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Canalith Repositioning Maneuvers (CRM)

What are Canalith Repositioning Maneuvers?

Canalith repositioning maneuvers, or CRM, are a common, non-surgical treatment for BPPV (benign paroxysmal positional vertigo), a type of vertigo. BPPV happens when tiny calcium “crystals” in the inner ear move into the wrong place. This can cause sudden spinning, nausea, and feeling off-balance. CRM uses gentle head and body movements to guide these crystals back where they belong.

A CRM is a hands-on treatment done by a trained provider.

Common maneuvers include:

  • Epley maneuver
  • Liberatory maneuver
  • Barbecue Roll maneuver
  • Head Shake maneuver

Each maneuver is used for a specific type of BPPV. Your provider chooses the right one based on which ear and which inner ear canal is affected.

Why am I having a Canalith Repositioning Maneuver?

You are having this treatment to:

  • Stop vertigo caused by certain head movements
  • Move misplaced inner ear crystals back where they belong
  • Reduce spinning, nausea, and imbalance
  • Lower your risk of falling

Are Canalith Repositioning Maneuvers Safe?

Yes. This treatment does not involve needles or surgery. It is widely used and supported by research. Most people tolerate it well. You may feel dizzy or nauseated during the treatment or for a short time afterward.

You can always:

  • Ask for a break
  • Ask your provider to modify any positions
  • Ask to stop if you feel too uncomfortable
  • Tell your provider how you are feeling during the treatment

Will a Canalith Repositioning Maneuver Help?

Research shows that these maneuvers work very well for many people with BPPV. Some people feel better after one visit, while others may need 1–3 visits. The best results happen when the correct maneuver is used for the specific ear and canal affected.

Before Your Appointment

Your provider may ask you to:

  • Eat a light meal (not a heavy one)
  • Avoid alcohol for 24 hours
  • Tell them if you have neck, back, or blood vessel problems
  • Allow extra time to sit and recover afterward
  • Avoid taking sedating medicines like Meclizine or Antivert before treatment

What to Wear

  • Comfortable clothes
  • Flat, stable shoes
  • A hair tie if you have long hair

If goggles will be used you should avoid: 

  • Heavy eye makeup 
  • Lotions or oils on your face

What to Bring

  • Photo ID
  • Insurance card 
  • A list of your medicines 
  • Glasses or hearing aids (if you use them)

Should I Bring a Ride?

Most people feel okay to drive home after their visit.

However, some treatments can:

  • Make you feel dizzy
  • Cause brief nausea
  • Make driving uncomfortable right away

If you can, bring someone to drive you home.

Questions You May Want to Ask Your Provider

It may be helpful to ask the following questions at your appointment to best prepare yourself for the treatment and its outcomes. 

  • Do you think this is BPPV, and if so, which ear is involved?
  • Which maneuver are you doing today, and why?
  • What should I do if I feel very dizzy or sick during the treatment?
  • Do I need to avoid anything after the treatment?
  • When should I follow up if I still have symptoms?
  • How many visits do people usually need?
  • What warning signs mean I should call you right away?

During Canalith Repositioning Maneuvers

What Will Happen?

During a canalith repositioning maneuver, your provider will guide your head and body through specific positions based on the type of BPPV you have.

You may:

  • Sit, lie down, or roll into different positions
  • Turn your head in certain directions
  • Hold each position for a short time
  • Wear goggles so your provider can watch your eye movements
  • Repeat some movements if needed

The treatment usually takes 10 to 30 minutes.

This is an example of an Epley maneuver, a common treatment for right-sided BPPV, performed by a trained clinician.

How Might I Feel?

  • Sudden spinning (vertigo)
  • Nausea or an upset stomach
  • Sweating or feeling warm
  • A “tilting,” “dropping,” or “floating” feeling
  • Unsteady when you sit up

These feelings are expected and usually last only a short time.

After Canalith Repositioning Maneuvers

How Will I Feel?

Most people:

  • Feel better right away or within a day or two
  • Feel slightly “off” for a short time
  • Feel tired

Some people may:

  • Still feel dizzy with certain head movements for a day or two
  • Have mild nausea
  • Have mild neck soreness
  • Need another visit

When Will I Notice Results?

Some people feel better right away. Others improve over the next day or two. Improvement may happen in steps. You can talk with your provider if you feel like you are not improving. 

What Should I Do?

  • Move slowly when standing or walking
  • Use a handrail if needed
  • Avoid risky activities (like climbing ladders) until steady

Your provider may give you a home exercise to fully resolve symptoms or to use if symptoms return. Follow all instructions carefully.

When Should I Call My Provider?

Call your provider if you have:

  • A severe or worsening headache
  • Severe neck pain
  • New hearing loss, ear pain, or ear drainage
  • Severe vomiting that will not stop
  • Vision changes that do not go away

Call 911 right away if you have:

  • Chest pain or trouble breathing
  • Fainting
  • Weakness or numbness
  • Slurred speech
  • New confusion
  • Trouble walking

Always ask your clinician if you have questions about anything not covered here.

Key Things to Remember

  • This treatment moves inner ear crystals back where they belong
  • A short burst of dizziness during treatment can be normal
  • Many people feel better quickly
  • It’s common to feel a little “off” afterward
  • Ask about driving and safety if you feel unsteady
  • It’s important to see a provider trained in treating BPPV (typically a vestibular specialist)

Additional Resources