In the space of one year, Jamie had been rear-ended twice, strained her whiplashed neck while trying to protect a child in her care (Jamie is a special needs care provider) and fell hard enough on winter ice to see stars (not the unlucky one, though!).

Jamie had been my client since 1996; we had made great progress with her chronic cranial stiffness due to a jaw reconstruction operation that had left her with permanent wires. The wires restricted natural cranial movement, which I believe led to a series of problems: headaches, fatigue, back and leg pain. Jamie and I experimented extensively, using her ability to give precise feedback as I worked on her head. She was often able to tell me when a certain cranial/sacral release would also relax her lower back or stimulate a new feeling in her legs. Now, she had a whole new set of problems stemming from the car accidents and other injuries and, as before, no one in her medical team had any answers that gave her relief.

Jamie's neck had been whiplashed not once but four times. Layered injuries like these are very hard on ligaments. The scar tissue that forms from a whiplash acts like rigid threads in the ligaments and intercostal and interspinous tissues. Between the vertebra and the upper ribs, surrounding the clavicle (collarbone) and scapula (shoulder bone), are masses of connecting tissue. Some of this tissue has muscular attachments, and some of it has very short but important connecting ligaments. These ligaments not only hold things together, but also determine range of motion and mobility. When the tissues are overstretched, torn or strained during a whiplash, they respond by tightening. The tissue itself becomes rigid and 'dry,' for the natural elasticity is lost. Under a microscope, the tissue appears to have thin white threads -- this is scarification. During the natural healing process (or via a therapist encouraging stretching), the scarred tissue is gradually replaced by healthy tissue. When a new injury occurs before the healthy tissue replaces the old, however, scar is laid on top of scar, always at the most vulnerable point: where it was injured before.

There are other important systems affected by neck injuries. The lymphatic system has a number of nodules in or around the neck, and there are various nerves that run from the brain stem through the neck column to the rest of the body. There are also vestibular receptors in the neck. These receptors were very important to Jamie, as they are part of the systems that determine balance, part of the complex way we relate to the orientation of our world. Most people recovering from a whiplash injury will experience neck pain and stiffness, shoulder discomfort, headaches stemming from muscular tension and structural displacement or disk injury. In a few cases, such as Jamie's, there may also be dizziness, vertigo, related nausea, and spatial disturbances.

We balance upright by taking cues from several areas of our body. We look at the world around us and judge its horizontal and vertical references. We feel the ground beneath us through proprioceptors in our joints. (Our ankles, feet, knees, and even our elbows and hands have proprioceptor receptors.) We respond to the changes of delicate fluid levels in our inner ear, within the semicircular canals. These fluids, in turn, change the angles of hairs or vestibular nerve receptors and send signals to the brain about our balance. The fluid within the ear is affected by many things: hydration, or having enough fluid in the rest of our bodies, is in turn affected by our salt and sugar intake; blood supply, how well the arteries in the neck are working (often affected by whiplash injury); oxygenation, another blood-supply related cause of problems; and headblow or whiplash that disturbs the proper functioning of the inner ear through restrictions in the temporal bone of the skull, which starts behind the ear and extends up over the side of the head.

I began working on the hypothesis that Jamie's problems were related to restrictions in her ears caused by repeated blows -- the sharp shaking of her head in the car accidents. We had several clues. First, Jamie had a feeling of stuffiness in her left ear and top of the head pain that seemed to be specifically related to one of the intracranial membranes, the falx cerebrum. There was also tightness of the other cranial membrane, the tentorium, on the left side. There was pain behind and in her eyes, which is usually related to the sphenoid bone, in turn very important to ear health. Most of all, we had Jamie's positive response to cranial/sacral work, for any time I was able to move the restricted plates of her skull within their proper range of motion, she had reduction of vertigo and headache.

Jamie has vertigo, as opposed to dizziness. Vertigo is when, sitting still, the world seems to turn around you. Dizziness is when you are spinning in relationship to the world. It is a small difference when you are feeling so bad that you are ready to throw up, which has happened to Jamie all too often. On-going rehabilitation with the physical therapist focused on Jamie re-training her visual referential abilities, but only a little time with the moving, flashing objects was enough to send her to the bathroom with a wonky stomach.

I began to work on the plates of Jamie's skull that I presumed had been affected by the various accidents -- her occiput and temporal bones. As we didn't get positive or long-lasting results, I switched to working on what Jamie told me helped. It didn't matter that there was no reason that her temporal/parietal juncture should be affected; releasing that area, especially on the left side, relieved her vertigo. I dredged up techniques I hadn't used much: dealing with the pterygold and palatine bones.

One day, working inside Jamie's mouth (much of the tension inside the ear can't be directly accessed externally), I said in frustration, "I wish I had another pair of hands!" I wanted to put tension on the tentorium, typically done by pulling on the outer ears, while I was encouraging the sphenoid to relax on the left. Then it occurred to me that I had another pair of hands right there: Jamie's! She was a long-time client and sensitive to the cranial work we had done from the beginning. Holding the tentorium steady wasn't delicate or dangerous. This would be the ultimate in client participation!

As Jamie held her own ears and stretched the tentorium, I accessed the other systems from holds within her mouth. All of a sudden, I could feel how the place where the tentorium, running horizontally, and the falx, going vertically, were 'stuck.' I could even feel the direction of the torque. I directed Jamie to apply tension in the directions I felt were needed. Asking Jamie more precise questions about the tilt of her head (her feeling that she was being 'pulled' to the right) yielded more information about the internal tilt of the sphenoid and the resulting tension on her left inner ear. Knowing where the tentorium attached to the temporal made my work on that area more specific.

Working together, Jamie and I began to make major progress. Experimentally, we tried a six-hands technique, recruiting Jamie's 10-year-old daughter to hold Jamie's ears while Jamie worked on her eyes and I worked inside her mouth. However, the results weren't any better, and we decided extra cooks didn't necessarily improve the recipe. With Jamie's active participation in our sessions, however, I no longer felt like I was shooting in the dark and we were able to approach the vertigo problem with a distinct idea of what was going on inside and with a definite plan of attack.

There is no instant cure for severe, life-style affecting vertigo such as Jamie's. So far, however, our cranial/sacral four-hands technique has brought about the most change, giving Jamie whole days without significant disturbance and opportunities to expand her activities to include reading, sewing, exercising, driving and even flying (though the last is still difficult, as her fluid systems react to the motion of the airplane). The headaches and eye/ear pain is better, and pain relief is longer, each time we work.

I know it will take patience and Jamie's co-operation. She has already extensively changed her diet by reducing salt and sugar intake and eliminating caffeine-laced soft drinks. She stretches, to keep tight neck ligaments limber. Best of all, she hasn't given up and neither have I. It may take another year, but we will have her back to work, back to being active and healthy, and no longer feeling like her world is turn, turn, turning.

Jocelyn Paine is a cranial/sacral therapist who also practices structural release and Laban Movement Analysis in Anchorage (under a lucky star!). She can be reached at 276-8195.