You’re Making Me Dizzy: Using The Epley Manoeuvre To Treat BPPV
In this article, we take a look at a lesser-known condition that can be treated by Chiropractors. Benign Paroxysmal Positional Vertigo, sometimes called BPPV or BPV, is a common inner ear condition causing intense bouts of dizziness.
4 minute read
BPPV causes intense bursts of room-spinning sensations
Dizziness is usually divided into two types:
Vertigo - where there is a sense that the room is “spinning”
Giddiness - a more “light-headedness” type of feeling - like you might get when standing up too quickly.
BPPV sufferers are far more likely to experience the vertigo-like symptoms above, though longer-term sufferers can experience a general unsteadiness, often described as “having sea legs” or similar.
What Causes BPPV?
Small crystals (canaliths) in the inner ear can migrate into one of the semi-circular canals. These canals contain fluid that helps to detect rotation of the head, and the crystals can interfere with that process. The resulting “confusion” in the vestibular system resulting from these mixed messages is what causes the spinning sensation.
The separation of the crystals from their normal place in the inner ear can be related to trauma, infection or simply a normal result of aging. The process is not reversible, however for the most part these loose crystals don’t cause a problem provided they stay where they belong!
Symptoms of BPPV
The hallmark symptom of BPPV is brief episodes of intense dizziness, usually lasting from 30 seconds to around 2 minutes. They are usually triggered by head movements like turning, looking up or rolling over in bed. These episodes are usually severe enough to be disabling and prevent the sufferer from doing anything until the symptoms die down.
Diagnosing BPPV
BPPV is often diagnosed from history alone, especially in this age of telephone consults. A more thorough diagnosis may include a detailed medical history, a physical examination focusing on eye movements and balance, and specialized vestibular tests. In our clinic we especially like using the Dix-Hallpike Manoeuvre or the Supine Roll Test to help identify the specific semicircular canal affected.
Treatment of BPPV
The most common first-line treatment for BPPV is anti-sickness medication and patients are sometimes given Brandt-Daroff exercises. Strictly speaking, these exercises do not cure BPPV, they merely help your nervous system to become adjusted to the condition. This approach is essentially waiting for the condition to self-resolve, while the medication and exercises dull the effects of the misplaced crystals. However self-resolution of BPPV is not guaranteed over any time frame - unlike a torn muscle for example that will heal given enough time.
A more effective approach is to manually reposition the crystals using specially-designed manoeuvres. The most common of these is the Epley Manoeuvre. If you are lucky, your GP may perform these exercises.
How effective are repositioning techniques?
In short, very effective. Patients are often astounded by how effectively a short manoeuvre can resolve severe symptoms. Roughly 80% of BPPV cases can be eased entirely with one treatment, with the remainder needing on average one further visit to ease what remains of the symptoms.
Can the condition reoccur?
Yes. As we said above, the crystals don’t go anywhere and so will be floating around your inner ear as long as you have an inner ear! However it is difficult to predict when you might have another bout - some patients are back in 6 weeks, while lucky ones may never need to seek help again.
Can I do these techniques myself?
Yes! There are online instructions for the Epley and Barbecue Roll manoeuvres, however the main reason to not do these at home is that performing these procedures can induce dizziness. This can be detrimental in two ways:
Firstly, the dizziness may cause the patient to make movements which could reduce the effectiveness of the manoeuvre
More importantly, the dizziness can cause falls which could cause further injury - especially detrimental in older patients.
So if you do decide to try these repositioning manoeuvres yourself, be aware of the risks and maybe have a friend to help.
The other advantage of having a professional do these manoeuvres is that they will be able to do tests to determine which side the movement should be done on. There are no harms in doing these exercises on both sides, but doing the movements may trigger symptoms without any therapeutic benefit.
What should I know before undergoing the Epley manoeuvre?
The manoeuvre can trigger symptoms - in our experience, triggering symptoms as we progress through the stages of the move tends to correlate with better outcomes post-treatment.
Patients report a range of feelings after treatment. For some, the improvement is immediate and they feel as if they are “standing on solid ground again”. Others may feel a little odd or slightly off-balance. Usually this feeling passes after a night’s sleep - when we phone the following day they are almost always feeling a lot better!
I think I have BPPV. What should I do?
Whether or not you have had yourself diagnosed by a GP, you can book a New Patient Exam with Mike (our Chiropractor) today. He will be able to assess you to diagnose BPPV and perform a repositioning manoeuvre such as the Epley. If you have further questions, you can contact us via email or phone.
“Mike saw me at short notice and corrected my [dizziness] problem in one session. He put me at ease in no time, and I felt very confident in his expertise and ability.”