Post maneuver precautions – worth it?

Following a treatment maneuver for BPPV many practitioners recommend staying upright for 48 hours.  This recommendation makes some empiric sense.  The idea behind it is to allow the particles, disturbed like snow in a snow globe, to settle before exposing the opening of the posterior canal by lying down.

In the attached image you can see the particles and the opening to the canal, at the top.  However, these precautions were never proven.  In fact, a number of researchers have demonstrated that restrictions do not improve the results of the Epley canalith repositioning maneuver. We think that this is because the disturbed particles, like snow flakes, don’t cause problems until they form clumps.  Unfortunately, there is no way to keep the flakes from finding their way back into the posterior canal everytime you “shake the snow globe” by lying down.  Eventually clumps will form again.  This is why BPPV is recurrent.

Many people who do try to complete the post maneuver precautions find that they loose two nights of sleep and get a sore neck. I am not sure it is worth it when there is no evidence for it and plenty against.  Below are three of the published articles on how and why the post maneuver precuations are of limited value.

  •  Simoceli L, Bittar RS, Greters ME. Posture restrictions do not interfere in the results of canalith repositioning maneuverBraz J Otorhinolaryngol. 2005 Jan-Feb;71(1):55-9. Epub 2006 Jan 2.[PubMed]
  • Nuti D, Nati C, Passali D. Treatment of benign paroxysmal positional vertigo: no need for postmaneuver restrictions. Otolaryngol Head Neck Surg 2000;122:440-4. [PubMed]
  • Massoud EA, Ireland DJ. Post-treatment instructions in the nonsurgical management of benign paroxysmal positional vertigo. J Otolaryngol 1996;25:121-5. [PubMed]

14 Responses


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  8. truck

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  11. Anonymous

    Raul Camarena, hi…do VRT. But here is the catch, what you eat plays an important rule also. Avoid food and beverages that triggers and increases the symptoms of dizziness/vertigo. Your VRT is only as good as what sustenance your body gets. There are different types of VRT also, some only do the head movements, eye movements and overall forgets the conditioning part. Your body needs conditioning exercises most specially to improve your blood circulation before doing the specific VRTs. As for feeling woozy then do slow balance and tolerance exercises which I am sure was also given as part of your VRT. However, if you have maintenance medications like for DM, MS, Heart and etc. you can check those medications regarding their individual side effects, that way your VRT and Epley’s won’t come to waste. Check with your doctor for medication alternatives. 🙂

  12. Clearwater Clinical

    Thanks for your great questions:

    1) Could I start doing VRT exercises and activity now or would I wait?
    If you have BPPV then you can do an Epley at any time. If you have vestibular neuronitis then you should probably take it easy for a days until things settle down before you do VRT.

    2) Does VRT or Brant Daroff cause BPPV?
    No. However, they can stimulate the symptoms if you already have BPPV. Brant Daroff exercises were intended to enable you to tolerate the symptoms better by acclimatizing to them but have largely fallen out of favor. VRT can be anything that moves your head around – walking and looking up down left right could be VRT. IF you have BPPV and are doing VRT I would suggest you stop and do an Epley which is much more effective at treating BPPV. However, there is no known maneuver that will create BPPV if you don’t already have it.

    3) Will I always have BPPV?
    An effective Epley has a very high chance of treating a BPPV episode. There is no permanent fix unless you want surgery (which I would not recommend unless this is a disabling problem). There are however, home treatment devices like DizzyFIX that will help you do an effective maneuver and quickly get you back to normal. I find the minimum time to get back to normal to be about 3-5 days from the onset of a BPPV episode. It can be much longer in some people and in the first instance of BPPV.

    Please discuss your treatment plans with your own physician to ensure they are right for you.
    Good luck

  13. Raul Camarena


    I’ve had a vertigo case in 2006, quick spinning vertigo with motion in almost every head or body position, but dix hall pike always tested negative. An apparent right vestibular dysfunction shown in the caloric test. Took 4 years to get rid of the symptoms completely. Then Back in 2014, Vestibular Neuritis got me, I couldn’t even see clearly, initial prednisone treatment and then 4 months of PT and activity again to get rid of symptoms again.

    Last Saturday a text case of left ear BPPV got me, dix hall pike positive, Epley conducted by ENT, it stopped that feeling but left me woozy. I’ve been off balance and with some quick spins with little head motion and a general uneasy feeling.

    In my past experience activity and VRT were the real fix for my dizziness so I wonder:

    Could I start doing VRT exercises and activity now or would I wait? ENT told 48 hours rest, take it easy for a week.

    Does the VRT head movements or something like the Brandt-Daroff or the Dix Hallpike can cause a BPPV episode? In the sense that this quick and angled movement of the head could bring some otoconia where they don’t belong?

    This final question is because I really don’t want to live with recurrent episodes of vertigo all of my life, I’m not a kid(47) but this has take it’s toll on me. Both times it was a triumph to be able to run, play, roll on bed with my kid again, without fearing the dizziness, and I’ve always have to thank VRT and exercise, so when this struck me for the third time, as “Benign” as it may be called, it is quite disheartening.

    So any tip or advice is really truly welcomed.

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