Ask a PT

156 Posts
 
Posted - 10/03/2006 :  23:14:14  Show Profile  Reply with Quote
Our user asked: "In late '97 I developed a very unusual problem and have been all over the country in an effort to get help. Both noise and visual disturbances cause me to lurch forward at the waist. When water is turned on I 'hold on' to something so I don't fall down. Items going by my eyes also cause me to lose my balance. Many prescription drugs have been tried, to no avail. Unfortunately I have reached the point where I now have horrendous pain in my lower spine from the years of 'lurching forward'. Injection performed at our Pain Clinic in Kenosha have been ineffective. Do you have any solutions for this unusual problem? Thank you very much!"

Ask a PT Response: "I am not very familiar with the exaggerated startle response so I don't know if I will be able to help you much in regards to this. However, I did a little research to understand it better. From what I found, this response can be attributed to a number of different sources, both physical and psychological. Often times psychologically an individual experiences a traumatic event which results in anxiety or post traumatic stress disorder (PTSD). As a result of the anxiety or PTSD, various situations, noise, and visual stimuli will often trigger an exaggerated startle response which you mentioned. Not knowing your entire situation and what treatment options you have tried, suggestions which I have found include hypnosis and medications such as klonopin, valium & depakene. I didn't discover anything on habituation or desensitization where stimuli is purposely provided so that the various systems of your body gets use to the stimuli. In physical therapy, we often incorporate habituation or desensitization treatment to various conditions which include vestibular or neurological disorders. Often times this can be quite effective in decreasing the negative response.

In regards to your back pain I am sorry to hear that the injections have not worked. I don't know if you have tried physical therapy in the past but if you were to undergo a physical therapy evaluation a physical therapist would look at various issues that could be contributing to your back pain such as: strength, range of motion, joint mobility, flexibility, posture, tissue irritability/tension, mechanics and compensatory patterns. If the etiology or reason you are experiencing the pain is more structural such as the development of a scoliosis, discogenic problems, arthritis (spondylosis) or slipping of the vertebrae (spondylolisthesis) you may require further medical attention such as surgical intervention. However, your exaggerated startle response will definitely need to be corrected as this response could lead to further problems despite the medical intervention. From my experience, aquatic therapy may be beneficial for you as well. As the warm water and the bouyancy of the water can help take stress off your joints and relax muscles. I don't know if the splashing of the water would elicit a response but the response would be slower in the water because of the hydrodynamics. Possibly a back brace could be utilized as well to limit the degree of "lurching forward" and to minimize the stresses on your back/body. Another common noninvasive treatment often utilized to control pain is a TENS unit. This is often given to patients with chronic pain as this machine will block pain input to your brain. However this modality is not effective for pain management for everyone. I hope this was helpful. Thanks for using CyberPT."