In every issue of our Journal of Massage Science, readers will find the Case of the Month submitted by SOMI’s current or previous students. Everyone who uses Medical Massage Protocols in their practice is invited to submit their cases for review. We will share the best ones with our readers in every new issue.
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, medical massage can deliver quick and stable clinical results. In our opinion, the medical massage therapy must be the first step in the treatment of ALL somatic abnormalities, and only after it fails should other, more aggressive options be considered (i.e., injection, surgery, etc.).
O. Bouimer, LMT, CMMP, successfully showed us that application of the correct Medical Massage Protocol, even if it was self-taught using the SOMI’s Video Library, can make a huge difference in the client’s life.
Dr. Ross Turchaninov, Editor in Chief
CASE OF THE TREATMENT OF VERTIGO
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 part of the analysis of what might have led to that condition, the client reported that the day before, she had been 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 advised her to see a specialist first. 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 seeking my assistance. Since I didn’t have a chance to look up any special protocols for Medical Massage for Vertigo before seeing her, 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. Immediately after the massage session, the client reported clear relief from the accumulated muscular tension; however, there was still no reduction in dizziness. We agreed that I would conduct 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 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 performed the Dr. Epley Maneuver, which took approximately 5 minutes. My client did not feel any better. The Doctor said my client would be feeling relieved soon, but she never did. Needless to say, she was highly disappointed with that 5-minute treatment since she felt no relief and did not get a clear explanation of her condition, either.
At the end of that appointment, the physician provided my client with written instructions for BPPV and scheduled another appointment for her in three 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 two more days of no relief, with her neck and back very tight from sleeping upright for 3 nights, she called me for help again.
This time, I referenced the SOMI’s 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 present, but less severe than it had been before. Then I explained the importance of scheduling another session in two days. However, because of her 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, she was completely relieved of all dizziness and nausea.
Another important element of that clinical success was to provide my client with correct recommendations on how to improve more quickly, such as avoiding driving, watching TV, or working on a computer, and emphasizing the importance of keeping her eyes closed while changing her body position.
Modified Dr. Semont’s Protocol
To conduct therapy effectively, I required full cooperation from my client. I explained to her all aspects of the treatment I must use and showed her the actual video from the Video Library. It really worked!
First, I asked the client to close her eyes and slowly lie down on the table, face down with eyes closed. 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 reported no discomfort, I proceeded with 2 minutes of high-frequency (60Hz) vibration in the continuing, fixed mode.
After completing work 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 Dr. Semont’s Protocol.
I started using fast movements of the head in flexion/extension and medial/lateral flexion directions, stopping each time she felt even the slightest initial signs of spinning. Gradually, I increased the range of the movements in each direction, maintaining the same speed.
Due to a significant decrease in symptoms after the first session, I additionally increased the speed and range of the head’s passive movements during the second session.
It’s been more than a month now, and my client exercises daily (including Pilates, tennis, weightlifting, and spinning classes) and feels great! She cancelled her follow-up appointment with the E.N.T. physician, who never even heard about Semont’s protocol and strongly advised her against using any massage therapy. That was my first client with Positioning Vertigo (BPPV).
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 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 visited a highly recommended Ear, nose, and throat doctor in Beverly Hills, CA. After a 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.” Pilates probably caused it, but he was really 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 perform the Dr. Epley Maneuver, which involves starting the patient lying down with the doctor positioned behind them.
1. The head is placed over the end of the table, 45 degrees to the left, with the head extended.
2. The head is rotated 45 degrees to the right; the head is kept well extended in the process of coming from position 1.
3. The head and body are rotated until facing downward 135 degrees from supine.
4. Patient is brought to a sitting position; head is kept turned to the right in the process of coming from the position
5. The head is turned forward with the 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, with no more than a 45-degree tilt in any direction for the next 48 hours. Using a cervical collar will help. Side-to-side head turns are okay, but 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 head. Use handrails on stairs and Do Not Bend Forward.
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 three more days of dizziness and recommended regime, my neck and back were very tight from sleeping upright for 3 nights. I called my Massage Therapist friend, Oleg Boumier, LMT, CMMP, and explained to him my Vertigo prognosis. He told me about Dr. Semont’s Protocol to cure BPPV, and despite never having worked with clients with BPPV, he had access to the SOMI’s Video Library, where this treatment was explained and shown in detail.
Oleg came over that day with a special vibrating machine that he used to vibrate my skull behind both my ears lightly. After that, he did the 25-minute Dr. Semont’s Protocol, and I felt instantly better when I got off the massage table. The little dizziness was still present, but not as severe as it had been 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, or 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 remarkably fast, as I was entirely cured by the third day. I was so grateful for this treatment and Oleg’s expertise. I called my Beverly Hills doctor and explained to him that I had undergone the 25-minute Semont’s Protocol for 2 days and was now cured. He said, “I never heard of this Semont’s Protocol, 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.
From the outset of his career, he has been engaged in scientific research on the efficacy of massage therapy in treating sports injuries. For several years, he worked at the Center for Scientific Research at the Ternopol Medical Institute in Ukraine. He is the author of many articles in European and American medical and massage journals.
As a three-time Ukrainian champion in triathlon and a coach, he learned the benefits and necessity of massage therapy very early.
Oleg maintains a very active practice of Sports Massage in Los Angeles. Star players of the NBA, NHL, and NFL seek him out extensively for his system of Russian Sports Massage. He teaches Sports Massage based on scientific principles nationwide.
Oleg is the founder of the Global Wellness Institute, a nonprofit organization in Southern California that sponsors fundraising events to promote research and education in massage therapy, as well as physical education in public schools for children. He lives in Los Angeles with his wife and son.
Category: Case Studies