Hi,

This post concerns a post from Jim Meadows (a looooong time ago about
"Phasic Eye Exercises as an Adjunctive Treatment for Posttraumatic Long
Term Musculoskeletal pain").

In this post Jim mentioned symptoms commonly seen in whiplash patients
(my summary):

Poor balance

Patterned hypertonicity - upper limb increased flexor tone, lower limb
increased extensor tone

No pattern in the cervical muscles but always some hypertonicity
somewhere

Difficulty in tracking a rapidly moving target with the eyes

Poor righting reactions

Jim also mentioned that these patients seem to be suffering from some
form of cervicovestibular dysreflexia as the righting reaction could
also be corrected with minimal mobilization of the neck.

He aslo says: "The patterned hypertonicity suggested to me that the
vestibular nucleus (which is partly responsible for muscle tone in these
groups) was not having its full inhibitory effect and that the eye
exercises somehow stimulated the nucleus to increase its inhibition and
reduce the tone in these groups."

When I happened to read the above recently I came to think about the
following.

The tonic neck reflexes serve to keep the position of the body constant
in relation to the head. It is elicited by stimulation of proprioceptors
(probably muscle spindles) around the three uppermost cervical
vertebrae, via reticulospinal and vestibulospinal tracts to a reflex
centre in the medulla.

The effects of the reflex are:

If the neck is flexed, the legs extend and the arms flexes.
If the neck is extended, the legs flexes and the arms extend.

The labyrinthine reflexes serves to hold the head in the same position
prior to a movement, i.e. to keep the position of the head in space
constant. It is elicited by stimulation of vestibular receptors. The
effects of the reflex are the opposite to the effect of the tonic neck
reflexes.

However the labyrinthine reflexes are dependant on the neck reflexes.
They work on the assumption that the head has a constant position
relative to the body, thanks to the neck reflexes.

Now if one consider the possibilty that a whiplash can cause atlas to
become hypomobile at one or more of its joints. That could cause atlas
to stay in a slightly tilted or rotated (or a combination) position.
What would that do to the tonic neck reflexes?

My guess is that it can cause several of the above mentioned symptoms
directly and by affecting the labyrinthine reflexes it indirectly is
responsible for many of the remaining symptoms.

Recently I have started to assess and treat the OA joints specificly. A
lot of the above mentioned symptoms has improved or disappeared when I
corrected the OA joints. (I have developed a very gentle technique for
this and if you want a more detailed description, just shout.)

By following this with mobilisation of the AA and C2-C3 joints further
improvement was reached. After assessing and treating any hypomobile
segments of the spine I carefully assess and treat the SIJs.

In more or less all whiplash patients I have seen I have found one or
more dysfunctions in the SIJs. My guess is that it is caused by a
combination of a strong dural pull from above, caused by the great
movements of the cervical spine, and an asymmetrical sitting position at
the time of impact.

Comments?

All the best,

David Felhendler, PT


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