In every issue of our journal you will find Case of the Month which we will select among submitted ones. Everyone who is using Medical Massage protocols in their practice may submit their cases for the review and we will share with our readers the best one in every new issue.

If you would like to share with our readers your account of professional success and participate in Case of the Month program click here.

We chose this submission because this case is what medical massage therapy is all about: simplicity and clinical effectiveness. When the correct protocol is used for the appropriate abnormality, the medical massage is able to deliver quick and stable clinical results. In our opinion the medical massage therapy must be the first step in the treatment of many somatic abnormalities and only after it fails should other more aggressive options be considered (i.e., injection, surgery, etc.).

O. Bouimer successfully showed us that application of the correct medical massage protocol, even if it was self taught using the Video Library, can make a huge difference in the client’s life.



CASE OF THE TREATMENT OF VERTIGO

 

by O. Bouimer, LMT

 

The client was a 44 year-old, very athletic, active woman who lives in Los Angeles, CA and works as a massage practitioner.

Clinical History

The client woke up one morning with extreme dizziness. She could barely get out of bed without the room spinning and a nauseous feeling. The client had never experienced that before in her life. As a part of the analysis of what might have led to that condition, the client had reported that the day before she was swimming (learning the backstroke) in an Olympic size pool for one hour. Also, earlier that day, she had done a one-hour Pilates session hanging with her head tilted back.

In order to rule out any possible serious medical abnormalities causing vertigo, I had advised my client to see a specialist. Still, the client waited for 2 days before going to see a highly recommended Ear, Nose & Throat doctor in Beverly Hills, CA, as her severe dizziness was not getting any better.

In the meantime, the client was asking for my help. Since I did not have a chance to look up any special protocol of Medical Massage for vertigo before facing my client, I decided to proceed with my regular massage. Of course, to make it safe – not to cause/induce any hypotension – I made sure to keep that session under 40 minutes.

I followed a common sense approach of using massage in the inhibitory regime, applied first to the area of upper back and neck (prone position, 15 min.); second, the clients’ feet with a focus on the toes (supine position, 15 min.); and third, the abdominal area, in a clockwise pattern (supine position, 10 min.).

That protocol was the closest to the protocol of Medical Massage in cases of Vertebral Artery Syndrome or Essential Hypertension. Right after that massage session, the client reported clear relief from the accumulated muscular tension, but there was still absolutely no reduction in dizziness. So, we agreed that I would do some research on her condition and follow up with her after her visit to the physician.

 

When my client finally visited the E.N.T. doctor, he did a very quick examination, He checked both of her ears with a light (to see if there was water or a ear infection), and he made her walk one foot in front of the other down his carpeted hallway office (to see if she was off balance, which she was). Based on that diagnostic assessment, the physician concluded that my client had Benign Paroxysmal Positional Vertigo (BPPV). He said he gets about 3 to 4 patients a week who come to his office with BPPV. He also said the Vertigo could last up to 3 weeks or longer and there is a 50 percent chance it will come back unexpectedly.

The E.N.T. physician specialized in cases of BPPV and he performed the “Dr. Epley procedure,” which took about 5 minutes. My client did not feel any better. The Doctor said my client would be feeling relief soon, but she never did. Needless to say, my client was extremely disappointed with that 5-minute treatment since she felt no physical relief and did not get a clear explanation of her condition, either.

At the end of that appointment, the physician gave my client some written instructions for BPPV and scheduled another appointment to see her in 3 weeks. In addition, he prescribed some strong sedative medication and suggested she undergo a VNG (Videonystagmography) – an expensive test of the inner ear and central nervous system balance mechanisms.

Among other recommendations he gave, there was an “absolutely NO massage” doctor’s order. However, after 2 more days of no relief, with her neck and back very tight from sleeping upright for 2 nights, she called me for help again.

This time, I referenced the Video Library and performed 25 minutes of the“Semont’s Protocol”, precisely following the step-by-step instructions. The client felt instantly better when she got off the massage table. The dizziness was still there a little, but not as extreme as it was before. Then I explained the importance of scheduling another session in two days. However, because of my client’s plans to go out of town, I came over again the next day and performed the same Semont’s Protocol. As a result, by the end of the second session, my client was completely relieved of all dizziness and nausea. Of course, another important element of that success was to give to my client correct recommendations on what to do to improve faster – like NO driving or watching TV or working on a computer; stressing the importance of keeping her eyes closed while changing her body position.

Medical Massage Protocol

First, I asked my client to close her eyes and slowly lay down on the table, face down. Then, I started by applying effleurage and kneading in the inhibitory regime on the posterior neck and shoulders. Next, I proceeded with the massage over the temporal area and behind the ears, followed by application of electric vibration behind each ear, on the mastoid process. Since the client had reported no discomfort, I proceeded with a full 2 minutes of high frequency vibration in the fixed, permanent mode.

