Mal de debarquement port nola fusion · TXT
Port of New Orleans · Cruise Crews · River Pilots · Offshore Rotations
Rocking. Bobbing. Swaying. Like you never quite made it back to land. It is not in your head, it is not anxiety, and there is a name for it — mal de débarquement syndrome. At The Fascia Institute and Treatment Center® we evaluate the vestibular and the cervical-fascial side of persistent rocking dizziness, fifteen minutes from the Erato Street and Julia Street terminals.
· Physical & vestibular therapy · Human TECAR® · Shockwave · PEMF · CoreSalt™ electrolytes · Ultrasound-guided nerve blocks in select cases
Jacques Courseault, MD, CAQSM, FAAPMR
Medical Director · The Fascia Institute and Treatment Center® · Metairie, Louisiana
01 · The Condition
Mal de débarquement translates roughly to “sickness of disembarkment.” Almost everybody gets a mild version — you step off a shrimp boat or a Carnival ship and feel the sway for a few hours. That is normal. Mal de débarquement syndrome (MdDS) is when it does not switch off.
The Bárány Society, the international body that defines vestibular disorders, published formal diagnostic criteria in 2020. All four have to be present:
Bárány Society Criteria (2020)
· Non-spinning, oscillating dizziness — rocking, bobbing, or swaying, present continuously or for most of the day. The room does not spin. You feel like the floor is a boat.
· Onset within 48 hours of ending exposure to passive motion — a voyage, a hitch, a flight, a long drive.
· Temporary relief with passive motion again — the tell almost nobody asks about. You feel better driving down I-10 or back out on the water, and worse the moment you stop.
· Symptoms persist beyond 48 hours. Under a month and still going is called “in evolution”; past a month it is “persistent.”
Two more things worth knowing, because they are the reason so many maritime workers get dismissed. First, MdDS is a clinical diagnosis — there is no blood test, no MRI finding, no balance-lab result that proves it. A normal workup is expected, not reassuring news that nothing is wrong. Second, it commonly drags along spatial disorientation, intolerance of visual motion (scrolling a phone, a busy grocery aisle, containers moving past on a gantry), heavy fatigue, worsened headaches, and anxiety. Those add-ons frequently get treated as the whole diagnosis.
02 · Who We See
This is a working port city with a cruise industry stacked on top of it. That combination produces a population that is repeatedly loaded, unloaded, and reloaded with passive motion — which is precisely the setup MdDS needs.
· Cruise crew finishing contracts out of the Erato Street and Julia Street terminals — six to eight months aboard, then a hard stop on land.
· River pilots and boat operators working the Southwest Pass, the Crescent, and the bar — on and off vessels multiple times a shift, in chop, on ladders.
· Towboat, tug, and barge crews on 14/14, 20/10, or 28/14 hitches — the brain never gets to settle on either land or water.
· Offshore and Gulf rotation workers including helicopter and crew-boat commutes, which stack aviation motion on top of marine motion.
· Longshoremen and terminal labor working container cranes, ro-ro ramps, and gangways — visual motion plus sustained overhead and head-down neck loading.
· Riverboat and excursion crews on the Mississippi day in and day out.
· Passengers — a healthy 52-year-old who took a seven-day Caribbean cruise, came home to Metairie, and has been rocking ever since. This is the single most common story we hear.
Almost every maritime patient who reaches us has already been told some version of “your scans are clean, give it time.” Some have been told it is stress. A few have been quietly moved off a safety-sensitive role while nobody worked out what was actually wrong. If that is you, you are not a difficult case — you are an under-evaluated one.
03 · The Mechanism
Balance is not one sense. It is three streams — the inner ear, the eyes, and proprioception, the position-sense feed coming up from your joints, muscles, and fascia, with the deep neck as the highest-density source of it anywhere in the body. Your brainstem and cerebellum fuse those three into a single answer: where is my head, and which way is down.
On a vessel, that fusion gets recalibrated. The deck moves, so the brain builds an internal model that predicts and cancels the roll — that is what getting your sea legs is. The leading explanation for MdDS is that this adaptation fails to reverse on land. The prediction keeps running against a floor that is no longer moving, and you perceive the difference as rocking. It is a learned pattern in a normal nervous system, not damage. That is genuinely good news, because learned patterns can be re-taught.
But it also means anything degrading one of the three input streams makes the problem harder to unwind — and keeps it going in some people who otherwise would have resolved. In port and cruise workers, the stream that is nearly always compromised is the neck.
04 · The Missed Layer
There is a second, separate condition called cervicogenic dizziness: disequilibrium and disorientation driven by neck pain and dysfunction, through altered cervical proprioception. It is well described in the neurologic and physical therapy literature. Its hallmark is dizziness that tracks with neck pain — worse with head turns, worse after holding one position, better when the neck settles.
