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

What Is Pilates?

Pilates is a low impact form of exercise that focuses on engaging your core to improve postural alignment, strength, flexibility and mind-body movement awareness.  

Pilates was created by a man named Joseph Pilates who was born in Germany in 1883.  Joseph studied yoga, meditation, circus arts, boxing and gymnastics and enjoyed a healthy active lifestyle.  He moved to England before the start of World War 1, but was interned with other German citizens when war broke out.  During his internment he worked with soldiers and detainees in the hospitals.  He began to notice a trend that soldiers who exercised, even if in bed, did not get influenza as often.  This bias began to set up the idea for Pilates, and he began attaching springs to patients beds to provide resistance training to exercise them.    

After the war he returned to Germany, and eventually emigrated to the United States and set up Joe’s Place, a gym, in New York.  He continued to refine his idea of Pilates and began teaching others his new concept.  Thus the Reformer (picture 1) and Cadillac (picture 2)  were born, based off a concept of a bed you could exercise on.

Reformer

Cadillac

Classical Pilates follows a rigid flow based on the growth and development of babies.  Movements begin with flexion based posture, then move to extension based posture and then add combinations of the two postures.  Joseph Pilates trainees began to refine that rigid structure and branch out to provide movements that better fit the clientele they were working with.  Pilates continues to evolve to this day.     

Who is Pilates good for?

Pilates is good for anyone looking to improve their breathing, trunk control, core activation, posture, body awareness and the knowledge of how to move within their own body.  It can be good for healthy persons, persons looking for injury prevention, persons looking to recover from injury and persons looking for continued strength to reduce the instance of re-injury.

-Katie Chen, DPT, OCS, COMT

The Role of Physical Therapy in Breast Cancer

According to the American Cancer Society, breast cancer remained the most common cancer among women in 2019, and statistics suggest it will remain on top for 2020 (1). While survivorship continues to increase, cancer survivors face numerous hurdles created by a fractured health care system and poor integration of survivorship care (2). Often cancer patients feel common side effects are something they have to endure because they have cancer, due to a lack of proper education. Physical therapists can provide education and exercise before, during and after cancer treatments to help ease some anxiety and functional deficits that active patients and survivors face.  

COMMON EARLY SIDE EFFECTS OF TREATMENT FOR BREAST CANCER:

• Arm, neck shoulder blade or mid back joint stiffness and/or pain

• Axillary Web Syndrome

• Cardiopulmonary complications

• Lymphedema

• Osteoporosis

• Radiation fibrosis

• Reconstruction complications

COMMON LATE SIDE EFFECTS OF BREAST CANCER:

• Anxiety and depression

• Arthritis and musculoskeletal disorders

• Cancer related fatigue

• Cardiac toxicity

• Chronic pain

• Cognitive dysfunction

• Lymphedema

• Osteopenia or Osteoporosis

• Peripheral Neuropathy

• Pulmonary Disease

• Sexual dysfunction

• Sleep disorders

WHAT CAN BE DONE?

Prehabilitation, or care that occurs between the time of cancer diagnosis and beginning of acute treatment, has been shown to be effective, with the primary goal of reducing the incidence and severity of current and future impairments. Individuals will often receive baseline measurements in activity level, circumferential measurements, strength, motion and posture. Individuals will also receive education on reduction of lymphedema, reduction of Axillary Web Syndrome, infection concerns, breath, posture, motion exercises and scar management. This is often performed by your cancer care network or hospital, but is not exclusive to them. 

Rehabilitation during cancer treatment can help minimize side effects, reduce pain and increase energy.  Often performed by your cancer care network or hospital, but is not exclusive to them.

Rehabilitation post cancer treatment with or without breast reconstruction can help to minimize side effects, reduce pain, increase energy, improve abnormal movement patterns, improve everyday activities, improve abnormal breathing patterns, improve abnormal posture and provide individualized care and education.  This can be performed by any licensed physical therapist unless a lymphedema specialist is required.  

WHO IS A CANDIDATE FOR BREAST CANCER RELATED PHYSICAL THERAPY?

• Anyone diagnosed with breast cancer

• Anyone currently receiving breast cancer treatment

• Anyone who is a breast cancer survivor

IS PHYSICAL THERAPY EXCLUSIVE TO BREAST CANCER?

The simple answer is no.  Physical therapy can help any cancer patient with decreased functional status or quality of life due to current or previous cancer diagnosis.  

The bottom line is care does not have to stop once your cancer has gone into remission or you have been released from your oncologist's care  if your function or quality of life has not returned to normal.  Don’t be afraid to ask for help if you feel like you need it, or know someone who needs help. 

For more information of the role of physical therapy in cancer treatment, click on the following link:

American Physical Therapy Association: Physical Therapy Guide To Cancer

-Katie Chen, DPT, OCS, COMT

REFERENCES:

1.American Cancer Society: Cancer Facts and Figures 2018. Atlanta, Ga: American Cancer Society, 2018.

2. DeSantis, CE; Lin, CC; Mariotto, AB et al. (2014) Cancer Treatment and Survivorship Statistics, 2014 CA: A cancer journal for clinicians

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