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Pain Relief

Where headaches are born

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Have you ever had a headache that started at the base of your skull and wrapped itself over your head finally lodging behind your eyeballs?  Those headaches really hurt.  And, it seems like they can last forever.

But where do they come from?  Headaches that start at the base of the skull actually start in the upper neck.  You see, there are two special vertebrae in your upper neck that are different from all the other vertebra.

First you have C1.  AKA: The Atlas because it holds up the entire world.  Well, it holds up your head which feels like the entire world.  C1 is special because it is shaped like a ring which allows it to move more than the other vertebra.

Next you have C2.  AKA: The Axis.  The entire world (or head) spins around C2.  That’s why it’s called the axis. C2 has a part that sticks up so that C1 can rotate around it.

This intricate design can get out of place, causing increased pain that translates into headaches.  Specifically, headaches that go up over the top of your head and lodged behind your eyeballs.

The good news is that there is help for these types of headaches.  You can finally stop having to deal with the pain and frustration of never knowing when the next headache is going to strike.

Now, you might be thinking to yourself, I don’t have neck pain.  I know.  These headaches usually do not have neck pain associated with them.  In fact, when we start working on the source of my problem my patients often tell me that they didn’t know there was pain there.

As we get C1 and C2 playing nice with the rest of the spine, the headaches can clear up for good.  No more need to take pain medication on a regular basis.  No more missing out on activities because of your neck pain.  No more wondering why you keep getting these headaches.

Are you ready to put an end to your headaches and get on with your life?  Please feel free to contact us and find out more about how we can help eliminate your headaches.

Chewing on another cause of headaches

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Have you ever had a headache that started in your jaw?  Maybe you have noticed that you wake up with a headache the morning after eating a big meal.  Perhaps you grind your teeth at night and wake up every morning with a headache.  Some people chew gum all day long, causing jaw and head pain.

Have you ever wondered how jaw pain is related to headaches?

First, let’s do a brief demonstration.  I want you to take your pinky fingers and place them inside your ears with your pinkies facing forward.  You don’t have to shove them all the way in just enough that the pads of your fingers are inside.  Next I want you to open and close your jaw.  Do you notice that when you close your jaw a bony part butts into your pinky finger?  That is the TMJ (TemperoMandibular Joint)!

Congratulate yourself on finding your TMJ!

Now, the part that moves is your jaw bone also known as the mandible.  This is the “mandibular” in temporomandibular.  The part that stays still is the temporal bone.  You put the two together and you have the temporomandibular joint.  See, they really didn’t get that fancy when they named this stuff.

The part that stays still is connected to your skull.  This is one way that TMJ pain can radiate into a headache.  Often this pain will be described as “temple pain”.  People will point to one or both sides of their temples and say “it always hurts here”.  This is a common sign of TMJ pain.

There is also a big muscle called the temporalis muscle.  It helps you to do things like close your jaw and chew your food.  This muscle can be found by placing your hands flat on the sides of your head.  Open and close your jaw and you will feel this muscle activating.

This muscle covers the side of your head and can cause pain to travel up the side of your head.  People with this type of pain often point along the sides of their faces, up to the top of their head.  They describe the pain as going behind their eyeballs.  People with this type of TMJ pain often say their pain increases after eating.

What if you have pain that starts in the back of your neck and comes up over your head to the front?  This type of pain often starts from the upper neck.

Is it still related to the TMJ?

Often, yes.  You see, there are many small muscles that cross from the TMJ to the upper neck.  They are coordinated to work together to allow for very small motions in your upper neck and jaw.  So when the jaw starts becoming a problem, the upper neck will feel the effects too.  And the upper neck will send it’s pain up the back of the head, over the top, and down into the front.

So there you have it.  The TMJ can cause headaches along the temples of up the side of the head.  Further, the TMJ communicates with the upper neck which tends to send it’s headaches up the back of the head, along the top, and down into the forehead.

Do you suffer regularly from the headaches types described above?  Are you ready to find the real reason behind your pain and get rid of it once and for all?  Please contact us and we will get you scheduled for an absolutely free 20 minute consultation to see if we are a good fit for each other.