Cervicogenic dizziness and MdDS are not the same diagnosis, and we are careful not to blur them. But three things are true at once, and they matter enormously for maritime patients:
1 · It can mimic MdDS. Persistent non-spinning swaying that started after a voyage is not automatically MdDS. A deckhand who spent eight months bracing against roll, sleeping in a bunk, and working overhead in a machinery space has an entirely plausible cervical explanation that deserves to be ruled in or out on exam.
2 · It can coexist with it. Having true MdDS does not protect you from also having a locked-down suboccipital and scalene complex. The neck layer is often the part that is actually treatable today.
3 · It can hold the pattern in place. If the brain is trying to re-fuse three input streams and the cervical stream is noisy, the re-learning has less to work with. Cleaning up that input is not a cure for MdDS — it removes an obstacle standing in front of one.
This is the part of the workup that gets skipped. Dizziness sends you to ENT and neurology, both of which are looking at the inner ear and the brain — correctly. Nobody in that pathway is putting hands and ultrasound on the deep cervical fascia, the suboccipitals, the scalenes, the sternocleidomastoid, the upper trapezius, and the thoracic outlet. That is the specific gap our clinic exists to fill.
05 · The Evaluation
You see a board-certified physical medicine and rehabilitation physician with sports medicine subspecialty training. Not a fifteen-minute slot. The visit has four jobs:
· Get the history right. Vessel type, hitch length, sea state, berth location, exactly when symptoms started relative to stepping off, whether motion relieves them, and what else changed. The motion-relief question alone separates MdDS from most of its mimics, and it is rarely asked.
· Rule out what has to be ruled out. Oscillating dizziness has a differential — vestibular migraine, persistent postural-perceptual dizziness, BPPV, inner-ear pathology, orthostatic intolerance and dysautonomia, medication effects, thyroid and metabolic contributors, anemia. If a piece of that belongs with ENT, neuro-otology, or cardiology, we say so and coordinate rather than improvise.
· Examine the cervical and fascial layer properly. Cervical range and end-feel, deep neck flexor endurance, joint position error, suboccipital and scalene tenderness, thoracic outlet provocation, jaw and upper thoracic contribution, and diagnostic musculoskeletal ultrasound of the tissue itself — the same fascial mapping approach we use across the clinic. Ultrasound shows fascial thickening, restriction, and gliding failure that no static image reports on.
· Tell you plainly what we think and what we do not know. Including, when it applies, that a component of this is central and will take re-training rather than a procedure.
06 · Treatment
There is no FDA-approved drug for MdDS and no single procedure that fixes it. Anyone promising otherwise is selling. What there is, is a two-front approach: habituation and re-adaptation work aimed at the central pattern, and hands-on plus device-based treatment aimed at the cervical and fascial input feeding it. Which front dominates depends entirely on what your exam shows.
07 · The Foundation Underneath It
Before we get to devices, there is a boring question that changes how a lot of these patients feel: are you actually replacing what you sweat out? On the Gulf and the lower Mississippi in July, in an engine room, on a container deck, in bunker gear or a fire-retardant coverall, you can lose an enormous amount of sodium in a shift. Add shift work, poor sleep in a bunk, coffee instead of water, and a galley diet you did not choose, and you get a plasma-volume problem stacked on top of a balance problem.
That matters here for a specific reason. Low plasma volume produces lightheadedness, greying-out on standing, brain fog, and unsteadiness — symptoms that layer on top of the rocking and make the whole picture worse and harder to interpret. It is a genuinely common finding in people with persistent dizziness, and it is also the single easiest thing on this page to fix. Increased sodium and fluid intake is standard, guideline-supported first-line management for orthostatic intolerance and dysautonomia, and a meaningful number of maritime patients have some of that in the mix.
CoreSalt™ — Developed In-House
The practical problem with sodium loading is that nobody sticks with it. Salty drink mixes taste awful, they are sugary, and drinking a liter of something sweet in 95-degree heat is its own kind of miserable — which is why compliance collapses in about a week.
So Dr. Courseault formulated CoreSalt™ — a taste-free sodium, potassium, and magnesium capsule. No flavor, no sugar, no mixing, no shaker bottle. You take it with whatever water you already drink. It fits in a pocket, it survives a hitch, and it works on a boat, a rig, a crane cab, or a gangway where a drink mix is a nuisance. Clinically, that is the whole point: an electrolyte strategy only helps if you are still doing it in month three.
