Have a Pain in Your Head?

Types of Headaches and How They Can Be Helped…

headache cure HPT

by Michael Brezak, PT, DPT – Hampton NH Clinic

We all live stressful lives. The hustle and bustle of day to day activities at times can leave us feeling a bit stretched too thin. Stress plays an important role in how we feel and interact with our friends, family, and colleagues. Leaving stress to become so ‘built up’ as it were can lead to further medical complications including headaches. It is estimated that about 80% of all individuals have experienced some form of a headache in one way or another(1). It is about understanding your symptoms to find the best treatment for your condition. This article will go over three different types of headaches (Tension, Migraine, and Cervicogenic) and then see how Hampton Physical Therapy can help.

Tension headaches are the most common and usually the type that affects the majority of the population on a day to day basis(1). It is that constant “pounding” sensation that one may experience along their temple or even in the back of the neck. This type of headache typically is the result of increased stress which can cause tightened muscles at the base of the neck. Largely these can be managed with over the counter medication, ice, and reducing stress levels all are effective management techniques to reducing your symptoms.

“Migraine headaches have controlled my life for years now. After trying just about every medicine available, I have found the best way to keep the migraines under control to be dry needling therapy. Kate and the team at Hampton Physical Therapy are great!” Ginny Carr

Next are migraine headaches which can often times be debilitating in terms of severity or longevity. Migraine headaches can be attributed to certain ‘triggers’ that develop over time, but largely their exact cause is unknown(2). The more common triggers include light sensitivity, noise levels, and even changes in the weather. These type of headaches are usually precipitated in the form of an ‘aura’ which foreshadowing of impending symptoms.
cervogenic headache
Lastly are cervicogenic headaches which can often times be confused with tension headaches are their presentation is similar. These types of headaches present with decreased range of motion in the neck and joint pain ranging from the shoulders to the base of the skull(3). One aspect of these type of headaches is even a joint dysfunction of the spinal column can be the underlying cause(4). An interesting specific feature of this type of headache is that they are usually one sided in origin(5). Meaning that its presentation is one where it feels as if it radiates from the base of the neck and wraps around in a crescent pattern towards the eye.

In the end, it truly depends on what type of headache you have and how to find the right treatment. A thorough evaluation by a primary physician or a physical therapist can be the first step in the right direction. Each therapist at Hampton Physical Therapy is trained in various techniques including the latest research based treatment of cervical manipulation (similar to chiropractors) and Trigger Point Dry Needling to reduce or eliminate headaches and related symptoms.

 

Fall Prevention Strategies in the Home

Louish-Pixel---tripping

By Katherine Younes, DPT – Hampton Clinic

Did you know according to the National Institute on Aging Senior Health 6 out of every 10 falls happen at home?2 This means the one place where seniors feel safe can actually be hazardous to their health. Hampton Physical Therapy wants to share that whether your loved one lives in their own home or with you, there are some easy ways to prevent falls at home which are the leading cause of fatal and non-fatal injuries for older Americans.1

Here are 7 of the best ways to prevent falls at home and keep your loved one safe.

Remove all fall hazards in the home: Remove throw rugs, frayed carpets, small furniture like plant and magazine stands,and piles of clutter. 2 Move pet bowls to a corner. Tuck electrical and phone cords into cord organizers that keep them out of traffic paths. Make sure that wet boots and shoes can be removed before making the floors inside the house slippery.

Provide wide walkways in the home: Squeezing through tight spaces can cause a senior to lose balance and fall. Make sure that the traffic patterns in the home are wide and free of clutter. This is important whether or not your loved one relies on a cane or walker. Aging can reduce vision and depth perception and that is why a clear, wide path is essential.

Remove trip hazards: Tablecloths are pretty but if the corners drag on the floor it can become a trip hazard. Toys are especially dangerous, whether they are children’s toys or pet toys.

Make the bathroom safe: Use non-slip bath mats that are a contrasting color from the tub. 2 This will make it safe and easy to see. Place handrails beside the tub and toilet and purchase a raised toilet seat. All of these will help to improve your loved one’s balance in a potentially slippery environment.

Maximize lighting: All light fixtures inside and outside should have bulbs with the maximum wattage allowed. 2 Make sure that they are positioned to eliminate shadows. Make sure that lights near the bed are within easy reach to avoid falling out of bed. Use nightlights in the bedrooms, bathrooms and hallways. Place a flashlight next to the bed in case the power goes out. 2

Arrange the house for convenience and safety: Ask your loved one to show you where he or she sits to watch TV and the location of frequently used dishes, pots and pans. Ask where he or she likes to read. In this way you can see where trip and fall hazards might occur and adjust the location of things to make them safer. For example, a throw rug should not be at the front door. Your loved one should not have to reach to a high shelf to get glasses or dishes, they should be on a lower shelf that is within easy reach.

