Eyes, Ears, Nose & Throat

Vertigo Exercises: You’ve Never Tried “Particle-Repositioning Maneuvers”?

Benign paroxysmal positional vertigo is a common, unpleasant, debilitating but ultimately harmless condition, for which the most common treatments are vertigo exercises. What are these vertigo exercises, and how can you use them at home?

By Leonaura Rhodes, MD • January 16, 2020

You’ve heard of vertigo, but do you know what benign paroxysmal positional vertigo (BPPV) is? It’s a common inner ear problem that produces a false sense of spinning, according to the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS). Many of us will experience one or more episodes of BPPV or other types of vertigo in our lives, the incidence increasing with age.

As the name suggests, BPPV is not life-threatening (benign), it comes in sudden, brief spells (paroxysmal), and it creates a sense that you, or the world, are spinning (vertigo). While benign, it is unpleasant, disorientating, and unsettling, and it can cause falls.

What Causes BPPV?

For most people, there is no apparent cause of BPPV, although it can occur due to trauma, migraine, diabetes, osteoporosis, lying in bed for a long time, and other inner ear problems.

It is believed that tiny crystals floating around in your inner ear cause BPPV. These crystals are known as “otoconia” and are made of calcium carbonate. Usually they rest in the center “pouch” of the inner ear, but sometimes they get dislodged and float around, and finding their way to sensors or the wrong ear canal where they cause the abnormal signals that result in vertigo.

Symptoms of Vertigo—and Clinical Evaluation

In BPPV, symptoms may include dizziness or a spinning sensation, nausea, vomiting and a feeling of instability, or disorientation. Movement such as sitting up, looking up, or bending over usually triggers symptoms. They may last a few seconds or much longer, and may come and go over several days. BPPV does not affect hearing or cause tinnitus (ringing in the ears).

If you suffer from the BPPV ymptoms described above on multiple occasions or for a long period, it is best to see your doctor or an ENT (ear nose and throat) doctor, to rule out more serious causes for your symptoms.

Vertigo Exercises: Particle Repositioning Maneuvers

While medications may help with some of the BPPV symptoms like nausea, the only effective treatments for BPPV are repositioning procedures. A doctor usually supervises these, but people who have had multiple episodes can learn to perform the maneuvers at home.

The official name for these exercises is “particle-repositioning maneuvers” (PRM). Your clinician may perform one of several techniques, among them the Lempert 360° roll maneuver, the Semont maneuver, the Gufoni method, the Vannuchi Asprella method, the Barbecue roll method, and the Epley maneuver. (MedicalNewsToday.com offers a detailed description of the latter; click here to see the steps involved in the Epley maneuver.) Each involves a series of body, head, and neck movements. The procedure may need to be repeated a number of times.

A study by the Cochrane Group found that the Epley maneuver resulted in resolution of symptoms in up to 56 percent of patients. They reported that side effects were uncommon and minor, with between 16 and 32 percent of patients reporting nausea. Patients with cervical spine problems may not be able to tolerate these procedures and should not perform them unless under medical supervision.

Vestibular Rehabilitation Therapy (VRT)

Some sufferers require a more intensive vestibular rehabilitation therapy (VRT). The Vestibular Disorders Association explains that VRT is “the specialized form of exercise-based therapy designed to alleviate both primary and secondary symptoms of vestibular disorders. [It] includes assessments of vertigo and dizziness, eye movements, balance and gait, and the musculoskeletal system, as well as treatment using vestibular habituation, gaze stabilization, and balance training exercises.”

Home Usage of Vertigo Exercises

If, and only if, your doctor has confirmed a diagnosis of BPPV, ask to be taught how to perform particle repositioning maneuvers at home, in case you suffer from another attack.

Experts at Johns Hopkins School of Medicine recommend the following steps to carry out the Epley maneuver at home:

If the problem is with your right ear:

• Start by sitting on a bed.
• Turn your head 45 degrees to the right.
• Quickly lie back, keeping your head turned. Your shoulders should now be on the pillow, and your head should be reclined. Wait 30 seconds.
• Turn your head 90 degrees to the left, without raising it. Your head will now be looking 45 degrees to the left. Wait another 30 seconds.
• Turn your head and body another 90 degrees to the left, into the bed. Wait another 30 seconds.
• Sit up on the left side.

If the problem is with your left ear:

• Start by sitting on a bed.
• Turn your head 45 degrees to the left.
• Quickly lie back, keeping your head turned. Your shoulders should now be on the pillow, and your head should be reclined. Wait 30 seconds.
• Turn your head 90 degrees to the right, without raising it. Your head will now be looking 45 degrees to the right. Wait another 30 seconds.
• Turn your head and body another 90 degrees to the right, into the bed. Wait another 30 seconds.
• Sit up on the right side.

Ask a friend or loved one to supervise you if possible and make sure that you perform the procedure in a safe place, in case you get dizzy and fall—the last thing you need is a broken bone on top of your vertigo!

Dr. Carol Foster, MD, an Ear Nose and Throat doctor from the University of Colorado Denver, developed a new technique for home treatment when she was struck down with BPPV. Her video about the new technique went viral in 2013; in it, she explains that the technique is easier to do at home than the Epley maneuver is, but it has not been widely evaluated.

Preventing a Recurrence of Vertigo

Unfortunately, BPPV sometimes recurs. If you suffer from frequent recurrence or if additional symptoms emerge, see your doctor to confirm your diagnosis.

While it is not strictly preventable, you can take steps to reduce your risk: Protect your head from injury (wear a helmet when riding a bicycle or motorbike), eat a healthy diet, take a vitamin D supplement (to reduce the risk of osteoporosis), stay hydrated, and exercise regularly.

While you’re suffering from BPPV, it’s also advisable to take these precautions to prevent falls:

• Standing up slowly
• Sitting down if you feel dizzy
• Using a walking aid if dizziness is prolonged
• Making sure your home is well-lit and free from trip hazards

Sources & Resources

For related reading on vertigo, see these University Health News posts:

• “What Causes Vertigo?‘
• “Vertigo: Symptoms Call for Screening and Treatment‘
• “Natural Remedies for Vertigo“

These organizations offer further information on the topic:

• American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS). A professional organization that offers public outreach.
• The Vestibular Disorders Association. A non-profit that aims to support and empower vestibular patients on their journey back to balance.