Another area of interest that might be causing the problems of vertigo
could be the vestibular system and not necessarily a problem of the neck or
of the vetebral artery. It is not uncommon that treatment of "neck" vertigo
problems are in reality treating the vestibular system through the active
neck movements and this gives relief of the symptoms.It is also possible
that the problem is not of the joints but a proprioceptive disturbance
which also can be alleviated through active neck exercises. It certainly is
a subject that can be looked into deeply.
Hope this helps a bit. Janet Berman

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From: sood <[log in to unmask]>
To: [log in to unmask]; [log in to unmask];
[log in to unmask]
Subject: Re: VERTIGO:CERVICAL ORIGIN
Date: 24 May 1999 10:01

Dear friend,
  
                      Thanks for your valuable opinion.Long back I realized
that  my quest for
solution of many musculoskeletal problems is some where in
Physiotherapy,hence my 
interest in physiotherapy and manual-therapy, I am able to help most of my
patients
without use of knife thanks to this wonderful branch of  healing.Unluckily
during my training
and education as ortho surgeon we were not told anything about
physiotherapy,But I am able to provide better results  where as my
colleagues who have little regard for this wonderful art are still
prescribing  loadful of drugs .shooting steroids in every joint or tissue
without giving a prior
consideration to physio.Sad but true.I hope it is not so in U.K
                                Can you please let us know ;what do you
mean by mobilization techniques MAitland & Mulligan and neuro dynamic
techniques, because of my limited knowledge of this field I am afraid I
know little about this.and my quest for truth will be incomplete till i
find all that is there to be found.
thanking you
Dr.S.C.Sood
-----Original Message-----
From: kevin reese <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Monday, May 24, 1999 12:44 AM
Subject: Re: VERTIGO:CERVICAL ORIGIN


Dear Sood
     
    Our experiences of the vertigo type symptoms associated with cervical
musculoskeletal problems are quite different.
     
    In very general terms it is the overall restriction in the tissues
which I find is the problem and the majority of strategies are focused on
increasing mobility; in my view a collar does not help this aim.
     
    As in so many of these general syndromes there can be a multitude of
reasons why a patient should be experiencing feelings of dizziness/
disorientation/ nausea/ visual/ audatory and other sensory disturbances. As
usual the aim in my practice is to try and identify the primary
cause/interface of the symptoms.
     
    In joint movements I prefer what physios would call the mobilisation
techniques eg Maitland and Mulligan. These low velocity accessory movements
can be highly effective and don't carry the risks of thrust manipulation eg
death.
     
    The autonomic system can often given vertigo type symptoms and access
to troublesome sites can be gained in techniques such as trigger point or
acupressure of muscles such as scm. scalenei, levator scap, upper traps and
many more. Anterior cervical spine will often given insights into the
sympathetic chain at interfaces such as first rib and cervical joints.
Treatment of the rib joints by mobilisation or manipulation can often
eliminate these symptoms. 
     
    The nervous system as a whole can be moved with neurodynamic techniques
and biases can be placed on peripheral nerves, autonomic and recent work
suggests some upper cervical cranial nerves.
     
    Soft tissues such as sub occipital fascia can either cause nerve
entrapment on their own or be the cause of secondary problems in structures
such as joint. This leading to the vertigo type symptoms as described.
     
    As usual I have just scratched at the surface of some of the possible
musculoskeletal causes of 'vertigo'. It is a detailed and complex
assessment with a multitude of sites and tests to consider. It is what
makes physio such a difficult but rewarding job. Hope this helps    Regards
Kevin. 
    -----Original Message-----
        From: sood <[log in to unmask]>
        To: [log in to unmask] <[log in to unmask]>;
[log in to unmask] <[log in to unmask]>;
[log in to unmask] <[log in to unmask]>
        Date: 22 May 1999 17:52
        Subject: VERTIGO:CERVICAL ORIGIN
        
        
        Dear Friends,
                                      Amongst many causes of Vertigo  seen
in this part of world
        is one caused by cervical spine pathology is most common,  causing 
vertigo in flexion of neck .stabilization with cervical collar provides
relief almost -always ! Vertebral artery in upper cervical segment is also
involved in some cases.
                        . Our approach is quite simple along with
chemotherapy and collar we advise
        isometric exercises to tone the posterior cervical muscles.
                                                    I have tried  giving
manual traction to these patients and was surprised to see  these patients
completely  cured.
         I wish to learn from your experiances that ;
        Is Moblisation or manupulation worth trying in these cases? 
        Can it cause increase in vertigo as seen in some patients? 
        why some patients feel vertigo in flexion ans few in extension of
neck ?Does type of 
        manupulation depend on this?



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