Benign Paroxysmal Positional Vertigo (BPPV) is a common inner ear disorder that causes sudden, brief episodes of intense spinning sensations, or vertigo. This condition is triggered by specific changes in head position, such as rolling over in bed or looking upward. The Half-Somersault Maneuver, also known as the Foster Maneuver, is a treatment designed to alleviate these symptoms. This exercise uses a sequence of body movements to resolve the underlying mechanical issue. Learning the correct technique and repetition schedule for this maneuver is essential for successfully treating positional vertigo at home.
The Mechanism: Why the Maneuver Works
The cause of BPPV lies in the inner ear’s vestibular system, which controls balance. The condition occurs when calcium carbonate crystals, called otoconia or “ear rocks,” become dislodged from their normal location in the utricle. The utricle is a small organ that senses acceleration and gravity.
When these otoconia shift, they drift into one of the three semicircular canals, most commonly the posterior canal. The presence of these particles improperly triggers the sensitive hair cells within the canal, sending false signals to the brain that the head is spinning. The Half-Somersault Maneuver utilizes gravity and specific head positioning to physically move these crystals out of the semicircular canal and return them to the utricle, where they settle without causing symptoms.
Step-by-Step Guide to the Half-Somersault Maneuver
The maneuver is a four-position sequence performed while kneeling. First, identify the affected ear, as the direction of the head turn depends on which side is causing the vertigo. Begin by kneeling on the floor or a firm bed, placing your hands on the surface in front of you.
The first step involves quickly tipping your head straight upward, aiming to look at the ceiling, and holding this position for a few seconds. Next, immediately drop your head down in a tucking motion. Your chin should be tucked toward your knees, with the crown of your head touching the surface.
This second position often provokes a burst of vertigo, which confirms the crystals are moving correctly. Wait in this position until any spinning sensation subsides, then add an additional 30 seconds of rest.
The third position requires you to slowly turn your head 45 degrees toward the elbow on the side of the affected ear, keeping your head tucked down. Hold this turned position until any induced dizziness resolves, plus an extra 30 seconds to ensure the particles settle. Finally, quickly raise your head to shoulder level while keeping it turned toward the affected side, moving into a flat-back position. After holding this last position for 30 seconds, slowly return to a fully upright, seated position.
Determining Frequency: How Many Times to Repeat
Repeating the Half-Somersault Maneuver involves considering repetitions within a single session and the daily frequency of sessions. For a single session, the maneuver is typically repeated only if a quick test suggests the vertigo has not fully resolved. After completing the full four-step sequence and resting for 15 minutes, test by quickly tipping your head up and down.
If this test still provokes dizziness, repeat the entire maneuver, waiting at least 15 minutes between repetitions to allow the inner ear particles to settle. While some recommendations suggest three to four repetitions in a row, a single successful execution is often enough. If performed correctly, the maneuver may resolve BPPV after just one attempt.
Regarding daily frequency, perform the maneuver one to three times a day until the symptoms have completely disappeared. Stop the treatment when you can perform the head-tip test without experiencing any dizziness or vertigo. If symptoms persist after performing the maneuver daily for one week, the technique may be incorrect, or the diagnosis needs re-evaluation.
Monitoring Results and When to Consult a Doctor
The immediate reaction to the Half-Somersault Maneuver is a reliable indicator of its effectiveness. Experiencing a sudden, brief increase in vertigo during the sequence, especially in the second or third position, is normal and confirms that the crystals are moving out of the semicircular canal. The maneuver is working if the intensity or duration of the spinning sensations begins to lessen with each subsequent repetition.
You should stop performing the maneuver once symptoms have been absent for at least 24 hours, even when performing the provocative head-tip test. If the treatment is unsuccessful, meaning there is no improvement after one week of diligent, correct use, consult a healthcare professional. Failure of the maneuver to provide relief may mean the crystals are in a different canal or the underlying cause of the dizziness is not BPPV.
Additionally, certain red flag symptoms that may accompany dizziness require immediate medical consultation, as they suggest a more serious condition than BPPV. True BPPV does not cause continuous, prolonged vertigo lasting over 24 hours or hearing loss. The presence of these symptoms warrants an urgent medical evaluation. These concerning symptoms include:
- A new, severe headache.
- Double vision.
- Difficulty speaking or swallowing.
- Noticeable weakness or numbness in the limbs.