- Hi, I'm Bob Schrupp, Physical Therapist.
- Brad Heineck, Physical Therapist.
- And together we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Brad, we're gonna talk about
benign paroxysmal positional vertigo.
Do you say it that way?
- Yeah, I just say vertigo.
Anyway, we're gonna show you one way to do it.
Which when you have symptoms to the right.
We're doing this right away.
And then again,
I'm gonna talk some more about why you may wanna do it.
- All right, okay. - Okay.
Let's start off.
We're gonna do it.
There's two ways to do it.
One with the pillow,
one without the pillow.
The first time we're gonna do it without.
- Right.
- Okay Brad? - Okay.
- Go ahead, sit up.
Okay. First,
Oh, before you even do that Brad, face the camera.
Because you're gonna have to know
what a 45 degree angle is for your neck.
All right, if he's straightforward, that's zero degrees.
If he goes all the way to the right, that's 90 degrees.
So halfway in between, that's a 45.
'Cause the first thing we're gonna have you do
is start by putting your head in a 45 degree angle.
Okay? - Right.
- So you need to know what that is.
- Yeah. - Okay.
Also, you need to know what ballpark
20 or 30 degrees is, back.
And that's just a little tilt back, like that.
That's about 20 or 30.
Okay.
- That would be too much.
- That'd be more like 90.
So again, 45 and 30 is about
a little bit like that, 20 or 30.
Okay. Why don't you go ahead and get up on the mat, Brad.
Now you're just gonna position yourself on this time
so that you can actually,
your head's gonna end up off the edge of the bed.
So I think you're probably gonna go back
a little more, Brad.
- I got it.
- A little more, right there.
Okay.
- A firmer bed would be desirable, right Bob?
- Yeah.
It's because he's got symptoms to the right.
This is the one we're doing to the right.
So he is gonna first turn his head 45 degrees to the right.
And then he is gonna bring himself back.
Go ahead and bring yourself back, Brad.
Go really soft down.
- Going slowly.
- I know a lot of people go fast on that one.
Even you can go fast.
And then a 20 degrees tilt.
So he is still 45 to the right.
And he's tilted about 20 degrees.
He's gonna hold this position.
Oh right, keep your eyes open, Brad.
The whole time. - Yep.
- And he's gonna hold this position until the symptoms stop.
If he's getting vertigo or dizziness
or nystagmus, where the eyes are going back and forth,
he waits until that stops before he does the next step.
This he holds.
If there isn't any, he should hold it for 20 seconds.
After 20 seconds, he's gonna just tilt his head now,
to the right, at a 45 degree angle.
Okay, same thing.
Symptoms, stop.
Wait till the symptoms stop
or wait until 20 seconds has passed.
After that, he's gonna get up onto his shoulder.
And then as soon as he gets onto his shoulder
he's tilted his head down like this.
Same thing, 20 seconds,
or until the symptoms stop.
After that,
he's gonna bring his legs off the edge of the bed,
push himself up with his arm.
His head's still tilted.
And then he brings his head this way, to the front.
And let's the symptoms stop.
Now, this is the most crucial part
that a lot of people are not doing, Brad, I think.
On our other video, we recommended,
'cause this is what Mayo used to recommend,
is that you actually keep your head upright for 48 hours.
And we used to have people wear a soft collar
and sleep in a recliner. - Right.
- But now with the recommendation,
the latest research is showing that
you just need to do it till the end of the day.
- Okay. - So,
but I would recommend that you do do that
because I've seen people that seem like
they don't have as much success with this
if they don't do that part.
Now, if you truly do have
benign paroxysmal positional vertigo,
and it is to the right,
this is helpful generally like 75 to 80% of the time.
- Sure.
- And sometimes it's helpful within the first treatment.
- So when you say, to the right,
that's saying, when you turn- - That's saying that if you,
if you turn to the right
that often brings on your symptoms.
If you roll to the right
it brings on your symptoms. - Sure.
- You can kind of see this pattern
where it's all right sided.
Now, the other thing you should know,
this is a treatment for when you're having trouble
with what we call your semicircular canals.
And there's three of 'em.
There's the posterior, anterior and horizontal.
This is the treatment for the posterior.
The posterior is the one that's involved 76% of the time.
- Okay. - So it's a good,
good chance that yours is posterior.
If that's what you're having.
But if this doesn't work,
maybe you have an anterior or horizontal.
Anterior is 13%, I'll read my numbers here,
and horizontal, 5%.
So there's something else that you should consider
when you're, you know,
if for some reason it's not getting better.
- Sure.
- All right. Now we're gonna show the same one
with a different angle.
We're gonna cut the cameras
and we're gonna show it from a different angle.
- Now, I don't wanna get technical, Bob,
but you said after you do this procedure,
wait till the end of the day.
Well, do you do it in the morning
or you could go at it in the afternoon?
- It just said,
it just said till the end of the day.
- Right. - So-
- It seems to me, from my experience,
with the technique I use,
I would do it in the morning
so you have more time- - Sure.
- To let those crystals settle in.
- It's a good idea.
- It's a no, you're not gonna harm anything.
- That's right.
Okay. We're gonna show a different angle now
on how to do this from, you know, doing it from the head.
What is this called?
Axial position? - You're right.
- All right.
So again, you're gonna start off in this position.
He's gonna turn the head 45 degrees to the right.
This time we're using a pillow
that's gonna hit you right around
about the mid shoulder blades.
He comes back
and he's got the tilt like 20 to 30 degrees.
He's still tilted to the right
or, you know, 45 degrees to the right.
Wait till the symptoms stop or 20 seconds.
Then he is gonna go ahead and tilt 45 degrees to the left.
Again, 45 seconds.
I'm sorry.
Not 45 seconds.
Wait until the symptoms stop or until 20 seconds.
He's still at the 45 degree.
Now he's gonna get up onto the shoulder.
And now he turns his head down, looks down.
Yep, perfect Brad.
Same thing, wait till the symptom's done or 20 seconds.
Now bring the legs off the edge, Brad.
Come on up.
Still got the turning to the left.
Slowly face the front.
Okay.
And now again, he's gonna wait till the end of the day.
Again, if you did this in the morning,
you're gonna wait till the end of the day.
Or even if you did in the afternoon,
you wait until the end of the day
before you allow the head to go down.
The head stays up the entire time.
- So you just gotta pretend you got a book on your head.
You can't look down, you can't bend forward.
- Right. You really, exactly.
All those things.
- Plan your day out before you do this
so you can do that. - Yeah.
A collar would,
a soft collar would be helpful, to be honest with you.
- Right. - I'll be sure to remind ya.
All right. Good luck with this.
We're also gonna do a video on how to do one to the left.
So, yeah for those of you who have symptoms to the left.
All right.
Thanks.
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