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Can Pilates Alleviate Migraine Associated Vertigo?
Douglas McBee September 22, 2016
CAP 2015 Balance Point Pilates, Davis, CA
Mywiferememberstheexactdate–November5,2010,inthelateafternoon,that
hervertigosuddenlycameon.Shewasatherjobatanartsupplyandpictureframing
store,andtherewasnoreasonforittobethere,noaccidentorinjuryorstrangenew
exerciseornewmedication.Elizabethwas56yearsoldatthetimewithnomaladiesother
thanalittlesorenessintheneckandsomearthritisdevelopinginherhands.Shehadbeen
aswimmerinheryouthandamemberofthetrackteam,andplayedcompetitivetennis
throughhighschool.Shehadcontinuedexercisingthroughadulthood:runningandlater
onworkingoutonmachinesingymsandtakinggroupexerciseclasses,includingan
occasionalmatclass.
Shewalkedhomecarefullyafterwork,seeminglyunabletofocusonobjectsand
landmarksaroundher.Herbalancewasunaffected.Muchlateroneofherchiropractors
explainedthatwecanexperiencetwokindsofvertigo:thatwhicheverythingaroundyou
seemstobespinning,orthatwhicheverythingseemstospininsideyourhead.Elizabeth
wassufferingfromthelater.
Atfirstwebelieveditwouldfadeanddisappearwithinhoursordays,likethose
mysteriouslittleafflictionsthatcomeandgo.Itdidnot.AsI’lldescribeshortly,Elizabeth
beganalongjourneythroughneurologists,chiropractors,audiologists,acupuncturists,
homeopaths,andmassagetherapists.WeneverthoughtaboutPilates.Whenhervertigo
beganIwasanavidstudentbutnotateacher.
2
TableofContents
TitlePage 1
Abstract 2
TableofContents 3
DiagramsandTheRadiofrequencyAblationProcedure 4
Elizabeth’sStory 5
Elizabeth’sSessions 9
Conclusion 14
BibliographyandResources 15
3
TheCervicalSpineandtheRadiofrequencyAblationProcedure
Fig.1:OverviewofthehumanspineFig.2:Thecervicalspine.Nervesareshowninyellow.–myissc.com
Fig.3:TheRadiofrequencyProcedure-DelilahCohn4
Radiofrequencyablationisaminimally
invasiveprocedureperformedunder
fluoroscopy(livex-ray)toguidetheRF
needletothedesiredlocation,in
Elizabeth’scaselateralbranchnerveson
eachsideofC3,C4,C5andC6.RFwaves
areintroducedtoheatthetipofthe
needletocreateaheatlesiononthe
nervetodisruptthenerve’sabilityto
sendpainsignals(1).
Imyselfhavehadvertigoforshortperiodsanditalwayswentaway;thishasbeen
thestoryforasurprisingnumberofpeople,werealizedlater.InElizabeth’scasedayswent
byandthenweeks,andthevertigowasstillthere.Somedaysshestayedhomefromwork.
Drivingwasoutofthequestion,readingmorethanaparagraphortwowouldsetherhead
spinningfaster,movingherheadalittletoofastandeventhesimpleactoftiltingherhead
upwardmadethingsworse.Atitsworstshehadtoholdontoawallwhilewalkingto
anotherroom.Headachesandnauseafrequentlyaccompaniedherdizziness.Heronly
reliefwassittingbackandrestingherheadonsomething,orlyingdown.
ThefirstneurologistshesawdiagnosedBPPV(benignparoxysmalpositionalvertigo),a
fairlycommondisorderarisingfromproblemsintheinnerear.AnMRIshowedno
problems,andahomeprogramperformingamodifiedEpleymaneuver(aseriesof
movementsconsistingofsitting,turningthehead,andlyingsupineorsidewaysina
prescribedpattern)threetimesadaywasassigned.Aphysicaltherapistshewassentto
gaveheranadditionalhomeroutine.
ElizabethstoppedthePTafteroneweek;itmadeherfeelworse.Shecontinuedthe
modifiedEpleymaneuverforoverthreemonthsbutmadenoprogressatall.Itwasbackto
squareone.
ForthenextsixmonthsElizabethsawherchiropractor,whofelthecouldalleviatethe
symptomswithneckadjustmentsandperformingthestandardEpleymaneuverregularly.
Shealsowenttoafewappointmentswithanaturopath.Nothingwashelping.
