- (upbeat song) Bob and Brad
the two most famous physical therapists on the internet.
- Hi folks.
I'm Bob Trump, physical therapist.
- Brad, I'm a physical therapist.
- And together we are the most famous
physical therapists on the internet.
- In our opinion, of course, Bob
- and Brad,
- Bob and Brad.
- Yeah. Today, we're gonna talk about
the epley maneuver
Brad for vertigo, what you need to do and how to do it.
We've done some videos on this already, but I,
thought we'd do a nice, comprehensive one where you do it.
Whether or not you have symptoms going
to the right or to the left.
- Sure.
- You know which ones to which one to do.
- Exactly.
- So B P P V.
That's what this is for.
Do you wanna say it?
- No, you do it Bob.
I it's always,
- I always say it wrong.
So benign proximal, positional vertigo?
- Right.
I like even B P P V.
You gotta make sure slow it down.
- Right.
So if you're, if you have vertigo, Brad
the most common cause of vertigo is B P P V.
- Sure.
- So this whole video is based to con on odds, really.
We're gonna show you the most likely cause
of your vertigo is B P P V.
And we're also gonna show you the most
likely thing that's gonna help it.
- Sure.
- So,
- And there's
you can have vertigo that can be treated
with medications and this will not work. Correct?
- Right.
And there's vertigo that can be, what, is more called.
This is a peripheral oral peripheral problem
- Out to the,
- Yeah.
It could be more of a central in the brain itself.
- Sure.
And this will not help that either.
- Okay.
- So the idea behind this, Brad
is that you've been diagnosed by a doctor and
and you have B P V. B P P V.
And you've probably even been treated for it already
- Sure.
- But they sent you home.
Sometimes they, you can go ahead
and do the epley maneuver again on your own.
- Right.
- They'll even show you how to do it, so.
- Right.
- 'Case your therapist didn't teach you, well
we're teaching ya!
- Right.
Or you may have an appointment
and you just wanna see what you're gonna experience.
- Right.
- And you'll go in and find out.
- Right.
- You know, so it's not all brand new to you.
- Exactly. And by the way, Brad,
- Yeah?
- Speaking of brand new,
- They are new.
- Yeah.
- Good segue.
So if you haven't already
please take a second to subscribe to our channel.
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We provide videos on us, stay healthy, fit, pain free.
And we upload every day.
- Boy, you're doing that well, Bob, so.
- Alright.
- Let's carry on.
- Alright. The vertigo B P P V occurs mostly in adults.
It's also, like we said, the easiest to treat in fact, 84%
they did a fairly large study, Brad.
- Sure
- 84% were cured after one treatment
and 93% were cured after two treatments.
- Sure.
- What I've seen personally, Brad,
is a lot of times it only takes one treatment
but sometimes I have to do a couple
of epley maneuvers in the same session.
- Sure.
- You know what I mean?
- Yep.
It didn't take the first time.
- With my people,
a lot of times they, they go and I say, you know
come back or call me.
I wanna know what's going on.
And I don't hear.
- Yeah. I know, which is a good sign, I hope.
So it's a great one in the sense
that it's one of the most easily things to cure.
So B P P V is
is usually a brief episode of vertigo spinning
after you change your head position.
- Right.
That could be laying in bed and you roll your head.
And it's like, whoa.
Things just really, I mean, sometimes get pretty severe.
You can get nauseous.
It's very uncomfortable.
- Yeah. It's not, not fun.
Yeah. It can be triggered by lying down
rolling in bed, bending over, looking up.
So a lot of people get it
like when they're gardening.
- Right.
- Or where they're, when they're in the shower
or washing their hair. Where I get a, a brief out of this
Brad is when I go to the dentist
and they take me back in that chair.
- Sure.
- Or maybe,
- It is just because the
psychological thing of what he is gonna do
to your.
- That could be it too, 'cause yeah.
That's not fun.
But the other one is when Brad goes to the beauty parlor.
- Shush!
- No, no.
- What? We're not gonna get
into the what's going on in the, in the canals and, and the
the crystals that are floating around.
