How Many Times Should You Perform the Epley Maneuver? (for BPPV)

If you're using the Epley Maneuver to treat posterior canal vertigo (BPPV), you might be wondering how many times you should perform the maneuver before you should stop...
Should you do the Epley once/day, or can you do it multiple times?
After your first day of treatment, should you continue to do the Epley?
How do you know when to stop?
In this video, I'll answer all these questions, with a focus on how to treat with the Epley Maneuver and then re-test with the Dix-Halpike Test.
I hope this video helps you get rid of your vertigo once and for good! Please leave a comment before you go, especially if you've had success getting rid of your vertigo!
- Luke Gordon, DPT
Doctor of Physical Therapy/Owner of Gordon Physical Therapy
www.gordonphysicaltherapy.com...

[@bretttaylor5297]

Don't know why, but when I try and like comments, it's checking the dislike (thumbs down icon). So I will stop at this point. I do like all the comments. Seems like Luke is helping you all. Awesome!

[@GordonPhysicalTherapy]

Thanks, Brett! I'm not sure why it's doing that, but I appreciate you trying.

[@Tad-zh4wr]

Ty for this. Also people might want to know that you can avoid things to dislodge them like don’t sleep on bad side, no yoga, no gargle w mouth wash etc

[@GordonPhysicalTherapy]

Good advice!

[@meganneal3170]

This is so generous to share, and so helpful, seriously thank you!

[@GordonPhysicalTherapy]

You're quite welcome! Thank you for your kind words :-)

[@Tad-zh4wr]

I know right. What an angel, so kind !

[@donpasulka]

Great video! Thanks.

[@GordonPhysicalTherapy]

Glad you liked it!

[@gss2855]

I really like you're energy & the simple way you explain*

[@GordonPhysicalTherapy]

Thank you so much 🙂

[@marymacdonald4080]

This is so educational! So very generous with his knowledge. Delivered with compassion 💯

[@GordonPhysicalTherapy]

Thank you!

[@jekbot]

Thank you for these videos! I've had the most intense vertigo since Sunday. Doctor gave me a handout for Epley but it doesn't seem to be helping too much, but then again, it's not as bad. When we tried the Dix-Halpike, my eyes spun counterclockwise!

[@GordonPhysicalTherapy]

What side was the Dix-Halpike positive on? And which side have you been treating with the Epley? You only want to treat the side with the BPPV.

[@jekbot]

@@GordonPhysicalTherapy We did both sides to check the eyes, they spun crazy when I was on my right side and I had more slightly more dizziness when I turned my head/body to the right. I did the Gufoni yesterday on the left side for the right (is that right?) and while not heaps and bounds better, I feel more steady and have not had the tilt-a-whirl appear.

[@cathrynory8854]

I believe you mentioned something about eye stabilization exercises. Have you made a video about those? Thanks!

[@stevefedorow5447]

Thank you for sharing. Just starting on this…really struggling so far 🤢

[@GordonPhysicalTherapy]

I hope it helps!

[@booshballchange9237]

Your videos have really helped to inform me of what is going on. Thank you! Question: If your not having the spinning sensation and your eyes don’t seem to be having nystagmus but throughout the day you are feeling like your floating on and off, is that just inner ear balance? Would you now just do gaze stabilization exercise? Also, does it have a negative effect to do epley without symptoms? Many thanks!

[@GordonPhysicalTherapy]

Thank you! If you still have vertigo during the Dix-Halpike test, but you don't have nystagmus, I would still keep treating with the Epley until you no longer have the sensation of vertigo with Dix-Halpike testing. After that, if you still have some sensations of floating during the day, definitely keep doing the various VOR and gaze stabilization exercises. Lastly, there are no negatives with continuing to do the Epley, but it doesn't help prevent BPPV either. I hope that helps!

[@cassiafriello5570]

Thanks for all the videos, they are very informative! Is there any evidence to show that the longer you have BPPV the more crystals there are, therefore the more manoeuvres you may need or not really? Haven't heard much about that but have wondered as I have had it for around 10 years. Thanks!

[@GordonPhysicalTherapy]

You're welcome! No, I haven't heard of any evidence that the length of BPPV symptoms correlates to more crystals or groups of crystals. However, it's hard/expensive to do a lot of imaging of the inner ear, so maybe the studies just haven't been done.

