Can Physical Therapy lessen or stop headaches/migraines?

Dennis Kaster, PT

Did you know that physical therapists are able to significantly decrease or eliminate headaches and or migraines?  Many times headaches and migraines are triggered by muscle tension or tightness in your neck.  These muscle issues can be alleviated with some simple corrections to poor posture and muscle weakness or tightness.  There are many ways that a physical therapist can help you to get rid of your headaches and migraines.  Physical therapy is a great alternative to taking expensive medications which can be detrimental to some of your body organs— like your liver.  Treatments like Botox can be very expensive and have only temporary effects.  The corrections that a physical therapist makes can be lifelong.  Here are some ways a physical therapist can help to decrease your headaches or migraines.

Posture – If you have poor posture or are looking down a great deal, this can cause the muscles that hold your head up to pull extra hard on the back of your skull.  This can trigger headaches and migraines.  By improving your posture or modifying your work station, these same muscles will not pull as hard on the back of your skull.

Ergonomic setup – if your workstation or even areas that you do crafting in are not set up correctly, this can put extra stress on your body and neck.  Simple things like wearing reading glasses instead of bifocals when you are at your computer can make a big difference.  A physical therapist can help you to set up your work stations to put less stress on your body.

Dry needling – This is a newer technique that can give instant relief for headaches and migraines.  I have seen some patients get total relief from migraines and headaches after just a couple of treatments using this technique combined with other treatments listed here.  This technique involves putting very thin needles into the sore muscles causing headaches and migraines.  It is very simple and takes only a few minutes to do.  Call one of our clinics for more details on this awesome technique.

Stretching – Muscle tightness can definitely trigger migraines and headaches.  A physical therapist can give you stretches specifically for the individual muscles that are causing your headaches or migraines.

Strengthening – Weak muscles in your neck and upper chest area can also contribute to your migraines and headaches.  A physical therapist can give you specific strengthening exercises to better support your head and neck.

Soft tissue mobilization – Many times the muscles in your neck and upper back can be very sore and have “knots” or trigger points in them, or just be tight.  A physical therapist can do soft tissue mobilization, a very specific type of massage, which will help to alleviate muscle tightness and trigger points in your muscles.

Ultrasound/Electrical stimulation – Ultrasound is a modality that helps to relax muscle tissue and promote healing.  Electrical stimulation is a modality that can help to decrease pain and inflammation in the tissues.  Either or both of these can be used to help decrease your pain or muscle tightness.

Unfortunately, one of the best-kept secrets is that physical therapy is a relatively cheap and easy way to decrease or eliminate headaches and migraines without taking expensive and powerful medications. 

Please call one of our clinics today.  We can do a free screen with you to let you know if we think we can help you.  Most insurances do not require a physician referral to physical therapy, so you can call and set up an appointment without having to see a physician first.  We look forward to helping you take control of your life and to eliminate the crippling effects of headaches and migraines.

Osteoarthritis of the Thumb CMC Joint

Written by: Tammy Vanevenhoven PT, DPT, CHT

As the season of fall hovers over us and the leaves begin to fall, the temperatures outside continue to fall as well. For those who suffer from arthritic hands stiffness and pain, it can quickly be felt by the changes in the temperature. Osteoarthritis is the most common of all joint diseases. It often affects the larger weight-bearing joints of the hips and knees, but it also commonly affects the smaller joints of the hands; especially the base of the thumb called the CMC joint (carpometacarpal joint). The CMC joint of the thumb is considered a saddle joint that allows the thumb its vast ability to grasp objects of various shapes and sizes, to open doors, jars, and packages, etc. It also allows pinching-- a more precision type movement for writing, buttoning, using scissors, picking up small objects or turning a key. We need our thumbs as they contribute to 60% of our hand function.

Signs and Symptoms of CMC joint arthritis are:

*pain at the base of the thumb after activity

*pain with active movement of the thumb especially with pinch

*morning stiffness

*joint tenderness to palpation

*crepitus (crunching noise in the joint) with thumb movement

*joint deformity with bony nodules felt at base of thumb

*weakness of hand grip (opening a jar, sealed packages, etc.) or with pinch (writing, buttoning, turning a key, etc.)

How is CMC joint arthritis diagnosed?

Usually a standard radiographic x-ray will show joint space narrowing, bony changes such as spur formation, and joint erosion. Based on the x-ray, the arthritic changes are usually classified as mild, moderate, or severe joint destruction.

What can be done non- surgically to help the painful arthritic thumb?