What not to wear

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Recently, I had a memorial service to attend right after treating patients.  So I wore my dress and flats while I was treating.  That afternoon, while I was standing at the memorial service, I felt my back tighten up.  “Oh well, it will be fine” I though like every other person does.

That evening I tried to avoid my low back pain by walking around the house and getting some things done.  I went and ran an errand at the mall to get more steps in.  My thought was – “move more and my low back pain will settle down”.  What I did NOT do was take off those flats.

The next morning I rolled out of bed and tried to stand up straight.  As I hobbled on my aching feet, holding my back and trying to stand up straight, I was reminded that it was not fine.  There are consequences for improper footwear and low back pain is at the top of the list.

Here’s the thing – I usually wear very supportive shoes all the time.  Especially when I am going to be working with patients.  I thought that I could get away with one day of wearing improper footwear and not have it bother my back.  I thought that doing it wrong, just this once, would not cause increased low back pain.  I thought these shoes were good enough to get me through my day.

What I am learning is that since I have hit the big 4-0, my body has less tolerance for these deviations.  My body requires me to work out daily.  My body requires regular stretching to maintain its performance.  My body requires me to not sit for more than 60 minutes while I am working on the computer.  And my body requires me to wear supportive shoes.

I have many people ask me what brand of shoes they should wear for work.  That is a complicated question as everyone has a different foot structure.  Also, your daily work requirements are different than your neighbors.  But I would be happy to discuss what works for me.  Feel free to send me an E-mail at amy@physicaltherapyforeverybody.com

One key way to decrease your low back pain?  Wear supportive shoes!  I have an order for new ones on the way as we speak.

 

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So, you have a herniated disc

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There are few things in life as painful as a herniated disc.  But it’s not just the pain that is difficult to deal with – it’s also the fear.  What is going on in my spine and am I going to live?  That may sound extreme but herniated discs are extreme.  They can cause extreme fear, extreme panic, extreme frustration, and extreme pain.

The first time I herniated my disc was in college.  I was in Air Force ROTC (don’t ask, long story) and we were doing physical training.  All of a sudden, I felt a ball of glass explode in my lower right spine.  Okay, I know that a ball of glass didn’t explode in my spine but that is absolutely what it felt like.

Of course, training must go on so I got up and went for a 3 mile run.  Each step caused a mini explosion of the glass shards in my right spine.  And I was one of the lucky ones.  My pain never touched my sciatic nerve and went down into my leg.

For many people, the disc herniates and then it irritates the nerves in the area.  The nerves are located close to the spine and right next to the disc.  When the disc herniates, the material inside the disc leaves the fibers of the disc and is hanging out right next to the disc.  This can cause increased pressure on the nerve which responds by sending pain down into your leg.

What are your initial steps when you have a herniated disc?

  1.  Breathe – Easy for me to say when the glass shards aren’t flying around my spine, right?  I know.  But it’s really important to breathe slow and steady.  Holding your breath increases the pressure on your spine which is not what you want right now.  I now it is incredibly painful right now but I promise it’s going to get better.
  2. Grab an ice pack and your favorite chair, floor, or bed.  You need to rest for the first 24-48 hours.  Find a comfortable position (as comfortable as possible) and an ice pack.  You might want to grab some magazines or the remote control.  You are going to be there for a day or two.
  3. Small movements matter. During the first 24-48 hours it is important to keep the area moving in small PAIN FREE ways.  This can mean trying to stand up straight while you walk to and from the bathroom.  Rolling your shoulders to get some movement in your upper spine.  Sitting and rotating your spine from side to side.  Don’t go crazy right now but keep those small movements.
  4. Get help. Once you can walk to and from the bathroom pain free you are ready to get some help.  A Physical Therapist will help you get back to moving pain free.  Yes, you will get back to all those activities you loved doing before.

Yes, the pain will go away.

Yes, we can help you figure out your path on this journey of healing.  Please fill out this simple form and we can get you started healing and back to living life on your terms.

Hip pain – it’s not just for “old” people anymore!

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Let’s admit it – we expect pain as we age!

