For Physical Therapy In Spokane Valley Call Now! 509.892.5442

Call Now! 509.892.5442

3-Step Approach to Eliminate Vertigo (BPPV – Benign Paroxysmal Positional Vertigo)
May 31, 2019
The first blog/video in this series was all about vertigo, particularly “inner ear vertigo” or BPPV (Benign Paroxysmal Positional Vertigo).

Click this link if you want to see the first part:

In this second part, I’m going to share some specific information about how we help our clients fix BPPV quickly in the clinic by following a 3-step approach.

Before I give you those details, recall that BPPV has some very telling symptoms: people tend to have sudden and often severe episodes of vertigo following certain head movements or position changes (like tipping the head back, bending forward, getting in and out of bed, and rolling over in bed).

If this sounds like you or a loved one, the information below should be very helpful!

*If you prefer to watch the video version of this blog, feel free to scroll down to the bottom 🙂

A 3-Step Approach to Eliminate BPPV

Step #1: Determine which canal is involved. Recall from last week that BPPV involves little rocks or crystals floating into the inner ear canals and affecting the movement of the fluid inside the canals. There are 3 canals on each side of the body. Before you can start trying to clear the little rocks, you have to figure out which canal is involved (if you’re lucky, it will just be 1 canal, but sometimes more than one canal is involved). There are 2 positional tests we use to help us with this task: the Dix-Halpike test (posterior canals) and the Supine Roll Test (horizontal canals). During these tests, our therapists will look for involuntary movement of the eyes, which we call “nystagmus”. These eye movements, as well as the accompanying reports of vertigo, help us determine which canal(s) are involved. From there, we can progress to step 2.

Step #2: Clear the rocks from the canal. The majority of our clients with BPPV will have rocks in one canal only, typically in one of the posterior canals. If this is the case, we’ll use the appropriate repositioning maneuver (the most common one is the “Epley Maneuver”). Essentially, these maneuvers allow us to roll the little rocks through the canal until they pop back through the opening (which is where they came from and where they belong!). After performing the maneuver 2-3 times, the vertigo is usually drastically reduced. Some people have 100% relief, while others still have some residual sensations of unsteadiness. This leads to step 3.

Step #3: Prevent and tune. Once we clear the rocks from the canals, the third step is twofold: first, we want to make sure the little rocks don’t float back into the canals. This involves sleeping in a chair or with your head elevated, as well as trying to avoid sudden head movements. And second, you want to “tune up” your inner ear with some specific exercises. Even if all the little rocks are cleared from the canals, people can still have some residual sensations of unsteadiness. I like to think of this as your inner ears being a bit out of sync. Think of turning the dial on an old FM radio until the station comes through clearly. This is the same thing we need to do with the inner ear: as we help our clients with specific “vestibular exercises”, we’re bringing the 2 sides back into clear reception of head movements.

Those 3 steps help the majority of our clients clear up sudden episodes of positional vertigo quickly. However, I’d like to add a 4th step to the larger picture regarding balance and fall prevention. Can you guess what it is? Think about all of the articles in this series, including things like the “3 Balance Systems” and the “8 Other Factors”… Any ideas?

The 4th step is this: realize that there are so many things that can still be impacting your balance and overall mobility. And while clearing up positional vertigo is a huge relief for most people with BPPV, if they’ve had balance issues for any length of time, it’s very likely that they can improve their balance and mobility by looking into all those other factors. So don’t settle!

I think that’s enough information about vertigo for one day! If you have more specific questions about vertigo, please feel free to email my at

And if you’d like more information and tips about how to improve your balance and reduce the likelihood of having a fall, you can download my free report titled “9 Way to Improve Your Balance & Prevent Another Fall” by clicking this link:

If you’d like to learn how to perform the Epley Maneuver for the treatment of posterior canal vertigo (BPPV), check out the video below!

This maneuver can be hard to perform on your own, so make sure you get some help in case you need it.

spokane valley gordon physical therapy

Monday   7:00 am - 6:00 pm

Tuesday  7:00 am - 6:00 pm

Wednesday  7:00 am - 6:00 pm

Thursday  7:00 am - 6:00 pm

Friday  7:00 am - 5:00 pm

Saturday  Closed

Sunday  Closed

Gordon Physical Therapy - Spokane Valley, WA

626 North Mullan Road #4, Spokane Valley, WA 99206

(509) 892-5442

© 2023 Gordon Physical Therapy

Share This