- Yeah. There's debris or just briefly fragments
and some they're in the wrong spot.
- Right.
- And we're trying to get 'em in the right spot
'cause there's different theories
on what's really going on, Brad.
- Okay.
- I don't think they all know for sure.
- Right.
- But yeah.
There's little debris.
You have these little canals in your inner ear.
- This is all in there.
We have another video that actually have pictures of this.
We're not gonna get into that today.
We're gonna get more into the treatment.
- Right.
- They're probably waiting for that now.
- Yeah.
But I think it's under, it's good to
understand what we're trying to do, Brad,
- Sure,
- So that, you know
by moving the head in different positions
we get the debris or the little rocks
or whatever you wanna call it in the right position.
And then hopefully they'll stay there.
So that's, that's what the important
the other thing is why it's important to
understand this spread is there's three canals.
- Okay.
- The posterior horizontal and anterior
the epley maneuver is gonna help almost three
different situations if you have the anterior posterior
or anterior and posterior.
- Okay.
- So it's gonna help though.
So it's gonna help in 95% of the cases. In 5% of the cases
if you have it in the horizontal canal
this is not gonna help.
- Okay.
- So if you're one of those people, you know
they do the epley maneuver on it,
doesn't work,
maybe you're that 5% and you need to, you know
do the another one.
- Sure, right.
- So, alright, let's talk about what we do.
Brad. When somebody comes in, once you get in the
long sitting position here,
- All right.
This is the test that you really wanna do
and we call it the Dix,
It is called the Dix Hallpike Maneuver.
- Sure.
- So basically before we, I have Brad do this, though,
I wanna make sure he is not having any neck problems.
- Okay.
- If he's had neck surgery,
or he's got rheumatoid arthritis, or
if you've been having pain down your arm from your neck.
- Sure.
- If you've had any problems
with your carotid arteries or anything like that, Brad
I probably wouldn't do any of this either.
- Sure.
- So just all those surgeries, but I usually what I
what we'd like to do is make sure
that they can turn their head at least 45 degrees,
which is, Brad, that's halfway.
- I wanna look at them though, Bob.
- Yeah. All right.
Well, we go that way 45 that way.
So 90 is all the way to the right.
45 is halfway.
So I gotta make sure his neck will allow that.
And then I gotta make sure he can go back about
20 to 30 degrees.
- Okay.
- If he can't do any of those, I don't, you know
let's say he has no neck movement going back.
I don't think this is gonna help him.
- Sure.
- 'Cause we can't even get into that position.
- Right.
- So, all right.
So I'm gonna check his right side first.
So I'm turning his chin 45 degrees, halfway,
and then we're gonna bring his head back very rapidly.
And he is gonna go into 10
20 degrees of extension or 30 degrees of extension around
like that different people say.
- So the head's going back?
- Yeah.
- With extension
- And Brad, what he's looking
for does this cause his symptoms
and I'm looking at his eyes to see
if his eyes are going back and forth and you're okay, Brad?
- Yep.
- This would actually set me off if I did this.
I yeah.
- What do they call that when the eyes are going back?
- Nystagmus.
- Right. And sometimes they put those funny glasses
on 'em so they can see it easier.
- Yeah. Yeah.
They, they put glasses on
so they can see it on a screen and they
and 'cause the eyes can go back and forth.
They can flicker up, they can flicker down.
- Sure.
- They can flicker in a whole bunch of different ways.
So, we went to the right.
There was no symptoms, or maybe there was symptoms.
We'll say there was Brad, okay?
- Okay.
- But let's go to the left 45 degrees.
- Yep.
- We're gonna go back.
No symptoms that time.
- No symptoms.
- Yeah. To be honest, if I found symptoms
going to the right.
I probably won't even do the left
because we already know that.
- Sure.
- That you're fine, so.
All right.
So now I know his symptoms are going to the right.
That's what sets it off.
- Sure.
- So we're gonna do the epley maneuver to the right.
So we're gonna start off in this position again.
45 degrees.
We go back. We go back to 20 degrees or 30 degrees depending
on who you research and we're gonna wait at least
until the symptoms stop, or as I stop moving, or a minute.
