From the Guidelines
After BPPV improves with the Epley maneuver, clinicians should not recommend postprocedural postural restrictions 1. This is based on the strongest and most recent evidence from the clinical practice guideline for benign paroxysmal positional vertigo. The guideline states that postprocedural postural restrictions are not recommended after canalith repositioning procedure for posterior canal BPPV, with a strong recommendation against it.
Key Points to Consider
- The Epley maneuver is a effective treatment for BPPV, and most patients experience complete resolution of symptoms after the procedure.
- The guideline recommends against postprocedural postural restrictions, which means that patients do not need to maintain a specific position or avoid certain activities after the procedure.
- However, it's essential to educate patients about the potential for recurrence and the importance of follow-up, as the recurrence rate of BPPV can be significant, ranging from 5% to 36% over time 1.
- Patients should be counseled about the risk of falls associated with BPPV, particularly in the elderly and frail, and should be advised to take precautions to minimize this risk.
Recommendations for Patients
- Patients can typically resume normal activities immediately after the Epley maneuver, without any specific postural restrictions.
- It's crucial to educate patients about the potential for recurrence and the importance of follow-up, as well as the risk of falls associated with BPPV.
- Patients should be advised to contact their healthcare provider if symptoms return or if they experience any concerns or difficulties after the procedure.
From the Research
Activity Restrictions after BPPV Improves with Epley Maneuver
After BPPV improves with the Epley maneuver, the following activity restrictions are recommended:
- Avoid heavy lifting, bending, or straining for a few days after the procedure 2, 3
- Avoid sleeping on the affected side for a few nights after the procedure 4
- Avoid making sudden head movements or changing positions quickly for a few days after the procedure 5, 6
- It is recommended to follow a post-Epley maneuver protocol which may include:
- Avoiding heavy lifting or bending for 2-3 days
- Sleeping with 2-3 pillows to keep the head elevated for 2-3 nights
- Avoiding sudden head movements or position changes for 2-3 days
- Avoiding strenuous activities for 2-3 days
Rationale for Activity Restrictions
The rationale for these activity restrictions is to allow the particles in the inner ear to settle and to reduce the risk of the vertigo returning 2, 3. By avoiding heavy lifting, bending, or straining, patients can reduce the risk of dislodging the particles and causing the vertigo to return. Similarly, avoiding sudden head movements or position changes can help to prevent the particles from becoming dislodged and causing vertigo.
Duration of Activity Restrictions
The duration of activity restrictions after the Epley maneuver is typically a few days to a week 4, 5. Patients are usually advised to follow the post-Epley maneuver protocol for 2-3 days to allow the particles to settle and to reduce the risk of the vertigo returning. After this period, patients can usually return to their normal activities, but it is still important to avoid making sudden head movements or changing positions quickly for a few more days.