To be clear about what this is and is not: CoreSalt™ is a dietary supplement supporting hydration and electrolyte replacement. It is not a treatment for mal de débarquement syndrome and it will not stop the rocking. It removes a common aggravating factor so the rest of the plan has a fair shot. Sodium loading is not appropriate for everyone — if you have high blood pressure, heart failure, or kidney disease, this is a conversation to have with your physician first, and we will have it with you.
For patients who show up significantly depleted, or who need to be functional for a crew change in 48 hours, we can also start with IV hydration in clinic and transition to oral maintenance from there.
08 · Straight Talk
MdDS is a hard condition and the honest literature reflects that. Many episodes triggered by a single voyage settle within weeks to months. Some persist for years. Repeated re-exposure — which is the job description for most people reading this — can make the pattern harder to break.
So here is the deal we actually make. We will take the complaint seriously, apply real diagnostic criteria instead of shrugging at a clean MRI, examine the cervical and fascial layer that the rest of the pathway skips, and treat what is treatable while being clear about what is not. If your rocking is mostly a central re-adaptation problem, the honest answer involves graded habituation and patience, and we will say so rather than sell you a device series. If a meaningful share of it turns out to be a locked, painful, poorly-signaling neck — and in this patient population it often is — that part we can do something about, and reasonably quickly.
Two honest caveats we would rather you read here than discover later. TECAR, shockwave, and PEMF are treatments for musculoskeletal and myofascial problems — there is no controlled trial showing any of them cures mal de débarquement syndrome, and we will not imply there is. Nerve blocks help a defined minority with a specific nerve-mediated pain generator, not persistent rocking as a general rule. What these tools do is address the cervical contribution, which in maritime workers is frequently substantial and almost always unexamined.
09 · Logistics
We know you are not on a normal calendar. You have a crew-change date, a hitch rotation, or a ship leaving Thursday. The clinic is in Metairie at 2520 Harvard Avenue, Suite 2B — roughly fifteen to twenty minutes from the cruise terminals, and straight up the interstate from the river terminals and the Westbank.
· Consolidated visits. When your window is short, we compress evaluation, ultrasound, and first treatment into the same appointment rather than spreading it over three.
· Programs that travel. Habituation and cervical retraining are written to be done in a cabin, a galley, or a rig gym with no equipment.
· Documentation that holds up. Clear written findings for your employer, maritime medical examiner, or occupational health — particularly when a safety-sensitive role or a fit-for-duty question is involved.
· Come back between hitches. We plan follow-up around your rotation, not ours.
The Fascia Institute and Treatment Center®
A real evaluation with a physician who will examine your neck and your fascia along with your balance — and tell you honestly which part of this we can move. Metairie, Louisiana. Call or request a visit online.
References
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2. Kinne BL, Owens EM, Schrot SJ, Weber MJ. Vestibular rehabilitation for individuals with mal de debarquement syndrome: a systematic review. Physical Therapy Reviews. 2022;27(3):205–213.
3. Cedras AM, Moin-Darbari K, Foisy K, Auger S, Nguyen D, Champoux F, Maheu M. Questioning the impact of vestibular rehabilitation in mal de debarquement syndrome. Audiol Neurootol. 2024;29(2):107–113.
4. Reiley AS, Vickory FM, Funderburg SE, Cesario RA, Clendaniel RA. How to diagnose cervicogenic dizziness. Arch Physiother. 2017;7:12.
5. Li Y, Peng B. Pathogenesis, diagnosis, and treatment of cervical vertigo. Pain Physician. 2015;18(4):E583–E595.
6. Devaraja K. Approach to cervicogenic dizziness: a comprehensive review of its aetiopathology and management. Eur Arch Otorhinolaryngol. 2018;275(10):2421–2433.
7. Dizziness and neck pain: a perspective on cervicogenic dizziness exploring pathophysiology, diagnostic challenges, and therapeutic implications. Front Neurol. 2025;16:1545241.
8. Occipital Nerve Block. In: StatPearls. Treasure Island, FL: StatPearls Publishing. NCBI Bookshelf NBK580523.
9. Vestibular Disorders Association. Mal de débarquement and cervicogenic dizziness patient resources. vestibular.org.
This article is for general education and does not constitute medical advice or establish a physician–patient relationship. Persistent dizziness has a broad differential that includes serious conditions, and it should be evaluated in person by a qualified clinician. Individual results vary, and no outcome is guaranteed. TECAR, shockwave, and pulsed electromagnetic field therapy are used here to treat musculoskeletal and myofascial conditions; they are not approved or established treatments for mal de débarquement syndrome itself. Sudden dizziness with new severe headache, double vision, slurred speech, weakness, numbness, or hearing loss is a medical emergency — call 911.
