Are your headaches not getting better?

Headache treatment at Synergy.

Headache treatment at Synergy.

I thought you might find it interesting to know how we specifically look at headache management. Synergy is known for treating patients with complex headache issues, and you might not know that.  These are the main areas we look at: history of falls, trauma/injuries throughout the whole body, nutrition (food sensitivities),  sleep, sleep postures, birth history, positional and occupational habits and recreational and hobby postures.

When treating headaches that are not cranial-trauma induced, it is necessary to take into account posture when sitting, standing and in supine.  A person’s posture is developed from habit, occupational and recreational repetitive activities, emotional strain, and injuries. So determining the history of falls, especially hard falls on the coccyx, sacrum or ischial tuberosities is very important.   The reason whysuboccipital muscles this information is useful is the nature of the pelvis, vertebral column, and base of the skull. Falls can lead to pubic bone, sacroiliac, and lumbosacral joint problems. The tendinous insertion problems can result in asymmetries that then lead to imbalanced muscle firing. This imbalance in muscular firing can wreak havoc throughout the spine.

 

Imagine it happening to the tiny muscles up through the spine. These muscles have the capacity to shift and change over and over throughout the day and night.  Studies show that they fire before any motion actually happens in preparation to protect the spine, however if a few of them are in the contracted short or elongated position,  other muscles will have to accommodate for them. This is generally not a problem, but what if they can’t accommodate anymore? Such as in permanent arthritic changes, surgery, disc damage, or a whiplash injury.

 

It then becomes imperative to give the body as much accommodation as possible in the available structures. Problems low down can contribute to headaches and pain syndromes along with myriad other complaints.

So how we treat is not as important as why we treat the way we do.  What is the rationale for the process that we use?
1.Removing edema and improving venous drainage through lymphatic drainage therapy, manual lymphatic massage, strain counterstrain venous/lymphatic  techniques, or total body balancing  (old Osteopathic global body treatment)  is generally the first approach.  We have many techniques to improve fluidic flow through the thoracic inlet.
2. Bone and ligament restrictions need to be addressed. We also check for spring in the rib cage. If that entire area is rigid and fixed, it can lead to all sorts of mischief.
3.  Next, we look at muscular and fascial restriction.   Whatever cervical musculature is in spasm can be relieved through lymphatic techniques, myofascial release or strain counterstrain.
4. We can determine specific arteries, veins, or nerves that are causing dysfunction and free them up.

Motion is first priority, then alignment through structural mobilization and then finally
strengthening with the body in a balanced position.

Once the pelvis, thoracic and cervical spine influences to the cranium have been reduced, I will utilize craniosacral therapy techniques to specifically mobilize local structures that continue to be drivers of the pain/symptoms.  These techniques are best suited to patients with post concussive syndrome, traumatic brain injury, vertigo, trigeminal neuralgia, Bell’s palsy, vision and auditory problems, (structurally based) birth trauma including colic, torticollis (jugular foramen compression) and myriad other specific cranial issues.

Lastly, I utilize progressive relaxation techniques to teach patients how to let go of muscle tension that they might not be aware of and review postures that might be contributing to maintaining dysfunctional patterns.

Vitality, mobility and position are the tenants of the clinic. Hope you enjoyed the leisurely walk through my thinking process.  

Sometimes a headache isn’t just a headache.

 

If you would like to read the full version the link is here. Link here to an article we sent to doctors.

DSCN1925

Shauna upside down and out of the box

 

 

Best,

Shauna Burchett OTR/L owner

 

 

 

 

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Are your headache patients not getting better?

I thought you might find it interesting to know how we specifically look at headache management for your patients.  Synergy is known for treating patients with complex cervicocephalic issues, and you might not know that.  These are the main areas we look at: history of falls, trauma/injuries throughout the whole body, nutrition (food sensitivities),  sleep, sleep postures, birth history, positional and occupational habits and recreational and hobby postures.

