to observe eye movements. If BPPV is truly present, a rapid eye movement, called a nystagmus, will be seen and recorded by a trained physical therapist, and the patient will experience dizziness.

In the healthy inner ear, three structures called the semicircular canals detect angular head movements such as looking up and down. Two other structures, the utricle and the saccule, detect both movement of the head in straight lines as well as the pull of gravity. The presence of calcium carbonate crystals in the utricle and saccule enable them to do this normally. BPPV occurs when the calcium particles break loose from the utricle and travel to one of the three semicircular canals located in the inner ear.

The treatment for this type of vertigo involves manually moving the crystals out of the canals. The most-common treatment for BPPV, the Epley Maneuver, will correct vertigo in one visit 80% of the time when performed by a physical therapist specifically trained in vestibular therapy. A skilled therapist will lay the patient down with the head tilted to get the crystals to move. When dizziness subsides and the crystals have settled into a new position, the therapist will move the patient a second time, to move the crystals farther along in the canal. When dizziness subsides again, the patient will sit up, and the crystals will have been put back into the utrical. To ensure all the crystals were put back correctly, the Epley Maneuver is performed a second time to make sure the patient isn’t still getting dizzy.

Even though this treatment is simple and effective, patients may put off contacting a therapist because they don’t want to feel worse before they feel better. But a skilled therapist can talk the patient through the procedure reassuringly to make sure he or she doesn’t feel poorly.

If a family member knows someone suffering from vertigo or dizzy symptoms, it is important to get to the primary care provider, who can directly refer to a vestibular physical therapist. If this is happening to you or a loved one, talk to your physician about a vestibular therapist referral.

Medication can calm down symptoms but doesn’t effectively treat the cause. It is important to keep patients active and mobile, so they don’t develop balance problems along with the vertigo. BPPV also affects women more than men and can cause migraines, which also disproportionately affect women.

Because not all therapists are trained in vestibular therapy, it is important to use a therapist who has been certified in the treatment of BPPV to ensure the most success in diagnosis and treatment. A video of a demonstration of how therapists diagnose and treat BPPV is available at wwspt.com.

The team of professionals at WWS Physical Therapy is committed to the profession of movement science and strives to provide an environment of healing to assist patients in recovering to their desired functional level, whether it is simple daily activities with their families or highly competitive sports. We look forward to a long-term relationship with our patients over their lifespan and to becoming their practitioner of choice for musculoskeletal and balance issues. For more information, visit http://www.wwspt.com.

Wendy Webb Schoenewald is the owner of WWS Physical Therapy and Vestibular Rehabilitation in Doylestown. She has been involved in teaching vestibular rehabilitation to other physical therapists at the Herdmann vestibular certification course for many years and lectures locally on vestibular rehabilitation and concussion management for PTs, MDs, PA-Cs, and CRNPs. Her practice is presently involved in a clinical trial with Temple University for the treatment of lateral canal BPPV.

Robin Coppinger
Bucks County Women’s Journal

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