BPPV – Benign Paroxysmal Positional Vertigo


What is BPPV?

BPPV stands for Benign Paroxysmal Positional Vertigo and is usually characterised by an intense, brief episode of dizziness associated with head movement, often when rolling over in bed or getting up in the morning.

Benign – not life threatening or sinister
Paroxysmal – it comes on suddenly, but usually short lasting
Positional – triggered by certain head positions or movements
            Vertigo – a false sense of spinning or dizziness

In our vestibular system, located in our ear, we have 3 canals in which fluid passes through stimulating tiny receptors that send messages to alert the brain of any head rotation or movements. The brain receives the messages and we can then adjust our eyes and posture accordingly. The normal fluid travelling within the canals do not react to gravity.
When BPPV occurs, a tiny crystal is formed and enters the vestibular system through one of the canals. As the crystal is heavier than the fluid moving through these canals, it reacts with gravity when our head is turned, causing the brain to receive a false message that the head is spinning at a much faster rate than what is happening. Therefore, there is a mismatch in messages between what the ears are sensing and what the eyes are seeing or how our body is reacting, resulting in a spinning experience or dizzy sensation.

What Are The Symptoms of BPPV?

The main and most common symptoms are a sensation that the room is spinning, dizziness, light-headedness, imbalance or nausea. These symptoms usually occur with change in body position. An external person will observe your eyes rapidly moving, this is known as nystagmus.

BPPV symptoms usually last a few seconds, this is until the crystal comes to rest in the canal due to gravity. It is important to know that BPPV will not give you constant dizziness that is unaffected by movement or a change in position. It will not affect your hearing or elicit neurological symptoms such as numbness, pins and needles, trouble speaking, weakness or difficulty co-ordinating your movements.

Why Do People Get BPPV?

The exact cause or reason for BPPV still is unknown; however, research has linked the following causes to cases of BPPV;

  • Head injury
  • Degeneration of the vestibular system in the inner ear due to ageing
  • Damage caused by an inner ear disorder
  • Illness such as the flu or viral symptoms

How is it Diagnosed?

Normal medical imaging (e.g. MRI) is not effective in diagnosing BPPV; however, a trained physiotherapist or doctor is able to assess a patient and diagnose the condition through a series of tests and head movements. A positive BPPV test returns when a patient displays nystagmus (rapid eye movements) and/or their dizziness symptoms. The most common manoeuvre to assess is called a Dix-Hallpike.
The aim of assessing and diagnosing is to reproduce your symptoms; therefore, it is advised that a patient be accompanied and driven to their appointment or that they are to wait in the waiting room after their treatment until they are safe to drive home.

How is it Treated?

Many patients are given medication for BPPV from their doctor; however, these medications usually just mask the symptoms.
Majority of cases can be corrected manually by your Enhance Physiotherapist. Once the affected canal is identified and the type of BPPV is determined, you will undergo the appropriate manoeuvre which makes use of gravity to guide the crystals back to the appropriate chamber where they are supposed to be. The most common manoeuvre is called the Epley Manoeuvre.

What Happens After Treatment?

Many studies have shown that the above technique has a high success rate after the first treatment. In some instances, the crystals may be more stubborn and require multiple treatments. There can also be more than one canal involved; however, only one canal can be treated at a time.
Even once the crystal has been successfully returned to the correct chamber, some people can be left with residual dizziness or fatigued feeling. Your Enhance Physiotherapist can give home-based exercises to address this.

Will it Come Back?

Unfortunately, BPPV is a condition that can re-occur periodically, especially those related to trauma. There are other conditions that can mimic BPPV symptoms, so it is always advisable to have a thorough assessment performed by an Enhance Physiotherapist and a diagnosis given before commencing treatment.

Book your Enhance Experience online, or call us today.


Peng You, R. I. (2019, February). National Center for Biotechnology Information. Retrieved from Benign Paroxysmal Positional Vertigo: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383320/pdf/LIO2-4-116.pdf

Benign Hypermobility Syndrome and Other Disorders

Enhance Physiotherapy is pleased to offer our patients treatments and other options for management of chronic health conditions such as benign hypermobility syndrome, fibromyalgia and other rheumatoid and body disorders, as part of our comprehensive services.


