Post on 30-Apr-2019
Headaches!!!
What can
Physical Therapy do???
Paul Wortley PT
Rocky Mountain Therapy Services
Take 2 Aspirin and Call Me in the
Morning
FACTS
During the past year, nearly 90-95% men and women have had a least one headache.
Over 4 billion dollars are spent annually on over the counter pain medication for headaches.
Employers loose an estimated 50 billion dollars each year due to absenteeism and medical expenses caused by headache, and those with migraines loose more than 157 million workdays each year.
TERMINOLOGY
ETTH (Episodic Tension Type Headache)
CTTH( Chronic Tension Type Headache)
CERVICOGENIC Headache
MIGRAINE Headache
What do you mean I have more
stress in my life than I Should???
THE PROBLEM
Life Gets in the Way
Home /Occupational /Recreation Stress and
how we react
Bad Life Habits and how they get formed
Proprioception and “Getting Used to It”
Muscle Physiology / Starving for Hydration
Myofascial Pain Syndrome / Stuck like Glue
Trauma /Sports injuries / MVA’s / Whiplash
What is the most
Common Denominator ?
GUESS
“THE” Common Denominator
is
BAD POSTURE!!!
Your Head is a Bowling Ball
10 to 18 lb. Bowling Ball
Forward Head Syndrome
Standing
Cervical Lordosis
Standing Examples
Purse / Backpack
Max Back Pack Weight <= 20% of weight
Flexion Addicted Society
Sitting / Computer / Phone
We call them Computer Jockeys
Mom’s Idea
I Pad / Car /Gameboy/ Texting
Physical Therapy Evaluation
Get a Good History (Freq, Intensity, Duration)
Record Baseline Cervical ROM
Look for SB / Rotation deficits to the same side
Look for postural deficiency
Look for muscle trigger points
Computer Program
Posture Analysis
Patients Headache Drawing
Physical Examination
Positive for Occipital Neuritis
Positive for Super orbital / trochlear neuritis
Secondary Problems to FHS The Gorilla
Protracted Scapula's / palms face backwards
Collapsed chest
Upper and Middle Trapezius stress / Trigger
Increase Levator Scapula muscle stress / Trigger
Upper Crossed Syndrome
Muscular Trigger Points
THE SOLUTION
Awareness / Restore Proper Posture
Changing Habits / 1 hour only on Computer
Identifying Triggers
Relaxation / return to normal muscle tone
Stretching / return to normal muscle tone
Coping with Stress / Need the right tools
(Women: It’s OK to be #1)
Nutrition and Hydration / Water vs. Diet Coke
Exercise and stretch the proper muscle groups
PHYSICAL THERAY
HEADACHE TREATMENT
Spine School / Posture Education & Practice
Use of modalities / Ice-Heat- Electrical Stimulation
Myofascial Release/Massage
Relaxation and Breathing Training
Spinal Mobilization
Cervical Traction
Aquatic Exercise / Posture Practice
Gym and Cardiovascular Exercise
Education/Implementation of Home Headache Program ( Headache Self Defense )
Posture Education and
Application
Proper Standing
Proper Sitting
Proper Posture / Computer
Add picture
Ice is my “New Best Friend”
Myofascial Release
Sub-occipital Release
Spinal Mobilization
Prone thoracic Mobs
Standing thoracic + C7-T1 Mobilization
Injections / Medications
Trigger Point Injections
Nerve Block Injections
Facet Joint Injections
Epidural Injections
Pain Meds
Muscle Relaxers
Anti-Inflammatories
Cervical Traction
Neck Trac vs over the door and under the chin
Postural Neuro-Muscular
Re-education
Pool Exercise
Postural Correction Exercise
UBE
Posture Chair by Body-Align
Postural Correction Exercise
Seated Row
Lat Pulls
Kinesiotape
EXPECTATIONS AND GOALS
Reduce Headache: Frequency/Intensity/Duration
Increase PPI index to 85% or greater
Decrease Neck Disability Index to <10 over 50
Reduce Neck Pain: Freq, Int, Duration
Reduce muscle tension
Restore / Improve Cervical Lordosis
Restore Cervical ROM to WNL
Independent with home exercise / stretching
Improve / Restore Proper Posture
RECOMMENDED DURABLE
MEDICAL SUPPLIES
Achey-Breaky Ice Pack System
RECOMMENDED DURABLE
MEDICAL SUPPLIES
Lumbar Support for Sitting
RECOMMENDED DURABLE
MEDICAL SUPPLIES
Neck Pillow
RECOMMENDED DURABLE
MEDICAL SUPPLIES
Neck Trac Cervical Traction Unit
(When indicated)
RECOMMENDED DURABLE
MEDICAL SUPPLIES
90 Glasses
But Doctor…Isn’t there just a pill
that will make it all go away?
If you are not willing to do what it takes to get
better….Go home and ENJOY your pain.
You Earned It!!!
So How Long will it Take?
Typical time frame to reach goals:
3 X per week for 2 weeks
2 X per week and X1 wellness for 2-3 weeks
1 X per week and X2 wellness for 4-6 weeks
Then 30-60 days wellness ( FREE )
Each Treatment Session is about 2+ hours
Independence
One of the biggest goals of treatment is:
“Have the patient become independent
from me and not dependent on me”
Paul G. Wortley PT
Remember
If you continue to do what you’ve always
done… You’ll always get what you always got.
Positive changes DO NOT occur without taking
appropriate action and positive changes on the
physical level DO NOT occur without the
persistence of doing the right things overtime !!!
Our Job is to help set them on the “The Path”
It’s a Team Approach
Patient
Physician
Physical Therapist
Working together Headache
Sufferers can be helped!!!
Acknowledgements
Thank You
Dr. Phil Savia ( Headache Neurologist )
THANK YOU
It has been an Honor!!!