♪ Bob and Brad ♪
♪ The most famous ♪
♪ Physical therapists ♪
♪ On the internet. ♪
- Hi folks. I'm Bob Schrupp, physical therapist.
- Oh, Brad Heineck, physical therapist
- Together, we are he most famous
physical therapist on the internet
- In our opinion of course,
- Today, we're going to talk about
understanding causes of vertigo
and effective (misspeaks) - cure
(laughs)
- Cure.
- Cure by the Epley maneuver.
It's a home treatment.
- That's right.
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All right, let's go on with this Bob.
- So, what is the-
this is one of the most common causes of vertigo,
which is a, the spinning that you get - dizziness.
- Right, and this is a relatively,
it's not rare by any means. - No.
- It's not really common, but it's not unusual at all.
- I've seen a lot of cases.
It's called BPPV.
- That's the, the short version.
- Yep. That's an abbreviation.
- Benign proximal positional vertical.
And obviously that's why they shorten up to BPPV.
And oftentimes with patients,
I just refer to it as vertigo
And a lot of people do unless we're
talking to some technical.
- I just remember reading in the textbook, Brad,
that if you have dizziness,
this is going to be the one of the most common reasons you
have to send this. There could be many others, right?
We can be low blood pressure.
There could be medications and such, but.
- Right.
So we're going to talk about the Epley maneuver and how to
do it. How to actually you can do it at home.
- The Epley maneuver is for this specific condition.
- Exactly. Symptoms- typical symptoms.
And now if you're having this, you'll see if you know,
this is consistent with what's going on with you is,
you know, typical dizziness.
I've had, you know, room spinning.
It can make you very nausea.
And actually sometimes you can start the vomit because it's
that bad.
- It's scary, actually. - Yeah
- I mean, suddenly you're, you're gonna fall.
- Right.
- And you might feel when you're in bed,
when you turn your head. - Exactly.
- And often is when you turn your head a certain way,
like turn to the right or you turn to the left.
- Right. Some causes us a lot of it really don't know,
but it seems that it's,
it can be commonly happen after a bump to the head,
some trauma or after an illness.
- Right.
- It kind of comes on for whatever reason.
- And where does it originate, Brad?
- In the ear. - Sure, inner ear.
- Both sides. Which is rather interesting.
And the vestibular system is what it's known as,
and there's,
I'm not going to get into too much of the technical anatomy
of it because it just makes your eyes glaze over.
But I am going to talk about there's little crystals in
there.
You always hear about the little racks or the crystals.
They start floating around in this vestibular system and
throw things off.
And that's where that get that dizziness and the Epley
maneuver puts them back into place.
- So that's what my Mom meant when she said
that you have rocks in your head.
- (laughs) I don't think so, Bob.
- But anyway, so yeah.
That's the theory anyway, Brad.
They really don't know for sure,
but that's a pretty good theory.
- Right.
- And it seems like it works, too.
- This is what I use with patients
so that it was very simple.
I try to simplify as much as possible. I said,
just imagine you got to level and
can you zoom in on this, Tanner?
So we've got some fluid in here that would be like the,
you know,
the vestibular system and you've got three or four loops in
there. So we've got a number, one different ones.
But if you turn your head one way or another,
like the bubble and there, we want to get it in the middle,
all just keeps you upright and balanced.
And if you bend over, turn,
what happens is a vestibular system sends messages to your
brain, which helps you balance and stay upright and all the
wonderful things that the human body can do and stay
balanced.
- Yeah, imagine that bubble stays in to the right,
no matter what you do. - Right.
- You know, it's not, it's not going to work.
- Or I I'll, I'll mention like you got that fluid in there.
Just imagine if you had some crystals,
I'd like to get some in there so I could be more visual.
But we want to get those crystals all the way to one side
So that's not interfering with that bubble.
If that analogy helps, you know, use it.
If not. just disregard that. - Right.
Let's go to work. Brad.
Let's show how this is going to work.
- Okay, so is this is called,
like you said, the Epley maneuver.
There's a number of different maneuvers
you can do to do this. This is the one I used,
I think a hundred percent of the time and very successful
with it when someone would come in.
So I don't know if you want to actually try this one or just
do this video,
watch this video so that when you go to a therapist and they
do it, you are familiar with how it works.
- Or maybe a therapists did it to you already,
and you want to repeat it.
And they said it was okay to repeat it right.
Then go ahead and do so.
- Usually, almost always with my patients
after I did it once, I would say,
and they felt comfortable with it and
they were alert and, you know,
I felt that would be appropriate.
You can do this to yourself at home tomorrow,
or the next day.
If it's doesn't clear things up a hundred percent
or you can come back to see me and
I'll be happy to do it again.
It's very short. - Yeah.
And what I found is that we often
did the Dix-Hallpike test.
I'm sure named it for some people again.
But that helped you determine which way you're going to go
to the right or to the left.
So I'm going to show that real quick, Brad.
- Sure.
- So you have the person long sit.
- Yep. And you could do this on your bed
- And you're going to turn your head one way
and go back a little bit.
- But before you get-
we do have these pillows here for a reason,
you'll want two of them.
So there's a fairly thick and you're going to go backwards.
- You actually go back fairly fast,
and then you're turning this to the left.
And that would also do to the right.
And if one of them elicits dizziness symptoms,
that's the way you're going to treat it
to the right or to the left.
- And that position is exactly,
there's four different positions.
You're going to go through on the Epley maneuver.
That's the first position. And you,
you want me to jump in there or do you want to,
should we do it too? - You can do it to me.
- I do want to talk a little bit more about some details on
that dix-hallpike maneuver.
Why don't you come back?
