ATTENTION!!! The physician responsible for the patient’s treatment must be informed of the MEDICAL MASSAGE PROTOCOL that will be used in manual therapy, and the practitioner must obtain the physician’s permission before the initiation of such therapy.
This video is a presentation of the MEDICAL MASSAGE PROTOCOL in cases of Vertigo. It is based on scientific publications reviewed in Medical Massage, Volume I. Please refer to pp. 377-383 of the Medical Massage, Vol. I textbook to learn more about pathology, clinical symptoms and diagnostic evaluation of tissue in cases of Vertigo.
In the videos, we will repeat each technique and approach only two or three times to save time and space. Follow the time guidelines shown at the beginning of each step.
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BPPV significantly affects the patient’s quality of life. However, vertigo may be a symptom of many other more serious abnormalities: Meniere’s disease, brain tumors, punctured eardrum, hypertension, etc. Thus, before evaluating a patient with vertigo, the practitioner must be sure that the physician has excluded all other potential causes before any diagnosis of Benign Paroxysmal Positioning Vertigo (BPPV) is firmly established.
The primary symptom of BPPV is the sensation of spinning and loss of balance during rapid changes in head and body position, for example, when getting in or out of bed. This symptom is also accompanied by nausea, goosebumps, sweating, and other autonomic reactions. As BPPV progresses, even slow changes in body position can trigger clinical symptoms, and their intensity increases markedly (e.g., nausea may be replaced by vomiting).
The patients begin to move like a slow-moving stick. They avoid head rotation and rotate slowly with the rest of the body. Getting up, sitting down, or getting into or out of bed becomes a real challenge. Patients do it very slowly; in severe cases, it takes 2-3 minutes. Driving (even in the passenger seat) frequently triggers the symptoms of BPPV.
Semont’s protocol, presented below, is a unique and effective tool for managing patients with BPPV. In mild to moderate cases, patients experience significant relief, even after a single session. In severe cases, 4 -5 sessions are needed.
TS is a perception of sound that is not elicited by acoustic stimuli. TS can produce a variety of sounds in one or both ears, from hissing to roaring. TS can be constant or intermittent, and it may or may not coincide with each heartbeat. TS is, in most cases, associated with a hearing decrease.
Usually, TS is a symptom of many ear disorders, head and ear trauma, hypertension, brain tumors, hypothyroidism, etc. In all these cases the original cause must be treated first by the physician. However, some patients with TS have so-called Essential TS when there is no direct cause established. These patients, as well as the patients who have TS as a residual symptom after the initial pathological condition was treated (e.g., ear infection, head trauma, etc.), can benefit from the application of Semont’s protocol.
Some patients with chronic Temporomandibular Joint Dysfunction have TS as a complication of tension and misalignment in this joint. Be sure to rule out the TMU dysfunction while evaluating the patient with TS.
We note that Semont’s protocol is a clinically validated method for the treatment of Benign Paroxysmal Positional Vertigo. There is no medical literature supporting our claim that Semont’s protocol has benefited patients with TS.
Our recommendation to use this therapy for patients with TS is based strictly on Dr. R. Turchaninov’s personal clinical experience. It started as a matter of professional curiosity, as an attempt to help a patient with an extremely severe case of TS. This patient had very intense noise for 24 hours without any relief. He used all of the traditional and experimental treatments without any success. His TS was so bad that he tried to commit suicide twice. The application of Semont’s protocol to this patient resulted in approximately a 50% reduction in TS intensity. At this point, we used Semont’s protocol on eight patients with TS in our clinic. We found that patients with severe TS typically experience a reduction in symptom intensity, sometimes to a level tolerable for them. At the same time, patients with very mild TS don’t get any clinical benefits from the application of Semont’s protocol.
This treatment doesn’t cure TS, but it improves the patient’s quality of life in severe cases. However, this is particularly important for these patients because they endure immense suffering daily.
Vertigo is a symptom of many possible abnormalities. This MEDICAL MASSAGE PROTOCOL (Semont’s protocol) is effective only in patients with a physician’s established diagnosis of Benign Paroxysmal Positioning Vertigo.
Duration: 25 to 30 min
The patient should lie down and perform any turns slowly, without provoking vertigo. For the same reason, ask the patient to keep the eyes closed during the treatment.
Step 1. Work on the posterior neck and shoulders
Duration: 3 min
Pressure: below the pain threshold
Start with superficial and deep effleurage strokes on the upper back and posterior neck in the direction of drainage. Apply kneading in the inhibitory regime on both shoulders and the neck.
Conclude this step with effleurage.
Step 2. Scalpotherapy
Duration: 5 min
Pressure: below the pain threshold
Apply scalpotherapy on the affected side in the temporal area and behind the ear. The video shows basic scalpotherapy techniques.
