Taking the Mal Out of De Mer
The Cawthorne Exercises
Is there anyone brave enough to tempt fate by saying they have never been seasick? Not even a little uneasiness, once a season or early in the cruise? While studies done for the military suggest that roughly half the population is susceptible to motion sickness, the degree of incapacity the susceptible half experiences can range from mild queasiness to a sincere desire for a quick and merciful death. And then there are those who never come to terms, so to speak. Landlocked by necessity, their love of the sea is unrequited. There are drugs and mechanical devices that promise either relief or prevention. Acupressure bracelets and sunglasses with an artificial horizon in the lens are available, and there is an extensive collection of drugs to choose from, whether prescription or over the counter. What there is a shortage of is a training regimen to make you immune to the causes. Just as you wouldn’t enter a marathon without training, you shouldn’t go offshore without conditioning your body (and mind) for the radically different environment.
Causes of Seasickness
Usually referred to as “motion sickness” by researchers, the root cause is a disconnect between what you are seeing and what you are feeling. Your eyes send messages to the brain that the cabin is tilted and the cockpit is bouncing around. The relation of your body to “up” and “down” is changing constantly. We determine up and down by a combination of visual cues and the information sent from the “semicircular canals.” Located in your inner ear, they look a little like the shell of a snail and are partially filled with liquid. Hair-like cilia sense the liquid and send the information to your brain. If the liquid is at the bottom of the semicircular canal, then your brain thinks you are standing upright. If that information matches what your eyes are seeing, then you are in your backyard. If it doesn’t, then you are in your boat. It’s the disconnect between what you see and what you feel, the “sensory input mismatch,” that is a large part of the cause of motion sickness.
The Cawthorne Exercises
There is evidence that you can adapt to the stress of motion by exercises. In the 1940s, a British otolaryngologist named Sir Terence Cawthorne noticed that some of his patients with inner ear problems recovered more quickly than others. These patients, he found, had been engaging in exercise that involved head and body motion. Together with a physical therapist named F. S. Cooksey, he devised a series of exercises to reduce dizziness. Note that the Cawthorne Exercises were not developed as a seasickness-prevention program, but according to Dr. Joseph Gavron, an Illinois sailor who is also an otolaryngologist, the exercises can help. “I have used [the Cawthorne Exercises] extensively,” said Dr. Gavron, “and they work.” While not a cure-all, he noted that the choices for seasickness prevention came down to either drugs or therapy, and the problem with drugs is the side effects. Scopalamine “is very well accepted, and if you are very susceptible [to seasickness], then it’s drugs or nothing.” The Cawthorne Exercises should be done for five minutes at a time, 10 times daily. Because you might feel dizzy, at least initially, it’s best to be seated. Have someone with you when you do the standing and walking exercises.
- The first set involves holding your head still and moving your eyes as far as they will go. Begin by looking up, then rolling your eyes to look down. Begin by doing it slowly, then speed up the movement. Focus on an object at each end of the limit of your movement. Some therapists include having the patient follow a moving finger. Repeat 20 times. Next, look from right to left, again beginning slowly and speeding up as you go. Just as with the up-and-down movement, find something to focus on at the far end of movement. Do this set 20 times. Head movements are next, beginning with nodding the head forward and then back. The head movement exercises start out with eyes open. As progress is made and dizziness is under control, do it with the eyes closed. Just as with the eye exercises, begin slowly. Next, rotate the head right to left, progressing from slow, eyes-open movement to rapid, eyes-closed movement as progress is made. Repeat both sets of head movement exercises 20 times.
- For the next set of exercises, shrug the shoulder 20 times, then rotate the shoulders to the right and left 20 times. Still seated, bend over and pick up an object from the floor. Repeat 20 times. Transition from a seated to a standing position and back 20 times, again progressing to doing this with your eyes closed. As your comfort with this improves, turn completely around before resuming a seated position. For safety’s sake, have a partner standing by. While standing, toss a small object, such as a rubber ball or rolled-up socks, from hand to hand above eye level, and then hand-to-hand behind one knee. Back in a seated position, five or six feet from a wall, focus on an object on the wall and turn your head right and left while keeping your eyes on the object. Do this at the rate of once a second for 20 repetitions. Do the same thing but with the head now moving up and down, as though nodding “yes.”
- The last set of exercises should be done with someone standing by in case you fall. Begin by standing on a soft, compressible surface such as a foam mat or cockpit cushions. With your eyes open, shift your weight back and forth from one leg to the other for one minute. On a firm floor, eyes open, rock back and forth using only the flexibility of your ankle joints. Keeping your back straight. You won’t be able to move far; the idea is to maintain balance at the edge of tipping over. Do this for 30 seconds. Put your back into a corner; stand on a firm floor for one minute with your eyes closed. Then, eyes open, stand on your heels and then your toes, eyes open, for 30 seconds. With your partner, walk across the room with your eyes open and then closed. Go up and down a short flight of stairs, eyes open, then closed. Repeat 10 times daily. Find a sloped surface and then walk up, down and across the slope. Begin by doing it with eyes open, progressing to doing it with eyes closed, accompanied by a partner. Repeat 10 times daily. If you can put together a small group of people, walk slowly in a circle around a central person who will gently toss you a large ball. While maintaining motion, catch and return the ball.
- Go dancing! Do frequent turns and bends, dips and dives, anything to accustom your inner ear-eye-brain connection to motion. The Cawthorne Exercises, to be successful, need to be done regularly. The severity of seasickness should be reduced, perhaps even eliminated in some people. Because it relies on repetition, “habituation,” for success, it needs to be part of your daily life. When you come ashore after an uneventful cruise, resume the exercises.
Onboard Cawthorne Exercises
When on deck, face forward and hold your head still. Rotate your entire body rather than swiveling your neck. Look at a fixed point of reference, perhaps a point on the horizon, rather than the pitching deck. Rather than allowing your body to move with the boat, move your body so that your head remains as nearly vertical as possible. This will keep the semicircular canals steadier and also give your mind the impression that you are in control of the motion. When on land, our body controls most of the changes in attitude and visual perspective. Tilt your head to the side and the world is tilted, but your mind understands why. It is important to have the feeling that the movement is predictable and under control. If you can take a trick at the wheel, for even half an hour, it can often reduce the misery index, again because you will feel that you are, in some small measure, in control of the motion. The important thing about any measures to control seasickness is that they have to begin before you are hanging over the lee rail.