BPPV Physiotherapy & Vestibular Rehabilitation in Toronto

Treatment of Benign Paroxysmal Positional Vertigo (BPPV) in Toronto

Vertigo & dizziness symptoms commonly can be triggered by rolling over in bed, getting out of bed, and lifting head to look up or bending forward. BPPV or vertigo is a false sensation of movement caused by head or body movement. It feels like you or the objects around you are spinning or moving. It is important to understand that vertigo or dizziness is not a disorder or disease in itself. Instead, it is a symptom of an underlying condition.




Click links below to learn more about causes, symptoms, and treatments

While dizziness can be caused by a number of diseases, most commonly it occurs due to a vestibular (inner ear) disorder known as Benign Paroxysmal Positional Vertigo (BPPV). BPPV is caused when the particles within the vestibular system are misplaced and it usually affects only one ear, however, occasionally it can occur in both ears at the same time.

A person affected by vertigo symptoms may have attacks of vertigo for a few days or weeks, then a period of time with no dizziness symptoms at all. The symptoms can come and go with no apparent reason. BPPV can easily be managed with vestibular physiotherapy. Usually, the physiotherapist or other trained professionals apply re-positioning maneuvers such as Epley and educate patients to manage symptoms. The vestibular rehabilitation program designed by Physiomobility is aimed at making a patient symptom free and to help them feel more confident and decrease their risk for trips and falls by treating dizziness and improving their gait, balance, and coordination.

What are the Symptoms of BPPV?

The symptoms of BPPV can include:

  • Sudden episodes of violent vertigo (spinning)
  • Dizziness and/or nausea
  • Movements of your head trigger the vertigo
  • Your vertigo may last half a minute or more
  • Your eyes may drift and flick uncontrollably (Nystagmus)

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What Causes BPPV?

Inside the inner ear, there are three semicircular canals filled with fluid. These canals are oriented at different angles. With each head movement, the fluids inside these channels are moved to create signals to inform the brain stem of the direction, speed, and quality of movement.

BPPV is caused by the displacement of little calcium carbonate crystals or otoconia within the vestibular canals. The treatment for BPPV is re-positioning maneuvers which essentially is finding which one of the canals, the particles are floating, position the head in a way that the gravity moves the particles to where they belong. These maneuvers, if done properly, are usually very effective and patients have immediate relief of dizzy symptoms.

Occasionally conservative BPPV treatments such as physiotherapy and medication fail. If despite treatments, the symptoms continue for more than 12 months, an operation may be needed.

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How does physiotherapy help vertigo?

To treat BPPV, physiotherapists determine which one of the three canals of the inner ear are the particles floating in and then apply a re-positioning maneuver specific to that canal to return the crystals to their original position. The most common type is loose crystals moving freely in the ear’s fluid canal and the second type is crystals clinging on the bundle of nerves responsible for fluid movement. Usually, one or two treatments are enough. If the episodes of vertigo go on for a long period of time then some imbalance in the vestibular system may occur and based on the diagnosis, the physiotherapists recommend a series of specific exercises called vestibular rehabilitation.

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Who treats Vertigo & BPPV?

These crystals are held in special reservoirs within other structures of the inner ear (Saccule and Utricle). These crystals can be dislodged and displaced due to injury or degeneration of the Utricle and move into the balance organ and interfere with your vestibular system. The vestibular physiotherapy is to relocate these crystals to their original location.

The following factors cause or allow crystals to migrate into vestibular canals include:

  • Head or ear injuries such as concussion or whiplash
  • Ear surgery or acute or chronic ear infection
  • Degeneration of the inner ear structures
  • Vestibular neuritis (viral infection of the inner ear)
  • Meniere’s disease
  • Some types of minor strokes
  • Idiopathic (no cause can be found

BPPV should only be treated by physiotherapists or other healthcare practitioners who have undertaken specific training to diagnose and successfully treat. Our Vestibular trained physiotherapists are registered with the College of Physiotherapists of Ontario. Vestibular physiotherapy is covered by most insurance plans.

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How is BPPV diagnosed?

Not every dizzy patient is suffering from a vestibular condition. A wide range of medical conditions can cause dizziness and vertigo. Therefore, it is important to find the exact cause of these symptoms. Vestibular physiotherapy is effective in managing dizziness and vertigo when the cause is in the vestibular system. The rehabilitation protocols can help patients manage the balance disorders related to the vestibular system involvement.

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What is the treatment for BPPV?

After the assessment and the confirmation of BPPV diagnosis, your vestibular trained physiotherapist will apply specific techniques to relocate the displace Otolithic derbies to an area in the inner ear that doesn’t stimulate the feelings of dizziness or vertigo.

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What is Vestibular Rehabilitation Therapy (VRT)?

Vestibular Rehabilitation Therapy (VRT) is a form of treatment for lingering dizziness and imbalance symptoms after many conditions causing dizziness and balance including vertigo and BPPV. Vestibular Rehabilitation Therapy (VRT) refers to specific exercises that are designed to eliminate or minimize symptoms related to vestibular dysfunction including vertigo and chronic dizziness. VRT incorporates vision and balance exercises with head movement and gradually adds dual tasks, cognitive exercises to facilitate a safe return to work, daily life activities, sports and social activities without fear of losing balance due to dizziness.

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Is BPPV treatment successful?

When BPPV treatment techniques are performed correctly, reduction of vertigo, dizziness and other symptoms of BPPV is immediate in 80% or more of cases. In most cases (90%+), quality BPPV practitioners have a high success rate within three applications of the maneuvers.

In addition, doctors may prescribe some medication to diminish your sensitivity to movement and manage nausea and vomiting. These medications are mainly management and are not considered to be treating the cause of vertigo and may just mask BPPV symptoms.

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What are the common treatment options for BPPV?

  • Repositioning maneuvers, such as Epley and Semont
  • Vestibular Rehabilitation Therapy (VRT)
  • Balance exercises
  • Gaze stabilization exercises
  • Education
  • Return to work program
  • Falls prevention for elderly

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BPPV & Vertigo in a nutshell

Benign Paroxysmal Positional Vertigo (BPPV) is determined when a person suffers from a series of episodes of unexpected and severe vertigo and dizziness. People suffering from BPPV may suffer from vertigo for a few days or weeks. Sometimes the symptoms disappear for a while and then return.

BPPV occurs when particles or the calcium carbonate crystals dislodge from the position, enter the fluid filling the vestibular canals forming the balance organ in the inner ear, and interfere with the vestibular system, causing the person to feel dizzy and imbalanced. Some symptoms of BPPV include:

  • Unexpected episodes of severe spinning
  • Nausea, dizziness, or both
  • Eyes drift and flick open and close uncontrollably
  • Vertigo lasts for thirty seconds or more
  • A loss of balance
  • Falls

At Physiomobility, we have a team of qualified professionals who offer specialized treatment for various conditions. If you suffer from dizziness and vertigo our experienced vestibular physiotherapists will provide you a personalized treatment, offering you relief from discomfort and enabling you to get back to your usual activities quickly.

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By: Gita Mikal, Registered Physiotherapist Certified in Vestibular Rehabilitation

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Physiomobility continues to remain open and is not part of the lockdown. We continue to have rigorous disinfection policies and procedures in place to ensure the safety of our community and are open for patient in-person visits with all of our practitioners.

Virtual appointments are available and encouraged for those who are at a heightened risk of illness.

We remain focused on our quality of care & our continued commitment to helping our patients feel their best. For further assistance, you can contact us at 416-444-4800 during our opening hours. 

The Physiomobility Team