Headaches 101

Headaches - we've all had them. Did you know that not all headaches are created equal? Some types of headaches are caused by tight muscles or irritated joints in the neck and can be helped with PT. The four most common types of headaches are:

• Migraines

  • Often experienced in recurring episodes with visual or sensory symptoms

  • Can last from a few hours to a few days

  • Many experience sensitivity to light, sound, and/or smell

  • Often accompanied by an aura (a visual, sensory, or speech disturbance prior to the headache)

  • Typically felt as pulsating pain on one side of the head and are aggravated by activity

• Cluster Headaches

  • Experienced as a severe headache on one side of the head

  • Last 15 minutes to 3 hours, happen in clusters from weeks to months

  • Pain felt behind the eye, with eye watering and nasal congestion

• Tension Headaches

  • The most common type of headache, experienced by 30-78% of people

  • Typically felt as "pressing or tightening pain" of mild to moderate intensity on both sides of the head

  • Can last minutes to days

  • Not worsened with activity

  • Often come along with increased tightness in neck muscles

  • Can be improved with PT!

• Cervicogenic Headaches

  • Pain felt on one side of the head and/or at the base of the skull

  • Can be associated with neck pain, dizziness, or jaw pain

  • Caused by tightness in the neck/shoulder muscles or irritation of the upper neck joints

  • Can be improved with PT!

If you're having headaches, reach out to a PT to see if manual therapy and targeted exercises may be able to help!

-Meghan Hom, DPT

Sources:

• Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalgia. 2013; 33 (9): 629-808.

Is Your Pain Getting Better?

The primary reason individuals end up in physical therapy is because they are experiencing pain, with the most common cases being back pain, neck pain, knee pain, foot/ankle pain, and shoulder pain. Subsequently, the main goal in physical therapy is to reduce or eliminate pain in order to help the individual get back to normal activities (think walking, lifting, reaching, squatting, running, etc.). Evaluating whether or not pain is improving can be challenging for some individuals going through physical therapy, especially if they are new to the process. Physical therapists will often hear about the difficulty in the self-assessment of pain due to the inherent subjectivity of the experience. This is understandable, as pain is a subjective experience! With that said, there are several metrics within the study of pain that can be helpful to consider when attempting to assess how effectively your pain-relief strategies are working:

• Pain Severity

  • This is a measure of how much your pain hurts, typically taken on a 0 to 10 scale in most clinics. A rating of “0” is easy to understand, as this is the complete absence of pain, while a rating of “10” is much more subject to interpretation. In general, we describe 10 out of 10 pain as a medical emergency, wherein you are experiencing so much pain that your only course of action is to rush to the emergency room. A common example I offer up is, “Imagine you were just bitten by a shark. That is 10 out of 10 pain.” Whatever your pain level may be, tracking pain severity is a well-established way to measure your progress. I typically encourage people to pick three activities that are important to them and track the pain severity they experience while performing these activities over the course of 6-8 weeks. If the numbers go down, then you can confidently say your pain is getting better.

• Pain Frequency

  • This is a measure of how often you experience pain in a given time-frame (hourly, daily, weekly, etc.). This can be thought about very simply as intermittent versus constant. Or, if symptoms are intermittent from the start, you can either estimate how many times per day do you experience pain or what percentage of the day you experience pain. If the pain you are experiencing was initially constant and now is intermittent, that is a sign of progress. If the intermittent pain you are experiencing goes from occurring approximately 50% of the day to 25% of the day, that is a sign of progress.

• Pain Irritability

  • This is a measure of how easy it is to trigger the pain you have been experiencing. For example, if you experience pain with prolonged standing, how long you can stand for before you notice pain gives us a general sense of how irritable your symptoms are. Being able to stand for only 10 minutes before the onset of pain as opposed to being able to stand for 60 minutes before the onset of pain would indicate GREATER pain irritability. This could also be applied to more intense activities, such as running: being able to run for 30 minutes before the onset of pain as opposed to being able to run for 2 minutes before the onset of pain would indicate LESSER pain irritability. Therefore, if you are able to perform the painful activity for greater amount of time or at a higher intensity before you experience the onset of pain, you can safely assume that you are likely getting better.

