Treatment for BPPV, lateral canal, right side, Lempert roll

By Marcello Cherchi, MD PhD

For cases of lateral canal involvement in which the side is known, the most commonly performed maneuver is maneuver originally developed by Dr. Thomas Lempert and Dr. Klaus Tiel-Wilck (Lempert and Tiel-Wilck 1996), sometimes also referred to as the “logroll” or “barbeque maneuver.”

Dr. Lempert described the maneuver as follows:

“We were concerned to try a rehabilitation maneuver that consisted of a single 270 degree rotation around the yaw axis (barbecue rotation) performed in rapid steps of 90 degrees with 30-second intervals. Motion started with a head rotation from the supine to the unaffected side. Subsequently, the patient rolled over to prone while the head was held in the previous position before it was turned rapidly to the nose-to-ground position. Finally, the head was rotated vigorously to the opposite lateral position with the affected ear underneath.”

Note that in order for the Lempert roll to work properly, one must know which lateral semicircular canal is affected by BPPV, and make sure to aim treatment at that side. One cannot “treat both sides” or “alternate treatment sides” because when you treat one side with the logroll maneuver, you will “undo” whatever might have been accomplished on the opposite side.

The Figure below, from Bhattacharyya and colleagues (Bhattacharyya et al. 2017), shows the right-sided Lempert roll for treating right-sided lateral canal BPPV.

The Lempert roll for treating right-sided lateral canal BPPV can be described as follows.

1. The patient lies on the affected (right) side, with the head midline, and maintains this position for 1 minute.
2. The patient rotates 90 degrees toward the unaffected (left) side and lies on the back, with the nose pointing toward the sky, and maintains this position for 1 minute.
3. The patient rotates 90 degrees toward the unaffected (left) side, with the head midline, and maintains this position for 1 minute.
4. The patient rotates 90 degrees toward the unaffected (left) side with the head midline, and thus with the nose pointing toward the ground, and maintains this position for 1 minute.
5. The patient rotates 90 degrees toward the unaffected (left) side, such that they are now lying on the affected (left) side, and maintains this position for 1 minute.
6. The patient sits up in a neutral position.

The Figure below, from Bittar and colleagues (Bittar et al. 2011), is another depiction of the right-sided Lempert roll for right-sided lateral canal BPPV.

The Figure below, from the University of Michigan, is another illustration of the right-sided Lempert roll for right-sided lateral canal BPPV.

Logroll maneuver / BBQ roll / Lempert roll, right lateral canal, videos

• https://www.youtube.com/watch?v=FtLtpHbRSoE (Michigan Medicine)

The Lempert roll has been studied in prospective trials without a control group (Lempert and Tiel-Wilck 1996).  It has also been studied in multiple prospective randomized trials against the Gufoni maneuver (Casani et al. 2011; Correia et al. 2022; Kim et al. 2012).  Modifications of the Lempert roll have been studied in a prospective randomized trial against therapeutic head shaking (Kong et al. 2020).  The regular Lempert roll has been studied in a systematic review (Alashram 2025).

References