You want to come back, not real slow,
as fast as you feel comfortable,
but the head extends and bends back.
So that's why we have pillows here so that your head is back
and about 45 degrees to the left.
And you know, if I'm a therapist I'm asking for,
are you dizzy or not?
And looking at their eyes to see if there's the eyes and
moving back and forth.
- The mistake is when the eyes move back and forth
- Exactly. Obviously you can't do that to yourself.
You can't see your own eyes.
Want to come back up? - Yep.
- And then just do the other direction to the heads,
to the right. And he goes back, and then Bob says,
I'm going to talk for you, Bob.
- It's it's worse to the right.
(groans) I feel sick. - Yep, yep.
So that means we're going to start position number one.
He's going to come back to that position.
Now I always have a clock when I do this and I look at the
timer or I have a digital one and I start timing.
I will go for a minute and I'll be talking to the person.
And if you feel dizzy initially in a cycle,
but within 20 to 30 seconds,
it's settling down and it's feeling better,
then you're good. - It's a good sign.
- If after 30 seconds,
the dizziness keeps going and it's like,
you're feeling sick and whatnot. Then you've got to stop.
- Yeah, it could be something else.
- Right? You got to go see a doctor.
And that's what a therapist would do, too.
They'd send you to see a doctor now after a minute,
And I always go into a minute,
although they say now is once it settles down.
I always did a minute. And I felt comfortable with that.
I felt, let's get those crystals where they belong.
Now head back here, we're going to just,
rotate, and this is position number two.
- So that was position number one.
- Yep. One minute.
- No position number two.
- Yep. The head still back, I would say,
imagine you're trying to dump the brains out of head onto
the floor. I didn't say that.
I said rocks. Going back.
But anyway, so your head is back like that.
Your hair's pulling this way.
Again, after 20 to 30 seconds,
usually it would be a little less dizzy initially
but it would produce some dizziness,
but not as bad as the first way,
but then it clear up after 20, 30 seconds,
then you know your gold when it's completely symptom free.
Now you have to turn slowly to your left side.
- So you don't fall off the bed.
- Sometimes I will stand right here.
- Yep, that's what I usually do. And the head
should stay turned looking down towards the floor.
And angled down a little bit.
- Lateral flex to the left.
- Okay. So if the head's angling down
and you're looking down at the
same time, and again, 20 to 30 seconds,
things should be clearing up.
And then once it's symptom-free or a minute at the most,
then you'll go up. And almost always,
I don't know about you, Bob, but when I got to position,
number three, things, weren't too bad.
Little bit of dizziness. - If it was helping.
- Yep.
Now this is important to get your feet off first.
- I would actually grab their neck too.
- Sure.
It is nice to do this with a little help with someone and
your head is going to be down.
Chin stays down to the chest while you go up and then start
the clock again, looking down.
And this one I've had people say there,
each position get a little dizzy,
but it seems to get a little better as you get from the
first one to the fourth one, which is number four.
And once sit down, get your head down,
I always have to do that to the patient, head down.
So all those crystals are going into the right place in,
you know, the vestibular system.
And we want to keep them there.
So bring your head up slowly.
And at that point, what happened?
There's a couple options, but for the rest of the day,
and it used to be for 48 hours,
they recommended you want to keep your head vertical.
- You don't want, you can look down with your eyes,
but don't look down with your whole neck.
I mean, don't bend your neck down.
And it's very hard to do that. You're going to try to do it.
And that's why we give you a reminder.
- Yep. So you can just take a pillowcase and
fold it up like this.
- You fold it in half and then you
fold it in half again lengthwise.
- Yeah. If you happen to have,
I used to tell my patients actually to get a soft cervical
collar cost about 10 or 15 bucks
with Velcro on. It's a little overkill.
You don't need to, but it has worked pretty nice,
but this works good too.
- Yep. You just actually tape it in place.
- Not too tight.
- And it'll remind you that, you know, don't look.
down like, look down with your eyes.
- Right, right.
Now we've had comments with people-
Initially it was 48 hours to do this.
And that was like 15 years ago.
I read an article from Mayo and that's what I always did as
my patients. And then as research went on, they said,
actually, if you do it in the morning,
do the procedure in the morning and you keep your head up
until nighttime, you can go to sleep and it'd be fine.
- And I've heard, you know, you read
a lot of different things.
I've read some research that says
you don't need to do it anymore.
I've read some research that says at night you should sleep
on a couple of pillows, have your head up a little bit.
So it's kind of like.
- I always used to have my patients sit in a recliner with
it reclined up or back, you know?
And sleep that way and
actually had them do it two nights. And then, you know,
recently in the last five years or more, it was,
I just go and tell
Do it in the morning. And then when it's time to go to bed,
lay down in bed and I've had good success with it.
- You definitely need a reminder though,
because people would have their head down before they left
the room for me.
- I mean, it's not a big deal if that happens.
What happens is the crystals are all home where they need to
be. They need that time to settle in and kind of quake.
What would you say?
Just settle in. So they don't move again.
When you put your head down,
they might come out and get loose, and then you got to,
all you have to do is do the whole procedure all over again.
- Well, I, I often had people where I,
I had to do the procedure twice in a day or even three times
in a day sometimes to tell it really felt like it had
settled. - Sure. Yep.
- And then some people had to come back.
But some people, we did it once and they were good.
They didn't have to come back.
- Right. Right. Yep.
So there you go. - All over the board.
- Is there anything else that we want to talk about?
- I think that's it.
- I think it is, too, Bob.
It's a nice procedure to do. Good luck with it
- It's nice, because it works quite often.
- It does. It does.
It does enjoy and stay, not dizzy.