Q & A: How to Choose the Right Pillow

Q.  How in the world do you find the right pillow?  I have tried so many, and none of them are comfortable.  They are all hurting my neck!  Could you please share some tips on what I should be looking for in a pillow?  Thanks!  -Aimey

A.  Great question, Aimey!  Finding the right pillow is arguably just as difficult as finding the right bed.  Neither process tends to be easy.  A poorly fitted pillow can be a big problem as it can often lead to many potential issues such as neck pain, headaches, and poor sleep.  Ideally, you will find a pillow that works best for your needs.

A properly fitted pillow can help address the following issues:

So how do you actually choose the right pillow?  Follow this 5-step process to narrow down the choices in order choose a comfortable pillow that best fits your preferences.

Step One

The first step to choosing the right pillow is to determine your preferred sleeping position.  Are you a side sleeper, back sleeper or stomach sleeper?  This doesn’t mean that you don’t move around.  Determine what position you spend the majority of your time in when sleeping in bed.

Step Two

Once you have determined which position you sleep in the most, choose the general shape and thickness of the pillow. This is important because you want the pillow to support your neck and head.  We are all different shapes and sizes.  Depending on the shape and anatomy of your upper back, neck, and head, the pillow shape and size vary.

As a rule of thumb, a person who sleeps on his/her side will need a slightly thicker pillow.  This is also true if a person has a larger kyphosis of the thoracic spine–meaning that the shoulders are more rounded, and the upper back has also started rounding.  This causes the head to move forward so that the head, neck, and shoulders are not in a neutral position.  In this case, you will also need a thicker pillow.

Thicker pillows that prop your head up more can also be helpful in reducing snoring and even acid reflux.  For acid reflux, it may be more beneficial to slightly tilt the entire bed up 5-10 degrees so that your head is higher than your feet.  A thicker pillow may also be helpful to prop your head up if you are suffering from a head cold as you may breathe a little better if your nose is stuffy.

In general, you want a pillow that allows for the proper positioning for the neck so that your neck and head remain in the most neutral position possible.  The pillow should assist your neck in keeping its natural curvature.  This is critical for anyone suffering from neck pain and tension type headaches.

Side sleepers need a little more thickness to insure that your head is supported in a neutral position while back sleepers will want a thinner pillow.  Depending on your neck, you may actually want a small cushion or roll used right along the neck to give extra support.

Step Three

Choose the shape of the pillow.  There are many different kinds and shapes of pillows.  There is the traditional shaped pillow.  Nowadays, you can find a pillow in almost every shape.  The idea is to find the shape that accommodates your personal sleeping style.

For me, I have a pillow that is shaped as a rectangle but the sides are thicker than the middle.  The two different width neck rolls on top and bottom provide a custom fit for my neck.  It’s like having a flat pillow when I sleep on my back, yet support when I sleep on my side.  This particular design allows my neck to stay in a neutral position whether I am on my back or side sleeping.

Step Four

Choose your filling.  There are many different types of fillings available.  Each one is designed to address a certain need regarding shape and comfort as well as for personal preferences or medical necessity.  The type of filling is also important to consider when you are deciding if you want a firmer or softer pillow.  This is mostly preference as long as you stick to the rule that on average you want your head and neck to remain in a neutral position.  However, if you have a larger thoracic kyphosis or other medical reason you may need your head more propped up.

Types of fillings include but aren’t limited to:

  • Down or feather pillows made from the inner plumage of geese or ducks
  • Wool
  • Cotton
  • Latex
  • Memory foam

If you experience any allergy related issues, first consider the pillow’s filling or fabric to make the appropriate choice for you.

Step Five

In this final step, you have determined your typical sleeping position, which allowed you to choose the proper style, shape, and fit for your head and neck.  You want to keep your head and neck in a neutral position if possible.  You have decided on the type of filling and basic firmness level.  Now it’s time to trial different pillows to determine your personal preference and to actually find a brand/style that most directly fits and accommodates for all of your needs.

It’s always best to actually lay down and trial a pillow before buying it.  Lay with the pillow as if you are actually going to sleep.  Place it and yourself in your typical sleeping position.  Does it address all of your needs?  Is it comfortable?

If you can’t lay down with it, then even finding a wall to mimic lying down may be beneficial.

Typically, you will need to sleep with a new pillow for several nights before determining whether or not the pillow will work out.  If you wake up with neck pain, headaches or have any other breathing or sleeping difficulties associated with the pillow, then throw that pillow on the guest bed and try the 5-step process again.

Thanks for the question, Aimey!  Finding the right pillow that fits your particular body shape and needs can be a challenge.  When you find the right one, you will be rewarded with restful and rejuvenating sleep which will be well worth it.

Do you have any tips or tricks to share when choosing the right pillow?  Please leave your comments below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Q & A: Thoracic Spinous Process Fracture

Q.  I have been diagnosed with a T-6 spinous process fracture.  I have been prescribed a thoracolumbar brace for 12 weeks.  If it takes away the pain, I’m willing to try it.  What do you think generally of braces?  I like swimming, walking, Pilates, and yoga.  All of that is out right now except the walking.  I have osteoporosis and compression fractures at T-6/7 and T-11/12.  I would love your insight on healing time or ability to get back to the activities I love.  I was encouraged to read the Q & A on the teenager who had the C-7 spinous process fracture, but my story is quite a bit different.  Thank you!  -Mary 

(Please note that the original question was much more detailed and personal, so it was truncated.  The name has been changed for privacy.)

A.  Thanks for the great question!  For general discussion purposes, I will address the following topics:  bracing; healing and recovery times; osteoporosis; and treatment.

Bracing

Lumbar and thoracic braces can be appropriate and necessary tools for the right circumstances.  Corset style braces and/or more rigid style bracing are typically prescribed for either of the following two reasons:  to stabilize an injury site that the physician is concerned that movement may compromise healing or safety or to stabilize an area in the hope of reducing pain.  In this particular case, a brace was likely prescribed for both reasons.

There are many potential down sides to wearing a brace.  It can be uncomfortable and inconvenient to wear.  More concerning, bracing can lead to over dependence and the loss of important muscle stabilization strength.  This is why an appropriate exercise program should be maintained while wearing the brace.  Once you’re cleared to wean from the brace and taper back into normal activities, you can progress into a more targeted and comprehensive exercise plan.

Healing and Recovery Times

Whether or not a spinous process will heal depends on the severity of the fracture.  Is it a small fracture with the bones still attached (basically a crack) or was the spinous process separated from the vertebrae?  If the two pieces were separated, then it is likely they will not heal back like a normal fracture.  The bone will not re-attach itself back to vertebrae.  When this occurs, it’s known as a non-union.  Scar tissue and fascia will surround the injury site and in most cases, form a solid fibrous pseudo-union between the two pieces of bone.

In most cases, there aren’t any deleterious effects from the injury and healing process.  Like bone healing, this process typically takes 6 to 8 weeks for most individuals.  It can take longer based on other factors:  age; nutritional status; smoking; and other conditions such as osteoporosis or diabetes.  Even certain medications, such as NSAIDs, may impede bone healing.  Speak to your physician and pharmacist about any and all medications and supplements you are taking.

(In Mary’s particular case, there may be other compounding factors or the fractures were quite severe since the expected time frame for healing is 12 weeks.)

Compression fractures will likely take about the same amount of time to heal.  If the bone is slightly collapsed, it will not recover its previous shape.  It will remain slightly more wedge shaped.

Osteoporosis

Although bracing is often a necessary part of the recovery, it will likely weaken the surrounding musculature.  A strong core and adequate stability of the muscle around the trunk are important components to one’s recovery as well as prevention for ongoing issues (particularly in cases of compression fractures).

Be proactive in dealing with your osteoporosis.  Otherwise, you will likely continue to experience fractures and other issues.  There are medications that can help, but they all have significant potential risks.

Proper nutrition and weight training are components to managing osteoporosis.  Please refer to Why Astronauts Resistance Train and So Should You.

In addition, I recommend Sara Meeks’ book, Walk Tall! An Exercise Program for the Prevention & Treatment of Back Pain, Osteoporosis and the Postural Changes of Aging.

Treatment

Nutrition is very important for healing.  Consult with a functional medicine practitioner to dial in your nutrition and address any potential nutrient deficits or nutrient absorption issues.  Also, refer to Why You Won’t Heal – Poor Nutrition.

I recommend starting with a walking program that includes a gradual taper up to at least 3 miles per day.  Once you’re medically cleared to exercise again, find a physical therapist (PT) that specializes in osteoporosis management.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.

A PT can help you initiate a comprehensive core stabilization program along with weight training.  In many cases, a core stabilization program can be initiated around the 6 to 8 week mark, but it depends on when your physician clears you to return to exercise other than walking.

Prior to initiating a full strength training routine, begin by initially focusing on your back extension strength (which will address the spinous process fractures as well as the compression fractures).  Any rehabilitation program should be slow and steady.  Start well before the 12 week period unless there are medical contraindications for doing so based on your particular situation.

Healing times vary tremendously.  It’s based on the severity of the injuries and your individual health status.  With poor bone health or other co-morbidities, it could be prolonged.  Full healing may take 4 months or so.

With these types of injuries, pain is always highly variable.  It can vary from a couple of weeks to 4-6 months.  Pain will typically slowly decline as the healing process progresses.  The early inflammatory process that was initiated after the injury will progress through an acute to more subacute phase.  Wearing the brace usually helps with early pain management.

Thankfully, this type of injury usually results in a full return to function without many long-term deleterious effects.  The key is to allow adequate healing time, and then slowly and strategically progress back into full activity.

Have you ever suffered from a thoracic spinous process fracture?  Please share your story below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

How to Avoid Overtraining as a Long Distance Runner

http://marathontrainingacademy.com/how-to-avoid-overtraining-as-a-long-distance-runner

Marathon Training Academy

May 30, 2018

In this podcast interview with Angie Spencer (RN and Certified Running Coach) and Trevor Spencer (co-host of the Marathon Training Academy Podcast), we discuss Overtraining Syndrome (OTS) and how it differs from an overuse injury, the top mistakes we see runners make in regards to training and recovery, and answer questions from runners.

In this episode, we speak with Dr. Ben Shatto about overtraining, which is a leading cause of injury and burnout in long distance runners.  Listen to the podcast

Disclaimer:  This blog post and podcast are not meant to replace the advice of your doctor/health care provider, or speak to the condition of one particular person but rather give general advice.

Q & A: Do I have Carpal Tunnel Syndrome?

Q.  My hand grip has been feeling weak, and I have noticed some tingling in my first two fingers.  Do I have Carpal Tunnel Syndrome?  I use my hands all day long, and I can’t miss work for surgery.  Is there anything I can do?  -Jared

A.  Thanks, Jared, for the great question!  Carpal Tunnel Syndrome (CTS) is a very common cause of hand pain and weakness.  It’s also often associated with numbness and tingling particularly in the thumb and first (index) and second (middle) finger.  It’s often accompanied with associated motor control issues within these fingers.  The symptoms tend to start gradually and typically worsen over time.  The pain can get to a point that is unbearable.  One can lose functional use of their hands because of the pain, numbness, and associated lack of motor control.

Symptoms of Carpal Tunnel Syndrome:

  • Pain in the wrist, palm of your hand, and/or fingers.
  • Numbness and tingling in the thumb and first (index) and second (middle) finger.  The median nerve is affected.  The fourth (ring) finger and pinky finger are not directly affected because it’s a different nerve (ulnar).  Along with numbness and tingling, many people will describe an electric shock type feeling in these same fingers.  Initially, the numbness and tingling is intermittent, but it can progress into a constant sensation.
  • People describe the lack of hand control and the tendency to drop objects.

Symptoms tend to worsen when gripping or performing hard manual labor, including repetitive motions with the hands that involve flexion (closing) of the hand.  Symptoms are often worse at night and may even wake you up.

Causes and Risk Factors for Carpal Tunnel Syndrome:

  • Pressure over the median nerve near the palm of the hand in the “Carpal Tunnel” which is a type of passageway from your forearm to your wrist.
  • Repetitive motion.  CTS is typically viewed as a repetitive motion or overuse injury.  Repetitive gripping and heavy use of the hands can lead to irritation of the median nerve.  This means that professions involving heavy use or repetitive use of hands (particularly, if there is vibration) are at higher risk of developing CTS.  This can range from manual laborers to pianists or typists.
  • Scar tissue build up and/or fascial restrictions in or around the carpal tunnel from repetitive use or trauma such as repeated compression.  Chronic vibration of the hands and arms is a risk factor.  Examples include heavy use of power tools (such as a jack hammer) or motocross racing.
  • A wrist fracture can narrow the tunnel space from swelling and inflammation or cause deformation of the bones in the wrist.
  • Swelling and inflammation from other pathologies such as Rheumatoid arthritis or cysts.
  • Any injury or pathology that causes deformation of the bones in the wrist that places additional pressure on the median nerve.  This would include obesity as fat deposits can reduce the space within the carpal tunnel.
  • Females are more likely than men to develop CTS.  This is likely due to anatomical variations where the carpal tunnel is typically smaller in women versus men.  This allows the area to be more easily compromised or affected from other causes.
  • Fluid retention may increase the pressure within your carpal tunnel and be irritating the median nerve.  This is common during pregnancy and menopause.  CTS associated with pregnancy will typically resolve on its own after pregnancy.
  • Muscle imbalances between wrist flexion and extension strength.
  • Mobility related issues in the wrist, shoulder, thoracic, and cervical spine.

CTS can be straightforward with a very typical mechanism of injury or can be very difficult to treat because of multiple factors leading to the syndrome.  Often it’s a multitude of risk factors that cause the symptoms in addition to anatomical variations from person to person.  Other compounding factors include:  diabetes; thyroid disease; kidney failure; other forms of inflammatory arthritis; poor posture; and cervical and thoracic derangements.

Poor wrist, shoulder, cervical, and/or thoracic mobility is often associated with CTS and other spine and/or upper extremity pain syndromes.  I find that even in the clearest cut of cases it’s always best to screen for other potential causative factors by starting with the cervical spine and working down the chain into the hand.  Whenever one part of the body doesn’t have adequate mobility, another part will do more to allow for the movement to take place.

My Top Recommendations to Alleviate Pain associated with Carpal Tunnel Syndrome:

Identify the offending movement.

If you’re experiencing CTS pain, try to identify which specific movement aggravates the symptoms.  Once you identify the movement, find ways to either avoid the motion or to change how you perform the activity as to not cause the symptoms.  This may mean adjusting your posture or body position or using an adaptive device to help your body compensate for the activity.  Eliminate as many of the noted risk factors from your daily activities as you can.

Work on your grip strength through extension movements.

Don’t just work on wrist flexion or gripping exercises.  Also work on finger and wrist extension in order to improve your grip strength.  Often in the case of CTS, there is a muscle imbalance between your ability to flex your fingers and wrist versus extending your fingers or wrist.  Work on extension biased exercises.  Your grip strength will improve more rapidly as your wrist and hand muscles find their optimal length tension relationship (which allows for maximum strength production).

For wrist extension, use an exercise band (as demonstrated below) to perform two to three sets of 20 repetitions.  Extend the wrist up, and then slowly back down toward the floor.  Be sure to move very slowly during the eccentric/muscle lengthening position (when your hand returns to the floor).

To improve finger extension strength, I often recommend using a thick rubber band as a way to improve finger extension strength (as demonstrated below).  Work on extending each finger equally when performing two sets of 10-15 repetitions multiple times per week.

If you want to be more precise and have the ability to exercise one finger at a time, try a device such as the CanDo® Digi-Extend® Hand Exerciser.  This is an excellent tool to improve finger extension strength.  It allows you to work the fingers in multiple ways including individually for rehabilitation purposes and as an important hack to improve overall grip strength (as described above).  It also allows for customization of resistance so you can track progress.

Stretch.

I suggest stretching the fingers and wrist multiple times a day.  Your fingers and wrist should have mobility in all directions.  Particularly focus on wrist extension (as demonstrated below).  Perform two to three sets of a 30 second stretch three to five times per day as long as you do not reproduce your CTS symptoms.

Work on your mobility.

Restrictions in mobility typically don’t just occur in the fingers and wrist, but also up the arm and into the thoracic and cervical spine.  I like to use items, such a PVC pipe, that you might already have at home.  This works great for forearm mobilization.  You could also use a golf ball.  You can use one hand to press or rub the PVC pipe over sore or tender areas.  The amount of pressure shouldn’t be painful.  Avoid pressing on especially boney areas.

Poor mobility elsewhere in the kinetic chain can and will affect hand and wrist symptoms.  Work on upper body mobility by focusing on shoulder and thoracic mobility.  You can automatically download my FREE resource for shoulder and thoracic mobility, My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain, when you subscribe to my e-mail list.

Be proactive.

Once you start to feel pain, be aggressive with your management and self-treatment.  Implement these recommended exercises, stretches, and mobilizations quickly so you can stop the pain from progressing.  It’s always easier to intervene early.  Take your rehabilitation seriously and perform the exercises diligently while you work to eliminate risk factors that may be affecting the condition.

Contact your Physical Therapist (PT).

If the pain persists, seek additional help.  Don’t let the pain linger.  The longer it’s left untreated, the more potential for harm and damage (which potentially could lead to a longer recovery).  The American Physical Therapy Association (APTA) is an excellent resource for learning more about physical therapy as well as locating a physical therapist in your area.

Thanks for the question, Jared!  Carpal Tunnel Syndrome (CTS) can be debilitating by limiting your ability to exercise, work, and perform daily tasks.  Be proactive in your care and management.  Most importantly, don’t let the pain and symptoms linger.  The longer you have the symptoms, the harder they can be to eliminate and recuperate from.

Have you ever dealt with Carpal Tunnel Syndrome (CTS) pain?  Which treatments have you found to be the most effective?  Additional discussion can help others to manage their pain.  Please leave your comments below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

21 Exercises for Better Posture

Cervical (neck), thoracic (upper back), and shoulder pain is often caused from stiffness in the thorax.  We spend so much of our day sitting slouched or standing hunched over (in a forward flexed position for the thoracic spine) that we lose normal mobility.  This stiffness in the thorax can cause compensation patterns in our cervical spine and shoulders.  Over time, this can develop into painful areas.

The key to eliminating pain is to improve posture and improve the mobility of the thoracic spine, so the neck and shoulders no longer have to compensate for the lack of mobility.

In this guest post for Get Correct Posture, you will discover different exercises to help you achieve better posture.

Q.  If you were to recommend just one exercise for someone to help them improve their posture, what would you recommend and why?

A.  The number one exercise to improve posture?  I don’t have just one exercise, but a series of exercises that I recommend.  These stretches are designed to counteract the stresses and postures of daily life and to restore the normal mobility to the upper back.

I prefer to use a foam roller, but you could utilize several rolled up towels as well or possibly a water noodle with or without towels rolled around it.  The key is to have a fairly firm surface which you can lay on that will not impede shoulder mobility.

Repeat the routine twice, at least 1-2 times per day as needed.

A variation of the foam roll stretches could also be to lie over a large Thera-Band Exercise Ball and perform the same arm positions.

When performing these exercises, it’s important to understand that stretching should never be painful.  You should feel a mild to moderate stretching sensation.  If you start to experience numbness or tingling in the hands or arms, you should discontinue the stretch at that time.

When performed regularly, these simple exercises will help you to improve poor posture and can be performed anywhere.

Continue reading for expert recommendations on which exercises to perform in order to improve your posture.

How You can keep Moving with a Busy Schedule

While juggling to have a happy personal life and getting through the burdens of an office job, we forget to do one little thing: move enough during the day.  Technology has made everything simpler, which also means less moving and a more sedentary lifestyle.

We forget that in order to be active, we don’t necessarily have to run to the gym and sign for a membership.  There are other simpler ways that we can adopt in order to make sure we are getting enough movement during the day.  It could be from parking a little further away from your grocery story and walking to it to taking the stairs for one or two floors.  Such little changes have positive impacts in our lives in the long run.

In this guest post for The Diabetes Council, you will discover the different ways in which you can ensure that you are moving enough for the day.

Q.  I have a full day of work, running around on errands. What are the simple ways to make sure I am moving enough for the day?

A.  It’s easy to let the busyness of life keep us from taking the steps necessary to insure a long life span and health span.  The good news is that frequent short bouts of exercise can be effective for maintaining general health.  The key is to incorporate frequent movement into your daily routine.

Get up and move at least every two hours during the day.  One option is to perform ten sit to stand exercises every hour.  (Simply, move from sitting to standing for ten repetitions.)  Another option is to walk at least every two hours for a minute or two.  The faster the walk, the better!  If stairs are available, walk up and down.  Combining the sit to stand exercises with walking is an excellent and fast way to elevate your heart rate no matter where you are!  Try parking further out in the parking lot when you’re out running errands.  It will force you to walk further.

Finally, make time to connect with not only yourself, but loved ones, too.  Walking after meals has been shown to stabilize blood sugar levels.  It’s also an excellent way to boost metabolism and connect with friends and family.  Frequent walking is the most important physical activity you can engage in.

Continue reading for more great responses from fitness experts about the ways in which you can ensure that you are moving enough for the day.

The Injury Episode!

With Special Guest Dr. Ben Shatto

http://marathontrainingacademy.com/injury-episode

Marathon Training Academy

May 11, 2017

In this podcast interview with Angie Spencer (RN and Certified Running Coach) and Trevor Spencer (co-host of the Marathon Training Academy Podcast), we discuss the prevalence of running injuries, the top mistakes we see runners make, and answer injury related questions from runners.

In this episode we talk injury prevention with our friend and physical therapy doctor Ben Shatto. Plus we answer injury related questions from real everyday runners like you. Glutes, calves, hamstrings, IT Band, foot and knee pain . . . we cover it all! Listen to the podcast

Disclaimer: This blog post and podcast are not meant to replace the advice of your doctor/health care provider, or speak to the condition of one particular person but rather give general advice.

Q & A: How did I get a Stress Fracture in my Foot?

Q.  I have been diagnosed with a stress fracture in my foot.  What causes a stress fracture?  Now what should I do?  The doctor wants me to avoid any weight bearing for the next four weeks.  How do I heal?  Denise

A.  Thanks for your question, Denise.  I’m sorry to hear that this has happened to you.  Stress fractures are a unique type of bone fractures as they rarely occur due to a specific trauma.  Stress fractures typically occur due to a silique of events that leads to the bone not being able to handle the stress of your activity which results in a crack in the bone.  Stress fractures are common in the foot, but they can occur almost anywhere.

Initially, you might barely even notice the pain associated with a stress fracture, but the pain tends to worsen with time.  The tenderness usually originates from a specific spot and decreases during rest.  As the injury worsens, the pain tends to spread out and become more diffused with a focal area of tenderness.  You might have swelling around the painful area.  In some cases, the entire foot may begin to swell.

footpain

Stress fractures typically occur as the bone is subjected to a new unaccustomed force without enough time for recovery.  Bone adapts gradually to increased loads through remodeling, a normal process that speeds up when the load on the bone increases.  During remodeling, bone tissue is destroyed, and then rebuilt.  This is a similar process in muscle tissue.  When the load and/or volume of activity are too much for the bone, a fracture will occur.

Risk Factors for a Stress Fracture:

  • Certain sports.  Stress fractures are more common in people who participate in sports such as track and field, basketball, tennis, dance or gymnastics.  High repetitive impact sports tend to have the most stress fractures.
  • Increased activity.  Stress fractures often result from increasing the amount or intensity of an activity too quickly.  For example, people who suddenly shift from a sedentary lifestyle to being more active (increasing training volume significantly) or those who rapidly increase the intensity, duration or frequency of training sessions.
  • Gender.  Women are more likely to develop a stress fracture, especially those who have abnormal or absent menstrual periods (known as amenorrhea).
  • Foot problems.  People who have flat feet or high, rigid arches are more likely to develop stress fractures.  Worn or poorly fitting footwear or high heels can also contribute to this issue.  For runners, transitioning too quickly from a more built up running shoe into a minimalistic style can be a factor.
  • Osteoporosis.  Osteoporosis or osteopenia causes weakening in the bones that makes it easier for stress fractures to occur.
  • Prior stress fractures.  If you have experienced one or more stress fractures, you’re at a higher risk.
  • Poor nutrition.  Lack of Vitamin D, calcium, Vitamin K, and magnesium can make bones more likely to develop stress fractures.  Generally poor eating habits are also a factor.
  • Hard surfaces.  Spending long periods of time or training on hard surfaces, such as concrete, can increase your risk.
  • Smoking.  Smoking leads to poor blood flow and affects the body’s ability to heal and recover.
  • Obesity.  The heavier you are, the more forces that ultimately go through your foot.  Depending on how you are exercising, your particular footwear and the surface which you walk on can contribute to increasing your risk factors.
  • Gait abnormalities.  Alterations to your normal mobility (from either another injury or a change in your body) that affect how you typically move.  The change in mobility, along with your activity level, can be enough to overload the bone.  Particularly, when other risk factors are present.

In most cases, it’s not one specific risk factor that leads to the stress fracture, but a combination of risks and events that lead to the injury.  Diagnosis is usually through X-ray.  However, an acute injury may not initially show, so a second X-ray may be needed after a week or so to confirm the diagnosis.  A bone scan can also be useful to determine if there is an injury to the bone.

In the case of a poorly healing bone, the use of a bone stimulating electrical device may be recommended by your physician.

Initial Treatment

Non-weight bearing or limited weight bearing for four to six weeks is a very common course of treatment.  It provides enough time to initiate the healing response while reducing the stress on the injury site.  If you continue to stress the site of injury, the fracture can worsen and require more invasive treatments (possibly even surgery).  Crutches, a walker or a Roll-A-Bout knee walker can be used while you have weight bearing restrictions.  A walking protective boot is also typically used to protect the injury site.

As with many injuries, the initial treatment for a stress fracture in the foot is PRICE (Protection, Rest, Ice, Compression, and Elevation).

  • Protection.  Wear a walking boot, and limit weight bearing on the foot.
  • Rest.  Limit any activities that cause pain.  Depending on the severity and your personal health status, this can last from two to eight weeks.  Those with diabetes usually take a significantly longer period of time to heal.
  • Ice.  Use ice as needed for pain and edema control.  The rule for icing is to apply ice no more than twenty minutes per hour.  Do not place the ice directly against the skin, especially if you are using a gel pack style.  A bag of frozen peas can be ideal.  Individuals with poor circulation or impaired sensation should take particular care when icing.
  • Compression.  If swelling is present, utilize a simple ACE wrap around the foot and ankle to help with the swelling and pain.  Start at the toes, and work up the leg.  Take care to not apply the ACE wrap too tightly as over squeezing the foot can be irritating.
  • Elevation.  Use pillows to position the foot above the level of your heart to help reduce swelling.  This would be an excellent time to apply ice, too.

In general, the application of heat, cold, or over the counter (OTC) topical agents, such as Arnica Montana (an herbal rub) or Biofreeze, may help you to manage pain and stiffness.

Addressing Your Risk Factors

After you have initiated PRICE and the pain and swelling has decreased, address any risk factors (if and when possible).

Stop Smoking

If you smoke, please stop.  It not only affects your bone density, but it has negative effects on every other body system.  It also increases your risk of cancer and heart disease.

Nutritional Management

Address any nutritional deficits.  This includes having adequate levels of Vitamin D3, Vitamin K1 and K2, magnesium, and healthy fats.

Vitamin D3 is critical to the absorption of calcium, through the intestinal wall, which is important for bone health.  Although calcium is a critical component of bone health, I cannot recommend extra supplementation because of the potential cardiac risks to over supplementation.  A healthy varied diet will typically supply adequate calcium levels (assuming that adequate Vitamin D3 levels are present for absorption and that you are avoiding drinking soda).  Vitamin D3 is also a critical nutrient in maintaining a healthy immune system.

Research indicates that Vitamin K can help to reduce bone loss by helping the body regulate osteoclast function with in the bone.  An osteoclast is a type of bone cell that breaks down bone tissue.  These very important cells are integral in maintaining proper bone density and insuring an appropriate amount of calcium in the blood stream.  Without adequate calcium, many critical cell functions can be affected (including heart function).  Both Vitamin K1 and K2 have been proven to reduce the risk of fractures, including hip and vertebral.

Vitamin K, found in green leafy vegetables, has anti-coagulation benefits.  If you take blood thinning medications, your physician will need to know how much you consume on a regular basis.

Magnesium is a critical component of bone health and health in general.  Magnesium helps the body to regulate calcium levels.  This has a positive effect on bone health and also has been proven to reduce the risk of kidney stones.

I also use magnesium as a sleep and recovery aid.  I consume it at night to help me sleep.  Magnesium can also reduce muscle soreness, cramps, and/or spasms.  You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.

Most people are deficient in the amount of magnesium they consume on a regular basis.  I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose in 100 mg intervals as needed.  I would caution you that taking too much magnesium can lead to diarrhea.  Mag Glycinate in its oral form is the most highly absorbable.  Although not quite as absorbable, Thorne Research Magnesium Citrate is also a fantastic product.

If you’re female (and especially if you suffer from amenorrhea, abnormal or absent menstrual periods), then consuming adequate levels of fats is pertinent.  Adequate levels of Omega-3 fatty acids and other healthy fats (primarily from plant sources such as avocados and coconut or olive oil) are critical in order to insure that your body has what it needs for proper hormonal support.  Amenorrhea can be a sign that your diet is lacking in adequate high quality fats as well as a sign of overtraining.

Avoid Soda and Distilled Water

Excessive soda intake (particularly diet soda) has been linked to poor bone density.  The exact cause isn’t entirely clear.  Many theorize that the acidic nature of the soda along with the chemicals and additives cause increased osteoclast activity in the bones.  This releases more calcium into the blood stream in order to help fight the negative effects of soda consumption.  It’s clear that too much soda is bad for your health and bones.  Similarly, distilled water is water that has been leached of all other nutrients and minerals.  Drinking too much distilled water can leach needed nutrients out of the bones. 

Weight Management

It’s important to manage your weight effectively.  Excessive body weight can cause additional stress on the body.  Whenever possible, work toward optimizing your health.  This includes maintaining a healthy body weight.  The heavier you are the more stress forces present throughout the lower extremity.

Rehabilitation

Once you’re cleared by your physician to initiate exercise and activity, it’s time to progress your rehabilitation.  For detailed descriptions and photos of potential helpful exercises, please refer to Foot Stress Fracture Rehabilitation Exercises(If you’re already working with a rehabilitation professional, such as a physical therapist, consult with him or her prior to starting my recommended rehabilitation exercises.)

  • Strengthen your foot and ankle complex. Weakness in the foot and ankle muscles (as well as the smaller foot intrinsic muscles) can lead to excessive strain on the tissues on the bottom of the foot including the plantar fascia.  I recommend initiating a complete ankle/foot strengthening protocol.  Please refer to Ankle Resistance Exercises Using the Elastic Exercise Band.
  • Improve your balance.  Poor balance is often associated with muscle weakness in the foot and ankle as well as weakness in the knee and hip musculature.  Weakness and balance deficits can lead to poor foot mechanics, which ultimately can lead to a stress fracture or even metatarsalgia.  Improving your balance can help to reduce the risk of metatarsalgia and is an important part of the rehabilitation process.  For more ideas on how to improve your balance, please refer to Improving Balance by Using a Water Noodle.  As your pain level improves, I recommend that you perform these balance exercises without shoes on.
  • Add an orthotic.  Often times, the stress fracture occurred due to alterations in foot mechanics or an old or poorly fitting shoe or orthotic.  If you are recovering from a stress fracture, consult with a podiatrist or a physical therapist that specializes in orthotics to determine the proper orthotic or shoe for you.
  • Did you progress too quickly into a minimalistic shoe?  The standard built up shoe offers more foot support and padding than most minimalistic style shoes.  If you attempted a quick progression, this may have contributed to the injury.  Unless you are a child or teenager, expect a safe transition to take at least three months.  A slow transition will allow your body to adequately adapt to the new stresses.
  • Weight training.  Once you’re cleared by your physician, initiating or returning to a weight training program is critical to the development and maintenance of strong bones.  Weight training (particularly barbell training) loads the skeleton progressively over time, which can decrease bone loss and increase bone mineral density.  It also positively affects the hormones, such as human growth hormone (HGH) and testosterone, needed to improve bone density and muscle strength.  Barbell training is the most effective method due to the progressive load on the skeletal system, and the muscle pull being exerted on the bone, which also stimulates bone formation.  The key to maintaining and improving bone density is always progressive axial skeletal loading and the associated pull of muscles against the bone during activity (particularly, strenuous activity).  Examples of such exercises include squats, lunges, and dead lifts.

It’s critical that you to slowly progress back into high impact activities.  It’s equally important that you address any of these risk factors in order to help reduce the risk of re-occurrence.  If you have experienced one or more stress fractures, you’re already at a higher risk.  As you taper up activity, monitor for signs of swelling and pain.  If symptoms occur, taper down the intensity.  Continue to work in a pain free range in order to strengthen around the injury site.

If you don’t experience a significant relief as you progress into your rehabilitation, please consult your medical professional.  I recommend a physical therapist that specializes in feet or who works with athletes for the treatment of stress fractures.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  You may also consider consulting with a podiatrist.

Thanks, Denise, for the question.  I hope you find this information to be helpful as you manage your condition.

Have you experienced a stress fracture in your foot before?  Which treatments worked the best for you?  Which treatments didn’t seem to help as much?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please e-mail contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

Q & A: A Holistic Approach to Managing Autoimmune Disorders (Myasthenia Gravis)

Q.  I have been diagnosed with Myasthenia Gravis.  It’s affecting my speech, swallowing, and general head, neck, and arm strength.  Are there certain activities that I should modify or avoid?  Which type of exercise can I perform in order to improve my function?  Owen

A.  Thanks for your question, Owen, as it presents an opportunity to discuss a very devastating autoimmune disease, Myasthenia Gravis (MG).  Your willingness and desire to maintain your strength and physical function despite the disease is an encouragement to others who may be suffering as well.

Approximately 50 million Americans (20 percent of the population or one in five people) suffer from autoimmune diseases.  Women are more likely than men to be affected.  Some estimates state that 75 percent of those affected are women.

Myasthenia Gravis (MG) is one of many different types of autoimmune diseases such as Rheumatoid Arthritis (RA), Multiple Sclerosis (MS), and Amyotrophic Lateral Sclerosis (ALS, which is also known as Lou Gehrig’s Disease).

An autoimmune disorder occurs when the body’s immune system attacks and destroys different parts of the body because it has confused itself with a foreign body or invader.  The body’s own immunogenic response against itself is a challenging and difficult problem to fix.  Although there are many different and evolving treatment methods, most (if not, all) autoimmune disorders are not curable.

manwithhishandonthroat

In the case of MG, it’s considered a neurologic autoimmune disease because the immune system attacks the nerves that control certain muscles of the body.  Symptoms of MG vary wildly and sometimes can be quite severe.  Symptoms may include:

  • Muscle weakness
  • Drooping of one or both eyelids
  • Double vision
  • Altered speech
  • Difficulty swallowing
  • Problems chewing
  • Limited facial expressions
  • Weakness in your neck, arms, and legs.  (If the neck is weak, it may be hard to hold up your head.)

Proper medical management is critical in all cases of autoimmune diseases.  Those diagnosed with MG (or any other autoimmune disease) should always be medically managed by a specialist in the disease.  In most cases, management of MG will be overseen by a neurologist (preferably, with experience in treating MG and other neurologic autoimmune diseases).  

In order to best address any autoimmune disorder, a multifactorial approach to managing the disease should be implemented.  Although the condition may affect one specific aspect of your body, a healthy and balanced body will always function better and be more resilient to fight and thrive in spite of the condition.  In addition, it’s important that you and your loved ones learn as much about the disease as possible.

