Using The Bow-and-Yaw Maneuver to Treat BPPV

Updated July 2026: Expanded with additional clinical guidance, treatment considerations, and a new Clinical Pearl based on current vestibular rehabilitation practice.

The Bow-and-Yaw maneuver treats the short arm of both the right and left posterior canals at the same time. Many practitioners are not familiar with this atypical type of BPPV.

This type of short arm posterior canal BPPV can cause spinning symptoms while upright, or lying down.

Short arm posterior canal BPPV typically is first felt with a brief spin lasting less than one minute while sitting up or standing upright during the initial onset.

This possibility is always on my mind if a patient complains of spinning feelings lasting less than one minute while their head is upright, or describes that scenario as their initial onset of vertigo.

This posterior canal BPPV variant presents with a history typical of BPPV but does not clear with the more common maneuvers for the long arm of the posterior canal, such as modified Epley or Semont maneuvers.

After the initial onset, it often presents the same as classic posterior canal BPPV but it will not clear up with Epleys or Semont maneuvers.

When to Use the Bow-and-Yaw Maneuver

A practitioner may choose to start with this maneuver if the patient tests positive for posterior canal BPPV and complains that their vertigo is worse upright than lying down.

A practitioner may also choose to do this maneuver as the first maneuver in a treatment series after a patient has a new onset of posterior canal BPPV, as opposed to starting with a modified Epley or Semont maneuver for the long arm of the posterior canal.

This maneuver is a good choice if upbeating ipsitorsional nystagmus is observed in a traditional Dix-Hallpike or sidelying test for posterior canal BPPV but it will not resolve with an Epley or Semont maneuver.

Special note: BPPV in the short arm of the posterior canal can produce a few different types of positional nystagmus, depending on the angles of the inner ear anatomy in the individual patient. This variability may confuse novice practitioners.

If your provider cannot figure out how to resolve your BPPV, you may need to switch to a more experienced provider with advanced skills.

One interesting note is that I’ve observed drastic variation in how Vestibular PTs perform the Bow & Yaw maneuver. That’s to be expected since it’s relatively new.

Work with a Vestibular Professional for Best Results

New treatments for BPPV are continually being developed and published, so it’s important to work with a professional who is continuously studying and reading research to stay up-to-date with the highest level of skill in this niche of health care.

Learn more about the Bow-and-Yaw maneuver in this article: Diagnosis and treatment of the short-arm type posterior semicircular canal BPPV

For quick reference, below are some key findings (from that research article linked just above) to justify their conclusion that starting a new treatment sequence with the Bow & Yaw maneuver is helpful:

• The Bow & Yaw maneuver does not cause neck pain like Epleys might
• Bow & Yaw does not produce as severe spinning as Epley maneuver
• About 40% of patients had a full resolution of their posterior canal BPPV after using the Bow & Yaw maneuver for a new onset

As always, I want to emphasize that it is important to be assessed by a professional and not attempt to treat yourself for BPPV as complications can and do occur during BPPV treatment.

Clinical Pearl

I believe many if not most patients diagnosed with vestibular paroxysmia actually have short arm posterior canal BPPV.

That possible alternate explanation improves the prognosis for those patients! Short arm posterior canal BPPV is always worth considering if patients have random spins lasting less than one minute while upright sitting or standing.