Vertigo! The Room is Spinning!

Did you know that dizziness is one of the most common reasons people visit their doctor? Pain is usually number one, but dizziness is high on the list.

One very common cause of dizziness is vertigo. More specifically, many people who say they have “vertigo” are actually dealing with a condition called Benign Paroxysmal Positional Vertigo, or BPPV.

BPPV can be incredibly unpleasant. It can make you feel like the room is spinning, affect your balance, increase your risk of falls, and interfere with everyday life, exercise, and sports.

What is vertigo?

Vertigo is a sensation of motion when your body is still. Some people feel like the room is spinning. Others feel like they are spinning, tilting, or moving even though they are not. Vertigo is a symptom, not the actual diagnosis.

The most common type of vertigo I treat in physical therapy is BPPV.

What is BPPV?

BPPV happens when tiny calcium carbonate crystals in the inner ear move into a place where they do not belong.

Here is a simplified way to understand it. In one part of your inner ear, you have tiny hair-like structures with a gel-like substance on top. Sitting in that gel are small crystals. These crystals help your brain sense movement and acceleration.

For example, imagine you are driving a Ferrari and you step on the accelerator. The weight of the crystals helps pull on those hair-like structures, sending a message to your brain that you are accelerating. The opposite happens when you slam on the brakes. This is one way your brain knows you are speeding up or slowing down.

In another part of your inner ear, you have three tiny loop-shaped canals on each side. I often describe these as hula hoops. These canals help your brain detect rotation. Normally, these “hula hoops” contain fluid, but no crystals. When you turn your head, the fluid moves, the hair-like structures move, and your brain gets the message that your head is rotating.

BPPV happens when some of the crystals from the first area break loose and end up in one of the hula hoop-shaped canals. Now imagine putting a marble inside a water-filled hula hoop. When you move the hula hoop, the marble sinks with gravity and moves the water. That movement sends a false signal to your brain that you are spinning, even though you are not.

What are the most common symptoms of BPPV?

The most common symptom of BPPV is a brief spinning sensation that happens with changes in head position. This often occurs with movements such as rolling over in bed, getting in or out of bed, looking up, bending forward, or turning your head quickly.

Some people describe it as “the room is spinning,” while others feel like they are spinning, tilting, wavy, or off balance. The spinning itself usually lasts only seconds, but the nausea, imbalance, or “off” feeling can last longer.

What should I do if I have vertigo?

If this is your first time experiencing vertigo, or if the symptoms feel severe, constant, unusual, or unexplained, it is important to get medically assessed.

Physical therapists can treat BPPV, but we also screen for signs that dizziness may be coming from something other than the inner ear. Not all dizziness is BPPV.

If dizziness comes with symptoms such as weakness, numbness, facial drooping, trouble speaking, severe headache, chest pain, fainting, double vision, or confusion, seek emergency care right away.

If you have already been medically evaluated, or if your symptoms clearly fit the pattern of brief spinning with position changes, physical therapy can often help.

Why should I go to physical therapy for vertigo?

BPPV can often be treated very quickly. In many cases, people improve in 1 to 2 physical therapy sessions.

However, I do not recommend trying to treat vertigo on your own by Googling maneuvers. Physical therapists screen for other causes of dizziness, including more serious central causes.

There are also six possible canals where the crystals can be located, three on each side. The treatment depends on which canal is involved, which side is affected, and whether the crystals are free-floating or stuck.

If you treat the wrong side, use the wrong maneuver, or miss the specific head position, you can make yourself feel worse. In some cases, you can even move the crystals into a different canal, making the problem more complicated to treat.

The goal is not just to “do a vertigo maneuver.” The goal is to figure out exactly what is causing the symptoms and treat the correct problem.

Can I do anything to prevent vertigo?

Yes and no. Unfortunately, once you have had BPPV, it can come back. Some people are more prone to recurrence than others.

During a physical therapy visit, we can talk about possible risk factors, what to watch for, and what to do if symptoms return.

The bottom line

If you feel brief room-spinning dizziness when you roll over in bed, get in or out of bed, look up, bend forward, or change head position, you may have BPPV.

If this is your first episode, or if your symptoms feel severe, constant, unusual, or unexplained, get medically assessed first. If it is BPPV, physical therapy can often help quickly and safely.

If you or someone you know is dealing with spinning dizziness, schedule an evaluation and let’s help you get back to moving with confidence.

If you are curious what vertigo can look like, scroll down to watch a video of nystagmus, the abnormal reflexive eye movements that can occur with vertigo.