Performing an Epley Maneuver for vertigo on patients with limited neck rotation is difficult but not impossible. Caution should be taken to ensure that an Epley maneuver is safe to perform.

Screening tests that physical therapists typically perform before attempting an Epley maneuver include checking the cervical range of motion and screening the vertebral artery, to make sure it will be safe. The patient must have adequate neck range of motion and a clear vertebral artery test. The patient must also consent to participate in an Epley maneuver, which can be unpleasant because it may provoke symptoms.

In the rest of this blog, I will discuss strategies to perform an Epley maneuver on patients with limited neck rotation or range of motion.

The Epley maneuver is one treatment used for patients with BPPV.

Epley Maneuver With Limited Neck Rotation Strategies

Reposition the Trunk and Arms

If the patient has limited neck rotation, one solution I use during the Epley maneuver for vertigo treatment is to tilt the patient’s body partially to the side that their head is facing in positions 1 and 2. That way their head is in the correct position in space even with limited neck rotation available.

In positions one and two of the Epley Maneuver, I may also have the patient reach across with their opposite hand to gently hold the shoulder on the side they are facing toward, thereby relieving neck tension.

Adjust the Position of the Shoulder

After the patient moves into position three of the Epley maneuver for vertigo, I may hold the patient’s head in place while they pull their under-shoulder down away from their chin. This technique of repositioning of their lower shoulder in position three can also give relief to patients with limited neck motion.

By pulling the under-shoulder down away from the chin, it reduces the amount of cervical rotation that is required to hold the head correctly in position three.

Turn from the Waist

As patients sit up from position three of the Epley maneuver, they must keep their chin near their lower shoulder. If that amount of neck rotation is not available or is uncomfortable, then I may instruct the patent to turn from their waist as they are slowly sitting up.

A bit of turning from the waist will allow their head to come up in the correct arc of motion while sitting up from position three, without straining their neck into rotation.

Another Treatment Option: Epley Chair

An alternative treatment option for patients with limited neck motion is to have BPPV treated in an Epley chair.  The Epley chair is a piece of medical equipment that can treat BPPV while the patient’s neck remains in a neutral position.

This may be helpful for patients with an unstable cervical spine or recent neck surgery.

Consult an Orthopedic PT for Neck Care

If dizzy patients have limited neck rotation, I also generally recommend for them to work with a professional to improve their neck range of motion. I usually suggest consulting an orthopedic manual physical therapist from this Directory for neck problems.

That orthopedic PT consult for the neck component of dizziness is likely in addition to working with a vestibular PT provider for the Epley maneuver. An orthopedic manual physical therapist may be able to help restore normal neck motion. They may also be able to resolve cervicogenic dizziness or cervical vertigo.

Patients with BPPV may develop neck pain from sleeping propped up. Patients with neck problems may aggravate neck pain while during the Epley maneuver for vertigo.

BPPV and the Neck May Both Need Treatment

In my unique approach to developing a vertigo treatment plan for my patients, I typically include treatments to resolve BPPV such as the Epley maneuver for vertigo, as well as treatments to restore normal neck motion.

I want to address all root causes of dizziness or vertigo for best results in a vertigo treatment plan.

I have written another blog for people who want to learn more about Dizziness from the Neck.


This blog is provided for informational and educational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.

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