Massage & Bodywork

July/August 2010

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pathology perspectives BY RUTH WERNER BENIGN PAROXYSMAL POSITIONAL VERTIGO It Will Make Your Head Spin! The fear of losing one's balance—and subsequently falling and sustaining a serious injury—is a fact of life for many aged 50 and over. Some research suggests that up to one-third of all U.S. adults in this age group occasionally have bouts of dizziness or disequilibrium, and for those who do, the chance of falling is many times greater than that of the general population. One cause of these symptoms is benign paroxysmal positional vertigo (BPPV). Our ability to stand erect and move through space is a tremendously intricate process. When we understand how complicated staying upright truly is, the question really becomes, why don't we fall over more often? ANATOMY REVIEW: WHAT IS EQUILIBRIUM? The accurate sense of our position in space and our relationship to gravity is provided by the functional coordination of three sources of information: the eyes, which tell us where the horizon is (or at least horizontal lines, when we're unable to see the horizon); our proprioceptors, which tell us if our joints are bent, straight, or twisted (as well as whether our muscles are long, short, moving, still, or bearing weight); and the vestibular system in the inner ear. The vestibular system consists of specialized nerve endings from a cranial nerve (the vestibulocochlear nerve) that terminate in the vestibule—a hollow area in the inner ear where the semicircular canals converge. Vestibular nerve endings are suspended in fluid, and they sway like seaweed whenever the head moves or tilts in any direction. This movement of nerve endings within fluid is the basis for interpretation of our head's position. If for some reason the signals we receive from these three sources don't match, our brain interprets this as being off-balance. Examples of mismatched information include the sensation we experience with amusement park rides that involve sitting still with a huge screen showing a projection of rapid movement—our eyes tell us we're moving, but our proprioceptors and vestibular nerves tell us we're not. The result: dizziness, nausea, and disequilibrium (and fun, if you like that sort of thing). Motion sickness is similar; this can be brought about simply by very rapid and sustained movement or by a disconnect between what the eye senses as the horizon and what the vestibular nerve conveys as upright versus horizontal. TYPES OF BALANCE DISORDERS Because senior citizens are among the fastest growing demographic of Americans, and because many of them seek massage or bodywork to help them cope with their health challenges, it behooves massage therapists to be well-informed about some of the balance disorders these clients can experience. We will focus on one fairly common condition called BPPV. But first, let's look at some connect with your colleagues on 99

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