Massage & Bodywork

July/August 2010

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PATHOLOGY PERSPECTIVES In BPPV, tiny calcium deposits called otoliths fall out the vestibule and into the semicircular canals. Available at (accessed March 2010) and (accessed March 2010). Mayo Clinic staff. 2010. Benign paroxysmal positional vertigo. 2010 Resources Bredenkamp, J., and L. Schoenfield. 2010. Vertigo, vestibular balance disorders. Mayo Foundation for Medical Education and Research. Available at www. (accessed March 2010). Ruckenstein, M.J. 2001. Therapeutic efficacy of the Epley canalith repositioning maneuver. Laryngoscope 111, no. 6:940–5. Vaillant, J. 2009. Massage and mobilization of the feet and ankles in elderly adults: effect on clinical balance performance. Manual Therapy 14, no. 6:661–4. Reuters Health Information. 2009. Vestibular dysfunction common in U.S. adults. Archives of Internal Medicine 169:938–44. Available at www. (accessed March 2010). Werner, Ruth. 2009. A massage therapist's guide to pathology (Baltimore: Lippincott Williams & Wilkins):331–2. been ruled out, this is well within our scope of practice and the risk for harm is extremely low. The best resource, if it is available, is to get instruction from the client's health care provider: their doctor, nurse, or physical therapist. But the Epley maneuver is so simple that it is easy to find written descriptions or video demonstrations online. A good one is available on YouTube, under the title "Epley for Dizziness": com/watch?v=QikUTAmeE0M. It is important to emphasize that working this way is only appropriate when a client has an official diagnosis and other possible disorders have been ruled out. Skilled massage with the Epley maneuver can make a powerful impact for a client with BPPV. But massage may have even more to offer our older clients with balance issues. Trigger points in the anterior neck muscles can contribute to sensations of dizziness, and resolving these may offer relief that other interventions (often involving antinausea drugs and tranquilizers) may not. It is important to be clear that a client is not at risk for carotid atherosclerosis (a type of cardiovascular disease) before working deeply on the lateral neck, however. Clients who are older may also have limited sensation in their feet due to poor circulation, diabetes, or both. Research indicates that massage designed to stimulate local circulation and nerve supply may improve a client's ability to walk with a lower risk of falling—all of this is contingent on he or she being able to keep up with any homeostatic challenges that massage may present, of course. Senior citizens are a growing population group in our society, and they are enthusiastic consumers of massage therapy. This group is obviously vulnerable to health challenges that the rest of the population doesn't have to deal with as often, and balance disorders are high on that list. A massage therapist who is comfortable and skilled in working with this population will find a rewarding specialty. Therapy Foundation. She is a writer and NCBTMB-approved provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2009), now in its fourth edition, which is used in massage schools worldwide. Her new book, Disease Handbook for Massage Therapists, is now available. Werner can be reached at www.ruthwerner. com or Ruth Werner is president of the Massage NOTE 1. M.J. Ruckenstein, "Therapeutic Efficacy of the Epley Canalith Repositioning Maneuver," Laryngoscope 111, no. 6 (June 2001): 940–5. connect with your colleagues on 103

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