My 39 year old client works with her husband in technology, juggling multiple business and projects worldwide. She reached out to me having read my google reviews.
She had been suffering with dizziness and symptoms of vertigo for 12 months, with a piercing right inner ear pain which has encompassed her life. Travelling on trains and planes has been excruciating and feeling disorientated when trying to get on with life was debilitating. She felt like she was ageing rapidly, and everything was an effort.
Standing from a lying positing was getting progressively worse and she had to sit on the edge of the bed to wait for the dizziness to pass.
Understanding the cause of vertigo.
I wanted to take a deep dive into any traumatic events which had occurred to her body throughout her life. She informed me of a head on collison with another car which caused trauma to the head and sternum. She didn’t receive any medical attention but unsure if headaches and dizziness started before or after the accident. She also revealed a fall on her right forearm that required surgical intervention and a boxing injury where a defect was identified to shoulder structures. She feels like her right shoulder doesn’t work the way it should and does not feel like the left side does.
She has had checks with doctors in London, who carried out a series of tests to determine the cause of her dizziness.
They didn’t find anything significant which was good but my client was advised to try physiotherapy and came to me.
The past always dictates the future and a patient’s story will always lead you to your starting point. Not many people have a head on collision at speed without absorbing that speed and energy and walking away without some long lasting adaptations.
Physiotherapy Assessment: The Art of Observation
I started to assess her neck and focus my attention to the way she was holding her head position. In standing and lying I could already see her head was in a side bend, rotating and looking up so I brought this to her attention. Is this position acquired due to the head on collision, or is this the way she was put together?
I also noticed that her right shoulder was depressed which means her spine is side bending to the right, which will lead to her neck side bending to the left.
This was pulling on her neck muscles and if we follow these big muscle attachments, they are attached to some significant bones such as the mastoid and occipital bones of the skull and clavicle attachments with a big bundle of nerves and blood vessels underneath.
Alignment was surely playing out and under further investigation we have a right shoulder which is affecting spinal mechanics, and a head injury that is altering her head position. This alignment issue was affecting the body’s capabilities to keep everything in harmony.
Mobilisation and Home Exercises
I started with some low-level bone manipulation of the cervical spine and gentle traction techniques to introduce some space, improve blood flow and give better length tension in the tissue surrounding her neck. Home exercises were neck rotation and side flexion stretches, both to the left. These are all stretches to improve neck movement and muscle length in the trapezius and sternocleidomastoid muscles.
Our aim was to build awareness of her neck mobility and improve functional everyday movements. We changed the side of the bed she slept on, the position she would set her computer monitor to and where she sat to watch TV at home so her body could experience right rotation and more flexion in her neck muscles. We don’t consider the things we do every day without thinking but making these small adjustments add up and make a big difference to recovery.
Movement Sequences for Better Alignment.
The aim over the coming weeks and months was to educate the body to start feeling more comfortable, to get away from carrying her head on the right as a default position in order to encourage her neck movements to discover more motion to left and for the shoulder to help her in moving her rib cage and thoracic spine to left and right with freedom and less restriction.
We used dynamic neuromuscular stabilisation techniques to encourage shoulder and neck stability, and mobility drills with verbal cues to improve her body awareness and open this new neural pathway.
Putting the body into positions you don’t often use, will ignite old neural pathways which help with re-educating these pathways which you have stopped using.
There is more to the body than just stretching and getting patients strong. We must learn how to move better doing everyday tasks, but the key is identifying what the patient needs and why so that you can plan rather than be reactive and symptom led.
I never thought it would be so simple, Kevin identifies a few issues and within a few sessions I found the vertigo on the tube reduced and everyday activities are so much better.
I have my daily Kevin exercises to do, it’s slowly improving and I now understand my body better which is the biggest take away.
Kevin identifies what you can’t do and then gives you the steps you need to go off and explore and learn how to perform the sequence that is specific to you.
Concluding Thoughts
The biggest learning curve from this case is getting a good history because people forget significant incidents and it only comes to mind when you start asking the right questions. We are all good at normalising our problems and forgetting about them because life gets in the way. I am guilty of this also. So, if you are looking for a new way at looking at your issues why not get in touch?