When we are young, our bodies seem to be able to get away with anything. We can run, jump, play, fall off our bikes, jump on a trampoline, and basically run ourselves ragged without any further complications. We go to bed and wake up feeling fine the next morning – and we run out to do it again! This is the joy of youth.

However, what happens when our young ones start complaining of a pain that will not go away? We take them to the doctor to start figuring out what is wrong and how we can help them.

In the case of hip pain, long term pain that does not go away with rest can often lead to a consultation with an orthopedic surgeon. The surgeon will often have X-rays or an MRI taken to assess how the bones inside the hip look. In the past 10 years, this has led to a new diagnoses or CAM or PINCER hip morphology. This means that there is a bony abnormality that is causing the hip to “pinch”, which is what brings about the pain in younger people as they tend to be more active. Of course, if the problem is a bone issue, surgery is what is recommended to fix it.

This increase in hip surgery in our younger population has become extremely concerning to myself and many other Physical Therapists. That is why there are now studies assessing hip strength, hip motion, and how the hip moves while also looking at the bony structure of both hip joints.

A recent study in the Journal of Orthopaedic and Sports Physical Therapy (JOSPT) was looking at that specific issue. The study assessed sub-elite football (soccer) players for pain, motion, strength, and motion analysis. They also took an X-ray to see what each hip actually looked like.

What they found was that the hip structure looked the same on X-ray between the painful hip and the pain free hip. Both of the hips had the same structure but only one hip had pain! Both the hips had the same bony changes that would be classified as needing surgery. However, sub-elite athletes were able to continue their sport and only have pain in one hip. Where they did see a difference between hips was in how the person was walking and the muscles they used while jumping.

This study shows that your hip pain may not be caused by how your bones look on X-ray. The pain may be caused by how your muscles are functioning while you walk, work, and play. Therefore, I strongly urge you to consider visiting a Physical Therapist to see if changing how you move through space can change your hip pain. It may help you to avoid surgery and the painful recovery that follows. Plus, you may be able to get back to your sport, your work, or your life more quickly!

Sub-elite Football Players with Hip-Related Groin Pain and Positive Flexion, Adduction, and Internal Rotation Test Exhibit Distinct Biomechanical Differences Compared with Asymptomatic Side. JOSPT: 48(7):584-593.

Chronic Pain Review

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Thank you for walking with me through this blog series on chronic pain. I hope you have found it useful in discerning the optimum path for your health and wellness. This post is a general review of what we have covered.

Chronic pain includes pain that has not resolved in a normal, timely manner. In general, it is pain that lasts longer than 3-6 months although we have seen that it is actually a change in the pain state. Chronic pain is mediated through changes in the peripheral and central nervous systems. This means that the tissue injury model of acute pain no longer applies. Acute pain is directly related to a trauma to the tissue and has a normal progression of resolution. This can be greatly aided by Physical Therapy to prevent it from coming back or to address any related issues. For instance, I have had patients who successfully treated an acute injury with a steroid injection only to have the pain come back 6-12 months later. That is often due to the fact that the comorbidities surrounding the initial injury were never addressed. However, chronic pain that has been sustained for a long period of time is no longer related to a specific tissue injury. That injury was the trigger that set into motion a change in the nervous system that needs to be addressed in a new way.

Chronic pain must be addressed at multiple levels simultaneously. I have had patients who “try” one form of therapy at a time to see what works and what doesn’t. Although I agree with this scientific approach for acute pain, it does not stand up to the current understanding of chronic pain. A scientific approach for chronic pain is to add one treatment at a time. I have begun working with other health care professionals in the area to maximize outcomes for patients. When I work with a chiropractor, I focus on the exercise portion of treatment to improve the patient’s ability to “hold” manipulations and decrease their need for adjustments. When I work with a massage therapist, I focus on joint mobilization to ensure proper tissue length and exercise for patients to maintain the benefits of massage. Although I feel medications in general are over prescribed, I help assist medical doctors in ascertaining the benefits of prescribed medication to the treatment plan being carried out in Physical Therapy.

