Hello, I’m I’m Bob Schrupp, physical therapist I’m Brad Heineck, physical therapist Don’t bother me, Bob. I’m looking up the Epley maneuver we’re talking about- Right, today we’re going to talk about the Epley maneuver- Basically were going to show you how to do it. It’s also called the Canalith Repositioning Maneuver and what it’s for is a type of dizziness and specifically we usually use it for Benign paroxysmal positional vertigo. -It’s a mouthful.
-It’s a mouthful. It’s a type of vertigo, a type of dizziness Basically what we would like to see is that you were diagnosed with this by your doctor now you were asked to do this type of maneuver or your physical therapist or somebody may be doing this maneuver with you. We’re just going to go over it with you, or maybe a professional who has to do this. It’s a good way– a review of that, so let’s go to it.
-Alright Okay After I interview a patient and I find out what’s going on and have confirmed that it is– [Brad] vertigo
[Bob] BPPV [laughing] If they’ve got vertigo symptoms, I just skip the big words and go right into it so it makes sense to the patient and it’s easy to communicate with Find out which way produces the symptoms and when I say which way, which direction and oftentimes they say, “When I lean or turn my head to the right, or when I’m in bed and I roll to the right”, and sometimes it’s to the left but in this case when Bob turns his head to the right or when he rolls to the right in bed thing start spinning. Is that right, Bob?
-That is correct It’s very uncomfortable.
Makes you feel very nauseous that can be different intensities as well So, once I determine which direction, that tells me which way to start the treatment and what I mean by that is which way to turn the head– so what I have someone do is get up on the table sit like Bob is sitting, and we get their back at approximately a 45 degree angle You don’t have to get the goniometer out and measure but just so– about Bob is now and then he’s going to turn his head to the right
and tilt back [murmuring] [Brad] I tilt back a little bit, Bob
[Laughing] Different therapists do this a little differently but– [Bob] Turn to the left, tilt back [Brad] Bob doesn’t like to tilt back yet I’ll do a little bit, depending on the patient’s response. Okay So, once we get to that point, we’ll hold it for 30 seconds to a minute and in this case we’re going to go for 30 seconds just to shorten it up. Okay, Bob, we just finished out at 30 seconds Now, we’re going to go to phase 2 of this treatment and what I’m going to have you do, I’m going to take a couple pillows I’m going to place them right here And you’re going to feel them right in your back right here So you’re gonna go down slowly.
Take your time. Now, you’re going to keep your head at that 45 degree
Adjust it as you need and you’re going to bring your head back while maintaining that 45-degree 30-degrees and that’s about 30 degrees right there How are you doing, Bob?
-Good This has to be done slow, And if you do it slow you shouldn’t have too many symptoms that are making you feel nauseous or real dizzy If you do, it’s too fast and too much too early We’re going to hold this for 30 seconds, okay? You’re going to time it.
A lot of times I like to use– I’ve got a clock on the wall in my– in the clinic And I just got a second hand and I look for 30 seconds or either that or you have someone come in and help me time if that’s not available right in front of me And then, we’re going to go slowly to the left Okay, so that we’re 45 degrees to the left and maintain that 30 degrees extension. How you doing, Bob?
[Bob] Good And I always communicate with the patient, see if they’re feeling dizzy and things are spinning but they let you know it. You’ll know it if you’re doing this to yourself. Hold that for the 30 seconds Bob, we’re done with this position, and now we’re going to go to the next position. So, what I’d like you to do is turn to your left side Bring your knees up.
Good, perfect Go over like that Now, while you do that, keep your head angled down towards the floor Good, bring the shoulder up
Okay, head down… there we go. Are you comfortable in that position? [yeah]
We’re going to hold that for 30 seconds Okay [Bob] We’ll jump ahead.
We don’t have to hold it. I mean– just pretend it’s been 30 seconds. Okay, now we’re at 30 seconds.
Bob, we’re the next position Now, what I want you to do is bring your knees forward so your feet and knees are up.
There, just that that. Now, let’s tuck your chin in towards your chest slightly and slowly go up [Bob] Look down at the floor
[Brad] Exactly As you go up, look more towards the floor Hold it steady. Nothing too fast. How are you feeling there?
-Good Good, okay? [Bob] We’re gonna to keep the chin tilted down
[Brad] Exactly, keep that down Now, this is the easy part of the treatment, Bob. After this 30 seconds, keep your head still… After this 30 seconds, the hard part of the treatment is the next 48 hours What Bob’s going to have to do is keep his head in a vertical position for 48 hours Now, what I’m going to give him to help him out– this means that you cannot look down, you can’t bend over to pick anything up, and you can’t lay down to sleep in bed That’s what makes us difficult. [Bob] You want me to come up now?
That’s been 30 seconds Ok, yep. Nice and slow, everything’s feeling good, you’re not spinning your anything?
-Nope, I’m good You get yourself a simple neck collar Velcro, cost about $10 at–
-A nice soft collar -Yup, a nice soft one at any pharmacy store. And we’re going to bring this around your neck You don’t have to use this but, if you want to maintain that
head vertical position for 48 hours This is a constant reminder
that you need to keep your head up I have some patients, and what they’ll do is actually
take a couple days off of work or do it on a weekend, because you’re not going to be able to do at work for most jobs. Okay, you okay with that, Bob?
-Very good? Again, this doesn’t have to be tight. When you’re sitting in a chair or standing and you want to take it off you’re welcome to do that at anytime
you can leave it off, but again it works great to hold that 48 hours because if you do bend over, or you look down you throw it off and you get dizzy again, It’s not a big deal, but you have to start the whole process all over again. And I think we should mention, Brad,
that you may need to do the process over again. -Yeah
-Some people have to do this, the Canalith repositioning maneuver, a number of times before it actually works
-Sure And the other thing is there was some debate online whether or not you need to do this part of it the 48 hours The mayo clinic advocates this this method. We’ve used it– When I was working at the Mayo Clinic
we did it that way so I think I feel pretty safe in saying that it needs to be done. -Right, and it’s been my experience in a clinic, that if you have to do a second time after the first time, and say you throw something off,
you will notice some gains Maybe, 25% improvement.
That’d be a good indicator to repeat it. But, if you do it right the first time,
hold that head up for 48 hours it’s your best chance for success
and use the neck collar And that’s it It’s not a real difficult treatment, but it is challenging
-One last thing, Brad I just want to tack this on at the end of the video here, if you are 40, 50 years old or older you’re going to want to subscribe to us because we are going to be covering videos that are going to help you as you get older, as you age. You know– stay fit and healthy We’re going to cover subjects like this and other things– on fitness So, subscribe! Because we both are kinda in that age range [Bob] In that age group, and we have been treating people of that age group for ever. -Right. Well you, forever… I’m a little younger than that. Very good