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I t p a y s t o b e A B M P C e r t i f i e d : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 115 4 Watch Til Luchau's technique videos and read his past Myofascial Techniques articles in Massage & Bodywork's digital edition. ABMPtv.com "Working with the Vestibular System" those areas, and floods the brain's processing centers with unexpected, random signals. There are other possible causes of vertigo—some of which require medical care—so persistent, unexplained vertigo is sufficient reason to refer your client to a physician for evaluation. (For more information about BPPV and exercises for its self-management, search the web for "Epley's exercises" or see Ruth Werner's column "Benign Paroxysmal Positional Vertigo," Massage & Bodywork, July/August 2010, page 99, available at www. massageandbodyworkdigital.com/i/68175/99). Vertigo is not the only reason we should include the vestibular system in our thinking. Even small amounts of vestibular input can have significant effects in the body. Many studies have linked vestibular stimulation to sympathetic (fight-or-flight) autonomic nervous system activation and physical reactions such 2 3 as higher blood pressure, respiratory changes, and increased muscular tension throughout the body. 1 Vestibular disquiet can also trigger body-mind reactions. Moshe Feldenkrais, a body therapy pioneer, postulated that humans begin their process of growth and learning with just one built-in purpose: the fear of falling. 2 His contemporary and colleague, Ida Rolf, the originator of Rolfing structural integration, is purported to have said, "Ninety-five percent of all neurosis is the fear of falling down." Though both of their statements were probably more hyperbole than substantiated fact, the underlying point is valid: our physical functioning—in this case, the functioning of our vestibular system—strongly influences our psychology, emotions, and inner state. In hands-on work, we can use this body-mind relationship to our advantage. When disturbed, the vestibular system causes sympathetic fight- or-flight activation, anxiety, tension, and unrest. Change in the opposite direction is possible, too: when soothed, supported, and steadied, the vestibular system can trigger a palliative, quieting, relaxing, and calming response instead. VESTIBULAR ORIENTING TECHNIQUE Because of its power to relax and calm, the Vestibular Orienting Technique is useful in the initial, preparatory phases of most manual therapy sessions; when working with stress; in most cases of "hot" whiplash (see "Working with Whiplash, Part 1," Massage & Bodywork, March/April 2010, page 108, available at www.massageandbodyworkdigital.com/i/68173/109); and when working with vertigo itself, as it is a simple and effective way to assess and reduce vestibular hypersensitivity and disturbance when done with care (see the special considerations below). Begin the technique by slowly lifting your client's head while gently flexing the neck. If your client suffers from vertigo, neck pain, or hot whiplash signs (spasm, guarding, or pain), ask him or her to keep her eyes open, and lift the head slowly enough to avoid triggering any dizziness or pain. If your client's dizziness or pain is acute, you may be able to lift only half an inch, but in Image 2: The semicircular canals of the inner ear sense movement, while the spiral-shaped cochlea and its associated nerves perceive sound. Image 3: The three semicircular canals of each ear are arranged orthogonally, and so can sense movement in each of the three dimensions. Images courtesy Primal Pictures, used by permission. Anterior Temperal bone Anterior semi- circular canal Lateral semi- circular canal Posterior semi- circular canal Cochlea Posterior