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!!!