• Pain Duration

  • This is a measure of how long the pain lasts when you experience it related to a particular activity. When triggered, does the pain last for seconds? Minutes? Hours? Days? A decrease in pain duration is indicative that your condition is improving, as it will have a lesser negative impact on your day-to-day life. For example, if I was experiencing pain for 2-3 days every time grocery shopping, but now I only experience pain for 2-3 hours after grocery shopping, I can definitely say my pain duration has decreased, which is a sign of progress.

These are just a few of the metrics you can use in order to track your progress in physical therapy, or when recovering independently from an injury. Keep in mind, most injuries will heal with time and do not require fancy tests or treatments. Patient, understanding, and persistence are the keys to getting back to full strength.

-Grant Hennington, DPT

Diagnostic Imaging: X-ray vs. CT scan vs. MRI

More than likely you’ve either had diagnostic imaging taken or have heard of X-rays, MRIs, and/or CT scans. These tests are great tools that provide medical professionals more insight and knowledge into the human body, allowing them to make more accurate diagnoses and choose the ideal treatment plan. Although all of these tools are used for diagnostic imaging, each one uses different techniques, providing varying levels of detail.

X-ray

X-rays are one of, if not the fastest and most accessible, forms of diagnostic imaging, commonly used as a first-line tool. It creates a 2D image by sending radiation through the body. How does this work? Dense areas of higher level of calcium (bones) block the radiation, leaving the image to appear white or transparent, while soft tissues (muscle, tendons, ligaments, etc.) allow the radiation to pass through and appear darkened, black, or grey. In some cases an X-ray may also look at internal structures with the use of barium sulfate, or dye, to make organs stand out more clearly. Although X-rays are great for seeing larger injuries to the bones, they don’t give a clear picture of more subtle injuries to bones or soft tissues.

Most commonly used for:

• Fractures

• Dislocations

• Bone disease or degeneration

• Pneumonia

• Cancers and tumors

Computed Tomography Scan

A Computed Tomography scan, or CT scan, is yet another fast option for receiving diagnostic imaging, utilizing radiation and occasionally dye just like an X-ray. However, instead of providing a simplistic image, a CT scan provides a 3D image, giving a detailed computerized 360 degree view of bones, blood vessels, soft tissues, and organs. This makes a CT scan ideal for injuries related to trauma or in emergency situations. 

Most commonly used for:

• Trauma

• Musculoskeletal disorders

• Heart disease

• Cancers

• Appendicitis

• Infectious diseases

Magnetic Resonance Imaging

Magnetic Resonance Imaging, also known as an MRI, utilizes a powerful magnet and radio waves instead of radiation like X-rays and CT scans, creating highly detailed 3D cross section images, providing views of soft tissue, nerves, and blood vessels. An MRI can also give better contrast resolution for bones and soft tissues when compared to other diagnostic imaging. Due to the use of a powerful magnet some patients will not be able to have an MRI completed if they have metal implants, pacemakers, or other implanted devices.

Most commonly used for:

• Injuries to ligaments, tendons, muscles (Meniscus, ACL, Achilles, Sprains/strains) 

• Cartilage damage

• Joint injuries

• Spinal injuries

• Brain injuries

Questions? Please contact the author, Brian Collins, DPT at brian@salmonbaypt.com.