A certified hand therapist (CHT) or an occupational therapist can be of great help in alleviating pain in the arthritic thumb by fabricating a thumb spica splint that stabilizes the base of the thumb while still allowing use of the thumb tip for light pinch and grip activities. Stiffness can be reduced by using a paraffin bath that is composed of paraffin wax and mineral oil which is then melted to a therapeutic warm temperature which molds around the bony prominences of the hand to help soothe pain and improve movement of the joint. Your hand therapist will also educate you on joint protection by recommending built up handles on objects that are difficult to grip such as tools, scissors, writing and eating utensils. Key adapters can also be placed on your keys to allow ease with key pinch. An electric can opener can also be used to avoid stressing the arthritic thumb with a manual can opener. Protecting the hands from the cold weather is very important. Wearing mittens and using warming packs if you like to be outdoors will help keep your hands from getting stiff and painful while you cross country ski, ice fish or while taking a winter hike.

What does the surgery for CMC joint replacement entail?

CMC joint arthroplasty is the most common joint replacement of the arthritic hand. The beak ligament reconstruction, or the LRTI, is the most common surgical procedure performed. The hand has, thankfully, many muscles that perform the same function. They are called “spare parts.” The eroded CMC joint is removed and one of these extra tendons of the hand/wrist is sacrificed and bundled up to fill in the joint space at the base of the thumb. Patients are placed in a cast and often external pins are inserted for extra immobilization.  At four weeks the cast and pins are removed, and the patients are placed in a forearm-based thumb spica splint and sent to therapy to see a certified hand therapist or an occupational therapist that specializes in treatment of the hand. Therapy includes gentle progressive range of motion to restore normal movement of the thumb, fingers and concurrent wrist; which becomes stiff from being in the cast. Swelling control and pain management are treated by working on scar mobility to avoid tendon adherence. Hypersensitivity often occurs from the surgeons having to retract the superficial radial nerve to perform the operation. Therapists can ease this sensitivity by performing desensitization exercises to calm the nerve pain. Restoring functional hand strength while appreciating joint protection and education of patients for life-long care for the arthritic thumb are just some of the various ways your hand therapist can help.

If you would like more information in treating your arthritic hands you can call Advanced Physical Therapy and ask to speak to a certified hand therapist or occupational therapist that can assist you in answering your questions. APTSM New London phone: (920)982-0100.

The 4 P's of Energy Conservation

The 4 P’s of Energy Conservation

Laura Johnson, PT, DPT

Has it been exhausting for you to complete your typical morning routine, or maybe you are having shortness of breath while grocery shopping?  When individuals have a diagnosis of Chronic Obstructive Pulmonary Disease (COPD), Multiple Sclerosis (MS), or Congestive Heart Failure (CHF), or are recovering from a recent illness or surgery, it can be difficult to complete daily chores due to fatigue and decreased activity tolerance.  Your lungs and heart may not be working as efficiently as they should, so it is important to conserve energy throughout the day.

In order to succeed, there are 4 simple steps to consider, and we are going to refer to these as the 4 P’s of Energy Conservation

1.     PRIORITIZE: Decide what needs to be done today, and what can wait for a later date.  Try to scatter your household chores throughout the week.  One day for laundry, next day for vacuuming and another day for grocery shopping.  If you are partaking in a social engagement, plan to skip some daily activities to reserve some energy before the fun begins! A good quality rest period each day is best!

 2.     PLAN: Plan ahead to avoid extra trips.  Gather supplies and equipment needed before starting an activity.  For example, before showering, make sure your towel, clothes and necessary daily items are all located in the bathroom area.  Also have a chair available to provide yourself a seated rest break if needed.  Another technique is to plan to alternate heavy and light tasks.  Find a good balance between work, rest and leisure.

3.     PACE: Slow and steady pace, never rushing!  Some individuals try to complete as many tasks as possible, as quickly as possible.  Unfortunately, this leads to complete exhaustion, and inability to perform tasks later in the day.  This can also lead to a greater chance of falls due to increased fatigue: We all know a fall can be extremely traumatic.  Plan to rest before you feel tired. Provide yourself with enough time to take short, frequent rest breaks. 

4.     POSITION: Think about your body position while completing tasks throughout the day.  Bending and reaching can cause fatigue and shortness of breath.  There is adaptive equipment available to make some daily tasks less stressful on your body.   Examples are: 1) Use a reacher to grasp the cleaning supplies in the low cupboard, 2) Use elastic shoe laces to avoid bending over to tie your shoes, or 3) Use a sock aid to get your socks or compression stockings on.  Eliminating some strain when bending or reaching will allow your lungs to expand more fully, which in turn helps get more oxygen into the body. 

