Headaches!!! What can Physical Therapy do??? Paul Wortley PT Rocky Mountain Therapy Services

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1 Headaches!!! What can Physical Therapy do??? Paul Wortley PT Rocky Mountain Therapy Services

2 Take 2 Aspirin and Call Me in the Morning

3 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.

4 TERMINOLOGY ETTH (Episodic Tension Type Headache) CTTH( Chronic Tension Type Headache) CERVICOGENIC Headache MIGRAINE Headache

5 What do you mean I have more stress in my life than I Should???

6 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

7 What is the most Common Denominator? GUESS

8 THE Common Denominator is BAD POSTURE!!!

9 Your Head is a Bowling Ball 10 to 18 lb. Bowling Ball

10 Forward Head Syndrome

11 Standing

12 Cervical Lordosis

13 Standing Examples

14 Purse / Backpack Max Back Pack Weight <= 20% of weight

15 Flexion Addicted Society

16 Sitting / Computer / Phone We call them Computer Jockeys

17 Mom s Idea

18 I Pad / Car /Gameboy/ Texting

19 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

20 Computer Program Posture Analysis

21 Patients Headache Drawing

22 Physical Examination Positive for Occipital Neuritis Positive for Super orbital / trochlear neuritis

23 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

24 Upper Crossed Syndrome

25 Muscular Trigger Points

26

27

28 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

29 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 )

30 Posture Education and Application

31 Proper Standing

32 Proper Sitting

33 Proper Posture / Computer Add picture

34 Ice is my New Best Friend

35 Myofascial Release

36 Sub-occipital Release

37 Spinal Mobilization Prone thoracic Mobs Standing thoracic + C7-T1 Mobilization

38 Injections / Medications Trigger Point Injections Nerve Block Injections Facet Joint Injections Epidural Injections Pain Meds Muscle Relaxers Anti-Inflammatories

39 Cervical Traction Neck Trac vs over the door and under the chin

40 Postural Neuro-Muscular Pool Exercise Re-education

41 Postural Correction Exercise UBE Posture Chair by Body-Align

42 Postural Correction Exercise Seated Row Lat Pulls

43 Kinesiotape

44 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

45 RECOMMENDED DURABLE MEDICAL SUPPLIES Achey-Breaky Ice Pack System

46 RECOMMENDED DURABLE MEDICAL SUPPLIES Lumbar Support for Sitting

47 RECOMMENDED DURABLE Neck Pillow MEDICAL SUPPLIES

48 RECOMMENDED DURABLE MEDICAL SUPPLIES Neck Trac Cervical Traction Unit (When indicated)

49 RECOMMENDED DURABLE 90 Glasses MEDICAL SUPPLIES

50 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!!!

51 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 days wellness ( FREE ) Each Treatment Session is about 2+ hours

52 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

53 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

54 It s a Team Approach Patient Physician Physical Therapist Working together Headache Sufferers can be helped!!!

55 Acknowledgements Thank You Dr. Phil Savia ( Headache Neurologist )

56 THANK YOU It has been an Honor!!!

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