- Okay.
- Whichever one comes first.
- Right.
- So if you say Brad's symptoms have stopped.
So now we're gonna go ahead
and turn his head 45 degrees to the opposite direction.
- So, and your head has to be hanging
off the edge of the table so we can get that extension.
Right, Bob?
- Yep. If you don't, sometimes we put pillows under people
so that they can stay on, on the bed itself.
- Sure
- You know?
- But that makes sense.
- Same thing.
We're gonna wait until the symptoms start to subside.
Now we're gonna have Brad roll onto his shoulder
and Brad and I were just talking about this quite often.
We have another person here so that they don't
go rolling right off the bed or they're afraid.
- Well, they feel a lot more comfortable
with someone run here.
- So now their head has turned still 45 down.
So they're kinda looking down here and now
with them in this position, again, the symptoms have stopped
or it's been a minute, we go ahead and have Brad push
up.
- And usually I'll have the people take their legs
pull 'em off the table.
And that kind of gives 'em some leverage too easier
easier to come up.
And a lot of times between each position, Bob
do you find that,
they'll say, oh, I'm feeling dizzy.
And then once they're there, like you say 20 seconds
or so it settles down and then.
- Yeah, in a big settle down
after 20 seconds, you can then go to the next position.
- And this one, I should be looking down.
- No, you were, you started off, you're there
but when you come up you're just up.
- Okay.
- You're fine.
- All right.
- Now we'll talk about what to do after that
but let's show the other direction now, Brad.
Why don't you come back up again here.
All right.
Now this time we're gonna go the other direction.
We're going to the left.
His symptoms were to the left, we're going to say.
So he goes 45 degrees.
He comes back.
You gotta be scoot back a little bit more.
Don't you Brad?
- Yep.
So now he's, we'll go 20 seconds here.
Or you know
until the symptoms go away, or a minute. We go this way
45 degrees here, still 20 degrees at the extension.
Now his symptoms have stopped.
Now he's gonna come toward me.
His head's still at 45 degrees looking down. Symptoms stop.
So he is gonna go ahead and push up.
Okay.
Now this is where we don't want him looking down anymore.
Yep.
So what we use, is we usually give them a collar
and this is just for the rest of the day.
You can buy a collar like this, just a soft collar.
- Yeah.
- Or you can actually just take a pillow case
and you fold it lengthwise in half,
fold it again.
And then you can just go around like this.
And it's just, it's just enough to remind you not to look
down because people will forget.
I've had people do this and I go, don't look down
and they look down before I even see 'em leave the room.
- Yeah they're gonna pick up the something
off the floor or you know, all those things.
Either that, or if they happen to have
Actually some
of my patients, I'll say, if you want to go buy one
and they just go buy one for 10 or 15 bucks
'cause they're so sick and tired of their problem.
- Yeah.
- And this may be a little more,
gives you more of a reason not to look
- Right, look down.
- It's a little more stiff than that.
- But either way for the rest of the day
you're gonna wear that support.
And then that night, what it used to be,
that it would be for 48 hours that I couldn't look down.
- Right.
- Yep.
- Now it's they found out
that it really didn't make any difference, Brad.
- Sure.
- So that night I'd like to have you sleep
on a couple pillows, so you're a little bit raised up.
- Yep.
- And then the next day you can do whatever you want.
- Right.
- So until the rest of the day
you have the collar, sleep on a couple pills that night,
and then the next day you can do what you want.
If the symptoms come back, you wanna repeat this.
- Right.
So sometimes, maybe 50% better.
It's like, oh, it's a lot better.
But it's still a little bit there.
Another reason to
- Yeah, some people get that sensation of
dizziness or floating that occurs.
- Yeah.
- You know, days afterwards, even.
- Sure.
- So,
- All right, well, I hope that helped.
And we can fix just
about anything.
- Except for that broken heart.
- Yep.
- But yeah, this epley maneuver's
not even close to this part
but you know, it's in the, I don't know.
- Yeah.
- We'll work on that, Bob.
- It's not in the head.
Thanks a lot.