Prepare the outdoors for safety. The exterior of the house can be especially hazardous and create falls. Make sure that the walkways are even and don’t have cracked pavement or uneven bricks. In the winter make sure that ice and snow is completely removed and that sand or salt is generously spread on icy surfaces. Make sure that stairs are well lit, the edges are marked with contrasting tape and that they are painted with non-slip paint. If you have fallen and need assistance call 911 – then call us at Hampton Physical Therapy (603) 929-2880 and we’ll get you back to your everyday best! Www..HamptonPT.com

These thorough yet simple fixes can help to prevent falls at home and keep your loved one safe. Falls, with or without injury, are one of the reasons older adults limit their activity and how often they leave their home.1

If you have fallen and need assistance call 911 – then call us at Hampton Physical Therapy (603) 929-2880 and we’ll get you back to your everyday best! www..HamptonPT.com

Resources  

1 Falls Prevention Facts. NCOA. 2017. Available at: https://www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/. Accessed April 1, 2017.

2 NIHSeniorHealth: Falls and Older Adults – Fall Proofing Your Home. Nihseniorhealthgov. 2017. Available at: https://nihseniorhealth.gov/falls/homesafety/01.html. Accessed April 1, 2017

Photo by Louish Pixel – https://www.flickr.com/photos/louish/

Painful Muscle Knots ~ Trigger Points and Relief

by Nate Wood, Hampton Physical Therapist – Seabrook NH Clinic. trigger-point-pain-hamptonpt

Have you ever woken up feeling extra sore a few days after a strenuous workout, all-day hike, or playing tennis for the first time in years? Sometimes that ‘charley horse’ or muscle knot stays for weeks or months and time just isn’t getting rid of it. Well, what is that ‘charley horse’ or muscle knot and how do you get relief?

To examine this we must look at the human body as the giant mechanical puzzle that it is. In a puzzle, every piece is essential in completing the whole. The human body puzzle is composed of bone, muscle, nerve, and liquid elements. In this write-up we will focus on muscle. Muscle makes up 36 to 42% of the body’s weight. Muscle consists of muscle cells known as fibers bundled together surrounded by connective tissue. Each fiber contains smaller fibers with small chain like structures connected end to end. In order for muscle to work, all muscle in our bodies must contract and relax. Well inside these small chain like fibers is where all muscle contracts and relaxes.

Charles_Hoss_Radbourn_1887Now we go back to our original question, What is that nagging ‘charley horse’ or muscle knot? Well if you are a trivia person, you may know that a muscle knot or cramp became known as a charley horse back in the 1880’s when there was a famous baseball pitcher named Charley “Old Hoss” Radbourn who suffered from muscle cramps during games. Of course an alternative theory is that a lame work horse, Charley, who limped around the baseball park doing various jobs, and any teammate who became injured limping around became known as ‘charley horse’. This explanation does not answer our question either. So what are those muscle knots? If the muscle knot seems to linger for a period of time, it is likely what we, physical therapists, call a trigger point.

What is a Trigger point?

Trigger points are defined as hyper-irritable areas associated within a taut band of muscle that are painful upon compression, contraction, or stretching of the muscle and often refer pain more distant to the location of the taut band (see reference).

trigger-point-complex

As I eluded to earlier, all muscles contract and relax and they do so by way of chemically charging and discharging the fibers with different body chemicals. One theory states that trigger points form from excessive release of a chemical called acetylcholine, which produces a sustained depolarization of muscle fibers, leading to a sustained contraction of the muscle fibers.

When there are numerous bands of thickened contracted areas, the surrounding fibers are overstretched thin. When you try to strengthen, or simply use, these affected trigger point muscles for activity they do not perform because many fibers are already locked in contracted phase and the other fibers are strained and weak. Trigger points have both the ability to have latent and active stages. Those latent trigger points are those muscle knots that are often not noticed unless pressed upon directly, and will go unnoticed at first, and possibly for years.

Even though a latent trigger point rarely causes a person to complain of pain, they often can restrict or distort normal movement patterns, and cause stiffness and weakness. Additionally, there are factors that can cause a trigger point to transition from latent to active. An active trigger point is the “ouch” trigger point. This active trigger point is a painful phase that produces unrelenting debilitating symptoms that include referral pain patterns in other regions with dull ache, deep, pressing pain, burning or a sensation of numbness and fatigue. Most trigger point symptoms reported by an individual are from active trigger points and often those dense taut bands within the muscle can compress and entrap many kinds of nerves leading to the complex array of symptoms. When the symptomatic trigger points are left untreated it will allow surrounding muscles to take up the slack, possibly causing more strain and overlapping pain patterns.

So what is referred pain from a trigger point?

Trigger points can refer pain in the local area or in other areas, the most common patterns have been well documented and diagrammed. Approximately 74% of trigger points are not located in the same place a person feels symptoms, so by knowing and understanding referral pain patterns we, physical therapists, can find the main source of your pain. For example, have you ever felt a squeezing pressure headache around the temple region after sitting slouched at your computer trying to get all that work done by a deadline? Well that may possibly be a trigger point in your upper trapezius muscle (marked in the diagram, with an X referring pain to the red dotted area).

trapezius-trigger-pointsTrigger points can cause various symptoms such as:

-Referred pain
-Dull ache, pressing pain, heaviness feeling
-Burning, numbness, or tingling
-Sweating
-Dizziness-off balance, unsteadiness
-Eyelid twitching
-Nausea
-Headaches
-Fatigue

 

So what are the ways in which trigger points form?

