As a Vestibular Physiotherapist, I often treat people with Benign Paroxysmal Positional Vertigo, or BPPV. While this condition is normally straightforward to identify and can be corrected in typically 1 to 3 treatments, not everyone fully recovers immediately afterward. Some people continue to feel “off”, even though they’re happy the spinning has stopped.
I hear things like: “Driving makes me uneasy, grocery shopping stirs me up and my balance feels a little off.” So what's causing it?
Understanding post-BPPV "weirdness"
Even after a person is no longer testing positive for BPPV, we often find that clients continue to be sensitive to motion or feel less steady balance-wise. One theory as to why symptoms persist, even though BPPV is cleared, is that the brain was making adjustments to try to deal with the problem while BPPV was present. Now that BPPV is no longer present, the adjustments are no longer appropriate and the brain needs time to "reset" back to normal.
One level on which this "reset" phenomenon presents itself is in terms of your balance. Research has shown that when you have BPPV, you have one inner ear telling the brain a different story than the other about where upright is. The brain gets busy trying to adapt to this, but then when BPPV is corrected, it needs time to readjust again. For most people, the system finds its way back to normal eventually, but it can take longer for some people compared to others.
Another level is in your sensitivity to head movement. Again, your brain becomes partially habituated to the incorrect information coming into your brain from the affected ear. Once the issue is corrected, it has to readjust again. As a result, you can feel more sensitive to head movements, feeling "weird" after certain head movements.
You won’t experience the same “spinning” sensation caused by BPPV, but it’s enough to make you guard your head movements. Clients often mention that they feel as though the spinning is about to start, but then it doesn’t.
The last level is visual or tactile. When you find yourself in an environment that challenges your vision or external support, like a dimly lit room, a busy environment or uneven/unstable ground, you suddenly start to feel uncomfortable. This is likely because when you had BPPV, the balance information from your ear became unreliable, so you started relying more on information coming from your visual or tactile senses.
Examples of this could include fixating on a target to help maintain your balance as you walk across a busy room or running your hand along a wall. When either or both of these systems are challenged, you might find yourself feeling more unstable than usual if your brain hasn’t realized yet that the information from the ears can be relied upon once again, since the BPPV has been corrected.
Clients often report ongoing uneasiness or mild symptoms with things like busy supermarket isles, driving their car, wide open spaces or soft walking surfaces like grass.
So what can be done?
The great news is that, just as these systems experienced a "reset" in the wrong direction, they can also be "reset" back to the correct settings through appropriate and progressive exercises. Physiotherapists trained to treat Vestibular disorders deal with problems like these every day.
You will be prescribed a series of daily exercises, tailored to your specific challenges and triggers, designed to restore correct and reliable interpretation of the information coming from your corrected inner ear. Your perception of what is the correct upright position can be normalized. Your dependence on visual or tactile inputs can be reduced and you can become desensitized to head movements. This process normally happens very quickly with the proper vestibular rehabilitation program.