A Holistic Approach to Managing Autoimmune Disorders (Myasthenia Gravis):

  • Medical/Physician Management.  Depending on the condition and triggering events, this may include pharmacological management or surgical intervention.  In the case of MG, the trigger may be a tumor in the thymus gland.  Your physician may order a CT Scan of your chest to screen for a tumor.
  • Speech TherapyOften with MG or other autoimmune disorders, you may develop difficulties with swallowing.  I highly recommend that you work with a Speech Therapist (ST).  Speech therapists are highly trained medical professionals that specialize in treating disorders that affect swallowing, speech, and cognition.  They can use very specific treatment modalities from exercise to diet modification.  Neuromuscular electrical stimulation (NMES) can be utilized to help the muscles responsible for swallowing improve in strength and coordination.
  • Nutritional Management.  Consume foods that promote a low inflammatory diet, including a diet high in Omega-3 fatty acids and other natural herbs (like garlic and turmeric) which can naturally lower inflammation.  Consuming food that helps to support the immune system is important because the nervous system is affected by MG and other autoimmune diseases.  This includes a diet high in Omega-3 fatty acids and having adequate Vitamin D3 levels.  Include foods that support the nerves and are typically high in good fats such as avocados, coconut oil, and healthier fish (such as sardines and wild caught salmon).  If you’re experiencing difficulty with swallowing, be sure that your food is prepared in such a way that you can safely eat and that it’s in accordance to advice from your speech therapist.
  • Weight Management.  It’s important to manage your weight effectively.  Excessive body weight can cause additional stress on the body.  Whenever possible, work toward optimizing your health.  This includes maintaining a healthy body weight.  Depending on the autoimmune disease and your body in particular, this may also mean maintaining enough body weight.
  • Activity Modification.  As the disease progresses, it’s important to understand how your body is functioning, and then learn how to adapt to manage the disease.  Unfortunately, certain activities and how you perform them will need to be modified or avoided.  Learn to pace yourself and take more frequent rest breaks.  Adequate night time sleep is also critical.  If any of your joints are affected, learning to limit the use and strain on them will be important.  Utilize adaptive devices (such as a cane) in order to limit the strain placed on your body during activities.  An assistive device will allow you to be mobile and will reduce your risk of falling.
  • ModalitiesThis is a broad category, but there are many ancillary treatments that can be utilized to help you feel more comfortable.  The good news is that they rarely have associated side effects.  In general, the application of heat, cold, or over the counter (OTC) topical agents, such as Arnica Montana (an herbal rub) or Biofreeze, may help you to manage pain and stiffness.  Gentle massage and TENS (Transcutaneous Electrical Nerve Stimulation, a form of electrical stimulation performed by a physical therapist) may also be beneficial for pain relief.  TENS is different than the neuromuscular electrical stimulation (NMES) used by speech therapy.  TENS is used for pain control only.
  • Limit StressOften in cases of autoimmune disorders and in particular, MG, poor stress management will lead to worsening symptoms.  The ability to effectively manage stress will be critical in managing your symptoms.  There are many different methods to help you manage stress more effectively.  Common methods include:  meditation; journaling; deep breathing; Tai Chi; and yoga.  You may also need to reconsider certain friendships and relationships in your life.  The key to effectively managing stress is to find an enjoyable activity, and then stick with it.  This is a process–a journey (not a destination).
  • Exercise.  Implementing exercise in order to promote general health will not only help you to feel better, but it will optimize your well-being during this very difficult time.
    • Strength TrainingStrength training is encouraged, and the exercise program should be established by a professional who is familiar with managing MG.  All exercises should be performed in a slow and controlled environment within the available range of motion (ROM).  Maintaining muscle mass through strength training is critical and should be performed only one to two times per week to minimize any risk of over fatigue.
    • Endurance Training.  Endurance training is critical for general health and should be included as part of a comprehensive exercise program for individuals with MG.  Focus on less impact activities such as bicycling, rowing, and water aerobics.  Avoid excessive fatigue.
    • Flexibility TrainingFlexibility training is important for everyone as part of a healthy lifestyle.  Take every joint through a full ROM at least once a day.  I highly encourage a regular two to three times a week flexibility program in addition to a daily ROM program.  Tai Chi and yoga both also address aspects of strength and balance and are wonderful for managing stress.  Other options include:  Pilates; water aerobics; and a stretching routine.
    • Aquatic Therapy.  Water can also be very useful in pain control and help with relaxation.  Many find that performing a regular exercise program in an aquatic environment can satisfy most exercise needs, including flexibility and strength.

Managing an autoimmune disorder, such as MG, is difficult and everyone’s journey will be different.  Your specific treatment protocol should be individualized based on your specific condition, how the symptoms are affecting you (which will vary over time), and your current health status.

Thanks, Owen, for the question.  I hope you find this information to be helpful as you manage your condition.

What has your experience with managing autoimmune disorders been like?  Are there any treatments that have or have not worked well for you?  Additional discussion can help others to manage these difficult diseases as well.  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please e-mail contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

Q & A: What Causes Headaches?

Q.  Several members of my family frequently get headaches.  Thankfully, I rarely get them, but what causes headaches?  Why do some people get them and others do not?  Thanks, Ben!  -Brad

A.  Thanks for your question, Brad!  Headaches are a very complicated subject.  I will do my best to answer your question from a physical therapist’s perspective.

Headaches can range from mild to severe with symptoms varying wildly.  Approximately 15-20% of the population will suffer from headaches at any given time.  It’s one of the top medical ailments for which people seek treatment.  Headache suffers are also one of the most heavily marketed to group.  There are no shortage of scammers and snake oil salespeople trying to sell you the next great remedy to cure your headaches.

Although there are many potential sub categories of classifications a person could use (particularly, within the tension class), I tend to classify headaches in one of five categories:  tension; cervicogenic; sinus; migraine; and cluster.

Business people with stress and worries in office

Classifications of Headaches:

Tension

These are the most common type of headache.  These headaches are often related to tension in the muscles of the head, neck and jaw and are frequently stress related.  The actual physical cause is still not fully understood, but it’s likely linked to how the brain and nervous system perceives muscular pain and stress.

