♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical Therapists ♪
♪ On the internet ♪
- That's all.
Hi folks.
I'm Bob Schrupp, Physical Therapist,
- Brad Heineck, Physical Therapist
- Together, we are the most famous physical therapists
on the internet,
- In our opinion, of course, Bob.
- We haven't done one of these for a while, Brad.
How to safely perform the Epley Maneuver at home, for BPPV
- Yes.
- BPPV.
- Benign Paroxysmal Positional Vertigo.
- Vertigo.
- Yeah.
- I thought I threw an extra P in there, but-
- Yeah.
- But that,
it's also called the Catalyst Repositioning Procedure.
- Or CRP.
- Or CRP, yeah.
We got lots of initials in when you're-
- Yes we do.
- In the medical field.
- And there's a couple really important things
that you need to know.
So you can go through this safely,
and we're gonna go through these on this video.
So, keep pay-
- Stay tuned.
- Yeah, and get your note papers, you know,
write a couple notes.
- All right, if you are new to our channel,
please take a second to subscribe to us.
We provide videos, how stay healthy, fit,
painfully upload every day.
Also we've got a big line up here today.
Don't we, Brad?
- Oh yeah, different colors too.
- I wanna make sure you join us on Instagram now.
Cause we're @officialbobandbrad,
- Right.
We we're also at Facebook, BobandBrad.
We're also at Twitter.
- Oh my goodness.
And we're also got our website, so.
- We're all over the place.
- We're everywhere.
- It's kind of scary Bob, but that's the way life goes.
- We're omnipotent.
- [Brad] So the Epley Maneuver.
Did you know that, that Dr. Epley started this in 1980?
- I did not know that.
- Was his first time he presented it
to a group of doctors and they all poo-pooed it.
They said, (brad grumbling).
- As they always do.
- Yeah, they're just, treat it with medication.
- The pioneers get the arrows.
- Right.
2001, it took 'em 21 years,
before it became officially accepted into the me-
- Okay.
- Yeah.
- Wow
- So it's been going on now for about 17 years
and it it's an excellent maneuver if you've got BPPV.
- So that's a type of vertigo,
most common type of vertigo.
- Right.
- And you know,
when you get into dizziness, or the spinning.
And what's nice about this maneuver,
when it, it is the problem, it really works well.
- Right, right.
- We did it on a live patient that one time.
- Right.
- And that video is out there.
- Yeah.
- So you can check that out as well.
One thing we do recommend,
if you wanna do this safely, I would,
see a clinician, a trained therapist,
that knows how to do it, and have 'em do it to you.
And I myself, when I do it to a patient,
and I feel that the patient understands it,
is very alert and able to do it,
I say, you can do this at home-
- Absolutely.
- After we go through it.
And then this video is a good reminder to watch,
and see to make sure-
- Exactly how to do it.
- In case you forgot something.
- Right. And,
and the thing is you can do it more than once.
So a lot of times at my first session
I might do it three, four times.
- Right.
- And then like you said,
sometimes it doesn't quite hold,
and you may need to do it again in a couple days or,
- Right.
- Maybe if it comes back,
you can do it again on your own in a, in a month.
- Exactly.
- One thing you wanna do though,
any clinician will do, is get a history.
What provokes the symptoms, what makes you dizzy?
And there's four questions.
You, if you answer yes to 'em,
I'm not gonna go through 'em all,
but it has to do with movement.
We have a video that just came out.
We put out a week ago, approximately a week ago.
- Yeah. Do you remember what was titled?
- If you answer yes, to these four questions you have-
vert-right.
- Might have BPPV?
- Right.
Something to that nature.
- Yeah. Look that up on Bob and Brad.
- Right, If you look up "Epley Maneuver with Bob and Brad,"
it'll be one of the videos that come up.
So if those answers are yes, then you're gonna,
you want perform the upload maneuver,
but there's one important test that you should do, Bob.
- Yes.
- And, and that's the "vertebral artery test."
And this is a modified vertebral artery.
- The vertebral arteries,
are the two main arteries in the back of your head.
- Right.
- I think they provide like 30% of your-
- It's something like that.
- Circulation.
- They go up to the circle of willis-
Whatever, it provides your brain with blood,
it's really important.
- So are the carotids,
- Right.
- But those are two that come from the back.
- And these two, if you have compromised arteries back,
in other words, they're not fully healthy.
You need to test it, very simple test.
And if your therapist, you know,
should do this to you, before they do the Epley Maneuver.
And it's very simple,
and this is a modified test, that's why it's called that.
The way you do it,
And there's more than one way to do it.
But the way I like to do it, elbows on the knees
on the chin, and this is gonna extend your neck.
And then you rotate 45 degrees.
Okay, and you're gonna hold that for about 30 seconds.
Maybe a little more than that.
But someone has to be looking at your eyes.
