What is the Epley Maneuver?

How Vestibular Rehabilitation Therapists Use Canalith Repositioning Maneuvers (i.e. the Epley Maneuver) to Correct BPPV

There are many different treatments that vestibular rehabilitation therapists can provide to help with a wide variety of vestibular problems. One type of treatment includes performing maneuvers to correct Benign Paroxysmal Positional Vertigo (BPPV) which is one of the most common causes of brief vertigo or 'room spinning'.

The Epley Maneuver is a Specific Series of Head Positions Performed by a Medical Professional

A person suffering from BPPV will normally find that moving their head into certain positions causes brief vertigo, lasting about 30 seconds.  This is because otoliths (calcium carbonate crystals) that are no longer in the correct part of the inner ear, move with gravity and deflect hair cells which stimulate nerves to send false movement signals to the brain.  In maneuvers like the Epley Maneuver a medical professional moves your head slowly and carefully through a very specific series of positions.  This allows gravity to move the calcium carbonate crystals (otoconia) out of the part of the inner ear where they are not supposed to be, back into a place in the inner ear where they’ll no longer cause false signals and debilitating symptoms like vertigo. (Vestibular Disorders Association - VEDA)

It is very important to understand, however, that the Epley maneuver is only one of numerous canalith repositioning maneuvers and will ONLY work for certain variants of BPPV.  It is normally highly effective for the most common form of BPPV but if it isn’t working perhaps you have a different type of BPPV requiring a different maneuver, the maneuver isn’t being performed correctly, or maybe you don’t actually have BPPV at all.

Don't Try the Epley Maneuver By Yourself

Despite instructions being readily available on the internet, it is advisable to avoid performing the Epley maneuver on your own in most circumstances.  It is important for the diagnosis of BPPV to be confirmed by a medical professional who is specifically trained to do so, and they can also determine whether a patient is a candidate for a canalith repositioning procedure based on mobility and other medical conditions.  They can determine which variant of BPPV you have, which then dictates if the Epley maneuver is the appropriate treatment or whether a different canalith repositioning maneuver is required.   They would then proceed with helping you through the appropriate maneuver, so doing it on your own shouldn’t be required.  If the treatment isn’t immediately effective, the professional can help screen for other medical conditions that might make self-treatment unadvisable, and if deemed safe, they may teach you to do the maneuver on your own, however it is still recommended to do this under medical supervision instead for safety and effectiveness.

How Many Times Does It Take Before the Epley Maneuver Works?

According to the Vestibular Disorders Association, canalith repositioning procedures (like the Epley Maneuver) are very effective for BPPV, with an approximate cure rate of 80% and low recurrence rate (VEDA).  BPPV as the result of trauma may require more treatments to correct, however most people require just one treatment.  The vast majority of cases are corrected by 3 treatments, so if it seems to be requiring more, the following questions need to be asked:  Has the BPPV variant been identified correctly? Has the appropriate canalith repositioning maneuver been chosen?  Is it being performed correctly? And, could this be something other than BPPV?  A medical professional well-trained in vestibular disorders can help answer these questions.

Read about why it is so important to treat dizziness.

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Decreased Medical Clearance Time with Cervicovestibular Rehabilitation After Sports-Related Concussion: Trial

Many Common Symptoms Between Concussion and Neck/Vestibular Injuries

In sports, a concussion is a common injury from which individuals usually recover in 7-10 days. But for athletes whose symptoms persist beyond that point, it is not always clear whether a neck injury is involved and whether the vestibular (balance) system has been affected. Many of the same symptoms are common to concussions and to injuries to the neck and/or balance system known as cervical/vestibular injuries. These include dizziness, unsteadiness, neck pain and/or headaches following a sport-related concussion.

Trial Studies Whether Combined Vestibular Rehab and Cervical Spine Physio Decreases Post-Concussion Recovery Time

In the June 2014 randomized controlled trial "Cervicovestibular Rehabilitation in Sport-Related Concussion", the objective was to determine if a combination of vestibular rehabilitation and cervical spine physiotherapy would decrease the time until individuals with prolonged post-concussion symptoms received medical clearance.

The trial concluded that the combination of cervical and vestibular physiotherapy did significantly decrease the time that youth and young adults who had sustained a sport-related concussion and suffered from persistent symptoms of dizziness, neck pain and/or headaches, were medically cleared to return to their sport. Evidence suggests that a combined approach to treatment of the cervical spine and vestibular systems may facilitate recovery and decrease time lost from sport in individuals with persistent symptoms. Future research is expected to evaluate the optimal timing of treatment and the effects of covariates such as age, history of concussion and dosage.

The trial was conducted by Drs. Kathryn J. Schneider, Willem J. Meeuwise, Alberto Nettel-Aguirre, Karen Barlow, Lara Boyd, Jian Kang and Carolyn A. Emery at the University of Calgary.

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