Sixth International Fascia Research Congress (FRC) is coming up in September 2022 and I submitted my case report on Benign Paroxysmal Positional Vertigo. After peer review, it was approved for Oral presentation at FRC 2022!
A Case Report: Could Benign Paroxysmal Positional Vertigo (BPPV) Have a Myofascial Mechanism?
Authors:
Cathy Kim, MD
Graal Diaz, PhD
Community Memorial Health System, 147 N. Brent St. Ventura, CA
Background:
Otolith theory for paroxysmal positional vertigo (BPPV) has prevailed for decades, providing the basis for particle repositioning maneuvers such as the Epley. In 1977, based on his animal study, otorhinolaryngology surgeon Dr. Nicholas Torok proposed the existence of a neural mechanism for BPPV and suggested changing the name of BPPV to positioning neurocervical vertigo. In separate work, Dr. Alf Breig, a functional neurosurgeon, explained that tension on nerve tissue, not compression, caused neural dysfunction by impairing conductivity. This paper presents a case report of cessation of acute BPPV with myofascial release of the thigh, supporting the possibility of an alternate mechanism to otolith theory.
Case Report:
A 32-year-old male presented to clinic complaining of two days of intense dizziness associated with change of head position, and had developed nausea, vomiting and loose stools by the end of the first day. Review of systems was negative for viral upper respiratory infection, fever, or allergy symptoms. Past medical history was negative for vertigo. Physical exam revealed no nystagmus. Genu recurvatum and hypertonic thigh fascia were noted. The patient reported the magnitude of dizziness, on a 0 to 10 scale with 10 being the highest intensity, as 10/10. Before treatment, the patient was positioned seated with optimized neutral pelvis and spine, parallel legs and feet, and knees bent at 90 degrees. Patient was instructed to initiate isometric contraction of the pelvic floor (kegel) and thigh muscles (pushing into heels) while the practitioner performed high velocity assisted myofascial glide on the anterior thighs bilaterally. This was accomplished with a smooth-edged tool to glide along the longitudinal axis of the thigh from proximal to distal. The patient reported instant relief of vertigo, 0/10.
Discussion:
Since particle repositioning maneuvers have high recurrence rates, vertigo research is ongoing, usually in tertiary centers for refractory cases, using validated symptom questionnaires. Although this is an incidental outcome without standardized tools, recent science confirming the continuity of the superficial fascia between the neck and the thigh supports the possibility that thigh fascia could play a role in an alternate mechanism for acute BPPV.
Category #3 (Sensory and Neural Aspects) or #13 (New Hypotheses and Experimental Research Methods)
All Authors: No disclosures.
There was no funding for this study.
References:
- Book: A Breig. Adverse Mechanical Tension in the Central Nervous System: An analysis of Cause and Effect, Relief by Functional Neurosurgery. Almqvist & Wiksell International (John Wiley & Sons, Inc.), Stockholm and New York City, 1978.
- Journal: CA Foster. A Comparison of Two Home Exercises for Benign Positional Vertigo: Half Somersault versus Epley Maneuver. CA Foster. Audiol Neurotol Extra, 2: 16-23, 2012.
- Journal: MF Pedersen, HH Eriksen, JB Kjaersgaard, ER Abrahamsen, and DD Hougaard. Treatment of Benign Paroxysmal Positional Vertigo with the TRV Reposition Chair. J Int Adv Otol, Apr; 16(2): 176-82, 2020.
- Book: C Stecco. Functional Atlas of the Human Fascial System. C Stecco. Elsevier, United Kingdom, 2015.
- Presented at the 6th Extraordinary Meeting of the Barany Society: N Torok, A Kumar. An Experimental Evidence of Etiology in Positional Vertigo. London, England, 1977.
