Physical Therapy Shown to be Effective Treatment for Headaches

Physical Therapy for Treating Headaches. New Heights Physical Therapy in Vancouver WA and Portland OR.

By: Gema Sanchez, PT

Headaches are one of the most common disorders of the nervous system, affecting approximately 47% of the global population. For three of the most common headaches; tension type headaches, cervicogenic headaches, and migraine headaches; several studies indicate that physical therapy can be a good treatment option.

Tension type headaches are the most common type of headaches and affect 38% of adults every year.  Several studies indicated that these types of headaches respond well to specific exercise. In a study by Van Ettekoven and Lucas, patients performed exercises against an elastic resistance band in conjunction with manual techniques. They found that the patients had a significant decrease in frequency, duration, and intensity of headaches for up to six months after the program. In another study, Anderson and colleagues had office workers with frequent neck and shoulder pain perform 10 weeks of resistance training using an elastic resistance band. Their findings showed decreased frequency of headaches in these patients in response to as little as 2 minutes of daily resistance training.

Cervicogenic headaches affect 22-25% of the adult population. This accounts for 15-20% of all chronic and recurring headaches.  These headaches are thought to arise from joint and muscle impairments of the neck. Two recent reviews looked at studies assessing the effectiveness of conservative physical therapy management on cervicogenic headaches. Both reviews concluded that neck spinal manipulation is effective in the management of cervicogenic headaches. In addition, one review also concluded that the most effective intervention for patients with cervicogenic headaches may be a combination of mobilization, manipulation, and neck and shoulder strengthening exercises.

Migraine headaches are reported by approximately 15% of the population. These headaches are believed to come from the blood vessels and the nervous system. Migraine headaches are usually managed using medication such as Propranolol and Topiramate. There are some patients, however, who do not tolerate medication due to side effects or who prefer to avoid medication for other reasons. For these individuals, manual therapy may be an alternative treatment option. In 2011 Chiabi and colleagues performed a systematic review of seven studies on manual therapies for migraine treatment. These included two massage studies, one physical therapy study, and four chiropractic spinal manipulative therapy studies. Treatments included massage, trigger point therapy, myofascial release, soft tissue work and stretching, postural correction, exercise, relaxation, mobilization, and manipulation. They concluded that the current studies suggest that massage therapy, physical therapy, relaxation, and chiropractic spinal manipulative therapy might be as efficient as medication (Propranolol and Topiramate) for prevention of migraines.

Physical therapy treatment for patients with headaches will vary depending on the type and origin of the headaches. At New Heights, we treat headaches using many different techniques including specific neck and shoulder strengthening exercises, stretching, postural correction, and manual techniques such as graded mobilization, myofascial release, augmented soft tissue mobilization (ASTYM), muscle energy techniques, and tender point therapy.

 

Abdominal Separation In Post-Partum Women

By: Gema Sanchez, PT (Edited by Bradley Brown)

Diastasis rectus abdominis (DRA) is a structural impairment of the muscular and connective tissue of the abdominal wall which presents as a separation of the abdominal muscles along their midline. It is measured as the distance between the right and left sides of the abdominal muscle grid (the “six-pack”), and is referred to as the inter-recti distance (IRD). Measurement of IRD in the clinic is generally made by hand or with calipers. Criteria for the diagnosis of DRA vary, but IRD is generally considered abnormal if it exceeds 2 fingers width at rest, measured at or just above the navel. DRA has been linked to support-related pelvic floor dysfunction and lumbopelvic pain.  One study in 2009 found that 74% of women seeking physical therapy for abdominal or lumbopelvic symptoms exhibited increased IRD and had significantly greater pain than those without DRA.

Risk of pregnancy-related DRA is about 27% during the second trimester and peaks in the third trimester at 66-100% due to the baby’s increase in size. Luckily, there is some research which suggests that exercise during pregnancy may mitigate the occurrence of DRA. In 2005, one such study looked at the effect of abdominal strengthening on the presence and size of DRA in pregnant women. Eight women who participated in a prenatal exercise program of abdominal muscle strengthening, pelvic floor exercises and education were compared to 10 non-exercising women. They found that only 12.5% of the exercising women exhibited a DRA as compared to 90% of the non-exercising women.

