Exercises for Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is a balance disorder characterized by a spinning sensation that may feel internal or external to the body. It is caused by abnormal positioning of special calcium crystals inside the ear that provide the body with input for balancing and movement. Several exercises are available to counteract BPPV's disorienting effects.

Initial Evaluation

• If you suffer from BPPV, you will likely undergo a process called vestibular rehabilitation therapy (VRT), which is designed to recalibrate your brain's sensitivity to input from the organs of balance, movement and body awareness (known collectively as the vestibular system). Before your begin this treatment, a therapist trained in VRT techniques will perform an evaluation to determine which exercises will be most beneficial for your particular circumstances. This evaluation will include information on your balancing and movement abilities, as well as your posture and any coping mechanisms you have developed to deal with your symptoms.

Exercise Options

• After your evaluation, your therapist or doctor may choose to begin treatment with exercises designed to reposition the displaced crystals (known as canaliths) inside your ear. These exercises are called canalith repositioning procedures (CRPs), and according to the nonprofit Vestibular Disorders Association, they cure the symptoms of BPPV in roughly 80 percent of patients.

  Typically, your CRP sessions will be conducted in a doctor's office, and at the beginning of each session you will receive medication to control any feelings of nausea. Once you are ready, your doctor or therapist will move your head and torso through a series of movements that will encourage your canaliths to move to a location in your ear where they will not trigger BPPV symptoms. In some cases, a CRP may also cause your canaliths to dissolve or break apart. The two main methods of canalith repositioning are known as the Epley maneuver and the Semont-Liberatory maneuver.

  Your BPPV may also be treated with another form of vestibular therapy called Brandt-Daroff exercises. These exercises work by repositioning your canaliths and may also help your body become accustomed to movements that can trigger your vertigo.

  During a Brandt-Daroff session, you will sit at the edge of a bed, then lower yourself to one side until you are lying down. You will stay in this downward position until any signs of vertigo disappear, then return to an upright posture. After remaining upright for a timed interval, you will lower yourself to the opposite side and wait as before. Typically, you will repeat these exercises several times throughout the day until you have experienced two consecutive days without any signs of vertigo.

Exercise Considerations

• Certain medical conditions may disqualify you from performing BPPV exercises. These include gastroesophageal reflux disorder (GERD), a detached retina and insufficiencies in the blood supply to your spine.

  In addition to BPPV exercises, you may also learn exercises that strengthen the muscles of your neck and head and make you less susceptible to external factors that trigger your vertigo symptoms. Consult your doctor or therapist for more information on these topics.