A clinician is looking at your eyes,
and looking for some symptoms that they're trained for.
- You would probably feel symptoms too,
wouldn't you say, Brad?
You might feel a little bit of dizziness.
- Right.
You'll see things shaking,
cause your eyes may get some nystagmus.
You wanna do that to the right and to the left.
It's an important test that should be done.
It's rarely, it's rare that it's positive.
- Right.
- Usually it's negative.
And that gives you the green light,
to continue on with the Epley Maneuver.
- I've seen it where, Brad,
I've seen it where people had their carotid arteries,
for like 98% occluded and 100% occluded.
- Yeah, sure.
- And they were getting enough circulation
from the vertebral arteries,
and was going up through the circle of willis,
that they were actually still functioning.
- So with an older person that may have that.
- Yeah.
- That could be a cause.
- Right.
- All right.
So the next thing we do, all those tests are passed.
We're on, we wanna start the, the procedure.
And we're gonna actually, gonna get Liz, our camera person.
- Yep.
Because Liz is a lot better to look at than I am.
And I tell you, you know,
people wanna break from this sometimes. You know, so-
- Right, yeah.
- I'm gonna be the camera person.
- Yeah, you get outta here.
So if the camera's shaking around,
that's Bob's responsibility.
- [Bob] Yeah. That's right, bad, bad maneuvers.
Hello.
- [Brad] You don't have to show them
a closeup of that mug Bob.
Well say hi first, Liz.
- Hello, they can't hear me.
- [Bob] Yeah that's right they can't hear her.
(Brad laughing)
Seen, but not heard.
- All right.
There's a couple ways you can do this.
You can put a pillow,
why don't you lay in your back now,
like this. So there,
so the head actually has to extend back and rotate.
You don't have any symptoms, do you?
You never have.
So you know, this wouldn't be exactly how you do it
because Liz has no symptoms.
Why don't you get up though.
I don't like to use the pillow,
see, I like to go off the edge of the bed.
It just works better for me.
- [Bob] So either way you can extend the head,
using either the pillow or off the edge of the bed.
- Exactly.
Okay, so sit up first,
I call this the long sitting position.
You're gonna have the person long sitting.
And you have to first do the "dix hallpike maneuver."
- [Bob] Right.
- And you're gonna do that to determine,
if you have it and which side you're gonna start on.
I'm not gonna spend a lot of time.
You can do this facing from the front, holding the head,
or I like to do it from behind,
because I don't have to bend over.
- [Bob] That's what I do. Yeah.
- So it's here, and we're gonna go 45 to the left,
and back quickly.
- [Bob] Yeah.
- And actually have to have her position,
so her head is back.
So why don't you come back?
- [Bob] You come back fairly rapidly
while you're doing that.
- Right.
- [Bob] And you bring your head right off the edge.
- Now I'm gonna be looking for nystagmus or eye movement.
- [Bob] Yeah.
- And whether the eyes twitch down,
or whether they Twitch up is gonna determine,
help, determine or analyze which canal is the problem,
- [Bob] Giving the problem.
- I'm not gonna get into that detail too much here.
Let's do it,
- [Bob] To the right now.
- To the right.
Okay, and we come back.
- [Bob] See, that's more like it.
Now, you showed the real time speed,
of how you should do it.
And you see her head is turned to the right 45 degree,
and it's also extended a little bit.
- And now I'm gonna gonna say, she's twitching.
Her head, her eyes are, are twitching and they're going up.
So that means the posterior canal,
which happens to be the majority of problems with,
- [Bob] Most common, right.
- With the Epley Maneuver.
Now, if I was doing this in my clinic,
I would have my stool back here,
and I have another person help me.
You don't have to do that, but it it's easier.
- [Bob] I usually do too.
I have someone help me because.
a lot of times it's elderly people and I,
I want to have make sure somebody doesn't fall off the bed.
- Right.
Yeah. Or if they get ill,
they start feeling ill, and they need to vomit.
They can help-
- [Bob] Have a container real quick.
- Yeah, exactly.
So let's go back to this position.
Now after doing, go ahead,
we're gonna go back,
now at this position,
Liz you might be feeling really ill
and you might be like, wanting to get back up,
holding onto the table, like the earth is shaking.
- [Bob] So you've started the maneuver now, Brad.
- And at this position, if it's positive,
and it's up and it's a posterior canal,
I'm gonna stay right here and continue with the procedure.
So I don't have to start all over again.
- [Bob] Oh, I see.
So you you're doing the test
and you went right into the procedure,
because you found out that was positive.
- It was positive and because like I said,
this happens a majority of the time,
I wouldn't stop and go back up,
and do it over because of technicality.
I don't wanna put the person,
through that uncomfortableness again.
And we're gonna stay here
and I'm gonna calm her down and say,
it's okay, I can treat you, things are gonna go well.
And after about 20 to 30 seconds typically,
the dizziness starts going away.