[@lararose9106]

​@@GordonPhysicalTherapyhi Dr. Is central vertigo from MS treatable with therapy? Im partially disabled in a wheelchair and many neck probs and overweight and i get seizures if i even do dixhalpike. Can u plz suggest how to live with bppv if i dont tolerate maneuvers and is it always room spinning? Why does have to be tested flat? I cant lay flat i sleepupright

[@Mellly411]

How many days can it take to cleanse, I’ve been doing the epley 3 times a day for 5 days and still have symptoms

[@youssefb8894]

Hi, Do you know why many therapist advice to do the epley once and then keep your head up for at least 24hr? How is that in line with retesting after you done the epley? And also some therapist advice the opposite. Sometimes it seems contradictory..

[@GordonPhysicalTherapy]

I always retest to make sure there's absolutely NO nystagmus left after the Epley, which often leads to me treating the person for 2-4 reps for the day. After that, if we cleared everything, THEN I recommend they avoid having their head down for 24-48 hours. You have to clear the vertigo first though.

[@tomektalk4671]

If you are perfectly healthy, will doing the epley maneuver or bbq maneuver mess anything up?

[@jameswerner7955]

Can you test on the left side and right side Epley during the same session?

[@GordonPhysicalTherapy]

Yes, you can test both sides. I usually just treat one side and a time though.

[@Burgerdog75]

So I had vertigo really bad 4 weeks ago I’ve been doing all the exercises. This past week I’ve had no dizziness whatsoever so I feel like I’m doing great…. but different parts of the day I start feeling like I have pressure or that fullness feeling on my ears almost like the feeling you get when you take a ride up into the mountains and the altitude changes is that normal?

[@GordonPhysicalTherapy]

That fullness isn't usually associated with BPPV in terms of the little crystals being loose in the canals. In can be related to an ear infection or Meneire's.

[@michaelgibson8402]

You know if it feels like your ears are filling up sometimes it's cuz your damn gum is station tubes are draining fluid out

[@sinhapul]

Can this be done as preventive one also ..? Like after spinning of head stopped after doing this Maneuver , can this is be done daily as a preventive one...?

[@GordonPhysicalTherapy]

Not really, no. Try the VOR X1 Viewing exercises to improve the inner ear function, and be prepared to do the Epley again in the future if the vertigo returns.

[@user-xg6zh9uy8o]

I've had veritgo for about 2 months now. Saw a PT a few weeks ago and did the epley. It worked and then the next morning woke back up with vertigo. Went back to her and did the epley 3 more times and it got slightly better. She told me to continue doing the epley at home. It's confusing because I'm fine when I go back in the dix-hale and zero spinning but I get dizzy when I face down. During the day I am really only dizzy when I turn to the right or move too fast. Can you help figure this out?

[@GordonPhysicalTherapy]

Have you checked yourself for horizontal canal BPPV? I’m wondering if your crystals switched from the posterior canal to the horizontal canal, which might explain your change in symptoms…

[@Tad-zh4wr]

in a switching case, what maneuver does one need to do?

[@user-yt5zi2by1r]

My question is I had a crazy 3 or 4 days of vertigo about 10 years ago, and when I have done the Epley maneuver which definately helps, it causes me to vomit for about 2 to 3 minutes usually just acid or yellow bile. Is this common and why?

[@GordonPhysicalTherapy]

Some people do get nauseous and vomit with the Epley Maneuver, as there's some motion sickness involved. Taking an anti-nausea medication can often help (if safely prescribed).

[@QQ21vr]

After anesthesia procedures I’ll get bppv if I later in the day bend over too far. Same with me husband after surgeries he’s had. Is there a way to prevent that before anesthesia or just make a mental note to try to keep the head straight for a couple days after. Wish the anesthesiologist could mention that to patients. Haven’t had one do it except one nurse afterward.

[@GordonPhysicalTherapy]

I haven't heard of that before... do you get actual vertigo, or is it more like lightheadedness?

[@lararose9106]

Can i do dental work if i have bppv or does dental work itself cause bppv

[@nicobay4512]

I get vertigo on my left ear, when i do the eplay , i got some short vertigo and short nistagmus * like 5 seconde* on the first movement, nothing when i turn my head, and nothing when i roll. But when i sit back , i got vertigo and nistagmus again that are also short but a bit stronger. Im tired , my doctor vestibular do me the semont move everytime and tell me to not move my head and sleep with head up for 1 week then he see me again . But it keep happening. I dont know what to do and would love some advice plz

[@GordonPhysicalTherapy]

See my comments on your other post...

