Background: Peripheral vertigo, also known as BPPV (benign paroxysmal positional vertigo) is a type of vestibular disorder, and can affect anyone at any age, but is most common in people over the age of 50, especially women4. There are semicircular canals filled with endolymph fluid inside your inner ear. The movement of endolymph through the canals is what provides your brain with information on movement of your head and where your body is in space. There are tiny particles called otoconia embedded at the base of these semicircular canals in chambers called otolith organs (utricle and saccule). In certain situations, the otoconia can escape from the utricle and be released into the semicircular canals. When this happens, the otoconia bump into nerve endings in the semicircular canals when the head is moved, and trigger signals to be sent to your brain that your body is moving even when it is at rest. This is what causes the sensation of the room spinning or the feeling like you just got off a ride at the fair6.
Why does this happen?: Vertigo can be caused by concussions or whiplash - a blow to the head or body can knock the otoconia loose from the otolith organs. It is common for people to experience vertigo as a sequela of a sports injury or car accident. Vertigo can be triggered from inner ear congestion caused by allergies or cold viruses. It can also be triggered by the head being held for prolonged periods in a recumbent position such as at the dentist or beauty salon7. Other risk factors include female gender, sedentary lifestyle, and vitamin D deficiency8. Also, vertigo can happen spontaneously, for no particular reason. It is very common for a person to wake up in the morning with vertigo symptoms that seemed to come from out of nowhere - “When I rolled over and got out of bed this morning I got the sensation of the room spinning. I haven’t been feeling right since.”
In many cases, vertigo will resolve on its own, as the otoconia will find their way back into the utricle, or be reabsorbed. However, in some cases, vertigo can persist and require treatment. Treatment can be performed right in your physical therapy provider’s office. The treatment consists of a series of positions called canalith repositioning maneuvers9, designed to encourage the otoconia to relocate back into the utricle. Home exercises can also be prescribed in cases of persistent vertigo10. Canalith repositioning maneuvers are the best way to treat vertigo. Many doctors will prescribe medications which only suppress the symptoms but do not cure the underlying problem11. Furthermore, the use of vestibulo-supressive medications can actually inhibit the rate of recovery3.
If you or someone you know is suffering with vertigo, call your physical therapist right away. There is no need to wait and see your doctor first. Early treatment is the most effective11,12. If treatment is delayed, there is more chance for the otoconia to become adherent and less easily maneuvered back to the utricle. Also, delayed treatment results in central nervous system adaptation which will, in turn require more time to adjust back to a normal state after treatment13.
