ATTENTION!!! The physician responsible for the patient’s treatment must be informed of the MEDICAL MASSAGE PROTOCOLs that will be used in manual therapy, and the practitioner must obtain the physician’s permission prior to 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 greatly 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 even considering the evaluation of the patient with vertigo the practitioner must be 100% sure that all other potential causes were ruled out by the physician before any diagnosis of Benign Paroxysmal Positioning Vertigo (BPPV) was firmly established.
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. This symptom is also accompanied by nausea, goose bumps, sweating and other so called autonomic reactions. While BPPV progresses, even slow changes in the body position will trigger clinical symptoms and their intensity greatly increase (e.g. nausea is substituted by vomiting).
The patients start to move like a slow walking stick. They avoid head rotation and rotate slowly with the entire body. Getting up, sitting down or getting into or out of bed becomes a real challenge. The patients do it very slowly and in severe cases in 2-3 minutes. Driving (even in the passenger seat) frequently triggers the symptoms of BPPV.
The Semont’s protocol presented below is an absolutely unique and effective tool to help the patients with BPPV. In mild to moderate case the patients feel great relief, even after one session. In severe case 4 -5 sessions are needed.
While you work on the patient ask him or her at home to continue to change body position slowly. Be absolutely sure to tell the patient that while getting up from the chair or sitting down as well as getting out and into bed he or she must close their eyes before beginning each maneuver and while doing it. The eyes can be open only after the new body position is established.
TS is a perception of sound which wasn’t provoked by acoustic stimuli. TS can produce the variety of the sounds in one or both ears from hissing to roaring. TS can be constant or intermittent, it may or may not coincide with each heart beat. TS in most cases associated with the 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 get 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 would like to state here that Semont’s protocol is the clinically proven method of treatment of Benign Paroxysmal Positioning Vertigo. There is no medical literature which supports our claim that Semont’s protocol has helped patients with TS.
Our recommendation to use this therapy for the patients with TS is based strictly on Dr. R. Turchaninov 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 on this patient gave him approximately a 50% decrease in the intensity of TS. At this point we used Semont’s protocol on 8 patients with TS in our clinic. We found that the patients with severe TS usually obtain decrease of the intensity of the symptoms sometimes to the tolerable for them level. 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 the life in severe cases. However, this is really important for these patients because they go through immense suffering on an everyday basis.
Vertigo is a symptom of many possible abnormalities. This MEDICAL MASSAGE PROTOCOL (Semont’s protocol) is effective only in patient with a physician’s established diagnosis of Benign Paroxysmal Positioning Vertigo.
Duration: 25 to 30 min
The patient should lie down and do any turns slowly without provoking the 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.
End this step with the application of 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), so as to inhibit the H-reflex.
b. Electric vibration
Duration: 3 to 4 min
Pressure: below the pain threshold
Fold the patient’s ear so as to expose the mastoid process, and apply electric 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 which generate vibration as a result of percussion. Also, the contact area of the massager must be semi-soft. The vibration may produce uncomfortable sensations of excessive vibration in the head, and so the patient should be made to understand the necessity and benefit 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 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 important points of information: at what level of the treatment the dizziness starts, and what the neck’s full range of extension is.
Ask the patient to move up onto the end of the table so that both shoulders are on the very edge of the table. Securely hold his or her head at all times and ask the patient to keep the 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: dizziness, nausea, etc. This is the first level. This position of the head is the level where the dizziness starts. Keep the head in the same position for 10 to 15 seconds until symptoms disappear. Slowly increase the head extension until you are able to detect its full range (this is the second level). If this further increase of extension — after the first interruption — continues to trigger vertigo, don’t test for the full range of extension. In such cases, work instead on the level of the head extension detected on the first level.
Step 5. Liberatory maneuver
The patient’s neck and shoulders must be completely relaxed, otherwise the treatment will have no effect. The practitioner should explain and demonstrate to the patient the entire procedure step by step, so that he or she completely understands it and feels ready to cooperate.
a. Extension part
Duration: 2 min
Pressure: below the pain threshold
The patient lies on his or her back on the end of the table with the 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 again begins suddenly release the head and let it fall back, however firmly stopping it when the first level of the extension (as established previously) is reached. Quickly bring the head up. If dizziness is triggered, hold the head steady until the uncomfortable sensations subside. 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 now stopping the patient’s head extension on the second level (as established previously).
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 the 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 (so that the head is now fully on the table) and repeat the treatment which we discussed above. Help the patient to slowly sit up, and only after that should he or she open the eyes.
Full Protocol: