What do you think of when you hear physical therapy? Most individuals may have experienced or know of someone who experienced physical therapy with a past injury or surgery. This is the bread and butter of what we do as physical therapists through rehabilitating individuals back to what they love to do; however, most people do not know the benefits of seeing a physical therapist for “prehabilitation” or “wellness checkups” prior to a possible or potential injury from occurring.
Just as one goes to the dentist for a biannual checkup for prevention of possible future dental issues, physical therapy has and can be an option for the public in addressing possible musculoskeletal impairments, muscle strength deficits, and range of motion deficits in the body. As most of us all know, exercise has been suggested to aid in multiple health benefits such as preventing chronic disease, boosting mental health, increasing overall longevity, reducing risk of cardiovascular disease, and improving bone health – just to name a few. As orthopedic physical therapists, we are trained and knowledgeable in rehabilitation and appropriate exercise prescription following injury and/or surgery, but we are also trained in injury prevention by providing patients and clients resources for reducing their chance of an injury.
As spring is approaching and we are gearing up for the beautiful Montana summer, physical therapy may be of benefit to you or someone you know to increase your chances of a healthy, active, and injury-free year. It is typically easier to address these possible impairments before an injury may emerge versus after an injury has occurred. Most everyone, including you, may benefit from a “biannual checkup” with physical therapy!
Matt Schumacher, DPT, MTC, CAFS, CSCS received his Doctorate in Physical Therapy from the University of Mary in Bismarck, ND where he was recognized as a nominee for Outstanding Student Award in his physical therapy class demonstrating excellence in academics, volunteering, and servant leadership. Following graduation, he received training from Gray Institute with a Certification in Applied Functional Science (CAFS). Matt also completed a rigorous year-long program with Evidence in Motion (EIM) achieving his Manual Therapy Certification (MTC) gaining advanced training in mobilization and manipulation techniques for common diagnoses of the spine and extremities. Matt specializes in assisting individuals following post-operative rehabilitation, sports medicine rehabilitation, and orthopedic injuries/ailments of the spine and extremities utilizing advanced knowledge and skill with manual therapy and appropriate exercise prescription.
I am frequently asked about whether it is normal for a neck to make a lot of noise. Some of the more common adjectives I hear from patients describing these sensations are creaking, grinding or crinkly noises…the kind of noises you hear on the inside but are not generally audible to others. The short answer is yes, some increase in neck noise is to be expected as we age. However, certain noisy necks deserve a bit more attention.
To clarify, the noisy necks described above should be distinguished from other common neck noises including popping, cracking, clicking or snapping sensations in the neck. The importance in this distinction is that the former is most likely associated with normal wear and tear as long as there is not pain associated with the noise, where the latter may indicate some problems brewing in your noisy neck. Necks that tend to pop a lot, especially those that need to pop to relieve tension or pain, are likely experiencing increased stress in the joints and/or disc at the level of the popping. This should be seen as a warning sign. For the owner of that noisy neck, there is likely some degree of asymmetry in the mobility of the joints in the neck. This can lead to degeneration of those segments of the cervical spine that may lead to more problems than just neck noise down the line.
If your noisy neck is associated with pain and/or ever increasing stiffness and loss of mobility then you should consider consulting with your Physical Therapist. While some loss of motion in you neck is common with aging, especially in your later 60’s and beyond, earlier onset of a significant loss in mobility could be a tipping point for your neck. Many folks who bring this up during a physical therapy appointment are relieved to learn that certain neck noise is normal. In situations where neck noise may be indicative of a neck that’s going south, taking action and making a plan may really make a difference in your quality of life a few years around the bend.
Matt Heyliger, DPT of Excel Physical Therapy completed his Doctorate in Physical Therapy at Eastern Washington University in Cheney, Washington. He has a particular treatment focus in the relationship of cervical/thoracic spine mechanics and upper extremity conditions. An avid rock climber, telemark/backcountry skier and mountain biker, Matt regularly practices yoga and enjoys frequent adventures in the mountains with his family and their two labs.
Although tinnitus, or ringing in the ears, can be a sign of serious brain pathology, tumors, and hearing loss, this condition can also be often diagnosed by your physician as idiopathic tinnitus. Such a diagnosis indicates no known or verifiable cause to the ringing in your ears. Ruling out the more concerning problems through brain imaging, neurological testing, and hearing tests is helpful, but often leaves the patient with no real answers about how to decrease or eliminate the annoying sound. One theory regarding the source of idiopathic tinnitus centers on the musculoskeletal system as a trigger for ear ringing. (more…)
What You Will Learn:
- How neck pain develops and becomes chronic.