When treating headaches that are not cranial-trauma induced, it is necessary to take into account posture when sitting, standing and in supine.  A person’s posture is developed from habit, occupational and recreational repetitive activities, emotional strain, and injuries. So determining the history of falls, especially hard falls on the coccyx, sacrum or ischial tuberosities is very important.   The reason why this information is useful is the nature of the pelvis, vertebral column, dural attachments in the suboccipital region, anterior and posterior longitudinal ligaments and nuchal ligament.   Any kind of trauma to the bone can lead to an intraosseous or interosseous lesion of the bone(s) in question.  Falls can lead to pubic bone, sacroiliac, and lumbosacral joint dysfunction.  These falls can cause a direct biomechanical problem or a more subtle change to the periosteum and then the attachment of tendons. The tendinous insertion dysfunction can result in asymmetries that then lead to imbalanced muscle firing. This imbalance in muscular firing can wreak havoc throughout the spine.

suboccipital musclesImagine it happening with the small Rectus Capitis posterior minor/major muscles as they attach to the occiput, C1,  and through a myodural bridge directly to the cervical dura. Hyperflexion extension injuries activate Rectus Capitus major /minor and Obliquus Capitus superior/inferior muscles and convey  forces through the attachment to the cervical dura. Studies show that links between the suboccipital musculature, fascia, and cervical dura mater have involvement  in cervicocephalic pain syndromes, sensorimotor activity, and postural regulation. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025088/

Imagine it happening to the tiny multifidi muscles up through the spine. These muscles have the capacity to shift and change over and over throughout the day and night.  Studies show that they fire before any motion actually happens in preparation to protect the spine, however if a few of them are in the contracted short or elongated position,  other muscles will have to accommodate for them. This is generally not a problem, but what if they can’t accommodate anymore? Such as in permanent arthritic changes, surgery, disc damage, or a high velocity injury.

It then becomes imperative to give the body as much accommodation as possible in the available structures. Dysfunction low down on the kinetic chain can contribute to cervicocephalic headaches and pain syndromes along with myriad other complaints.

Aggressive treatment of the dural tube, the intraosseous and interosseous lesions in the sacrum, ilium, ischium and the pelvic floor to give as much ability to move in the pelvis, will invariably give the vertebral column room to move. More motion provides more motion. Give a little bit of motion in a lot of places translates to a lot of motion overall, versus focusing on the one area which doesn’t move. This is very common with new practitioners. The suboccipital region is tight and patients say that their headaches come from that spot. Practitioners do everything in that area, ice, heat, estim, vertebral mobilization, massage.  Patients get some relief,  but it often comes back eventually because the therapist didn’t find the source of the dysfunction. Finding the source that is driving that dysfunction is a much more global approach, it may take longer, but it also can be more permanent. Often times, headaches are as a result of lack of mobility in a certain area of the spine or pelvis.

So how we treat is not as important as why we treat the way we do.  What is the rationale for the process that we use?

1. Removing edema and improving venous drainage through lymphatic drainage therapy, manual lymphatic massage, strain counterstrain venous/lymphatic  techniques, or total body balancing  (old Osteopathic global body treatment)  is generally the first approach.  We have many techniques to improve fluidic flow through the thoracic inlet.

2. Osseous and ligamentous restrictions need to be addressed (clavicular mobilization sternoclavicular and costoclavicular mobilization, including first rib and C7-T1 junction) and all of the associated ligaments. We also check for spring in the rib cage. If that entire area is rigid and fixed, it can lead to all sorts of mischief.

3. Next, we look at muscular and fascial restriction.   Whatever cervical musculature is in spasm can be relieved through lymphatic techniques, myofascial release or strain counterstrain.

4. We can determine specific arteries, veins, or nerves that are causing dysfunction and free them up.

For example, if someone has a Sternocleidomastoid chronic hypertonicity, we are going to evaluate the sternal, clavicular and mastoid attachments  and see if there is rigidity, edema, heat or fibrosity.  All of those symptoms reveal some sort of causality. We need to get fluid to flow to reduce hypertonicity. Jugulodigastric, anterior cervical and supraclavicular lymph needs to flow really well for ultimate healing to occur.  Ligamentous hydration is addressed through oscillatory techniques.   Fascial and muscular mobilization and stretching may be indicated, however we now know that compression of a structure is much more effective to provide long term change.  Taking a region into ease is much less stimulating to the nervous system which promotes parasympathetic  tone. Overall healing only happens in heightened parasympathetic tone.

Motion is first priority, then alignment through structural mobilization and then finally strengthening with the body in a balanced position.

We want to increase vitality in all of the structures treated. What is vitality? It is the inherent health of the tissues. Tissues on a 60-year-old smoker is much different than an organic eating 30-year-old athlete. Restoring vitality to the bones, increasing their hydration and capacity for hydration, changes the nature of the periosteum, thereby changing the tendinous attachments, thereby changing the ability, and perhaps even make up, of the muscle fibers from static to more dynamic.

It is very necessary to ensure that dura is moving as well as it can, especially in the upper cervical region.   Direct mobilization is necessary with prolonged gentle force to make a change, because it is one tough mother, if you will.

Anterior longitudinal ligament and nuchal ligament mobilization in the cervical spine will improve cervical lordosis. As we age and have trauma and falls, the curves in our spine can change leading to a more flattened curve in the lumbar, thoracic and cervical region thus

displacing the forces of gravity and shifting them into a less energy conservative manner. As energy is expended to keep the head in neutral position and the eyes level with the horizon, muscles can splint into place and shorten posteriorly and lengthen anteriorly, especially in the neck. The contracted nuchal ligament  can lead to degenerative changes in the spine. If the curves are maintained throughout life, the less chance of degenerative changes, especially at C5-6 and L4-L5,L5-S1, the most common areas for the discs to wear out.  Optimal organ function and fluidic exchange is also tied to maintaining the curves.

Once the pelvis, thoracic and cervical spine influences to the cranium have been reduced, I will utilize craniosacral therapy techniques to specifically mobilize local structures that continue to be drivers of the pain/symptoms. These techniques are best suited to patients with post concussive syndrome, traumatic brain injury, vertigo, trigeminal neuralgia, Bell’s palsy, vision and auditory problems, (structurally based) birth trauma including colic, torticollis (jugular foramen compression) and myriad other specific cranial issues.

 

On the first or second visit I start to implement an exercise routine to give patients control over their own care and build body awareness. The one that I’ve most recently fallen in love with is called Total Motion Release. Otherwise known as TMR in our clinic. It’s a balancing technique, not a strengthening one because I’ve learned over time that pain is a result of imbalance. Perhaps in a joint, throughout the spine, various offending musculature regions, or intraosseous driven. It really doesn’t matter. Total Motion Release directs the patient to treat the good side, and by some weird neurological quirk, it fixes an imbalance in the body.

Try it. This is the participation part of the article- I know you didn’t expect this, bare with me, no one is watching you, well maybe they are,  but be a rebel. Put your feet squarely on the floor, sit forward on the edge of the chair. Put your hands on your stomach, Twist to the right and look over your shoulder, then twist to the left and look over that shoulder. Test and see which way goes further, has greater ease, and no pain. Then twist that way (the good way) for 20 seconds, two times and then reevaluate (make sure you make it count, don’t be whimpy- push it). Your twists should be more symmetrical when you check right versus left.  You might need to do it two, three or four times to get them even but eventually they will be, unless you have some sort of structural issue that needs treatment from someone like me. Balance leads to less pain.

Lastly, I utilize progressive relaxation techniques to teach patients how to let go of muscle tension that they might not be aware of and review postures that might be contributing to maintaining dysfunctional patterns.

Vitality, mobility and position are the tenants of the clinic. Hope you enjoyed the leisurely walk through my thinking process.  Sometimes a headache isn’t just a headache.


Best,

Shauna Burchett OTR/L owner

 

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What Really Causes Migraines?

headachesMany people have tried to answer this question over the years. The most recent contender is Dr. Peter James Goadsby, and what he has to say is really turning heads. As mentioned in our previous article, migraines are different than tension or sinus headaches in that they aren’t caused my muscle tension or sinus congestion. Most people know that migraines can be triggered by things like bright lights, certain foods or hormonal imbalances- but is the trigger really the cause?

