can pilates alleviate migraine associated vertigo? · can pilates alleviate migraine associated...

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.

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TableofContents

TitlePage 1

Abstract 2

TableofContents 3

DiagramsandTheRadiofrequencyAblationProcedure 4

Elizabeth’sStory 5

Elizabeth’sSessions 9

Conclusion 14

BibliographyandResources 15

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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

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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.

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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.

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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.

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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.

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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.

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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).

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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!

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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.

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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.

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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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