By Daniel Lopes, CMMP, LMT, Colorado Springs
In the second week of January, I received a phone call from a very concerned father in regards to the health of his 18 year-old daughter. He stated that she was diagnosed with Benign Paroxysmal Positioning Vertigo (BPPV).
CLINICAL HISTORY
When symptoms first began, the patient would get random moments of dizziness here and there that would usually go away in 10-20 seconds. These happened at school, work and periodically throughout the day. A few days later she was sitting in her bed doing homework. She laid back to rest her neck, when all of sudden she couldn’t keep her eyes in one place (nystagmus). In her own words, “The entire room was spinning out of control and all I could do was to lay down absolutely still in the dark room or I would vomit.” The patient had never experienced this before. Her parents took her to see her primary care physician. She was diagnosed with BPPV. They administered an IV of saline, prescribed pain medication and prednisone, an anti-nausea medication. They also tried the “Head-drop method”. There was absolutely no improvements, so she was sent home. The parents researched various methods of home-treatment on the internet and attempted several with no positive results. The primary care physician prescribed PT and a referral to the E.N.T. However, the wait for PT was 2 months, and the E.N.T. wait was 2 weeks. Her father then decided to do some additional research and found an article at Science of Massage Institute (SOMI) online. He spoke with Mary Preuss (Director of Services) who recommended my services for their daughter. Even though they lived approximately an hour away from my practice, they were willing and desperate to give medical massage a try.
When the patient first arrived at my office, she came with her mother because she was unable to walk unassisted and was highly sensitive to light and all movements.
MEDICAL MASSAGE PROTOCOL
The major symptom of BPPV is the sensation of spinning and loss of balance during fast changes of the head and body position, e.g. getting in or out of bed, car, etc. I explained to the patient and her mother all the steps for the Semont’s Protocol & Particle Repositioning Technique also known as Liberatory Maneuver Protocol for BPPV. First, I asked the patient to close her eyes and then to slowly lay facing down on the table. Then, I started by applying effleurage and kneading in the inhibitory regime on the posterior neck and shoulders. Next, I proceeded with superficial and deep effleurage strokes on the upper back and posterior neck in the direction of drainage. Following this, I applied scalpotherapy on the affected side in the temporal area and behind the ear, massaged shoulders, the posterior neck, and the anterior neck. I then turned the patient’s head to the side and work on the anterior neck, while applying intense circular friction below and on the mastoid process.
Then I folded the patient’s ear to expose the mastoid process and applied permanent vibration. Before beginning, I asked that the patient report any occurrence of the nausea sensation during the treatment so that I could discontinue vibration as soon as the sensation was triggered. Since this is a sensitive area, I put a hand towel in between the patient’s mastoid process and the massager. I began with the lower frequency for the first 30 seconds, and then switched to the higher frequency for the remaining 60 to 90 seconds. The patient did not report any discomfort from dizziness nor nausea, so I proceeded with a full two minutes of high frequency vibration in the fixed, permanent mode.
After completion, I asked the patient to turn over SLOWLY, while still keeping her eyes closed. While in the supine position, the goal was to identify the neck’s full range of extension. I made sure that both of her shoulders were on the very edge of the table, while her head was resting in both of my hands, in preparation for the Liberatory Maneuver Protocol. I asked the patient to keep her eyes closed. She was reminded of the importance to completely relax her neck throughout the procedure. Slowly, I tilted her head back until the symptom of vertigo would appear. Once arriving at this position, I held the patient’s head for 10-20 seconds in the same position, waiting for the uncomfortable sensations to diminish. Later, finding the angle to which the neck was full extended, I slowly lifted the head back to the starting position. I then continued with the MEDICAL MASSAGE PROTOCOL from SOMI’s Video Library.
Once the treatment was over, the patient’s first questions was, “How soon can these horrible symptoms that I am dealing with go away?” I responded by explaining that I would have a better idea based on the feedback from this treatment. Before leaving, we scheduled her next treatment. The patient was reminded to continue to close her eyes during each movement so it wouldn’t trigger her dizziness. At the conclusion of the first treatment, the patient indicated that she was a bit dizzy still but it was better. She later indicated that when she went home, she was able to lay in bed and watch TV, which she had not been able to previously do without nausea and dizziness.
SECOND TREATMENT
She came in four days after her initial treatment. I followed the same protocol above. After her feedback, I indicated she would need 2-4 additional treatments. In her own words, she described that she was feeling, “Worlds better. My balance and nausea have improved but I’m not able drive or go to school yet.”
THIRD TREATMENT
Three days later, she came for the third treatment. She looked much better. It was noticeable how the treatments were making the difference in her life. Even though she wasn’t 100%, she commented that she felt amazingly better and was able to attend school. Due to the distance and knowing that her father is a massage therapist, I gave him the basic instructions on the protocols. I scheduled a forth visit four days from the third treatment. However, a day before the appointment I received a text from the patient’s mother informing that her daughter was feeling pretty good and they would be cancelling the appointment. I was thrilled with the news but still wanted to follow up to make sure that her daughter wouldn’t have another vertigo episode. I contacted them a week later. Their report was that the daughterr was driving again and everything was back to normal.
PATIENT THOUGHTS
“First of all, I want to say that you were an absolute blessing in one of the scariest times of my life. Through all three back surgeries and everything I’ve been through; the vertigo was definitely the scariest and you were our last hope after we tried absolutely everything. I can’t imagine what we would have done if we didn’t come to you. The way it took away my life, it was basically my worst nightmare and I’ll be grateful to you for your help forever!”
PATIENT’S MOTHER’S REVIEW
“When my 18 year-old daughter had vertigo and the doctors were at a loss, we took her to Daniel, to see if medical massage would work. After three visits her vertigo was gone. Daniel was very gentle and let us know what he was doing every step of the way. Even after we stopped going, he followed up to make sure she was still doing ok. Hopefully she’ll never have vertigo again, but if she does, we know exactly where to go! We are also considering some regular visits for migraines. Just wish we lived closer. Thank you, Daniel for everything you do.”
LESSONS:
1. Medical Massage has a wide range of clinical impacts on patients’ health, from active trigger point in the trapezius muscle to BPPV and visceral disorders. The clinical case Daniel presented illustrates this fact.
2. BPPV is a devastating condition which limits and sometimes completely ruins the patient’s life. The clinical effectiveness of the treatment protocol (Semont’s protocol) surpasses any therapy modern medicine offers to these patients. The massage therapy is an integrative part of the modified version which made treatment even more effective than the original protocol.
3. In many cases when used correctly and applied in time, Medical Massage delivers stable clinical results in a very short time.
Dr. Ross Turchaninov
Category: Blog