- What the anatomic sources of neck pain are.
- How a specialized physical therapist utilizes manual therapy, patient education, exercise, and dry needling techniques to treat neck pain.
- How improving posture can alleviate neck pain.
- Which exercises are most effective in self-treatment of neck pain.
- Other self-treatment techniques.
- There also will be time at the end of the seminar to speak with David regarding your specific neck problem.
My Personal Bout with Acute Neck Pain: The Onset ~ Part 1 of 3
Evaluating and treating individuals with neck pain has been my specialty over the past 15 years. I have literally treated over a thousand people suffering from this affliction. Recently, neck pain became a much more personal issue, as I experienced the sort of agony which some of my patients deal with. For the past 20 years, my neck has been intermittently stiff, with the occasional inability to turn my head for a day or two and what felt like an acute muscle spam, but there has been nothing of serious concern. This was different. While still in bed, I opened my eyes in the morning and noticed neck stiffness when turning over. Could this be one of those mornings where there would be trouble turning my head? Better to get up slowly. I sat up and immediately felt a rush of nauseating pain sweeping into my low neck and then shooting into my left shoulder blade. I don’t have time for this I thought. Into the shower for some hot water on the neck and down the hatch with 600mg of Ibuprofen. I drove to work applying traction to my neck with both hands and steering with my elbows and knees. A smarter man would have just stayed at home and called in sick. But I had patients that depended on me.
Luckily, this was my short day of the week at work. My neck pain steadily grew worse and by 2PM I was stuck with my head down and turned to the right, avoiding the worst ache. I utilized a home traction unit from work and had to go very slowly and gently not to aggravate my symptoms. That night, I managed about 2 hours of sleep, constantly readjusting to avoid pain.
The next morning, I called a physician friend of mine and he prescribed me a round of oral steroids. After 3 days, my neck pain slowly started to improve and within 1 week I was 75% better and training on my road bike for short periods. Unfortunately, this progress did not last.
8 days after the initial onset, my symptoms suddenly returned in the morning and were even worse. At this point I had to be honest with myself about the serious nature of my neck problem. My symptoms included weakness in the left arm, severe pain behind the left shoulder and into the shoulder blade, severe neck pain, numbness in the left hand, and I could not extend my neck or turn to the right. This was a very familiar presentation, a cervical radiculopathy. It had to be a disc bulge in my low neck that was inflaming and compressing one of the spinal nerves. Megan Peach, DPT, here at Excel PT did a great job at treating my acute problem, but my presentation was too severe to benefit from PT at that time. I decided to make an appointment with a local orthopedic specialty physician.
My Personal Bout with Acute Neck Pain: Recovery ~ Part 2 of 3
As a physical therapist specializing in treatment of the spine, I had a great deal of experience with the physicians at Bridger Orthopedic & Sports Medicine. This seemed like a good place to seek advice and help for my agonizing condition. I called Christine, a patient care coordinator at Bridger, and she was kind enough to get a same day appointment for me with Dr. Speth and Bryce Wiley, PA-C. They performed a very thorough evaluation and determined that I most likely had a cervical radiculopathy. I was in for a cervical MRI the next day and Bryce called to inform me that the imaging revealed a left C5/C6 disc bulge with compression on the C6 nerve root. There was also some cervical arthritis present in the mid to low neck.
Again, the patient care coordinators (Christine & Shane) quickly scheduled me for a cervical steroid injection with Dr. Slocum at the surgery center, just below Bridger Orthopedics & Sports Medicine. Dr. Slocum was kind enough to come downstairs between seeing patients and perform a transforaminal steroid injection in the neck. During the procedure, I took the opportunity to dissect what was going on. Some of my patients go through spinal injections and they will often ask me if it is painful. Now I was about to find out. I’m sure the experience is different for all people, but my procedural pain was considerable, though quite brief. Dr. Slocum injected around C6 on the left and for about 5 to 6 seconds I felt all of the pain that I had experienced over the last week and a half condensed into my neck, shoulder blade, and arm. Within a few minutes there was some relief. Dr. Slocum explained that the injection could take 1 to 2 weeks for the full positive effect, but I would experience an initial decrease in pain within the first day, which might not last.
The next morning I woke up and felt 90% better. I could move my neck, lie down comfortably on my back, and work on patients without concentrating on my own pain. Slowly, by the next day this reduction in pain slid backwards to about 50% better. I had a problem. Two days later, I was to be on a flight to Chicago for a much anticipated PT continuing education course. Bryce prescribed me another round of oral steroids and more hydrocodone for pain relief. I made it to Chicago, wearing a soft cervical collar on the airplane to support my neck.
