• Van der Velde GM

• Dizziness / rehabilitation
• Manipulation, Chiropractic
• Vertigo / rehabilitation

To review the range of treatment interventions for benign paroxysmal positional vertigo (BPPV) with a focus on recent physical treatments (repositioning manoeuvres) inspired by the theoretical pathophysiology canalithiasis. To qualitatively review clinical trials which have examined the efficacy of these repositioning manoeuvres for treating BPPV and present a case report of BPPV treated with a repositioning manoeuvre.

Data sources:

Relevant studies were identified using the bibliographic database MEDLINE spanning from 1966 to March 1997.

Study selection:

A total of 21 studies were selected on the basis of their relevance to Part II of this review.

Data extraction: The findings and results of relevant studies, and their subsequent conclusions were compared and compiled into a historical summary of the physical treatment of BPPV, focusing on the state of the knowledge regarding the efficacy of repositioning manoeuvres.

Results of the data synthesis:

The most recent pathophysiological theories for BPPV, cupulolithiasis and canalithiasis, have inspired a number of physical treatments which seek to reverse the pathological mechanisms believed to be responsible for BPPV. The most recent physical treatments, Epley’s canalith repositioning procedure and its variations, are “bedside” procedures which seeks to reverse canalithiasis by the application of a series of positioning manoeuvres.

Conclusion:

The efficacy of these repositioning manoeuvres has not been satisfactorily determined, but despite this, their popularity is apparently growing. The repositioning manoeuvre can easily be performed in the chiropractic practice setting. However, prior to undertaking these physical treatments, the chiropractor should be confident in the diagnosis of BPPV, given that numerous causes of vertigo are serious and life-threatening.

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