How To (Properly) Calculate Your Target Heart Rate Zone

Monitoring our heart rate during exercise is an excellent way to determine and quantify the intensity of our workout. But what intensity should we be working out at and what is the best way to calculate this? The traditional method of calculating your target heart rate (Percentage of Predicted Maximum Heart Rate) factors in only your age (Predicted Max HR = 220 - Age). For example, world-class ultramarathoner Scott Jurek is 46 years old and therefore has a predicted maximum heart rate of 174 beats per minute (bpm). While using this traditional method, most recommend a target heart rate zone (the zone you want your heart rate in during exercise) to fall between 50-85% of your maximum heart rate. For Scott Jurek, we find his target heart rate zone to be roughly 87-148 bpm. The benefit of this method lies in the simplicity of the calculation. However, there are shortfalls of utilizing this method to calculate target heart rate zones. First, the range of this target heart rate zone is much too large and subsequently not very prescriptive. Second, the low end of this target heart rate zone may not be attainable during exercise, especially in older adults with higher resting heart rates. For example, the predicted maximum heart rate for a 75 year old woman is 145 bpm. Let’s assume this individual has a resting heart rate of 75, which is fairly typical. Utilizing the traditional method results in a calculated target heart rate zone of 73-124 bpm. As you can see, her resting heart rate is higher than the low end of her target heart rate zone for exercise. Therefore, the percentage maximum heart rate method of calculating her target heart rate zone would say she is exercising at rest, which is nonsensical. In other words, the traditional method often prescribes heart rates that are too low when working out at lower intensities, especially in older adults. Third, the traditional method fails to factor in your level of fitness, thus overly simplifying exercise prescription for a variable population. Since the traditional method of calculating your target heart rate fails to factor in your resting heart rate, it will prescribe the same target heart rate zone for Scott Jurek as an age-matched couch potato who smokes two packs per day. You see, as you become more fit, your resting heart rate will decrease as your heart becomes stronger and subsequently more efficient at pumping blood to the rest of your body. A highly trained athlete may have a resting heart rate of 48 bpm while the sedentary smoker may have a resting heart rate of 88 bpm. If they are both 40 years old, the traditional method of calculating target heart rate would recommend exercising between 90 and 153 bpm for both individuals. The traditional method therefore lacks this level of specificity.

So what is a better way to calculate your target heart rate zone? The answer is using the Karvonen method, otherwise known as the Heart Rate Reserve (HRR) method. The Karvonen method factors in both your age and resting heart rate, allowing for a more precise and effective target heart rate zone. The low end of the target heart rate zone tends to be at a higher heart rate than the traditional method of calculating target heart rate zones, while the predicted maximum heart rate is still the same. Those with a higher resting heart rate will see a higher number at the low end of the target heart rate zone as compared to those with a lower resting heart rate, to account for variability in the baseline levels of cardiovascular fitness within the population. Click on the link below to calculate your target heart rate zone using the Karvonen method:

TARGET HEART RATE CALCULATOR

Once calculated, it is recommended that you use this target heart rate zone to monitor your intensity during your workouts, in order to ensure that you are exercising at an intensity high enough to provide a cardiovascular benefit. This will help you get the most out of your exercise routine moving forward.

To find more information on heart rate or how to find your pulse, CLICK HERE.

-Grant Hennington, DPT

Blood Flow Restriction Therapy

High load - high intensity training has been shown time and again to be one of the most successful ways to make significant strength gains and muscle hypertrophy. However, there are many conditions and pathologies (post-operative, osteoarthritis, chronic pain, etc.) that require strengthening, but are unable to tolerate the demands of a high load - high intensity workout in order to achieve the desired results. Blood Flow Restriction Therapy (BFRT) is a method of training that allows a person to make significant strength gains through low load training, thus reducing overall stress on the body.

BFRT utilizes pneumatic cuffs that are applied to the extremities and in turn provide external pressures occluding venous outflow while maintaining arterial blood flow. This leads to the release of hormones, hypoxia (reduction of oxygen to the muscles and ultimately leading to the production of lactate), and cellular swelling. Ultimately, these physiological effects lead to strength gains and muscle hypertrophy, which are all desired effects of high load -high intensity training, but accomplished through the completion of low load training. 

A typical BFRT workout includes 3-5 exercises at a training volume of 75 repetitions over 4 sets (30 reps, 15 reps, 15 reps, 15 reps) with a 30-60 second rest break between sets. As stated above, BFRT should be performed at a low load, with studies showing a load of 20-40% of an individual’s 1 repetition max being most efficient. The pneumatic cuffs should be left on for the entirety of the workout (maximum of 20 minutes at a time) in order to get the desired physiological effects. 

For more information about the effects, application, and safety of Blood Flow Restriction Therapy, CLICK HERE or contact us through our Ask A PT feature.

-Brian Collins, DPT

References:

• https://www.physio-pedia.com/Blood_Flow_Restriction_Training

• https://www.apta.org/patient-care/interventions/blood-flow-restriction/what-to-know-about-blood-flow-restriction-training

• Patterson SD, Hughes L, Warmington S, et al. Blood Flow Restriction Exercise: Considerations of Methodology, Application, and Safety [published correction appears in Front Physiol. 2019 Oct 22;10:1332]. Front Physiol. 2019;10:533. Published 2019 May 15. doi:10.3389/fphys.2019.00533