Today I'm going to teach you:
1. How you can tell if the dizziness that you're feeling is being caused by BPPV, otherwise known as the crystals and if a maneuver like the Epley maneuver may be helpful for you.
2. Or if it's been caused by something else which may warrant further investigation from a healthcare professional like a physical therapist
All right so let's get down to the details of how to determine whether your dizziness is caused by BPPV or not. The key to seeing if you have BPPV is if you have nystagmus with certain head positions. Nystagmus describes your eyes jumping and in the case of BPPV what we want to see is your eyes jumping after you've moved your head when your head is still. What we look for is the direction that the nystagmus is jumping as that direction will determine where the BPPV or the crystals are. Knowing where they are is crucial in treating someone as there are 6 canals they could be in and 10 different positions. Before we get into the specifics of which canal it's in I will say with BPPV you should expect to have the problem fixed within one to six sessions of treatment so if you're going like 10-12 sessions of treatment and it's not fixed there's a good chance that it might be something else and you really should have it look into further.
The first type we want to look at is what we call Posterior Canal BPPV. With posterior canal BPPV, we should expect the nystagmus to jump upwards and twist (what we call
Tensional). The position we want to get someone in, for right-sided Posterior Canal BPPV, is sit on a bed, turn the head to the right, and then lay back over a pillow with the head extended. When we get someone into this position and you look at her eyes you should expect to see the nystagmus or the eyes jump upwards and to the right. If you see that when she's into this position she has posterior canal BPPV. This is the position where the Epley Maneuver is warranted. Then what you want to do is figure out which side it's on because if it's on the left side the torsion or the twisting will happen to the left. If you do the Epley maneuver for the wrong side obviously that's not going to help and a lot of times it might make actually make things worse.
So if you do consider trying this at home be 100% sure you know where it's at and do it properly because if you don't do it properly you may make it a lot worse. And don't do it 10-20 times a day. I had one of my patients do that for a couple of weeks and she ended up herniating a disc in the neck because this is a position that can irritate the neck.
The second type of BPPV we want to talk about is when it's in the horizontal canal which is a different canal to the posterior canal. For this you want to lay down with your head tilted forward at about 30 degrees, so a couple of pillows typically are great. What we want to do is turn her head to the side relatively quickly and see what happens to her eyes. Then turn her head the other way very quickly and see what happens to the eyes. If it is a case of a horizontal canal BPPV what we should expect is the nystagmus or the beating of the eyes to happen sideways instead of up and down. But it's important to figure out which direction it's beating. With the horizontal canal BPPV simple version. When we turn to the right we should expect her eyes to beat down towards the ground. When we turn to the left the same thing should happen it should beat down towards the ground. If that is happening you have horizontal canal BPPV and the maneuver to perform is the Gafoni Maneuver which is a relatively simple maneuver.
The difficulty with the horizontal canal BPPV is to determine which side it's on because nystagmus is going to happen both sides. The typical rule of thumb is the side that has the more intense symptoms is likely the side affected. Let's say you feel it worse when I turn your head to the right versus the left, it’s likely the BPPV is on the right so the Gafoni maneuver would be performed to the right side. If you perform the Gafoni Maneuver on the wrong side you might migrate the crystals further into the canal which creates a more complicated version of BPPV which we'll talk about next.
The third version of BPPV is a horizontal canal BPPV but this time the crystals have gone way into the canal and it's actually stuck at the end of the canal which makes it obviously more complicated to get out. With this, what you should see is when I do the same test as before and turn your head to the right and to the left, we're going to see the eyes beat sideways but we're going to see it beat towards the ceiling now. My recommendation if that's happening because it's more complicated and may require two or three different maneuvers such as the Vanucci-Asperella Maneuver is to get it checked out by a healthcare professional like your physical therapists. At this stage you also have to figure out whether it's on the canal side or whether it's on the Utricular Side of the canal and it takes a bit of finagling to figure that out. It really can cause a lot of difficulties if you're trying to do this yourself.
The thing with the horizontal canal BPPV is they tend to cause more intense dizziness than the posterior canal so moving yourself around when you have this condition can really make you feel intensely dizzy and nauseated so you don’t want to be repeating it too many times.
So as you can tell it's really not that hard to tell if you have BPPV but the difficulty comes in determining where the crystals are. If you determine it in a wrong way then treatment could actually make you worse. So if it's something that you think you have. It’s very simple to have
someone look into your eyes or grab your cellphone and video record yourself and see if your eyes are jumping in these positions. This way you can determine if it is BPPV or not. Remembering the nystagmus when you do these tests should only last around about 30 seconds to a minute. If it doesn't stop and it continues for minutes at a time it's most likely not
BPPV and is likely something else. You should really get yourself checked out by a healthcare professional like your physical therapist. We can do further testing to determine if it's something
else like an infection a mismatch or some of the other conditions that create dizziness.
If you think you have BPPV I suggest you check it out. Have a look at yourself but before you start treatment get in touch with your healthcare professional like FYZICAL therapists because we're all trained in determining these things and we can help you go through and pick the right maneuvers to do. Remember, in most cases people get better within one to six visits so there's no reason to live with dizziness if it's something easily fixed like that.
For more information on BPPV and dizziness or if you would like to talk to us about your problem, call us at (570)501-1808 or email: Hazleton@fyzical.com.