AftersomeonlineresearchElizabethscheduledtestingandevaluationattheUCSF
5
AudiologyClinicinSanFrancisco.Afterafourhourvisitandlotsoftestingitwas
determinedtherewasnoproblemwithherearsandthatshewassufferingnotfromBPPV
butfrommigraineassociatedvertigo,orMAV(seeWikipediaforanoverviewofMAV).
Again,physicaltherapywasprescribedbutwasnoteffectiveandfrequentlyintensifiedher
symptoms.
Inthesummerof2012Elizabethfoundafunctionalneurologistwhowashavingsome
successwithneurologicalpatientsbyadministeringvaryingIVtreatments,usually
concentrateddosesofvitamins,antioxidantsorsupplements.Afterevaluationhefelthe
mightbeabletosuccessfullytreatherMAV.OnceaweekwedrovefromSonomatohis
officeinDaviswhereElizabethsatcomfortablyforanhourormorereceivinguptothree
solutions.
(DuringthistimeIdiscoveredBalancePointPilatesStudioinDavisandwescheduled
herappointmentstocoincidewithmetakingBootyBarreclassesthere,andthroughthisI
discoveredBASIPilatesandeventuallytookmyteachertrainingthere.Butthatisanother
story!)
Hertreatmentsactuallyseemedtobehelping.Thevertigowasbecomingalittleless
severe;shewashavingfewer“baddays”andbeganhavingmore“notsobad”days.Her
improvementleveledoffafterapoint,however,andafteraboutninemonthssheendedthe
visits.
Forthenext18monthsElizabethtriedacupuncture,anotherneurologist,achiropractic
neurologist,andaneurologicalchiropractor.Atbestherconditionwouldimproveabitbut
thentheimprovementwouldplateau.
6
In2014anotherneurologistsuggestedamoredetailedMRIoftheheadandcervical
spine,mainlytolookforwhitematterlesionsonthebrainoranyotherproblemsrelatedto
migrainesorvertigo.WhattheMRIshowedwasdegenerativedamageinthecervicalspine
andanarrowingofthespinalcolumn,possiblyexplainingtheheadachesandthevertigo,as
wellasneckpainthatwasbeginningtodevelop.Elizabethwassenttoapainmanagement
specialistwhoperformedatypeofnerveblock,calledradiofrequencyablation,inthe
cervicalspine:injectionsthatheat(inordertodeaden)themedialbranchnervesthat
supplythefacetjoints.Herdoctorexplainedthattheprocedurehadthepotentialtorelieve
painforonetotwoyears,untiltheaffectednerveshealorgrowbacktogether,afterwhich
shehadtheoptionofrepeatingtheprocedure.Thetreatmentwouldnotaffectthevertigo,
heexplained,butsincetheheadachesexacerbatethevertigo,herconditionwouldstill
improve.
Resultswerealmostimmediate.Theheadachesandneckpainwerevirtuallygone,but
thevertigowasstillthere.
Visitswithonemoreneurologicalchiropractorputthingsinperspectiveforher.After
proprioceptivelight-touchtestsontheforearmsandextraocular(eyemovement)testing,
heexplainedthatpartsofthebraincontrollingmovementwerenotquitesyncingwiththe
partsreceivingvisualfeedback.Themoreshemovedherheadaround(andhereyes)the
moredifficultitwastofocusonthings.Activitieslikelookingforonesmallitemina
groceryaislewereespeciallychallenging.Herbrainalsohaddifficultylisteningand
followingalonginaconversation;imagineapersontalkingat50MPHwhentheearsand
brainareonlycapableof40MPH.Hercognitiveprocesswasalsohampered.
7
Whichiswhy,onceIfinishedcomprehensiveteachertraininglastOctober(2015)Iwas
reluctanttorecruitElizabethformypracticeteaching.Shewasstillunabletokeepupa
moderateexerciseprogram–elevatingtheheartratetoacertainpointevennowthrows
hervertigointohyperdrive.SoIwassurprisedwhensheagreedtobemystudent.
BeforebeginningIpreparedElizabethbyhavingherperformtheHeadFloat,inwhich
theclientliessupine,headonafoldedtowelforalignmentwiththethoracicspine,and
barelybeginstolifttheheadoffthefloorortowel.Thispre-engagesthedeepanterior
cervicalmuscles.ThensheperformedtheSmallCurl-up,liftingtheheadandjusttheupper
partofthethoracicwithoutchangingthedistancebetweenthexiphoidandthepubic
bone(2).Ineededtoknowherneckwasstrongenoughtoholdliftedwithoutunduestrain
orsorenessafterthesessions.Still,Iwouldmodifymanyexercisesbyhavingherkeepher
headdownorinterlacingfingersbehindtheheadasinChestLift.