Her nystagmus clears up, and then Liz, how do you feel now?
Good.
At that point,
now different clinicians do this differently.
I'm gonna stay for an additional 30 seconds.
- [Bob] Really?
- Yep. Just to make sure the crystals are are in there.
And then we're gonna rotate, while the neck has extended.
We're gonna do this kind of slowly,
better, slow than fast, I like, and-
- [Bob] So the neck is still extended.
- Yep.
- [Bob] But he's taking it to the opposite 45 degrees now.
- There you go, yep.
And I'm gonna, did you feel-
typically the person will feel a little bit dizzy.
You never had a, a vertigo, so you can't explain that.
But usually through that position,
the dizziness will come back.
Usually I find it's not as bad as that first one,
- [Bob] the first one's the worst.
- And then again,
typically within the 30 seconds or so,
the dizziness and the symptoms clear up,
and when they clear up, I, she tells me
does it feel good, Liz?
Yep. I'm gonna hold another 30 seconds.
Now we're gonna rotate to your left side.
Okay? So you're gonna go on your left side.
- [Bob] And this is where I like to have the second person,
because sometimes I'm afraid they're gonna rotate
right off the bed.
- Yeah. Right.
What I usually do is,
I literally go through the positions with myself.
- [Bob] Right. That's what I also do too.
- This is, this is what we're gonna do,
and so there, there's no big surprises.
Now she's gonna turn her head and look down.
The position of the body is really not critical.
- [Bob] Yeah. It's all about the head.
- Right. All about the head.
And once again, I'm gonna be,
actually down here looking at her eyes,
talking to her, and then I, you know,
you feel a little dizzy and then,
usually by this time it's not as bad, although it could be.
- [Bob] If it's working, it usually isn't as bad.
- Yeah.
- [Bob] By now.
- And, and then,
at that point, now bring your, in the same procedure,
wait till it clears up, wait 30 seconds.
Can you pull your knees forward,
so you're in a-
she's a therapist, so she knows a 90 degree hip flexion,
90 degree knee flexion.
Pull your knee your feet forward off the table, there.
And now I'm gonna continue to hold onto her head,
bring your chin towards your chest.
Hold it there.
How are you doing?
And at this point, sometimes,
I don't know Bob, in your experience,
which one you have had.
But usually they get dizzy here too.
And the same thing.
But the first one is typically by far the worst.
- [Bob] Yeah, right.
- And we go through the same procedure with that,
slowly bring the head up.
There we go.
Now at this point, after she clears up,
given instructions,
you need to keep your head vertical for, at-
You know, 20 years ago, about 15, 20 years ago,
when I first started this,
it was for 48 hours to keep your head up
and sleep in a recliner.
And now after years of doing this-
- Oh where did Liz go?
(Brad laughing)
- Well, she's doing her job cause someone wasn't uh-
- Someone wasn't doing their job.
- Yeah. So once the patient is up and they're clear,
then the instructions are,
you need to keep your head vertical for-
- Yeah, you can look down with your eyes,
but you don't wanna look down with your head,
is what I tell people.
- Right, because that can re-agitate the symptoms,
and you have to start all over again.
- But you're right.
I, I've, looked up the studies on this too, Brad actually,
and different people are saying different things.
Like you said, it used to be for 48 hours.
- Yeah. You had to sleep in a recliner
with it tipped up as far as possible.
- And we had 'em wear a neck collar.
- Yep, and I'll still do that just so they remind,
remind 'em, of soft Velcro neck collar.
- Well, you know what I do, Brad?
- What?
- Well, you keep talking, but I'll
I'll get mine ready, but-
- Right. And now instead of 48 hours,
it's pretty well accepted,
that if you do it in the, you know, in the AM,
just keep your head up,
until you go to you go to bed that night
and then you're clear.
- Well then that thing,
additional thing that I read is,
that night sleep with two pillows underneath your head.
- Oh, I see.
To keep your head-
- Just, just that one night.
- Right.
- But what I do, cause you know,
to get a neck collar for everybody,
I just take a pillow case.
- Sure.
- And I, I folded in fours like, in four piece like this,
and then I just go around like this
and it's enough to remind them.
- Yeah.
- You know what I mean?
That's all they need is a reminder.
- Right.
And it still stops 'em a little bit, from going down.
- Yeah. But you're right.
If they just remember,
cause if you're thinking of something else,
then you bend over to pick, you know,
to tie your shoe or something,
you can throw off the whole procedure.
- Right.
- And then you gotta start over again.
- Yeah. So, it's not as critical as it used to be,
but now that's, that's what they are still recommending.
- Yeah. So that's it in a nutshell.
It's, it's simple but there's some simple things
that need to be done.
So, you can do it at home,
but again, remember what we talked about.
You should do it after seeing a clinician
and get the little things tidied up.
- All right, thanks for watching.