Chronic pain truly takes a village that is focused together on the goals of each patient. Every body responds differently to an intervention and this needs to be constantly reassessed. This is why I opened my company in the first place. To give each patient one-on-one access to one provider so they can be followed through a successful treatment regimen. The input I receive from each patient directly influences the treatment they receive that day. Education is always emphasized and I encourage my patients to ask as many questions as they can.

If I can be part of your team, please feel free to contact me at (360) 367-0970 or amykonvalinpt@gmail.com.

Maple Valley Physical Therapy

Complex Regional Pain Syndrome

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(formerly known as Reflex Sympathetic Dystrophy)

Complex Regional Pain Syndrome (CRPS) occurs after a trauma to the distal part of the extremity or after direct injury to the nerve. CRPS is associated with distal extremity pain and swelling, with the pain being disproportionate in time and degree to the injury. Patients may also have increased blood flow and swelling, abnormal hair/nail growth, loss of motion, and weakness. This is a classic example of what happens with chronic pain. The initiating event led to a sensitization of the nervous system that is now causing abnormal reactions throughout the limb.

Before we talk about Physical Therapy treatment, let me state that this is one particular case where pharmacological approaches have been well researched and proven extremely effective. Systemically administered antidepressants and anticonvulsants or topical use of capsaicin and lidocaine have been proven to significantly reduce symptoms of CRPS. I have had patients who are frustrated by being placed on an antidepressant because they feel the doctor is saying their pain isn’t “real”. However, the truth is that the antidepressants affect the processing of the pain through the nervous system and have been shown to significantly decrease symptoms. I would strongly recommend that patients discuss all pharmacological options with their doctors so they can find a path that works right for them.

Okay, back to the Physical Therapy stuff! CRPS is a challenging disease that makes slow progress no matter the treatment option. A graded exercise program to return each patient to their desired activity level has proven effective for long term management of CRPS. Along with this, instruction in home TENS use and performance of mirror therapy has proven to be effective in treating CRPS. The goal is to support each patient with pain reduction and making positive steps towards improving range of motion and strength so they can return to their lives.

If I can help you on your path, please feel free to contact Amy at (360)367-0970 or amykonvalinpt@gmail.com.

Physical Therapy in Maple Valley

Neck Pain

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Neck pain typically comes in two flavors – Whiplash Associated Disorder (WAD) and nontraumatic neck pain. There are many types of treatment for neck pain both within the physical therapy realm and outside of PT. Which makes the research confusing and difficult to interpret!

For instance, the book I am using for this blog series is titled “Mechanisms and Management of Pain for the Physical Therapist”. In the “Neck Pain” Chapter, the author states that “early results from trials of cervical disc arthroplasty for radicular symptoms seem to show similar early symptomatic improvement when compared with anterior discectomy and fusion surgery”. In my personal experience, I have had one patient who had a cervical disc arthroplasty who had extremely poor results. So, is the research not really far enough along to recommend this surgery as the new “gold standard”? Or did my patient just have poor surgical results? These questions are difficult to discern and I am trying to hold out on passing judgement on cervical disc replacement. From a biomechanical perspective, replacing the disc allows for maintenance of normal motion which is GOOD. This is opposed to fusion surgery which disturbs normal motion which is BAD. However, all my patients who have had fusion surgery report GOOD results after the surgery. Now, to be fair, they almost all require future surgeries later in life as the body compensates for the decreased motion from the fusion – which is BAD.

Patients who have been in a motor vehicle accident and suffer from WAD tend to do better if they receive early intervention that consists of manual therapy, exercise, and education. Patients who have higher levels of pain and dysfunction tend to require longer treatment times. Therefore, beginning treatment for the problem earlier most likely decreases long term dysfunction and improves outcomes.

Nontraumatic neck pain also responds well to intervention consisting of manual therapy, exercise, and education. However, since there is not an “event” that started the neck pain, these patients tend to wait longer to start treatment. This increases the likelihood of the pain transitioning into a chronic pain situation which then involves abnormal processing through the central and peripheral nervous systems.

What’s the take away here? If you have neck pain of unknown origin or from a car accident, take conservative measure for the first few days. Move your neck gently through pain free motion. Use ice to decrease pain. Limit activities that cause pain but keep exercising as usual if at all possible. If your symptoms do not resolve with the first 4-7 days, it is time to contact a medical professional to get to the root of the problem.

