The Short Answer Educational content only. Any suspected concussion warrants medical evaluation. Consult vestibular-trained physical therapist, neuro-optometrist, or concussion specialist for individualized guidance. The Epley maneuver treats posterior canal benign paroxysmal positional vertigo (BPPV) by repositioning dislodged otoconia from the semicircular canal back into the utricle through a sequence of head positions using gravity (Silverberg et al., 2020). Effectiveness 70-90% for posterior canal BPPV. Post-traumatic BPPV following concussion may require 2-3 sessions due to multiple otoconia and multiple canal involvement. Home Epley exercises supplement professional treatment for recurrent BPPV. Alternative maneuvers address different canal involvement patterns: Semont maneuver alternative for posterior canal, BBQ roll (Lempert) for horizontal canal, and deep head hanging for anterior canal. Vestibular-trained physical therapist provides most effective initial treatment. Epley repositions otoconia via gravity. Repositions otoconia via gravity. 70-90% effectiveness for posterior canal. 70-90% effectiveness posterior canal. Post-traumatic BPPV may require 2-3 sessions. 2-3 sessions post-traumatic. Epley Maneuver Steps Step 1: Sit on edge of examination table. Sit on edge of table. Step 2: Turn head 45 degrees toward affected ear. Turn head 45 degrees toward affected ear. Step 3: Lie back quickly with head hanging 30 degrees below horizontal. Lie back head hanging 30 degrees. Step 4: Hold position 30-60 seconds. Hold 30-60 seconds. Step 5: Turn head 90 degrees toward unaffected side. Turn head 90 degrees toward unaffected. Step 6: Hold position 30-60 seconds. Hold 30-60 seconds. Step 7: Roll body toward unaffected side with head turned. Roll body toward unaffected. Step 8: Face angled 45 degrees toward floor. Face 45 degrees toward floor. Step 9: Hold position 30-60 seconds. Hold 30-60 seconds. Step 10: Sit up slowly. Sit up slowly. Why Epley Works Sequential position changes use gravity. Sequential position changes use gravity. Otoconia migrate through canal by gravity. Otoconia migrate through canal. Positioning ends in utricle where otoconia reabsorb. Positioning ends in utricle. Removes otoconia from provoking position. Removes otoconia from provoking position. Restores normal vestibular function. Restores normal vestibular function. Post-Treatment Instructions Sit upright 15 minutes after maneuver. Sit upright 15 minutes after. Avoid provoking positions 24-48 hours. Avoid provoking positions 24-48 hours. Sleep upright first night (traditional recommendation). Sleep upright first night. Recent evidence questions sleep restrictions. Recent evidence questions sleep restrictions. Avoid rapid head movements. Avoid rapid head movements. Return for reassessment if symptoms persist. Return for reassessment. Home Epley Exercises Home Epley useful for recurrent BPPV. Home Epley useful for recurrent. Instruction by vestibular therapist essential. Instruction by therapist essential. Modified Epley sometimes recommended. Modified Epley sometimes recommended. Perform 1-3 times daily until asymptomatic 24 hours. 1-3 times daily until asymptomatic. Video instruction supplements provider guidance. Video instruction supplements guidance. Not appropriate before initial diagnosis. Not appropriate before diagnosis. Alternative Maneuvers Semont maneuver alternative posterior canal. Semont maneuver alternative. BBQ roll (Lempert) for horizontal canal. BBQ roll horizontal canal. Gufoni maneuver alternative horizontal canal. Gufoni maneuver alternative horizontal. Deep head hanging for anterior canal. Deep head hanging anterior canal. Yacovino maneuver anterior canal. Yacovino maneuver anterior canal. Post-Concussion BPPV Considerations Multiple canal involvement more common. Multiple canal involvement more common. Bilateral involvement more common. Bilateral involvement more common. Cervical range of motion assessment first. Cervical ROM assessment first. Modified positioning for cervical instability. Modified positioning for cervical instability. Nausea management during maneuvers. Nausea management. Slower position changes. Slower position changes. Cautions and Contraindications Severe cervical instability. Severe cervical instability. Recent cervical spine surgery. Recent cervical spine surgery. Severe carotid artery disease. Severe carotid artery disease. Severe cervical stenosis. Severe cervical stenosis. Recent retinal detachment. Recent retinal detachment. Modified maneuvers for high-risk patients. Modified maneuvers for high-risk. What to Expect During and After Vertigo during maneuver expected. Vertigo during maneuver expected. Nausea during maneuver possible. Nausea during maneuver possible. Symptom improvement often immediate. Symptom improvement often immediate. Residual imbalance common. Residual imbalance common. Symptoms resolve completely in 70-90%. Complete resolution 70-90%. Follow-up in 1-2 weeks. Follow-up 1-2 weeks. Supporting Mobility Routine These exercises support recovery through cervical mobility and nervous system regulation. JME 155 Diaphragmatic breathing supports vagal tone and parasympathetic regulation during concussion recovery. 10 breaths every 60-90 minutes. JME 14 Chin tucks reduce upper cervical tension common in concussion injury. 10 repetitions with 5-second holds. JME 1 Cervical rotation supports cerebral blood flow and nervous system regulation. 10 repetitions each direction. JME 150 Thoracic rotation restores breathing depth shallow during concussion recovery. 8 repetitions per direction. Start your 3-day free trial for joint-specific mobility programs that support nervous system regulation through concussion recovery. How effective is the Epley maneuver for post-concussion BPPV? Epley maneuver resolves 70-90% of posterior canal BPPV within 1-3 treatments. Post-traumatic BPPV may require additional sessions due to multiple canal involvement. Bilateral BPPV requires bilateral treatment. Follow-up assessment at 1-2 weeks confirms resolution. Recurrence rate higher in post-traumatic BPPV. Can I perform the Epley maneuver at home? Home Epley useful for recurrent BPPV after initial professional diagnosis and instruction. Not appropriate before initial diagnosis. Modified Epley sometimes recommended for home use. Perform 1-3 times daily until asymptomatic 24 hours. Video instruction supplements provider guidance. Return to provider if symptoms persist or recur frequently. Why does the Epley maneuver cause vertigo during treatment? Vertigo during Epley maneuver reflects otoconia movement through canal. This is expected and confirms proper positioning. Vertigo typically brief (under 60 seconds) at each position. Nausea common. Symptom provocation supports diagnosis and treatment effectiveness. Complete absence of vertigo may indicate incorrect canal identification. Do I need to sleep upright after the Epley maneuver? Traditional recommendation was sleep upright 48 hours after Epley. Recent evidence questions necessity of sleep restrictions. Current practice varies. Some providers recommend elevated head 30 degrees for first night. Post-treatment restrictions do not significantly affect resolution rates in most studies. Follow your provider's specific recommendations. What if the Epley maneuver does not work for my post-concussion BPPV? Try alternative maneuver (Semont for posterior canal). Reassess canal involvement (horizontal or anterior canal may require different maneuver). Multiple canal involvement common post-concussion. 2-3 sessions may be needed. Consider cupulolithiasis vs canalithiasis. Consider vestibular rehabilitation for residual symptoms. Vestibular neurologist evaluation if refractory. References Patricios, J. S., et al. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695-711. PubMed Silverberg, N. D., et al. (2020). Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Archives of Physical Medicine and Rehabilitation, 101(2), 382-393. PubMed