Vertigo: Are you dizzy getting out of bed or bending forward?


Do you get dizzy or feel like the room is spinning when you lay down or attempt to sit up? If so, you may have Benign Paroxysmal Positional Vertigo (BPPV). Read on to learn more about BPPV and what Physical Therapists can do to help.


I Have Crystals Loose In My Head?

The answer is you may… but first what are these crystals everyone keeps mentioning? The vestibular system is your balance organ in the inner ear that contains calcium carbonate otoconia, which are referred to as “crystals”. When those crystals get loose, you may become dizzy.


A Quick Anatomy Lesson:

Otoconia (the crystals) are housed on top of a gelatinous membrane in the utricle and saccule in the inner ear that have hair cells that send signals to the brain that provide information on acceleration of the body. The hair cells are very sensitive to changes in gravity. When otoconia get stuck in the semicircular canals, people can feel dizzy. Based on the orientation of canals, the posterior canal is most commonly affected due to its proximity to the utricle.





What is Benign Paroxysmal Positional Vertigo?

Benign Paroxysmal Positional Vertigo (BPPV) is a condition where people experience transient feelings of room spinning vertigo, typically when lying down or when they attempt to sit up in bed. The sensation of vertigo is accompanied by nystagmus, or quick turning and flicking of the eyes. To see nystagmus in action- click this.

Nystagmus occurs due to nerve connections between the semicircular canals and the eyes. These connections are useful when you are trying to maintain focus with your eyes while your head is moving. However, this connection becomes faulty in BPPV, because the loose crystals are telling your eyes you are moving when in fact you are not. To learn more about nystagmus, read our short blog describing its function.

The cause of displacement of the otoconia crystals can be due to trauma to the head or neck (concussion or whiplash) or it could occur with no known cause (idiopathic). There are theories regarding why otoconia migrate to the canals when no trauma has occurred. Some believe it is a degenerative process that is associated with normal aging, which may explain BPPV’s increased prevalence in individuals over the age of 60 years old.


Can We Put The Crystals Back Where They Belong?

Yes! Physical Therapists who specialize in Vestibular Rehabilitation Therapy (VRT) are trained in non-invasive maneuvers to reposition the loose otoconia. The maneuvers utilize the natural orientation of the semicircular canals relative to gravity to move them back to the utricle. Many people search the internet and find videos and attempt to treat their own BPPV.


A word of caution: it is important that you are treating the correct canal and type of BPPV. Treatment by someone who is not trained in VRT could result in migration to canals that may be more difficult to treat than the original affected canal. Additionally, it is important for a trained professional to screen individuals for other conditions that mimic BPPV.