Wewerereadytobegin.
8
TheEarlySessions
TheWarmUp
Webeganwithsomecarefulroll-downs–Iwasconcernedaboutherheadhangingand
thepossibilityofneckdiscomfortworseninghervertigo.Shedidfine,though.Ididnotice
asymmetryinhershoulders.Shehadbeguncomplainingofshoulderpainseveralyears
earlier,whichIwouldsoonrealizewasimpingement.
TheFootwork
ThemovementoftheReformercarriagedidnotaffecthervertigoasIwasafraidit
might(goodnews!)soItookherthroughthefullfootworkroutinetoincludePrehensile,
CalfRaises,Prances,andSingleLeg.SoonImodifiedSingleLeg(bothToesandHeels)by
havinghertakemovementinthestationarytabletopleg,extendingandflexingthekneeto
coincidewiththeconcentric/eccentricmovementoftheworkingleg.ThenIhadher
reversetheflexion/extensionoftheknee(3).Thementalfocusrequiredtoorchestratethe
coordinatedmovementsdidwondersforclearingherbrain.
TheAbdominalWork
StandingPikeontheWundaChairwasnext.Again,therewasnoproblemwithher
headdroppedforward.IaddedChestLiftontheStepBarrel,whichprovidedvaluable
spinalextension,asElizabethhadstarteddevelopingmoderatekyphosisovertheyears.
TheHipWork
SheespeciallyenjoyedthehipworkontheReformer(don’tweall?)andwewent
throughtheentireseries.Wediscoveredsomeasymmetryinthelegmovements.
9
SpinalArticulation
Iwantedtoavoidanychallengingspinalarticulationfornow,especiallyanythingthat
riskedcompressioninthecervicalspine,soIstartedherwithPelvicCurlonthechair,
whereIfeltherneckwouldbesafer.Itwasjustchallengingenough.
TheStretches
IsetherupontheReformerfortheStandingLunge.Likemostpeople,shedoesn’t
stretchenoughandthoroughlyenjoyedthelengthening.
FullBodyIntegration
ReverseKneeStretchandeitherRoundBackorFlatBack(KneeStretchSeries).Ikept
thespringslightsoshecouldfocusonprecision.
TheArmWork
EventheArmsSupineSerieswithaverylightspringwastoopainfulforhershoulders,
soIborrowedtwoexercisesfromSamanthaWood’sPilatesforInjuriesandPathologies
Course:SupineRetractionandSupineProtraction(Cadillac).Theclientliesalongahalf-
rollerwiththeshouldersunderneaththepushthroughbarandpullsdownthetop-loaded
bar,thenpushesupthebottom-loadedbar(straightarms),wrappingthescapulaearound
therollerorliftingthemup(4).ThesewereinvaluableforteachingElizabethcontrolofthe
shouldercomplex.They’redefinitelyfeel-goodexercises!
TheLegWork
ElizabethlovedLegPressStandingonthechair;itchallengedherbalanceandengaged
herfocusandconcentration.Itwasanotherexercisethatsheclaimed“clearsthefog”from
herbrain.
10
LateralFlexion/Rotation
WealternatedbetweenSideStretchonthechairandSpineTwistSupineontheStep
Barrel.Thelengtheningwassomethingsheneededandenjoyed.
BackExtension
IwashesitantaboutSwanBasiconthechair,butherneckwasfineandsherelishedthe
feelingof“openingup”.
Weendedsessionswitheitherarestposeorafewrolldowns.
Tomysurpriseshethoroughlyenjoyedthesessions!Shewouldbepleasantlyfatigued
butnotexhausted,andwecontinuedonetotwosessionsaweek,sometimesforafullhour
butusually30to40minutes,dependingonherenergylevel.Overexertionwillstill
exacerbatethevertigo.
Soonweaddedsomeofmymatclassestoherroutine,alsomystretch/coreclasses
(againonthemat)thatincorporatesfundamentalPilatesandyoga,popularwitholderand
deconditionedclients.Currentlysheisdoingoneapparatussessionandtwomatclassesa
week.