Incidence of DRA decreases postpartum but is still present in as many as 39% of women six months postpartum, and some women still have not fully recovered one year postpartum. DRA-related abdominal instability can be especially limiting during this time, as women return to previous normal activity in addition to the load of caring for their child.

Integrity of the anterior abdominal wall is essential to stability, posture, breathing, trunk movement and support of internal organs.  Specific abdominal exercises are used to narrow the IRD and help prevent future separation. In two recent studies, ultrasound measurements were used to assess the effect of active abdominal contraction on DRA in post-partum women. Both studies concluded that IRD was reduced with regular, static abdominal contraction. In another study, researchers used ultrasound to measure IRD at rest and during abdominal exercises in 84 women during and after their pregnancy. Their results support the notion that conservative abdominal exercises consistently produced a significant narrowing of the IRD.

It is important that women with DRA receive individual supervision and assessment so that adjustments can be made based on each patient’s reaction to exercise as well as rate of improvement.

New Heights Physical Therapy Plus has physical therapists with the training, skill, and knowledge to assist your clients with DRA during and after their pregnancy.

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Five Tips for Making the Most of Your Physical Therapy Experience

Making the Most of Your Physical Therapy Experience. New Heights Physical Therapy in Vancouver WA and Portland OR.

We’re at about mile 18 on the new clinic marathon, and while our efforts are yielding some beautiful results, there’s still some distance to go. At this point in the project, New Heights owners Kevin Poe and Donna Gramont have to dig deep and call upon the lessons they’ve learned in physical therapy to see them through the daily grind. Turns out rehabbing a building isn’t much different than rehabbing a body, it requires the same grit and determination. They offer up these five tips for turning pain into gain to help you reach your recovery goals.

 

Tip #1: Begin with the end in mind.

Donna and Kevin envisioned a bigger space for patients and staff to work their recovery, which led them to purchase the former Montavilla Sheet Metal building, a treasure trove of raw materials. In their mind’s eye, they pictured the rubble of lumber not laid to waste, but instead transformed into desks, tables, cabinets, and other furnishings for the beautiful new clinic. 

Having A Good Physical Therapy Experience - New Heights Physical Therapy - Portland OR Vancouver WA

What do you imagine for your recovery? If you’re rehabilitating a broken ankle, picture yourself on campus walking to class or taking a hike with a friend. A powerful first step is placing yourself at the finish line having achieved your goal.

Tip #2: Learn some new skills.

Kevin didn’t know how to weld and Donna had never built furniture before, but both knew that they were capable of learning. Yes, they were operating outside their comfort zone, but they also knew the furniture wouldn’t build itself. They asked friends and family for help, and with some trial and error, they gained the necessary skills to make the furniture.

What new skills do you need to learn to reach your goal? Pilates? Strength training? Our therapists excel at educating patients about their injury or condition. Lean on them and bank some knowledge that will help you achieve your goal.

Tip #3: Show up and do the work.

Every.darn.day. Donna and Kevin realize they can’t carry this heavy load forever, but until the new clinic opens in December they have committed to working hard every day in order to realize their dream of a new clinic.

Recognize that physical therapy can be hard, challenging work. But it’s a matter of fact: you’ll realize your recovery goals sooner if you commit to your therapy plan and do your home exercises. Sometimes life just doesn’t offer shortcuts!

Tip #4: Find the Zen in the work.

Planing, sanding, joining, and staining a thousand board feet of lumber would be enough to drive anyone mad, but Donna resists the urge to resist, and settles into the work itself. By finding a peaceful zone in which to work she ensures that she isn’t expending unnecessary energy that would be better spent accomplishing her goal.

 

Pay attention to when you feel overwhelmed and frustrated during your recovery. Try to accept your current reality and work with what is, not what isn’t. You may find that things will soften and shift, ultimately moving you closer to your goal.

Tip #5: Prepare to Celebrate!

You better believe there is a big party planned in early 2015 to celebrate the opening of our new clinic, we can hear the champagne corks popping now! We want to share this with you, our valued patients, whose health and well-being is the reason all of this is hard work is happening.

We recommend that you celebrate every small achievement you gain during your recovery! It’s easy to lose sight of how far you’ve travelled and the ground you’ve regained. Take a moment to pat yourself on the back for all the hard work you’ve put in and the results you’ve achieved. Let the sparks fly!