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Benign Paroxysmal Positional Vertigo is a disorder of the vestibular system in the inner ear. The condition is characterized by a sensation of dizziness and spinning with change in head positions. It occurs when calcium crystals called otoconia are dislodged from their normal location from the top of the utricle (sensory organ of inner ear). These free floating crystals travel in the fluid contained within the semicircular canals of the inner ear. It is the movement of these crystals that can trigger the sensory receptors within the inner ear resulting in disorientation and disequilibrium.


  • Old age.
  • Head trauma.
  • Meniere’s disease.
  • Vestibular migraines.
  • Vestibular neuritis.
  • Maintaining static positions of the head such as in a dentist chair and prolonged bed rest.
  • Ototoxicity (inner ear infection).


  • Vertigo
  • Dizziness
  • Lightheadedness
  • Nausea/vomiting
  • Imbalance
  • Difficulty concentrating
  • Nystagmus (involuntary eye movements)

Symptoms are triggered by the change in head position like getting up from the bed, tilting head in shower, reaching for upper shelf.


BPPV is diagnosed by taking a medical history, a physical examination and vestibular and auditory tests. MRI may be recommended to rule out other conditions such as a stroke.

Dix Hallpike maneuver – This is a vestibular test: the physiotherapist or chiropractor will instruct you to sit on treatment table. You will be asked to lie back quickly while your head is held stationary in a certain position. These set of movements will usually trigger an episode of intense dizziness (vertigo) in patients with BPPV.


  • Epley maneuver- This treatment involves a series of movements.  First, while sitting up, the patients head is turned about 45 degrees to the side that normally provokes the vertigo. Then the patient is quickly laid down backwards with their head just over the edge of the examining table. This position usually provokes strong vertigo. The head is kept in this position for about 30 seconds and then turned 90 degrees to the opposite side. After another 30 seconds, the head and the body are turned together in the same direction so that the body is pointing towards the side, and the head is pointing down toward the ground at a 45 degree angle. After 30 seconds in this position, the patient is brought upright again. This is repeated as many as five or six times until neither vertigo or nystagmus are elicited when the head is brought into the previously aggravating position.
  • A hand held vibrator is applied to the bone behind the affected ear to help dislodge the crystals that may have become stuck on the walls of the semicircular canal.
  • Anti-nausea or antiemetic medicine is prescribed if vomiting sensation is severe.

If you are suffering from BPPV or have any questions regarding this condition don’t hesitate to contact us and book your free consultation. All the health professionals at P&C Rehabilitation Services have experience treating this condition. We have been providing chiropractic and physiotherapy to the Jane and Finch Community for 6 years. We take pride in providing excellent health care services to the North York community.

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P&C Rehabilitation Services Inc.
2100 Finch Ave West, Suite 310 North York, ON M3N 2Z9
Phone: 647-559-2003