LaterAndCurrentSessions
TheWarmUp
IntermediateWarmUpontheCadillac:Roll-UpwithRollupBar,MiniRoll-Up,Mini
Roll-UpOblique(noRoll-UpTop-Loaded;causesstrainintheshoulders).
11
TheFootwork
ElizabethnowcanperformallthefootworkonboththechairandtheCadillac.Ilether
decidewhichshefeelslikeonthatday.
TheAbdominalWork
We’llpickoneortwo:OntheReformer,Coordination,usuallywithherheadremaining
downtoavoidneckstrain.ThisexerciseiscalledCoordinationforareason,anditreally
engagescognitiveability;justwhatElizabethneeds!Onthechair,StandingPikeReverse
and/orCatStretchKneeling.OntheCadillac,BottomLiftWithRollUpBar.
TheHipWork
EithertheentireSupineLegSeriesontheStepBarrel,orontheCadillac,theSupineLeg
SeriesortheSingleLegSupineSeries.WalkingandtheBicycleexercisesarefavoritebrain
challenges.
SpinalArticulation
WenowfeelsafewithBottomLiftontheReformer.Whensheisfeelingenergeticwe
addtheExtension.
TheStretches
TheStandingLungeontheReformerisstillfabulous,andwe’veaddedTheLyingSplits
fromAnthonyLett’sInnovationsInPilatescourse:lyingontheReformerintheOpenings
position(legsopen),graspingtheropeswiththehandsandcontrollingthestretchofthe
adductors(5).Probablynobetterwaytostretchtheinsideofthethighswithoutbeingtied
tohorses!
12
FullBodyIntegration
OntheReformer:Scooter,goodforspeedinguptheheartratejustalittle.Onthe
Cadillac,SittingForwardforcontrolofthespineandSideReachforlengthening.
TheArmWork
StickingwithSupineRetractionandSupineProtractionfornow.Wewilltryexploring
theArmsSupineandtheArmsSittingSeriessoon.
TheLegWork
Onthechair,theHamstringCurl.SometimesweaddaLegPressStandingvariation
fromtheInjuriesandPathologiescoursecalledLegPressStandingSide(4),inwhichthe
clientstandssidewaystothefootpedal,atamoderatedistanceaway,andenjoysexternal
hiprotationwhilepressingthelegdownwhilerotatedouttotheside.
LateralFlexion/Rotation
SideKneelingStretchonthechair.SometimesMermaidontheReformerifherheadis
clear;Mermaidcanbeavertigo-inducer.
BackExtension
OntheReformer:BreaststrokePrep.OntheChair:BackExtensionSingleArm.
13
ThereisprobablynowaytoscientificallymeasurewhetherorhowmuchPilateshas
helpedElizabeth’svertigo.MAVisnotawell-understoodmalady;therehasbeensome
successwithmultiplemedications(usuallyafterlongtrial-and-error)andavoidingtrigger
foods.Withsomepeoplehaltingthemigrainesmeanshaltingthevertigo.Ithasbeen
abouttwoyearssinceherRFprocedureandherheadacheshavebeengettingalittlemore
intenseandfrequent,andlonger-lasting.
Hervertigohasdefinitelyimprovedsincethefirstyear.Webelievethevarious
treatmentshavehelpedinlittleways,andthatavoidingstresshelps(shewasabletoretire
inAprilofthisyear).Overexertionandexhaustionaretobeavoided.Thewonderfulthing
aboutPilatesisthatonecanhaveaworkoutatanylevel,andIbelieveElizabethreturning
toaregularexerciseprogramhashelpedherbodyphysicallyandalsoreinvigoratedher
spirit.
Westillholdouthopethatthisthingwilleventuallyjustgoaway,butifnot,Pilatesmay
bethebestwaytocopewithit.
14
BibliographyandResources
1. Spine-Health.com,article,“RadiofrequencyAblationProcedure”
2. MadelineBlack,Centered,HandspringPublishing,2015
3. PilatesAnytime,RaelIsacowitz,OnlineReformerClassNo.1896
4. PilatesForInjuriesAndPathologies,SamanthaWood,AdvancedEducationCourse,
BASIPilates,CostaMesa,CA,2015,andaccompanyingworkbook
5. InnovationsInPilatesReformer,AnthonyLett,AdvancedEducationCourse,Mt
Shasta,CA,2016,andStretchingOnThePilatesReformer,EssentialCuesAndImages,
AnthonyLettandKenyiDiaz,RebusPress,2016
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