BPPV or Benign Paroxysmal Positional Vertigo

Wed, 27 May 2026 22:35:44 GMT

BPPV or Benign Paroxysmal Positional Vertigo

Most of us have experienced dizziness at some point in our lives, be it from getting up too quickly, dehydration or even spinning rapidly in an office chair. However, there may come a time when dizziness isn’t as easily explained and the symptoms persist for a much greater length of time. This could indicate a form of dizziness known as vertigo, where the spinning sensation isn’t necessarily just within the head but the room appears to be moving instead.

Vertigo can be due to numerous reasons, but one of the most typical causes is Benign Paroxysmal Positional Vertigo (BPPV) which is an inner ear disorder ¹ . To help determine if BPPV is the leading factor of a patient’s symptoms, a physiotherapist or health care practitioner trained in vestibular therapy may perform various maneuvers which will provoke symptoms if positive. A confirmation of BPPV can then be treated by the vestibular physiotherapist. Typically the majority of individuals experiencing BPPV are aided by treatment, as studies have shown usually one third of patients will be fully recovered by 3 weeks ² . Despite recovery, it is not uncommon for BPPV to reoccur months, even years later.

Risk Factors

In the majority of cases, there is no known cause of BPPV, as 50-70% of cases are idiopathic ² . There are some risk factors for the condition, but in general these risk factors cannot be controlled. Risk factors include: increasing age, genetics, female gendered, head trauma, osteoporosis, vitamin D deficiency in post-menopausal women, prolonged bed rest, chronic headache and neck pain, diabetes mellitus with high blood pressure, hyperlipidemia, thyroid disorders, hearing loss, pigmentation disorders such as vitiligo, multiple sclerosis and Parkinson’s disease ² . Generally the occurrence of BPPV is often spontaneous in those aged 50-70 years. The most common cause in younger individuals is due to a head injury, but it could still occur from a spontaneous onset ³ .

There are some types of dizziness that may mimic BPPV, but there are often other identifying characteristics for these conditions. For instance, the type of vertigo due to Meniere’s disease may also present with fluctuating hearing loss and tinnitus ² . Meniere’s is typically treated with medications, however for true cases of BPPV medications tend to not significantly affect symptoms and repositioning procedures are by far the superior method of treatment ¹ . Thus it is important to be properly diagnosed before entering any form of treatment.

Cause of BPPV

So what makes the room spin with BPPV? The cause is due to small calcium crystals that end up entering one of our three semicircular canals ⁴ . These little crystals/rocks are meant to be present in our ears, but they are supposed to be located just outside the canals within a gelatinous fluid filled cup (the utricle). The utricle is one of the components that helps us with our balance. The three semicircular canals that are present in each ear should just be filled with fluid (endolymph) with no crystals present; when we turn our head to one direction, the fluid in our ears will move which then cause little hairs at the end of the canal to move. These tiny hairs then send a signal to our brain letting us know which position our head is in. Our eyes will also send a signal to the brain telling us which way we are positioned. As both signals match, our brains create a semblance of balance.

However, should the crystals end up getting into one (or multiple) canals of our ears, when we turn our head a certain direction the fluid in the canal may hit against the crystal/rock and a backflow will be created. This backflow of fluid causes the hairs at the end of our canal to move in a different direction. Our brain will then receive the signal from our ears that our head is facing a different direction compared to the signal coming from the eyes. Having these mixed messages is what causes the room to spin. In order to fix this spinning, various positioning maneuvers can be done to relocate the crystals out of our ear canals and back to the utricle they came from.

Treatment

As mentioned above, repositioning maneuvers are the golden standard for treatment of BPPV. However, it can be difficult to self assess which of the three canals is being effected, which ear is effected, and if the crystals are free floating within the canal or have become stuck. Each one of these factors are important in determining which maneuver is needed for treatment. For instance, the Epley’s maneuver (the most commonly used technique) is most effective for free floating crystals (canalolithiasis) that are in either one of our posterior or anterior semicircular canals. The majority of research has determined this type of BPPV is the most common, however there are many cases where the Epley’s maneuver is performed and symptoms will not improve due to a different canal being affected ⁴ .

