BPPV Becoming More Prevalent and Treatable

By Sarah Sitzmann-Ruehle, PT, DPT

When I started graduate school for physical therapy, I would never have thought this would be my
path, shares Sarah Sitzmann-Ruehle, PT and DPT, Dynamic Physical Therapy office clinic manager for the Dakota Dunes office.

I am a manager of a clinic, specializing in vestibular care, and doing research on Benign Paroxysmal Positional Vertigo (BPPV).

I did a clinical at FYZICAL Therapy & Balance Centers my last year of school and started working at Dynamic Physical Therapy after graduating in 2018.

In 2019, I began to formulate the idea of performing a retrospective research study on BPPV. Retrospective means data collection without variable manipulation, so I am still doing the appropriate treatments, but collecting data on demographics and other information.

I am so thankful that when we were bought by local owners in November and renamed Dynamic Physical Therapy, that the owners supported me to continue this endeavor to gain further information for our patients.

BPPV is one of the most common diagnoses treated at the specialty clinic. BPPV occurs when otoconia (crystals) break loose from their bed and dislodge, getting trapped in the semicircular canals.

Now crystals are tiny, seven times smaller than a strand of hair. We are born with millions on each side, and we need them to sense certain types of movement. When they break loose and get stuck, it is like a marble loose in the maze. Fortunately, our body helps us out, using something called nystagmus (an involuntary eye movement) when these crystals are loose. What is more fortunate is that the eyes move differently based on which canal is trapping the crystal (six different canals). Once I know where a crystal is located by “reading the eyes,” I can perform certain maneuvers to get the marble out of the maze.

Now that we have talked about what happens in the body, let’s talk about what a patient feels.

When crystals move through the canals, there is a signal sent to the brain that whatever movement has just happened, is still happening. Our eyes and smart brain know that we are done moving and the brain gets very confused. It thinks the Earth must be spinning around us and results in visual room spinning dizziness (aka vertigo). It is usually short, anywhere from 5-15 seconds, but can be up to a minute and the lingering effects can make a patient feel very off.

Typically, at our clinic, we can fix a patient with BPPV in an average of two sessions (a statistic I am tracking through my research).

Other data being collected: gender (well known that women have an incidence of 4:1, which my research agrees with), age, cause, treatment, canal, how often it reoccurs in patients, and what I am most interested in is any tie to the time of the year or seasonal allergies.

I plan to continue collecting data and will do statistical analysis at some point to find any statistical significance between the data. This research is only possible at a clinic like ours because of the volume of patients who come through our doors. My team has been pivotal in helping with data collection as well and for that I am truly grateful. We get a very minimal amount of education in school on the vestibular system and our clinic prides itself on our above and beyond education.

I am certified in Vestibular Level 1, 2, and 3 and BPPV certification. At Dynamic Physical Therapy, we have equipment and knowledge not seen anywhere else in the Siouxland area.

Our focus has always been patient centered and will continue to be under our new name,
Dynamic Physical Therapy.

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