Rehabilitation Techniques for BPPV Management

BPPV treatment is one of physiotherapy's genuine quick wins — but "quick" depends on using the right technique for the right canal. Here's the toolkit, and how each piece fits.

Step one: find the canal

The inner ear has three semicircular canals on each side, and displaced crystals can settle in any of them. Positional tests — the Dix-Hallpike for the posterior canal, the supine roll test for the horizontal canal — provoke a brief, characteristic eye movement (nystagmus) that tells your clinician exactly where the crystals are. Treatment is only as good as this diagnosis.

Repositioning maneuvers

• The Epley maneuver — the workhorse for posterior-canal BPPV. A sequence of four head and body positions, each held for 30-60 seconds, guides the crystals out of the canal and back into the chamber where they belong. Success rates are excellent, often within one to three sessions.
• The Semont maneuver — a brisker alternative for posterior-canal BPPV, useful when the Epley is impractical or hasn't worked.
• BBQ roll (Lempert maneuver) — a series of rolls used for horizontal-canal BPPV, which the Epley does not treat.

This canal-specific matching is why self-treating from internet videos often fails: the most-viewed maneuver only treats one of the possible canal patterns.

After repositioning: rebuilding steadiness

Resolving the spinning isn't always the end. Many patients are left with residual unsteadiness or motion sensitivity, especially if they avoided movement for weeks. Vestibular rehabilitation fills that gap:

• Gaze stabilization exercises — retraining the reflex that keeps vision sharp during head movement
• Habituation exercises — graded exposure to the movements that provoke mild symptoms until the nervous system stops overreacting
• Balance and gait retraining — progressive challenges that restore confidence on stairs, uneven ground, and in the dark

When to seek help

If brief spinning hits when you roll in bed, look up, or bend forward — or you've been "a bit off balance" since an episode weeks ago — an assessment takes one visit and treatment usually starts the same day. Call 587-355-3555 to book with our vestibular-trained team in NW Calgary.