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Vertigo and BPPV: Vestibular Physical Therapy in Brooklyn

By Dr. Jack Engelberg, PT, DPT · · 4 min read

You roll over in bed, tip your head back to get something off a high shelf, or bend down to tie your shoe, and suddenly the room is spinning. It lasts less than a minute, but it's frightening and can leave you feeling off-balance and nauseated for hours. This is a classic description of benign paroxysmal positional vertigo (BPPV), the most common cause of vertigo. The reassuring news is that BPPV is often treated very effectively with simple in-office maneuvers performed by a trained physical therapist.

What Is Vertigo?

Vertigo is the sensation that you or your surroundings are spinning or moving when they're not. It's different from feeling lightheaded or faint. Vertigo usually points to a problem with the vestibular system, the balance organs in the inner ear and the brain pathways that process their signals.

What Is BPPV?

Inside your inner ear are tiny calcium crystals (otoconia) that normally sit in a part of the ear that senses gravity and linear movement. In BPPV, some of these crystals come loose and drift into one of the semicircular canals, which sense head rotation. When you move your head in certain directions, the crystals move in the fluid of the canal and send a false signal of spinning to the brain.

Common Symptoms of BPPV

  • Brief episodes of spinning vertigo, usually lasting less than a minute
  • Triggered by specific head movements: rolling over in bed, lying down, sitting up, looking up or bending forward
  • Nausea, sometimes vomiting
  • Unsteadiness or a sense of imbalance between episodes
  • Feeling "off" or foggy

What Causes BPPV?

Often no clear cause is found. BPPV is more common in older adults and can follow a head injury or concussion, an inner ear infection, or long periods of bed rest.

Other Causes of Dizziness

Not all dizziness is BPPV. Other causes include vestibular neuritis or labyrinthitis (inner ear inflammation, usually causing prolonged vertigo), Ménière's disease, vestibular migraine, neck-related dizziness, medication side effects, blood pressure issues, and heart or neurological conditions. That's why a careful evaluation matters.

How Physical Therapy Helps

Vestibular rehabilitation is a specialized area of physical therapy for dizziness and balance disorders.

Evaluation

Your therapist will take a detailed history, then perform positional tests, such as the Dix-Hallpike or roll test, while watching your eye movements for characteristic patterns. They'll assess balance, eye-head coordination and your neck, and screen for signs that suggest a non-vestibular cause needing a physician.

Treatment May Include

  • Canalith repositioning maneuvers — a series of carefully guided head and body positions, such as the Epley maneuver, that move the loose crystals out of the canal. Many people feel significant relief after one or a few treatments.
  • Habituation exercises — for movement-triggered dizziness that persists
  • Gaze stabilization exercises — to improve how your eyes and inner ear work together
  • Balance training — to restore steadiness and confidence (see balance and fall prevention)
  • Education — on what to expect and how to manage recurrences

What You Can Do at Home

  • Move carefully when getting up: sit on the edge of the bed for a moment before standing.
  • Use a night-light and keep paths clear to prevent falls.
  • Don't avoid all movement. Avoiding head motion can make the brain slower to readjust.
  • Avoid trying maneuvers from online videos before you've been evaluated. Doing the wrong maneuver for the wrong canal may not help.
  • Keep a symptom diary — what triggers dizziness, how long it lasts and what it feels like. It helps your clinician pinpoint the cause.

When to See a Physical Therapist

Consider an evaluation if:

  • You have brief spinning spells triggered by head or body position
  • Dizziness persists after an inner ear infection or concussion
  • You feel unsteady or have fallen
  • You've been diagnosed with BPPV or a vestibular disorder

Call 911 or go to the emergency room for dizziness with sudden severe headache, slurred speech, facial drooping, weakness or numbness on one side, double vision, trouble walking, chest pain or fainting. These can be signs of a stroke or heart problem.

Frequently Asked Questions

Can BPPV be cured?

The repositioning maneuvers are often effective at resolving an episode, sometimes in one or two visits. BPPV can recur, but it's usually treatable again.

Is BPPV dangerous?

BPPV itself is not life-threatening, but it can increase the risk of falls, especially in older adults.

Do I need medication for vertigo?

Medications can ease nausea short-term but don't fix BPPV and may slow the brain's adaptation if used long term. Discuss options with your physician.

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About the author. Dr. Jack Engelberg, PT, DPT is a Doctor of Physical Therapy and owner of Refuah Physical & Occupational Therapy, with offices in Midwood and Boro Park, Brooklyn, and on Staten Island.

Medical disclaimer: This article is for general education only and is not medical advice, diagnosis or treatment. Everyone’s situation is different. Talk with your physician or a licensed physical therapist about your symptoms. If you think you have a medical emergency, call 911.

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