I recently had a follow up appointment with a patient of mine. “Sam” came to our clinic after having failed attempts of treatment from standard Physical Therapy and chiropractic care. His past physical therapist had given him generalized stretching with little to no benefit, and by the time I evaluated him, Sam admitted that, “(he) was not impressed with his therapy treatment.” He had heard about Nick Rinard Physical Therapy, and he was hoping to get the results he desired with us.
During his initial evaluation, Sam presented with limited, painful movements in several motions of the shoulder. The most painful motion was the motion of putting the arm behind him (like he was going to scratch in between his shoulder blades). Incidentally, this was also the motion which initially caused his pain three months ago.
I had Sam passively stretch into the painful motion. This was not a random decision. It was a clinical decision based off of his baselines and has been clearly documented and researched by the works of Mark Laslett. As Sam repeated this movement, the pain dissipated and all of his baselines improved. Sam continued to perform this exercise until his next visit, at which, he reported 95% improvement.
Sometimes the exercise required to fix the mechanical problem is counterintuitive (moving into the pain). A trained mechanical therapist is able to recognize these pain patterns and can make a clinical decision as to what exercise should be performed and interpret the results.
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By Megan Plante, DPT
21 Mar, 2014
Clinical Case of the Week
BPPV, easily treated, improvement, MDT, Mechanical Diagnosis and Therapies, Mechanical disorder, Nick Rinard physical therapy, Physical Therapy, Portland Oregon, Positive response, vertigo
The most common cause of vertigo (dizziness) is benign paroxysmal positional vertigo (BPPV) and it is a mechanical disorder. A trained clinician can evaluate and treat this condition based off of the patient’s symptoms. The evaluation consists of moving the head into specific positions. Symptoms of BPPV include vertigo with change in head position, nausea with or without vomiting and disequilibrium (poor balance).
Curable
Vestibular System
BPPV is a curable condition affecting the vestibular system (inner ear). Your inner ear is comprised of 3 semicircular canals (SCC) and 2 otolith organs. These structures detect head movements (acceleration). Crystals called otoconia are embedded in the otolith organs. Sometimes, the crystals can become dislodged and misplace into the semicircular canals. The misplaced crystals result in increased sensitivity to head movements.
Hopes for a Positive Response
I was treating a patient for low back pain when she mentioned that she was experiencing severe episodes of dizziness. I informed her about BPPV and mentioned that the treatment was very simple and effective. She agreed to have an evaluation in hopes for a positive response.
My patient tested positive for BPPV utilizing the Hallpike-Dix test for the left semicircular canals. I also performed a few other tests and exercises to rule out other potential causes for symptoms. Once we had our diagnosis of BPPV, the treatment was very simple.
Improvement in just one week
I took my patient through a series of head movements that reposition the crystals back into the otolith organs (the saccule and ultricule). After performing the repositioning maneuver, baseline symptoms were decreased and she returned the next week without having any severe episodes of vertigo.
BPPV – A Common Vertigo that is Easily Treated
BPPV is the most common cause for vertigo. Luckily, it is very easy to diagnose and treat with a trained therapist. If you or someone you know has vertigo as a result from head movements, have a physical therapist evaluation so that you may start feeling better today!
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I had Sam passively stretch into the painful motion. This was not a random decision. It was a clinical decision based off of his baselines and has been clearly documented and researched by the works of Mark Laslett. As Sam repeated this movement, the pain dissipated and all of his baselines improved. Sam continued to perform this exercise until his next visit, at which, he reported 95% improvement.