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Spinning when you turn or sit up in bed ? It might be benign paroxysmal positional vertigo

Benign Paroxysmal Positional Vertigo (BPPV) is the most common vestibular disorder we treat in physical therapy. BPPV is easily treatable. It is the only thing in physical therapy that is quick! Physical therapists can treat in usually 1 visit.

I will leave the world wide web to educate you about the actual disorder and instead tell you a few patient stories from this year.

I've seen hundreds (okay, maybe a hundred? a ton) of people with vestibular disorders. The vestibular system includes the inner ear, which is where our body learns information about where we are in space. If a small part of this system isn't working as it should, our brains interpret this as if we are moving when we are not. Dizziness, vertigo, and imbalance can occur for a multitude of reasons (I can tell you 25 reasons right now off the top of my head) and BPPV is one that originates from the inner ear. It is benign and not serious, thank goodness.

Earlier this year I had a referral for a 25 year old female with dizziness. She had no medical problems, except having her wisdom teeth out and some knee pain. The problem had been going on for a few weeks, after she had been sick with the what she thought was the flu. It only happened when she got out of bed in the morning or rolled over at night. She had been to the ER but they told her nothing serious was going on. I did an exam and diagnosed and treated her for BPPV that visit. I didn't see her again because it was effective in 1 session. The mystery about her case was etiology. How did a 25 year old without a medical history get BPPV? BPPV occurs in people who strike their head or possibly someone with migraines. BUT she had the flu. This was late January 2022. The height of another COVID wave. Vestibular disorders can occur with COVID infection, either during or after. I would say every vestibular therapist at this point as treated a person post COVID infection with vestibular issue. We are seeing more complicated issues than only BPPV, however I suspect this 25 year old got BPPV post COVID. Luckily, it was an easy fix for her.

An 82 year old basketball player came to see me for BPPV. He had diagnosed himself using youtube and wikipedia and found a solution online - the somersault maneuver. The somersault is a a newer maneuver (2012) developed by Dr. Carol Foster and is extremely popular online. The positions of the head are in line with the historical treatment - the Epley- and the maneuver should do the job. BPPV is a mechanical problem with a mechanical fix. As long as the head is moved into the correct position, the treatment should work. Most of the research on the somersault is by Dr. Foster and I do not think the evidence base is otherwise very strong, especially compared to the Epley. However, it depends on the person who is doing the movements. A half somersault may be quicker and easier to understand than the Epley for a younger, fit person. An older person may have a hard time doing it on their own. Yet, our basketball player reported he did it! Well he didn't do it right or it didn't work because I diagnosed and treated him that same day for BPPV. He had some other issues with balance that were impeding his play, so he continued to see me for a few months until he could run and dribble down the court again. I highlight his story because my experience has taught me seeing a vestibular PT early for BPPV is valuable, time saving, and more effective than trying to do it on your own using you tube.

Please reach out if you are having spinning when you turn in bed or sit up. Many people go years without knowing there is such an easy fix!

Ashley Stanley, PT, DPT

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