Step 3. Work in the area of the mastoid process
a. Work on the shoulders, the posterior neck, and the anterior neck
Duration: 4 min
Pressure: below the pain threshold (in the area of the mastoid process); however, increase pressure to the level of the pain threshold.
Start with bi-manual effleurage and friction strokes on both shoulders and the posterior neck.
Turn the patient’s head to the side and work on the anterior neck. Apply intense circular friction below and on the mastoid process.
End this step with the application of repetitive compression below the mastoid process on the tendinous part of the sternocleidomastoid muscle (also known as the sternomastoid muscle), to engage the H-reflex.
b. Electric vibration
Duration: 3 to 4 min
Pressure: below the pain threshold
Fold the patient’s ear to expose the mastoid process, and apply electrical vibration in the permanent, fixed mode. Start with the lower frequency for the first 30 seconds, and switch to the higher frequency for the remaining 60 to 90 seconds.
Be sure that the massager produces true vibration; don’t use machines that generate vibration as a result of percussion. Additionally, the massager’s contact area must be semi-soft. The vibration may produce discomfort, and the patient should be informed of the necessity and benefits of this treatment.
During this treatment, some patients may experience a slowly building sensation of nausea. Before you begin, request that the patient report the occurrence of any such sensation during the treatment; accordingly, discontinue vibration as soon as such a sensation is triggered.
Step 4. Diagnostic step
Duration: 1 min
Pressure: below the pain threshold
Before Semont’s protocol is fully implemented, the practitioner should establish two critical pieces of information: at what level of the treatment the dizziness begins and the neck’s full range of extension.
Ask the patient to move to the end of the table so that both shoulders are on the very edge. Securely hold the patient’s head at all times and ask the patient to keep their eyes closed. The patient’s neck must be completely relaxed. Now, slowly extend the head and stop as soon as the patient reports any symptoms of vertigo, such as dizziness or nausea. This is the first level. This head position is the level at which dizziness begins. Keep the head in the same position for 10 to 15 seconds until symptoms disappear. Slowly increase the head extension until you can detect its full range (the second level). If this further increase in extension—after the first interruption—continues to trigger vertigo, don’t test for the full range of extension. In such cases, work at the head-extension level is detected at the first level.
Step 5. Liberatory maneuver
The patient’s neck and shoulders must be completely relaxed; otherwise, the treatment will be ineffective. The practitioner should explain and demonstrate the entire procedure step by step to ensure that the patient fully understands it and feels ready to cooperate.
a. Extension part
Duration: 2 min
Pressure: below the pain threshold
The patient lies on their back at the end of the table, eyes closed. Hold the patient’s head by the occipital area. Ask the patient to execute deep inhalations and slow exhalations. After several breath cycles, when the next exhalation begins again, suddenly release the head and let it fall back, firmly stopping it when the first level of extension (as established previously) is reached. Quickly bring the head up. If dizziness occurs, hold the head steady until the discomfort subsides. Repeat this treatment 3 to 4 times.
If the patient does not experience severe dizziness as a result of the previous therapy, the practitioner should apply the same treatment, except for stopping the patient’s head extension on the second level (as previously established).
b. Lateral flexion
Duration: 3 min
Pressure: below the pain threshold
Hold the patient’s head in your right hand, and during the patient’s prolonged exhalation, quickly “throw” it to the left hand and back to the right. This movement is analogous to that of tossing a ball back and forth between your two hands. Apply this treatment 3 to 4 times, with a slight pause between each leftward-then-rightward throw.
Next is a repetition of the extension part of the Liberatory Maneuver discussed above in Step 5.a.
End this step with the application of the same treatment, except now “throw” the head to the right hand and back to the left — i.e., first rightward, then leftward — 3 to 4 times, with a slight pause between each rightward-then-leftward throw.
Be sensitive to the patient’s responses (of manifest or impending nausea) and work with them, interrupting the “throws” momentarily and retaking them at a lesser intensity.
Step 6. Work on the neck and shoulder
Duration: 2 min
Pressure: below the pain threshold
Ask the patient to move down onto the table (with the head fully on the table) and repeat the treatment discussed above. Help the patient slowly sit up, and only after that should they open their eyes.
PATIENT’S HOMEWORK
While you work on the patient, ask the patient at home to continue changing body position slowly.
Be sure to tell the patient that, when getting up from the chair or sitting down, and when getting out of and into bed, he or she must close their eyes before beginning each maneuver and throughout the maneuver. The eyes can be open only after the new body position is established.
During therapy, the patient should avoid exposure to fast-moving images (e.g., sports broadcasts, thrillers).
The patient should take two hot showers, placing a stream of water on the mastoid process behind the ear. Be sure that the patient closes the ear canal with a finger or an earplug.
Over-the-counter Dramamine will be invaluable if it is taken before sleep
Full Protocol: