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The Infamous Epley

Benign Paroxysmal Positional Vertigo.

Personally, when I say these words, I feel smart. First, just because I know how to say “paroxysmal” but, I tend to say it very slowly. Second, because I can treat it. Third, I want to teach my patients about it.

Let’s break it down. Benign means non-harmful in effect. Paroxysm means violent attack or sudden occurrence of symptoms. Positional mean the episode of evoked with certain head positions. Vertigo means the room is spinning. All known as BPPV.

BPPV is the most common cause of episodic vertigo and accounts for about 90% of patients who complain of vertigo. Basically, there are calcium carbonate deposits, “crystals”, that are in a specific area of your inner ear. For reasons largely unknown, these crystals get knocked loose and go moving around a different area of your inner ear (a place they shouldn’t be). So, everytime you move your head in a certain position, these crystals start moving around and stimulating cells that are normally not stimulated with that particular head movement, therefore, your brain is getting signals that it is used to not getting with these movements. Your brain gets confused and doesn’t know what to do. Thus, you have vertigo.

The reason BPPV is considered to be benign is because it won’t cause any other injury to your body. And luckily for a good percentage of the population, it will resolve on its own. However, for those unlucky few, BPPV can be extremely upsetting and debilitating. It can cause nausea, vomiting, and severe imbalance. Which all makes sense because the people who experience this SERIOUSLY SEE THE ROOM SPINNING.

By now, there is a chance I could be losing your interest. But, this single diagnosis is more complex than what it seems. To keep things brief, there are 6 canals in your inner ear (3 in each ear). The crystals can get stuck in any of the canals and can be either free-floating or stuck. There are roughly 10 different ways people can have BPPV. And that’s if they ONLY have BPPV (which is not that common).

While the internet makes it seem like it is easy to treat (which sometimes it is), there is more to the treatment than meets the eye. And that is why, I am not a proponent of people doing the infamous Epley maneuver on their own without seeing a medical professional who is skilled with treating BPPV. The Epley maneuver does not treat all types of BPPV. Let me repeat that: The Epley maneuver does not treat all types of BPPV.

And, I would highly recommended to NOT do the Somersault maneuver.

So, now you’re probably wondering, if you can’t just do what the internet tells you, what are your options? Since I’m a physical therapist, and a lot of states now have direct access to physical therapy, I would recommend you seek an appointment with a physical therapist who is trained in vestibular rehabilitation. If you’re not sure if there is one in your area, this website provides a list:


You can also make an appointment with an ENT (Ears, Nose, and Throat doctor) as some of them will be knowledgeable in how to treat BPPV and, hopefully, will refer you to a physical therapist.

So, there it is: the first of many vestibular disorders that will be discussed. I’m sure there are so many questions that I would love to answer.

XOXO, Therapy Tash

Feel free to leave a comment or question!

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