Conserving your energy can allow you to complete the tasks you want to complete throughout the day.  You do not want to run out of energy before the day is through and we definitely do not want you to entirely stop your activity for constant rest.  Get moving, but move smarter!

If you’re interested in developing an energy conservation plan specific to your needs, contact one of our physical or occupational therapists today to discuss it further.

Click here for a complete list of locations.

Image by Pavlofox from Pixabay

Are You a Smart Consumer of Healthcare?

ARE YOU A SMART CONSUMER OF HEALTHCARE

Think about the last time you made a big purchase, say $1,000 or more. Did you go out and buy the first thing you saw? Take one recommendation from somebody? Or did you research it, learn some things, compare it to other options, and select something that was right for you? Most people tend to be educated and research large purchases like cars, televisions, or the newest iphone. So why do we so often fail to do this with healthcare?

By becoming more educated healthcare consumers we can go from passive patients who take the first recommendation that comes from a practitioner to an active consumer who weighs options and makes choices. Here are some questions to talk through with your practitioner the next time a healthcare decision comes up.

WHAT ARE THE BENEFITS OR EXPECTED RESULTS?

When a treatment or procedure is recommended, the patient often assumes that it will make them "better." But what the patient expects and what the healthcare provider expects are often two different things. For example, a patient having back surgery expects to be pain free after surgery. The surgeon probably doesn't expect that to happen. Outcomes from back surgeries are terrible. A large study of 1450 patients in the Ohio worker's comp system showed that after 2 years 26% of patients who had surgery returned to work. Compare that to 67% of patients who didn't have surgery. There was also a 41% increase in the use of painkillers in the surgical group.

WHAT ARE THE RISKS AND DOWNSIDES?

Patients want to hear about the benefits of a treatment, but they often don't ask or care about the risks. To be an educated consumer, you need to. If one treatment has a 3% edge over another, but has a high risk of making you itchy or causing frequent headaches, do you want it? Going back to the back surgery study from before, the researchers found a 1 in 4 chance of a repeat surgery and a 1 in 3 chance of a major complication. With surgery you risk infection, blood clots, complications with anesthesia, and a whole host of other things. These risks need compared with other treatments. In the case of back pain, physical therapy is a valid alternative with a much lower risk profile. You might have some soreness with physical therapy, you might sweat some and be challenged with exercise, but the risks of PT compared to surgery are minimal.

WHAT ARE THE ALTERNATIVES?

Don't feel bad asking about alternative treatments. If you were looking at a certain car you wouldn't go out and just buy it. You'd at least consider the competitors and probably even test drive them. You should at least look at the other options in healthcare too. Maybe the first recommendation that your practitioner makes is the right one for you, but if you don't consider the alternatives you'll never really know.

WHY THIS TREATMENT OVER THE OTHER ONES?

This is the question where the rubber meets the road. You've learned about all the options, now you can see if your practitioner is balancing the risks and benefits to make the right choice for you. Staying with the back pain example, research shows that more than 40% of people who seek care for back pain will not receive a treatment of known effectiveness. Back pain is also the #1 reason for opioid prescriptions, despite a 2016 recommendation from the CDC to avoid prescribing opioids for back pain, and opt for non-drug treatments like physical therapy. By asking for the rationale and carefully weighing options, you can avoid being one of the people who gets an ineffective treatment.

WHAT'S IT COST?

This last question is becoming more important as patients bear an increasing share of the cost of healthcare. Even if you don't have a high deductible plan or hefty co-pays, by being financially responsible today, you'll probably see smaller price increases in your premiums down the road. That back surgery that we've been talking about? It'll likely cost between $60,000 and $80,000. So if we put the whole picture together, a patient who takes the first recommendation for surgery will have a $60,000 procedure that leads to a higher risk of disability, and a higher risk of long term painkiller use, while risking infection, and blood clots. Don't forget the 25% chance that you'll get to do it all again in a repeat surgery. Seems like a bad deal. An educated consumer would learn that physical therapy is a viable alternative to surgery with comparable outcomes, much less risk and lower cost. In fact, a large study of 122,723 subjects showed that people with back pain who got physical therapy in the first 14 days lowered their healthcare costs by 60%. It's easy to see why bargain shoppers love PT!