SOMI’s former student and exceptional therapist, Brenda Howell, LMT, CMMP, opened the Institute of Massage and Bodywork Therapy (IMBT) in Fayetteville, NC. From its inception, the school’s curriculum has been to lead future therapists into the clinical application of MT. IMBT is educating a new generation of therapists using only scientific data.
In the Case of the Month section of the #1 issue of JMS (2024), we published the clinical case of an MT student, Jaci Stephens, LMT, from the same school, who worked on a patient with a complex somatic abnormality and completely restored the patient’s health while still in school!
Here is a link to that publication:
The case you are about to read here is another example of the clinical expertise of students from IMBT. Julia Shackelford, LMT, also a student there, decisively solved (in four sessions!) a three-year-old case of Benign Paroxysmal Positioning Vertigo (BPPV) using Semont’s Protocol provided by SOMI. All other modalities failed, while this treatment completely restored the patient’s health.
We would like readers to pay attention to Julia’s reasoning for justifying her treatment and how deeply students of IMBT understand the clinical application of Medical Massage. SOMI acknowledges and applauds Brenda’s efforts to educate new generations of therapists who exhibit clinical thinking and exceptional skills to help patients in complex situations.
Dr. Ross Turchaninov, editor-in-chief
MEDICAL MASSAGE vs. VERTIGO (BPPV)
Julia Shackelford, LMT
Fort Liberty, NC
THE PATIENT
The patient is a 71-year-old female who has been diagnosed with Benign Paroxysmal Positional Vertigo (BPPV) by her family physician. Her symptoms started one morning when she got up and immediately felt a wave of dizziness, loss of balance, and severe nausea, which she has since been experiencing for the past three years. Severe episodes of BPPV are always accompanied by nausea. Within the last year, the nausea episodes have subsided, but dizziness and loss of balance are still affecting the patient.
CURRENT COMPLAINTS
Episodes of BPPV are triggered by changing positions: standing up, sitting down, walking, and rotations from left to right. The patient has noticed that dizziness significantly increases in intensity when she is prone or gets up from her right side.
ASSESSMENT
Vertigo cannot be examined outside the body; evaluation relies on the patient’s sensations. That said, the patient’s symptoms (being prone and rotating to the right) indicate that otoliths in her vertical (head flexion/extension) and horizontal (head rotation) semicircular canals are mostly affected.
TREATMENT
It was very important to explain the application of Semont’s Protocol to my patient and what each movement aims to accomplish. Communication with the patient and her understanding of my treatment would be crucial components of the therapy’s success.
First, I explained to her the nature of Vertigo (BPPV). Our sense of body positioning comes from two equally important sources: vision and the vestibular apparatus in the inner ears. Both sources must deliver similar data for the brain to form a perfect picture of our body positioning.
Inside the inner ears are three membranous semicircular canals filled with endolymph fluid. Each time we move our head, endolymph flows through the semicircular canals. This movement of fluid bends the top of hair cells (stereocilia) located on the bottom of semicircular canals in the direction of the flow. The accumulation of debris that lands on stereocilia makes them heavier, preventing them from getting into the neutral position as soon as needed, similar to the acceleration we experience in a car or roller coaster. The delay of stereocilia getting into a neutral position does not match data from our eyes, and the consequent mismatch between the two equally important sources confuses the brain, triggering a vertigo sensation.
I used Semont’s Protocol, recommended in the Medical Massage Volume I textbook and the Video Library of the Science of Massage Institute. Once the patient understood the chain of events outlined above, it helped her understand the goal of Semont’s Protocol to dislodge debris from the stereocilia and restore the proper functioning of the vestibular system.
I asked her to get close to the table, close her eyes, slowly get on the table, and lay on her stomach. She needed to keep her eyes closed during the entire treatment until I let her gradually sit up. Shutting down the visual analysis helps to reset cooperation between the vestibular and vision systems more efficiently without visual interference.
Semont’s Protocol starts with posterior neck and scalp therapy to loosen the posterior cervical muscles and decompress the cranial aponeurosis. The crucial area of this therapy is the small space behind the mastoid process, which is located behind the ear. That is where the minor occipital nerve, which innervates the temporal area and outer ear, emerges under the scalp.
The patient’s brain triggers compensatory reactions in the form of increased muscle tone in posterior cervical muscles and restricted cervical ROM to decrease the intensity of vertigo episodes. Thus, to achieve the optimal application of Semont’s protocol, I needed the posterior cervical muscles to be completely relaxed. I started with effleurage and kneading on her posterior cervical muscles to decrease their resting muscle tone.
Next, I turned the patient’s head to the right side and placed an electric massager that produced true vibration on the mastoid process. I held it for a minute and then repeated the same on the left mastoid process. I started with low-frequency vibration and increased it as soon as the patient was comfortable. Applying true vibration in a fixed regime preliminarily loosens the debris that has landed on the stereocilia or helps to untangle them.
For the final part of Semont’s Protocol, I asked her to move closer to me so that her shoulders were on the edge of the table while I held her head. First, I gently lowered her head back to detect her level of comfortable extension and estimate her cervical ROM. Also, before I did the extension, I asked her to inform me immediately if she felt any sensation of upcoming vertigo. I planned to use the angle of her comfortable extension or ‘dizzy point’ as a starting point for my therapy.
Next, I brought her head back to a neutral position, and while keeping it in my hands, I quickly moved it back into extension and then back into a neutral position. I did this while she performed long exhalations. I stopped head extension each time at the ‘dizzy point’ I had detected earlier. She felt dizzy only during the first two quick extensions. I repeated extensions five times.
The last step of Semont’s Protocol is to toss the patient’s head quickly from right to left (5 times) and then from left to right (5 times) during her exhalations. All the time, I secured her head in my hands. During quick extensions and lateral flexions, the forceful flow of the endolymph knocks the debris off the stereocilia or untangles them.
At the end of the session, the patient slowly got seated, waited for stabilization, and then opened her eyes.
RESULTS
The effect of Semont’s Protocol was immediate. While she had BPPV, she had avoided getting up on her right side since it always triggered vertigo. After the first treatment, she could get on her right side with only moderate discomfort.
After the second session, she had only two episodes of dizziness. After the third treatment, she had only one episode. And after the fourth session, her vertigo was completely gone. She has continued to be vertigo-free since we completed therapy.
We are looking for clinically oriented massage therapists interested in the proper training in Medical Massage based on medical science. Please join SOMI’s Medical Massage Program in 2025. We will take you from the theory and basic techniques all the way to the correct clinical evaluation of the soft tissue and hands-on application of Medical Massage Protocols. Here is SOMI’s 2025 schedule:
https://www.scienceofmassage.com/seminars/
ABOUT THE AUTHOR
Julia Shackelford, LMT holds a liberal arts degree from East Carolina University, works as a Massage Therapist at Fort Liberty, NC, and is a proud Institute of Massage and Bodywork Therapy graduate from Fayetteville, NC. Her specialty is managing chronic pain and nerve irritations. She is well-trained in Medical Massage to address chronic pain, somatic dysfunctions, hypertonic muscle abnormalities, and fascial tension.
Julia can be reached at: Julia.e.shack@gmail.com
Category: Case Studies
Tags: 2024 Issue #3