Benign Hypermobility Syndrome, or BJHS is a connective tissue disorder that can lead to hypermobility, where musculoskeletal symptoms occur without a systematic rheumatologic disease. This syndrome is thought to be an inherited disorder. BJHS clinically presents with hypermobility and pain in multiple joints. It is different from other disorders that cause local joint hypermobility and generalized joint laxity such as Ehlers-Danlos Syndrome and Marfan Syndrome; all of which an Enhance Physiotherapist can help with structuring a treatment plan to suit your individual condition.

When a patient first presents with BJHS the chief complaint is general joint pain so Benign Hypermobility Syndrome can be easily overlooked and not considered in a diagnosis. Here at Enhance Physiotherapy we follow a complete assessment that uses the Beighton criteria to facilitate the diagnosis of BJHS.

Fun Fact – generalized joint laxity is commonly seen in healthy individuals who do not have complaints. Hypermobility that is not associated with systemic disease occurs in 4% to 13% of the population. Hypermobility diminishes with age and it appears to be related to sex and race.

Fibromyalgia, is a common condition that affects a large population.  It is characterized by symptoms of widespread pain and tenderness in the body often accompanied by fatigue and problems with concentration. At Enhance Physiotherapy, we offer thorough assessment of pain structures to assist in designing a specific individualized treatment plan to ensure your goals are met and pain is well-managed.

Other Disorders of the body arthritis/rheumatoid arthritis and other such conditions, Enhance Physiotherapy and our highly trained exercise physiologists and physiotherapists are here to help with diagnosis, maintenance, management and giving you the ability to achieve your goals and live your best life. Through individualized treatment plans and programs focusing on your goals; not your limitations of your pain, together, we can achieve anything and everything.

Book your Enhance experience online today or call us on 9583 5165

Upper Crossed Syndrome – how can remedial massage help?

What is Upper Crossed Syndrome (UCS)?

Upper Crossed Syndrome (UCS) a very common musculoskeletal imbalance of the upper body. It is usually caused by poor posture or repetitive tasks in prolonged standing or sitting positions. As a result, particular muscles become chronically tight and shortened due to becoming overactive. These include the muscles of the upper back and neck (upper trapezius, levator scapula & sub-occipitals), and the chest (pectoralis). Excessive shortening of muscles, results in an imbalance. The surrounding counter muscles are under used and weak. These include the muscles of the upper back (mid-lower trapezius, rhomboids & serratus anterior), and the deep cervical flexors in the neck. This muscular imbalance results in rounded shoulders, winging of shoulder blades, and a forward head position with a protruding chin.

What are the Symptoms of UCS?

  • Neck & jaw pain
  • Headaches
  • Pain, tension and restricted mobility in the neck, upper back, shoulders, chest & ribs
  • Weakness in the front of the neck, while strain in the back of the neck
  • In some cases pain,numbness, and tingling in the upper arms
  • Lower back pain
  • Discomfort when sitting to read, watch TV and prolonged driving
  • Fatigue
  • If untreated can result in chronic conditions such as shoulder instability, impingement and bursitis.

What Causes UCS?

UCS can present itself because of prolonged poor posture, eg. standing or sitting for long periods with the head pushed forward.

  • Reading
  • Watching TV
  • Using a iphone, laptop, or computer
  • Cycling
  • Driving
  • Congenital defects or injuries in small cases.

How can a remedial massage therapist (RMT) provide relief for individuals with UCS?

An RMT can use their skills in soft tissue work and a variety of techniques to release the tight and overactive muscles, and then stimulate the weak and underactive muscles. This is beneficial in order to properly encourage them to activate and strengthen. An RMT will then formulate a treatment plan which can include simple self-care exercises and stretches to manage UCS causes and relieve symptoms.

At Enhance Physiotherapy, a skilled RMT such as myself can be used as an effective complementary treatment for UCS.  Especially most effective in conjunction with treatment and exercises prescribed by our experienced team of Physiotherapists and Exercise Physiologists.

Briella RMT

(08) 9583 5165

Enhance Physiotherapy – Mandurah