They can form from a variety of different ways such as mechanical overload, muscle inefficiency, repetitive usage resulting in fatigue, trauma (physical and psychological), inflammation, nutritional or metabolic perpetuating factors. Some common mechanisms for trigger point origin within the clinic is from patients who have repetitive overuse injuries such as using the same body part in the same way hundreds of times on a daily basis with activities such as typing/mousing, hand held electronics, gardening, home improvement projects, and certain work environments or poor work ergonomics. Other common mechanisms of injury we see in the clinic are sustained loading, as with that shoveling of snow, or heavy lifting, carrying babies, briefcases, or boxes, wearing body armor, and some from caregivers or healthcare workers lifting bedridden patients. Other various ways trigger points may form are from muscle clenching and tensing due to mental or emotional stress, a direct injury such as a blow, strain, break, twist or tear from car accidents, sports injuries, or from falls, and even from inactivity such as prolonged sitting or bed rest.

Other less common causes of trigger points are from nutritional and metabolic factors, and although minimal studies have shown the exact effect of these factors on trigger points, there is a wealth of expert clinical experience suggesting that low normal and subnormal levels of vitamins and minerals act as strong perpetuating factors for trigger points. Additionally, there are specific comorbidities such as hypothyroidism, iron insufficiency, statin drugs, vitamin D insufficiency and vitamin B12 insufficiency that may link muscle pain as a possible secondary symptom. One of the most common causes for trigger point discomfort is from postural stress or poor posture.

Posture-Good-and-Bad

If you ask anyone who has had PT for related postural issues, they will likely tell you that their physical therapist often repeatedly uttered these three words to them: “posture, posture, posture”. One example of a posture domino effect could be if a person has repeated bad posture while typing on their laptop either for school, work, or leisure. This poor posture may lead to a forward head, bent neck position, this puts strain on the small network of muscles called the suboccipitals that connect and stabilize the head to the neck or cervical spine. This postural strain may cause trigger points leading to active trigger points, causing radiating somatic pain, muscle atrophy, fibrosis or tissue hardening, and decreased tensile strength. Additionally, this muscle group has a high density of proprioceptors, so muscle atrophy may lead to loss of proprioceptive balance.

If symptoms are untreated, this may lead to chronic neck pain and headaches. Therefore, postural training is paramount in rectifying and preventing trigger points.

So, what treatments can a physical therapist provide for you to alleviate both your trigger points and your related symptoms?

Since a trigger point is a contraction mechanism of muscle locked in shortened position, treatment involves unlocking the contraction, and your physical therapist can do this in a variety of ways. The original way is through trigger point release which involves using a squeeze grip or a tool where direct pressure on the trigger point for 30-120 seconds according to research can release and soften a nodule, once released the muscle tissue needs to be moved throughout its full range of motion, which is why your physical therapist will give you stretching and range of motion, as well as postural retraining exercises. Postural retraining of surrounding muscles can alleviate the load upon the affected muscle group and provide stabilizing strength in the appropriate areas to both alleviate and prevent discomfort.

graston-dry-needling

Other common effective treatment techniques practiced by your physical therapist are instrument assisted soft tissue mobilizations which are done with a tool. Graston Technique™ or FRAMS utilizes a metal tool to allow for deep tissue mobilization. Dry Needling is another highly effective treatment for trigger point relief which utilizes needles (acupuncture needles) to release a trigger point. All of these techniques have been shown both clinically and through research to be very effective and long lasting results for individuals suffering from Trigger points.

So, if you’ve started gardening, recently helped a friend move by lifting and loading boxes, or plan to head out for a game of golf, you may find yourself with a charley horse that just won’t go away. Don’t just sit and suffer through the pain. Call us at Hampton Physical Therapy, we can help you!

References:

  • Trigger Point Therapy Headache & Migraine Book. N.p., n.d. Web. 04 Nov. 2015.
  • Dommerholt, Jan, and Peter Huijbregts. Myofascial Trigger Points: Pathophysiology and Evidence-informed Diagnosis and Management. Sudbury, MA: Jones and Bartlett, 2011. Print
  • “National Association of Myofascial Trigger Point Therapists | Myofascial Therapy | What Is It?” National Association of Myofascial Trigger Point Therapists | Myofascial Therapy | What Is It? N.p., n.d. Web. 04 Nov. 2015.
  • Kisner, Carolyn, and Lynn Allen. Colby. Therapeutic Exercise: Foundations and Techniques. Philadelphia: F.A. Davis, 2012. Print.
  • “Referred Pain.” Referred Pain. N.p., n.d. Web. 04 Nov. 2015.
  • “Trigger Points and Myofascial Pain.” PainSciencecom RSS. N.p., n.d. Web. 04 Nov. 2015.
  • “Information about Trigger Points and Their Treatment.” Pain Education. N.p., n.d. Web. 04 Nov. 2015.