Common Theories

Up til now the theory has been that migraine headaches are an exaggerated pain response. When the brain perceives pain (ex. those bright lights) the blood vessels to the brain are enlarged and the nerve fibers coiled around them are compressed to make even more pain. Of course the mystery behind why some people react that way while the rest of us are migraine free has eluded researchers. What is Dr. Goadsby’s research bringing to the table?

Taking a Step Back

Researchers have been using brain scans to monitor what happens during a migraine for a while. Dr. Goadby’s research takes a step back in that  his focus is on what happens before the migraine. For the study researchers used mildly radioactive water to track brain activity while the subjects were given a well known migraine trigger. Interestingly before the onset of a painful migraine the subjects showed increased brain activity the hypothalmus, midbrain and pons- all areas that are active during a migraine. Also areas in the visual cortex and medulla that control light sensitivity and nausea were activated which implies that these symptoms might not be associated with the pain of a migraine but with the actual migraine process.

Conclusions

After looking at the brain scans researchers concluded that migraines  are not a response to pain, it is actually a brain disorder. What does this mean? Dr. Goadby believes that with this added insight they can start developing medications that will target the brain and underlying problem. If you suffer from migraines what can you do? First get to know your body and listen to what it says. Try to figure out what your migraine triggers are and avoid them. There are many different treatments for migraines, get the advice of your doctor and try to find something that works for you.

What can Synergy do?

While Synergy Healthcare therapists can’t write you prescription for medication we definitely have the skills to help! Shauna Burchett, OTR/L  specializes in craniosacral therapy.  This is a gentle technique that focuses on balancing the flow of cerebrospinal fluid in your brain and spine. Many people have found it effective in relieving chronic migraines- why not try it for yourself? We also have physical therapy that can address many components of migraine pain.

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Yikes! I have a Migraine… or do I?

headache

headache

Headaches are a pain in general but they sometimes can be a sign of some deeper issue. How can you tell if you have a migraine or a simple tension headache? How do you know if you should see a doctor? What can Synergy Healthcare do to help??

Migraine vs. Tension Headache

Generally migraines are more severe and last longer than tension headaches but don’t assume that all bad headaches are migraines. Each kind of headache has some specific characteristics that are important to consider.

 

 

Migraine:

  • Sometimes preceded by fatigue, insomnia and/or loss of appetite.
  • Starts fast and lasts from a few hours to a couple days.
  • Focused on one side of the head in the temples, forehead or base of the neck.
  • Accompanied by light-sensitivity, nausea, vomiting and generally being laid up on the couch.
  • Vision disruption, weird skin sensations like itching or burning, and speech problems like slurring and skipping words are called an “aura”. The “aura” generally starts soon after the migraine and lasts less than hour. Sometimes the “aura” can last longer but this isn’t common.

Tension Headache:

  • Generally starts in the neck or back of head and slowly travels forward.
  • Can be one or both sided, focused in the sinuses, forehead, temples or cheekbones.
  • Associated with irritability, difficulty concentrating.

What if it’s a deeper issue?

Chronic headaches can be a sign of a deeper health issue or lifestyle habit. Migraines have been linked to some specific food triggers such as white wine, milk chocolate, beer, apple juice or dried apricots. Tension headaches can be brought on by poor posture or trigger points in the neck and shoulders. Other causes of a headache could be hormonal imbalances, head injury, high blood pressure, sinus problems and reactions to medication. You should call your doctor if you start presenting these symptoms associated with your headache:

  • Rise in temperature.
  • Vomiting.
  • Paranoia, or sense of impending danger.
  • If your headache was triggered by a head injury, coughing, bending over or strenuous activity.
  • You get a sudden horrible headache along with a stiff neck.
  • You have headaches two or three times a week.

What can Synergy Healthcare do to help?

Our staff of highly trained occupational and physical therapy have a unique blend of techniques that can help relieve even severe chronic headaches. Craniosacral therapy, myofascial release and strain counterstrain have all been extremely effective in treating headaches. We accept most major insurances. Email us at info@synergyspokane.com or give us a call at (509) 413-1630 anytime!

Stay tuned for things you can do at home to help reduce headaches! Have something you want us to blog about? Give us a shout out on Facebook or comment below- we love to hear what you think!

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