If you have any questions regarding your neck pain, please feel free to contact Amy at (360)367-0970 or amykonvalinpt@gmail.com.

Low Back Pain

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Dear Friends,

I cannot believe that I find myself writing a blog about low back pain. The interweb is FULL of blog articles about low back pain. Some are very informative/helpful and some are just personal stories or what worked for one person. See, that is the struggle with low back pain – everyone has a story about it and something that worked for them – but may not work for you!

Yes, I realize that low back pain affects 85% of people at some point during their lifetime. Yes, I realize that LBP is the leading cause of chronic pain and disability with a financial cost in the billions of dollars annually. Yes, I realize that some people have had great outcomes from Chiropractic, from pain medication, from inversion tables, from traction. But, can I just be honest for a couple of minutes here? First, let’s agree that we are only talking about nonspecific low back pain – pain that is not attributed directly to a structure in your low back. So, we aren’t going to discuss your grandma’s spinal stenosis. That is a specific cause of low back pain and is treated in a much different way! Okay, back on topic here. I have seen too many patients during my career who have had negative results from chiropractors, medication, inversion tables, and traction. In fact, a Cochrane review of 32 studies clearly shows that traction is not effective for acute, subacute, or chronic low back pain. We can talk about inversion tables if you want to – I have a great story of a patient who I fired from therapy for using an inversion table. I am not saying that inversion tables do not work for some people – it does! But, you have to know what you are dealing with before using an inversion table.

What has been substantially proven in the research and what have I learned is effective treatment for low back pain that significantly resolves the issue and decreases re-occurrence? Manual therapy (hands on treatment), trunk coordination and strengthening and endurance exercises, centralization and directional preference exercises, patient education and counseling, and progressive endurance exercise and fitness activities. Which basically boils down to hands on treatment to decrease pain and normalize movement followed by progression to an independent exercise program. That is what we offer at Physical Therapy for EveryBODY. The research proves that it works, my clinical experience tells me it works, and my patients show me it works.

So, can we please not discuss how your friend had amazing results after spending $5000 on a traction regimen at the Chiropractors office? Many thanks!

TMJ (Pain in your Jaw!) & Headaches

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Temporomandibular disorders (TMD) involve pain and dysfunction around the TMJ (your jaw) and jaw muscles. The National Instititue of Dental and Craniofacial Research performed a 3 year study to identify biopsychosocial and genetic risk factors in the development of TMD. Potential risk factors for first-onset TMD were identified with older age, African American, pain on jaw opening and palpation tenderness of head and neck muscles, increased incidence of other regional pain conditions including low back pain and irritable bowel syndrome, other nonspecific comorbid conditions including fibromyalgia and depression, and lower overall quality of life and health status. Systematic reviews have repeatedly supported instruction in a self-management strategy including education, resting during pain, relaxation techniques, massage, hot and/or cold packs, and stretching and/or exercise. Did you know there were exercises for your jaw? Yes, there are! Use of medication and splints has not been found in the literature to be effective in decreasing pain and dysfunction from TMD. Conservative treatment with a home program has the best results found in multiple systematic reviews.

Now, headaches are a bit more complicated tale to tell because there are different types of headaches with different findings in the research. Migraines are primarily managed with pharmacological agents. Physical therapy can be beneficial if included with relaxation and biofeedback treatments. Cluster type headaches are very rare and, therefore, there is little research on the effectiveness of physical therapy with this diagnosis. Tension-type headaches are effectively treated with physical therapy which involves education regarding posture and biomechanics, an exercise program aimed at improving posture of the cervical spine, and manual therapy to reduce muscle tension.

Seventeen years of clinical experience tells me that tension type headaches respond really well to physical therapy. Migraine intensity, duration, and frequency can be dramatically altered with physical therapy. The one cluster type headache patient I saw had a significant decrease in intensity and frequency of his headaches.

If you would like to discuss your TMD or headache symptoms, please feel free to contact Amy at (360)367-0970 or amykonvalinpt@gmail.com.