Why Vestibular Therapy Works So Well for BPPV (And Why So Few People Get It)

Benign paroxysmal positional vertigo - BPPV - is the most common cause of vertigo in adults. It's caused by tiny calcium crystals (otoconia) that have migrated from their correct location in the inner ear into one of the semicircular canals, where they shouldn't be. When you move your head in certain positions, these crystals trigger false movement signals, causing a spinning sensation that can last 10–60 seconds.

The treatment for BPPV is a repositioning maneuver - a specific sequence of head movements, performed by a trained therapist, that uses gravity to move the crystals back where they belong. The Epley maneuver (for posterior canal BPPV, the most common type) typically resolves BPPV in 1–3 sessions. In many cases, it resolves in a single session.

So why do most patients with BPPV go months or years without getting this treatment? Because vertigo is commonly treated with medication (antivertigo drugs, anti-nausea medications) or reassurance to 'give it time.' Medication doesn't resolve BPPV - it suppresses the symptom while the crystals remain in place. And time alone helps only about 50% of cases within a month, versus 90%+ resolution with repositioning.

The problem is referral pathway. Primary care physicians often manage vertigo without referring to vestibular PT. Neurologists see it as benign and may not refer. ENTs sometimes treat it but don't always have the PT training for canal repositioning. Vestibular physical therapy sits in a gap where the treatment exists, is evidence-based, and works - but patients don't know to ask for it.

At Momentum, our vestibular evaluation begins with a Dix-Hallpike test to identify the specific canal involved (anterior, posterior, or horizontal) and the side. This takes about 15 minutes and is itself diagnostic. Once we know the canal, we perform the appropriate maneuver. For the most common presentation (posterior canal, Epley maneuver), resolution that same session is the norm, not the exception.

If you've had vertigo for more than two weeks, have been told it's 'just BPPV,' and haven't seen a vestibular PT, call us. The treatment is brief, non-invasive, and has an extraordinarily high success rate. It's one of the clearest wins in all of rehabilitation.

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