After completing working on both sides, I asked my client to turn over SLOWLY, while still keeping her eyes closed. Then, I made sure that both of her shoulders were on the very edge of the table, while her head was resting in my hands, in preparation for the Liberatory maneuver.

Noticeably, during the performance of both Extension and Lateral Flexion parts of that maneuver, there was a protective tension on the client’s part, both when I was dropping her head and when I was “passing” it from side to side. Therefore, I decided to spend some more time explaining this procedure to the client, while watching the actual video from the Video Library together. It really worked! I was able to repeat that with my client with a full range of motion during our second session the next day. Surely enough, that helped me to feel more confident as well. After all, that was my very first client with vertigo.

It’s been more than a month now, and my client exercises daily (Pilates, tennis, weight lifting, spinning classes, etc.) and she feels great! She cancelled her follow-up appointment with that E.N.T. physician, who never even heard about the Semont’s protocol and strongly advised her against using any massage therapy.

CLIENT TESTIMONIAL

I’m a 44 year-old, very athletic, active woman who lives in Los Angeles, CA. I woke up on the morning of Jan. 16th, 2010 with extreme dizziness. I could barely get out of bed without the room spinning and a nauseous feeling. I’ve never had this experience in my life. I waited 2 days before going to see a doctor as my severe dizziness was not getting any better.

On January 18, 2010 I went to see a highly recommended Ear, Nose & Throat Doctor in Beverly Hills, CA. After a very quick examination he then concluded that I had Benign Paroxysmal Positional Vertigo or BPPV. He was vague when explaining why I have this condition. He said, “You have particles trapped in the ‘balance tubes’ of the inner ear.” It was probably caused from Pilates – but he really was just taking a guess. He took me into another office that had a chiropractic table. He had me lie on my back with my head hanging off the table (he held my head with both his hands). He proceeded to do the “Dr. Epley Procedure” which is: start patient lying down with doctor behind patient.
1. Head is placed over end of table, 45 degrees to left, with head extended.
2. Head is rotated 45 degrees to right; head is kept well extended in process of coming from position 1.
3. Head and body are rotated until facing downward 135 degrees from supine.
4. Patient is brought to sitting position; head is kept turned to right in process of coming from position 3.
5. Head is turned forward with chin down about 20 degrees.

This procedure took about 5 minutes. I did not feel any better. The Doc said I should be feeling relief soon, which I never did. I was still very dizzy and the doctor told me it was OK to drive home, which I did. He gave me written instructions for BPPV: Keep my head in a vertical plane no more than 45 degrees tilt in any direction for the next 48 hours; Use of cervical collar will help; Side to side head turns are okay; Avoid quick head movements. Do not exercise. Do not go to appointments that require you to tilt your head (hairdresser, dentist or barber). When brushing your teeth, use a cup to rinse your mouth. This will help to keep your head upright. Sit down and get up from chairs while keeping your back straight without bending forward to avoid tilting your held. Use handrails on stairs and Do Not Bend Forward.

Recommendations For Sleeping:

If on a recliner, the back of the chair should be angled at no more than 45 degrees. Pillows should be placed under your head on each side of you head to keep it vertical and from rolling over.

If sleeping in a bed, prop yourself up with plenty of pillows to keep your head as upright as possible. Place something at the bottom of your feet to prevent slipping down during the night. The doctor wanted to see me again in 3 weeks. He said the Vertigo could last up to 3 weeks or longer and there was a 50 percent chance it would come back.

I was extremely disappointed since I felt no relief. After 2 more days of dizziness and recommended regime, my neck and back were very tight from sleeping upright for 2 nights. I called my Massage Therapist friend, Oleg Boumier. I explained to him my Vertigo prognosis and he knew about the “Semont’s Protocol” to cure BPPV and he had access to the Video Library.

Oleg came over that day with a special vibrating machine that he used to lightly vibrate my skull behind both my ears. After that he did the 25 minute “Semont’s Protocol” and I felt instantly better when I got off the massage table. The little dizziness was still there, but not as extreme as it was before. Oleg came over again the next day and did the same treatment and I was completely cured of all dizziness. Oleg told me that I should NOT be driving, or watching TV or going to the movies, No sitting at computer screens and I should keep my eyes closed most of the time. The Beverly Hills doctor told me none of these crucial things.

My recovery was so fast because by the 3rd day, I was completely cured! I was so grateful for this treatment and Oleg’s expertise. I called my Beverly Hills doctor and explained to him that I had the 25-minute “Semont’s Procedure” done for 2 days and I was cured. He said, “I never heard of this Semont’s Procedure, I don’t think it’s a good idea.” Needless to say, I cancelled my follow-up appointment with this doctor who wasted my time and money and did not help me.

I highly recommend this treatment to cure anyone who has been diagnosed with vertigo (BPPV). It’s been over a month now, and I exercise daily and I feel great. I’m a little nervous to try swimming laps again, especially the backstroke.

 

Tracey Smith

Category: Case Studies

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