Tension headaches are categorized as either episodic (meaning that you experience less than 15 headaches per month) or chronic (meaning that you experience more than 15 per month).  Women tend to experience them more often than men.  Many food or environmental factors can trigger tension or migraine headaches.  Food and environment triggers for headaches could easily be a classification of their own.

Please refer to Prevention and Treatment Strategies for Tension Headaches.

Cervicogenic

Not everyone would say this is a separate class of headache, but I tend to classify cervicogenic headaches separately.  Cervicogenic headaches are often associated with tension type headaches.  There can be a lot of overlap with tension headaches, but in this class the underlying cause of the headache is from the cervical spine.  There are many pain generating structures in the cervical spine.  A few potential causes could be nerve related, trigger points, facet joint or cervical mal-alignment related, or cervical disc related.  I find that postural dysfunction tends to go hand in hand with this type of headache as well as in tension headaches.

Cervicogenic headaches tend to be found more often found in women.  This seems to be primarily due to the anatomical differences of men versus women.  Men tend to have more muscular necks while women tend to have more long and slender necks with less muscle to provide support to the head (meaning that there is less muscle strength for support).

Please refer to Cervicogenic Headaches: A Real Pain in the Neck (and Head).

Sinus

Your sinuses are located on your forehead, behind the bridge of the nose and under your cheek bones.  In cases of infection or allergy, the mucosal lining will become inflamed and causes pressure and pain.  This results in headache type symptoms.  Pain is often worse when bending over or straining.

Other than headache type pain, you may also be suffering from other symptoms of illness including a stuffy or running nose, earache or fever.  Sinus headaches are often a trigger to other types of headaches such as tension and migraines.

For more information, please refer to 9 Treatment Tips for a Sinus Headache.

Migraine

Migraine pain is the second most common type of headache (with tension/cervicogenic type headaches being the most common).  Up to 16-17% of the population complains of migraines.  These headaches can be far more debilitating than the typical tension/cervicogenic type headache.  Migraine pain is often in combination with tension headache pain.  Migraines can also be caused by menstruation or hormonal imbalances.

Frequently, people will classify any type of severe headache pain as a migraine although it may or may not actually be the case.  The severity of pain is not what leads to a migraine classification, but which symptoms are present.

Symptoms of a migraine will differ for everyone.  Initial symptoms and patterns may occur one to two days prior to the actual migraine.

Typical symptoms may include:

  • Throbbing pain on one side of the head (but pain can be present on both sides)
  • Pain behind the eyes
  • Difficulty performing typical activities which worsen with activity or heat
  • Nausea
  • Vomiting
  • Sensitivity to light, noise, and smell

Less common symptoms may also include:  difficult with speaking; tingling in the face, arms, and hands; and short term upper body weakness.

Migraines are more commonly found in women.  Like tension headaches, migraines are often associated with known varying triggers like food, smells, excessive heat, fatigue, and dehydration.

Please refer to How to Prevent and Treat Migraine Headaches.

Cluster

This type of headache tends to appear in cycles (clusters) which last hours to days.  By most accounts, these are the most painful type of headache.  Typically, cluster headaches present with a sudden onset and usually subside as quickly as they start.

These headaches are the least common and only affect approximately 1% of those who suffer from headaches.  The first onset for this type of headache is usually between 20-30 years old.

Please refer to Cluster Headaches, the “Suicide Headache” for more information.

When to Seek Emergency Care:

Although most headaches do not require emergency medical attention, the following signs and symptoms indicate when to seek emergency care.

If you have any of these signs or symptoms, please seek emergency care:

  • Abrupt, severe headache
  • Severe unrelenting pain
  • Headache with a fever; stiff neck; mental confusion; seizures; double vision; weakness, numbness; and speaking difficulties
  • Headache after a head injury (especially, if the headache gets worse)
  • Muscle weakness/paralysis and/or face drooping (signs of a CVA)

How to Determine the Cause and Design an Effective Course of Treatment:

The symptoms of headache pain are nearly as diverse as the causes of headache pain.  Regardless of the onset whether sudden (such as from an injury, from a fall or motor vehicle accident) or more subtle and chronic, there are few aspects of care that are important for all headache suffers to consider.

  • Start a headache log or diary.  I always recommend beginning the process by keeping a diary in order to determine the most likely culprits prior to working on less common scenarios.  There are many obvious and common potential causes to address first.  Sometimes, it takes some serious detective work to rout out the cause and design an effective course of treatment.  The patterns noted in the diary will be clues to guide you down the right treatment path.  Don’t perseverate over every little detail of your headaches, but you need an accurate account of frequency and triggers.
  • Look for patterns.  Try to establish patterns to the headaches.  When do they occur?  Do certain foods trigger the headache?  Which activities will cause a headache?  What makes the symptoms better or worse?  Are they associated with certain movement patterns, activities or even certain times of the day or month?
  •  Which treatments work for you?  Everyone has his/her preferred cure, but what really works for you?  Don’t feel bad if someone else’s cure doesn’t work for you as we are all different.
  •  Leave no stone unturned.  When looking for patterns, consider all aspects including: food, medications, and supplements.  Also, consider your living environment.  Could there be mold in the home?  Other unknown allergens?  How is your micronutrient status?  Dental issues?

Don’t give up hope!  Headache pain is difficult to manage, but with proper care most headache pain can be cured or effectively managed.  The most frequent mistake I see people make is to not stick with a thorough plan.  Jumping around from one treatment to another rarely works.

With severe and/or chronic headache pain, a very thorough and specific plan of addressing all aspects of your health and wellbeing will need to be addressed for long term success.  This process can be slower than desired, but when executed properly, it will almost always leads to significant success.

Thanks, Brad, for the question!  I hope you and your family members find this information helpful and that they are able to experience some relief from headache pain!  Stay tuned as I will profile typical self-treatment strategies for each type of headache in upcoming posts.

Do you or a loved one suffer from headaches?  Which treatments have worked the best for you?  Please share your experience.  Together we can all grow and learn how to best manage this condition. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.