I arrived at my continuing education course tired, now only 40% better, and unable to sit during the presentation. I was truly blessed to be traveling with Jason Lunden, one of our sports specialist PTs from Excel PT, and sitting next to another experienced PT named Effie. During the first break she looked at me and asked if I was OK. She got the full story. Effie said “I can help you.” I immediately explained how serious this problem was and that I probably was not appropriate for hands-on PT treatment. She assured me that her specialty was in spine. Sounds familiar. Effie performed left sided cervical and upper thoracic joint mobilizations, soft tissue techniques to the shoulder blade and shoulder muscles, and traction to the neck. These techniques were more aggressive than I would have chosen for my patients, but I was willing to try anything and I trusted her. After 10 minutes of treatment, my pain was reduced greatly and I practically fell asleep on the table.
Effie treated my neck again on the following 2 days of class and, by the time I returned home to Bozeman, the symptoms were improved to 75% of normal. I continued under the care of Megan Peach, at Excel PT, and I reached 95% improvement over the next month with physical therapy treatments 2x/weeks. The remaining 5% of symptom reduction and full strength in the left arm took 2 to 3 more months of performing my exercises independently.
My Personal Bout with Acute Neck Pain: Lessons Learned ~ Part 3 of 3
I believe that there was a silver lining or a purpose to why I experienced this cervical radiculopathy. As health care practitioners, we sometimes lose perspective on the severity of what our patients are dealing with. The terrible pain, decrease in function, and loss of sleep will be hard to forget. I gained valuable familiarity with the use of a Saunders Cervical Traction Unit and other treatments that are best for an acute and sub-acute radiculopathy. I also became more personally familiar with the use of different medications to treat this condition.
Perhaps the most valuable lesson learned was an appreciation for how important good physical therapy and excellent physician specialty care are. I would not be where I am today without the tremendous care from Megan and Effie (my physical therapists), Dr. Slocum, and the doctors at Bridger Orthopedics and Sports Medicine. Hands on manual therapy, exercises, diagnostic imaging, and epidural steroid injection were all very helpful to me.
This ordeal has helped me to be a better physical therapist when treating the neck. I value the experience over any class or formal education in my past.
Headaches can cause lost time from work, visits to multiple physicians, and a general loss in quality of life. The major categories include migraine headaches, tension headaches, TMD headaches, and cervicogenic headaches. While cervicogenic headaches are not the most common type of headache, the prevalence in the general population is estimated at 15%.
Cervicogenic headaches are defined as one sided, or one side dominant, head pain, which is caused by a neck problem. Other symptoms include stiffness in the neck, decreased range of motion in the neck, increased headaches with neck movements or poor cervical postures, and a possible history of trauma. Although physical therapy can be effective in treating tension headaches and TMD related headaches, cervicogenic headaches have shown, in multiple studies, excellent response to manual therapy. Mechanical joint and muscle restrictions in the neck lead to a referral of pain into the head (cervicogenic headache). Manual therapy based physical therapy utilizes hands-on techniques to restore muscle and joint mobility, eliminating the head pain.
Interestingly, research indicates that manual therapy success in treating cervicogenic headaches does not depend on chronicity. Cervicogenic headache patients can benefit from manual therapy treatments whether the symptoms have been present for 20 days or 20 years! As a manual physical therapist for 15 years, my success rate with treating cervicogenic headaches has been very high. Our research from this study hopes to clinically show which manual therapy techniques are the most effective for treating cervicogenic headaches.
Excel Physical Therapy is enrolled as a clinical site in a national research study to determine the best manual therapy techniques to treat cervicogenic headaches. There are several other clinical sites throughout the United States also collecting data on real patients being treated in a physical therapy environment. Mobilization or manipulation of the neck and upper back are the two manual therapy variables in this study. Mobilization is a joint “popping” technique and mobilization is a joint “stretching” technique.
The Treating PT at our clinical site is skilled and trained in performing both spinal mobilization and manipulation. One treatment group will receive only manipulation and the other treatment group will receive only mobilization and exercise. We anticipate that both groups will benefit from the manual therapy treatments, but the magnitude of improvement is part of our research question. Both groups will have 6 physical therapy visits over 2 to 4 weeks.
"I adore everyone at Excel Physical Therapy. Over a 9 month period, Megan was not only my excellent physical therapist but she also became my friend and confidant. There are no words to express how much she helped me not only physically but mentally and emotionally to learn to cope with what proved to be a chronic, degenerative condition. Also, Nicole taught me more about my insurance coverage than the insurance company could have! Good luck to all of you and Thank You!" --Bozeman patientView more testimonials from Excel PT clients »