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.
Click Here to read David’s Personal Bout with Acute Neck Pain: Lessons Learned ~ Part 3 of 3
Click Here to read David’s Personal Bout with Acute Neck Pain: The Onset ~ Part 1 of 3
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.
Click Here to read David’s Bout with Acute Neck Pain: The Onset ~ Part 1 of 3
Click Here to read David’s Bout with Acute Neck Pain: Recovery ~ Part 2 of 3
Excel Physical Therapy Participates in a Research Study on Cervicogenic Headaches
Seeking Research Study Participants
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.
We are looking for patients to be part of this study – To be included:
patients must have one side dominant head pain, pain in the neck or the base of the skull that is felt to project into the head, and at least one headache per week for at least 3 months.
Patients cannot be included in the study if they have a history of stroke, high blood pressure, high cholesterol, diabetes, heart disease, peripheral vascular disease, smoking, or whiplash injury to the neck in the last 6 weeks.
Patients are not being offered free treatments in this study. As with all of our patients, cost for physical therapy services will follow our normal fee schedule and we are happy to bill your insurance or provide you with a payment plan. In most cases, a doctor’s prescription is not required to receive physical therapy services in Montana. Excel Physical Therapy is a preferred provider for many insurance companies as well.
Please contact me if you meet the criteria for this study or if you have any questions.
“Headaches Can Be a Pain From the Neck”
Self-Help Techniques and Treatment Options
Presented by David Coletta, MPT, CMPT, Certified Manual Therapy Specialist
Thursday, May 3, 2012
Bozeman Public Library Community Room
Community Education Series – free and open to the public
What You Will Learn:
The various types of headaches that originate from
Understand why you are suffering from headaches.
Learn what to do when you experience headache pain with simple exercises, treatment options and suggestions to self-treat.
Q&A session to follow.
David Coletta, MPT, CMPT specializes in the treatment of back and neck pain, spinal issues, whiplash, headaches, TMJ/jaw pain, and postural dysfunctions. David received his masters in physical therapy from Mount St. Mary’s College in Los Angeles, California. He enjoys finding long-term solutions for his patients — solutions that involve a fine-tuned combination of manual manipulative therapy and a targeted exercise program that address even the most difficult patient presentations.
A considerable amount of David’s advanced training has occurred through the North American Institute of Orthopedic Manual Therapy (NAIOMT). He has completed advanced certification in manual therapy (CMPT) with NAIOMT, and he is working towards his Orthopedic Clinical Specialist (OCS) certification with the American Physical Therapy Association.
It has been a long stressful day and you can feel your head getting tight, like it’s being squeezed in a vise. The pain in your head becomes bad enough that you pop some ibuprofen and go to bed early. Sound familiar?
Tension headaches are included as one of the major classifications in the all too common world of head pain. Other types of headaches include migraines and cervicogenic headaches. A study by Haldeman (2001) found that 78% of adults will experience tension headaches once in their lives. This type of headache can range from the isolated incident that is illustrated above, to people who have severe and unrelenting tension headaches.
A tension headache is described as pain on both sides of the head (often in the temples and the back of the head), pressing and tightening in quality, with tenderness in the muscles on the sides of the head and on the base of the skull. The source of chronic tension headaches is poorly understood, but many researchers think that there is a link between dysfunctional brain interpretation of pain and the muscles of the head and upper neck becoming hypersensitive.
How do you treat tension headaches when they become more than just the limited occurrence, which is resolved quickly with over the counter medication? A visit to your general physician or a neurologist and trial of prescription medication is a good starting place. However, some patients don’t find adequate relief with medication. I would advise that the next step should be an appointment with a physical therapist specializing in headaches and neck dysfunctions. The physical therapist will be able to thoroughly evaluate your neck, head, and posture to determine if chronic poor postures and strain to the head and neck is present. Often, improving posture and showing the patient gentle stretching exercises will lead to a reduction in tension headaches.
Excel Physical Therapy
Headaches Can Be a Pain From the Neck
Headaches can take on many forms and be the source of major disability in the general population. 20% of all visits to a Neurologist in the United States are made because of headache complaints. Major classifications of this diagnosis include migraines, tension headaches, and cervicogenic headaches. As a physical therapist, specializing in the evaluation and treatment of musculoskeletal dysfunctions, I am particularly familiar with the cervicogenic headache.
Temporomandibular Joint (TMJ) Dysfunction is a disorder of the joint where the jawbone meets the skull or the muscles surrounding that region. People suffering from TMJ Dysfunction complain of popping or locking in the jaw, pain in the face with eating or opening the mouth, and headaches. TMJ Dysfunction can be further classified into joint dysfunction, myalgia, or a combination of dysfunction and myalgia. Myalgia is simply defined as intra-muscular pain. Pure joint dysfunction of the TMJ involves popping in the jaw, pain coming from joint structures (bone, cartilage, disc, ligaments, joint capsule), and a predictable and measureable loss in mouth opening or closing range of motion. Myalgia in the TMJ region relates to inflammation and dysfunction in the muscles surrounding the TMJ. These muscles can cause local facial pain, neck pain, headaches, and changes in how the jaw is actively moved. Combined joint dysfunction/myalgia of the TMJ is the most common presentation and can include all of the elements in the individual disorders previously described.
It is important to explain some the underlying reasons for TMJ dysfunction. The most obvious cause is a serious blow to the face or jaw, disturbing the normal biomechanics of the joint. However, more common causes include chronically poor posture, stress-induced grinding of the teeth or clinching the jaw, malocclusion of the teeth (high or low tooth), and neck pain or trauma to the spine. My experience has been that over 90% of patients that I treat, with the diagnosis of joint dysfunction or myalgia of the TMJ, present with dysfunctions of the neck. These patients require a careful evaluation of the neck and treatment that includes joint mobilization or manipulation, soft tissue massage, and exercise to improve posture and restore pain-free jaw active range of motion.
As with any orthopedic problem, the most important step in treating TMJ Dysfunction is to obtain the proper diagnosis by a specialist. Some physical therapists, dentists, and medical doctors are specialty trained in TMJ Dysfunction. Myalgia is the easiest presentation to resolve and treatment can involve simple self-massage exercises, range of motion exercises, nonprescription anti-inflammatory medication, and ice/heat to the face. Treating joint dysfunction of the TMJ involves exercises to re-educate joint motion and fabrication of an oral appliance (acrylic splint) to fit over the teeth, altering joint motions and forces. I would suggest that only specialist dentist fabricate an oral appliance. These devices are expensive and often have to be remade when a dentist who does not understand the intricacies of TMJ fabricates them. Combined joint dysfunction/myalgia requires the combination of treatment approaches.
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