[@dand4075]

Can I do the maneuver even when I'm feeling healthy with no symptoms, just as a preventive measure. I had it once before few years ago.

[@GordonPhysicalTherapy]

Great question! No, it won't really help to do the Epley when you're not having vertigo. There's no evidence that this will help prevent BPPV from recurring.

[@dand4075]

@@GordonPhysicalTherapy Thank you so much 😊

[@brienmuller]

Im not vlear on the vertical vs horizontal eye movements.

[@GordonPhysicalTherapy]

Horizontal is pretty obvious when you see it: the eyes dart side-to-side. Vertical/torsional looks much different. check out this video on horizontal: kzbin.infoGr_rN313ilE?feature=share

[@MC1RPOSITIVESusieQ]

What are your thoughts on PPPD?

[@GordonPhysicalTherapy]

I don't see PPPD a lot, but I think it's worth treating with vestibular and balance exercises to try to reestablish better neural pathways.

[@MC1RPOSITIVESusieQ]

@@GordonPhysicalTherapy I agree, because when I started doing these exercises, it seem to help. And I haven’t been doing them, and I have noticed a gradual increase in the PPPD.

[@moecase5050]

I just finished 4 sessions to clear it. I’m much better now, but the treatment was more than I was expecting. It was difficult. This was at a therapist’s office, not on my own. I did feel nauseous at one session and then had a sensation like I was falling after completion of the Epley at the final session. After that I was better but felt a little light headed for a few more days, especially when waking up in the morning. Is that normal? Also, to be honest, I am still a bit anxious about tipping my head back. I think psychological at this point!

[@GordonPhysicalTherapy]

I would definitely follow up with some vestibular exercises to see if that helps calm down your residual symptoms. And if you’re still nervous to tip your head back, you might still have a touch of BPPV left to treat. I would keep pushing until you can clear all your symptoms 👍

[@moecase5050]

Thanks for your response. I did do vestibular exercises after these sessions and that did help. I feel like I MIGHT have some slight vertigo remaining though. I just need to get up my nerve to go back because I hate that vertigo sensation so much. Ugh. I would say I am mostly improved (95%) however from where I was a month ago. I’ve had 10 Epley’s over 4 sessions (days) so far. My last session the therapist saw no more eye movement so I’m taking that as a positive sign.

[@amygalvin1799]

Morning are the worst.

[@chrisfry436]

Oh that nausea.....it starts when I am laying on my side! I keep a trash can close because when I sit up I vomit!! and I started doing it in the morning before I eat, but then dry heave and that is horrible!! so I drink a water only before doing this and then if I do get sick at least there is some water in there....geez louise.....

[@vike1929]

I've done the Epley three different days with good results but my vertigo comes back. Because I don't like seeing the spinning room can I do the Epley in the dark or will that make things worse?

[@GordonPhysicalTherapy]

Doing the Epley in the dark will actually probably make you feel worse, as you won't be able to focus your vision as well. I like to have a dark room when working with clients, because they can't focus as well visually, which makes it easier for me to see their nystagmus (the direction of eye movement). Have you been able to have someone take a video of your eyes to make sure you have posterior canal BPPV (your should have upbeating, torsional nystagmus)?

[@vike1929]

No I have not had someone shoot a video. I did the Epley three different days and everything goes as advertised meaning the room spins in position 1 then it spins again in position 2 then spins again when I look down in position 3 so I think I'm doing it correctly? But I have not gone to see a medical professional yet??

[@CrickBuzzUniverse123]

I have few doubts? Can I discuss?

[@GordonPhysicalTherapy]

Fire away!

[@CrickBuzzUniverse123]

Do bppv create weakness as well as it got diagnosed later so took pills of vertigo?

[@CrickBuzzUniverse123]

And is cervical spondylitis and bppv related?

[@lorimueller4847]

Can you do both ears in the same twenty four hours

[@GordonPhysicalTherapy]

You can, you just run the risk of undoing the work on one side when you treat the opposite side. Do you have BPPV on both sides? It's not very common, but it does happen at times.

[@lorimueller4847]

Yes both sides but I'll do the r side at noon, it's 23 hours then, thanks I've done this many times. But forgot

[@Mellly411]

How many days can it take to cleanse, I’ve been doing the epley 3 times a day for 5 days and still have symptoms