Hello, I'm I'm Bob Schrupp, physical therapist
I'm Brad Heineck, physical therapist
Don't bother me, Bob. I'm looking up the Epley maneuver we're talking about-
Right, today we're going to talk about the Epley maneuver-
Basically were going to show you how to do it.
It's also called the Canalith Repositioning Maneuver
and what it's for is a type of dizziness
and specifically we usually use it for
Benign paroxysmal positional vertigo.
-It's a mouthful. -It's a mouthful. It's a type of vertigo, a type of dizziness
Basically what we would like to see is that you were diagnosed with this by your doctor
now you were asked to do this type of maneuver
or your physical therapist or somebody may be doing this maneuver with you.
We're just going to go over it with you, or maybe a professional who has to do this.
It's a good way-- a review of that, so let's go to it. -Alright
Okay
After I interview a patient and I find out what's going on and have confirmed that it is--
[Brad] vertigo [Bob] BPPV
[laughing]
If they've got vertigo symptoms, I just skip the big words and go right into it
so it makes sense to the patient and it's easy to communicate with
Find out which way produces the symptoms
and when I say which way, which direction
and oftentimes they say, "When I lean or turn my head to the right, or when I'm in bed
and I roll to the right", and sometimes it's to the left
but in this case
when Bob turns his head to the right or when he rolls to the right in bed thing start spinning.
Is that right, Bob? -That is correct
It's very uncomfortable. Makes you feel very nauseous
that can be different
intensities as well
So, once I determine which direction, that tells me which way to start the treatment
and what I mean by that is
which way to turn the head-- so what I have someone do is get up on the table
sit like Bob is sitting, and we get their back at approximately a 45 degree angle
You don't have to get the goniometer out and measure
but just so-- about Bob is now
and then he's going to turn his head to the right and tilt back
[murmuring]
[Brad] I tilt back a little bit, Bob [Laughing]
Different therapists do this a little differently but--
[Bob] Turn to the left, tilt back
[Brad] Bob doesn't like to tilt back yet
I'll do a little bit, depending on the patient's response.
Okay
So, once we get to that point, we'll hold it for 30 seconds to a minute
and in this case we're going to go for 30 seconds just to shorten it up.
Okay, Bob, we just finished out at 30 seconds
Now, we're going to go to phase 2 of this treatment
and what I'm going to have you do, I'm going to take a couple pillows
I'm going to place them right here
And you're going to feel them right in your back right here
So you're gonna go down slowly. Take your time.
Now, you're going to keep your head at that 45 degree Adjust it as you need
and you're going to bring your head back
while maintaining that 45-degree 30-degrees
and that's about 30 degrees right there
How are you doing, Bob? -Good
This has to be done slow,
And if you do it slow you shouldn't have too many symptoms that are making you
feel nauseous or real dizzy
If you do, it's too fast and too much too early
We're going to hold this for 30 seconds, okay?
You're going to time it. A lot of times I like to use--
I've got a clock on the wall in my-- in the clinic
And I just got a second hand and I look for 30 seconds
or either that or you have someone come in and help me time
if that's not available right in front of me
And then, we're going to go slowly
to the left
Okay, so that we're 45 degrees to the left
and maintain that 30 degrees extension.
How you doing, Bob? [Bob] Good
And I always communicate with the patient, see if they're feeling
dizzy and things are spinning
but they let you know it.
You'll know it if you're doing this to yourself.
Hold that for the 30 seconds
Bob, we're done with this position, and now we're going to go to the next position.
So, what I'd like you to do is turn to your left side
Bring your knees up. Good, perfect
Go over like that
Now, while you do that, keep your head angled down towards the floor
Good, bring the shoulder up Okay, head down... there we go.
Are you comfortable in that position? [yeah] We're going to hold that for 30 seconds
Okay
[Bob] We'll jump ahead. We don't have to hold it. I mean--
just pretend it's been 30 seconds.
Okay, now we're at 30 seconds. Bob, we're the next position
Now, what I want you to do is bring your knees forward
so your feet and knees are up. There, just that that.
Now, let's tuck your chin in towards your chest slightly and slowly go up
[Bob] Look down at the floor [Brad] Exactly
As you go up, look more towards the floor
Hold it steady. Nothing too fast.
How are you feeling there? -Good
Good, okay?
[Bob] We're gonna to keep the chin tilted down [Brad] Exactly, keep that down
Now, this is the easy part of the treatment, Bob.
After this 30 seconds, keep your head still...
After this 30 seconds, the hard part of the treatment is the next 48 hours
What Bob's going to have to do is keep his head in a vertical position
for 48 hours
Now, what I'm going to give him to help him out--
this means that you cannot look down,
you can't bend over to pick anything up,
and you can't lay down to sleep in bed
That's what makes us difficult.
[Bob] You want me to come up now? That's been 30 seconds
Ok, yep. Nice and slow, everything's feeling good,
you're not spinning your anything? -Nope, I'm good
You get yourself a simple neck collar
Velcro, cost about $10 at-- -A nice soft collar
-Yup, a nice soft one at any pharmacy store.
And we're going to bring this around your neck
You don't have to use this
but, if you want to maintain that head vertical position for 48 hours
This is a constant reminder that you need to keep your head up
I have some patients, and what they'll do is actually take a couple days off of work
or do it on a weekend, because you're not going to be able to do at work for most jobs.
Okay, you okay with that, Bob? -Very good?
Again, this doesn't have to be tight.
When you're sitting in a chair or standing and you want to take it off
you're welcome to do that at anytime you can leave it off,
but again it works great to hold that 48 hours
because if you do bend over, or you look down you throw it off and you get dizzy again,
It's not a big deal, but you have to start the whole process all over again.
And I think we should mention, Brad, that you may need to do the process over again.
-Yeah -Some people have to do this,
the Canalith repositioning maneuver, a number of times
before it actually works -Sure
And the other thing is there was some debate online whether or not you need to do this part of it
the 48 hours
The mayo clinic advocates this this method.
We've used it--
When I was working at the Mayo Clinic we did it that way
so I think I feel pretty safe in saying that it needs to be done.
-Right, and it's been my experience in a clinic,
that if you have to do a second time
after the first time, and say you throw something off, you will notice some gains
Maybe, 25% improvement. That'd be a good indicator to repeat it.
But, if you do it right the first time, hold that head up for 48 hours
it's your best chance for success and use the neck collar
And that's it
It's not a real difficult treatment, but it is challenging -One last thing, Brad
I just want to tack this on at the end of the video here,
if you are 40, 50 years old or older
you're going to want to subscribe to us
because we are going to be covering videos that are going to help you
as you get older, as you age.
You know-- stay fit and healthy
We're going to cover subjects like this and other things-- on fitness
So, subscribe!
Because we both are kinda in that age range
[Bob] In that age group, and we have been treating people of that age group for ever.
-Right. Well you, forever... I'm a little younger than that.
Very good