A vestibular therapist is trained in knowing which type of treatment to perform depending on where the crystal or crystals are located. There are cases where BPPV self resolves, but some symptoms still remain. In this case, specific exercises known as “habituation exercises” may be provided. In the circumstance where a patient is assessed and no tests of BPPV are positive, then the therapist will likely provide a note indicating their findings for your home doctor. As BPPV is the most common form of vertigo, it is worthwhile being checked by a vestibular therapist as to avoid undergoing any unnecessary testing or interventions. According to research, more than 65% of patients with BPPV are misdiagnosed ⁴ . If you are concerned you are experiencing symptoms of BPPV, please book in with a vestibular trained therapist at Central Park Physiotherapy.

Citations

Saishoji, Y., Yamamoto, N., Fujiwara, T., Mori, H., & Taito, S. (2023). Epley manoeuvre’s efficacy for benign paroxysmal positional vertigo (BPPV) in primary-care and subspecialty settings: A systematic review and meta-analysis. BMC Primary Care, 24, 262. https://doi.org/10.1186/s12875-023-02217-z
Koshi, E. J., & Sutton, A. E. (2025). Benign paroxysmal positional vertigo. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470308/
Hornibrook, J. (2011). Benign paroxysmal positional vertigo (BPPV): History, pathophysiology, office treatment and future directions. International Journal of Otolaryngology, 2011, 835671. https://doi.org/10.1155/2011/835671
Bhandari, R., Bhandari, A., Hsieh, Y.-H., Edlow, J., & Omron, R. (2023). Prevalence of horizontal canal variant in 3,975 patients with benign paroxysmal positional vertigo: A cross-sectional study. Neurology: Clinical Practice, 13 (5), e200191. https://doi.org/10.1212/CPJ.0000000000200191

Why Pickleball Is Great for Your Health: A Physiotherapist’s Perspective

Thu, 09 Apr 2026 22:14:47 GMT

Why Pickleball Is Great for Your Health: A Physiotherapist’s Perspective

Pickleball has quickly become one of the fastest-growing sports across Canada and North America, and it’s easy to understand why. It’s social, easy to learn, and suitable for a wide range of ages and fitness levels. From a physiotherapy perspective, pickleball can be an excellent way to stay active, improve physical health, and support long-term mobility.

The Physical Benefits of Pickleball

Pickleball combines elements of tennis, badminton, and table tennis, requiring quick footwork, balance, coordination, and controlled upper body movements. Regular play can help improve:

Cardiovascular fitness through continuous movement and rallies
Lower body strength from squatting, lunging, and side stepping
Core stability to support balance and rotational movements
Upper body strength and coordination in the shoulders, arms, and wrists
Reaction time and agility with quick directional changes

For many adults, it provides an enjoyable way to meet weekly exercise recommendations without feeling like a traditional workout.

Why It’s Great for Joint Health and Mobility

As physiotherapists, we often encourage movement as one of the best tools for maintaining healthy joints. Pickleball encourages regular movement in multiple planes, which helps support:

hip and knee mobility
ankle stability
shoulder range of motion
spinal rotation and trunk control

Because the court is smaller than a tennis court, it can be a more approachable option for people who want a racquet sport with less running.

Injury Prevention Tips

Although pickleball is generally low impact, injuries can still happen, especially if players are returning to sport after a period of inactivity.

Common issues we see include:

shoulder strain
tennis elbow / wrist irritation
calf or Achilles tightness
knee pain
low back stiffness

A proper warm-up, strength training, and mobility work can significantly reduce injury risk.

Before playing, consider:

5–10 minutes of brisk walking
dynamic leg swings and lunges
shoulder mobility exercises
calf and hamstring activation

How Physiotherapy Can Help

If you’re experiencing pain during or after pickleball, physiotherapy can help identify movement restrictions, muscle imbalances, or technique issues contributing to symptoms.

Treatment may include:

manual therapy
mobility work
strength and conditioning
balance training
return-to-sport programming
a personalized home exercise plan

The goal is not just to reduce pain, but to help you continue enjoying the sport safely and confidently.

Final Thoughts

Pickleball is more than just a trend — it’s a fantastic way to stay active, social, and healthy. Whether you’re new to the sport or playing several times a week, keeping your body strong and mobile can help you perform better and prevent injuries.

If pain is limiting your game, a physiotherapy assessment can help keep you on the court. Contact us or book an appointment today .

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BPPV or Benign Paroxysmal Positional Vertigo