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Solving the Mystery of Headache Pain

May 13, 2013 in Lifestyle Tips, Rehabilitation, Sports with 0 Comments

There are currently 28 million headache sufferers in the United States. 21 million are female, and 7 million are male (www.americanheadachesociety.org).

People often attribute headache pain to allergies, food or other causes, but some headache pain often originates from the cervical spine. If the source of your headache pain is a mechanical diagnosis, it may be treatable with physical therapy.

If you answer “yes” to ANY one of the following questions, you could be a good candidate for physical therapy to address your headache pain:

  • Headache produced consistently with certain posture or activities (such as when you are propped up in bed reading)
  • Loss of range of motion of cervical spine when headache occurs (more painful/stiffer to turn or look up)
  • Unilateral or headache on one side of your head
  • Headache at base of the posterior portion of your head
  • Headache occurs more often when “still” versus “moving”

During my years as a clinician treating a variety of different patients, I have found alleviating a patient’s headache pain is the most rewarding. One of my former female patients arrived in my office six weeks post cervical spine fusion surgery. Two weeks after the surgery, she received an epidural injection that resulted in a constant headache. She attributed the cause of her headache to the injection. During the course of her mechanical exam, we were able to find a simple sustained head and cervical spine positioning that she could perform easily while sitting. During her first exam, this position decreased her pain from a 9 (on a 10-point scale) to a 2. She was instructed to perform this movement every 2 hours and with the occurrence of headaches. On her second visit, one week later, she reported that her headache had completely subsided within 24 hours from the initial visit. She also reported that when she felt the trace of a headache beginning to start that she could relieve it with the exercise.

If you are suffering from headaches, please don’t hesitate to tell your physician because you may be able to receive therapy as a conservative treatment option. At the St. David’s Spine and Sports Therapy Clinic, we can assess your headache and determine if it is a mechanical diagnosis that can be treated in an average of two to four visits.

-Susan Hennigan, DPT
St. David’s Spine and Sport Therapy Clinic

Importance of Physical Activity for People with Multiple Sclerosis (MS)

May 9, 2013 in Community, Rehabilitation with 0 Comments

Screenshot_5_9_13_6_25_AMAs you may know, March was Multiple Sclerosis (MS) Awareness Month. As a physical therapist who treats patients with MS, and someone with MS myself, I find I am in a unique position. Providing therapy for MS patients is something I have wanted to do since PT school, and I wrote my master’s thesis on the utilization of physical therapy by persons with MS. It is my goal to reemphasize the importance of physical activity for the MS population, as well as remind the community of the many available resources at their fingertips.

We all know that everyone benefits from physical activity, and it’s important to remember the same is true for persons with MS. However, some individuals may have more barriers than others, so activity must be individualized to fit your specific needs. I tell my patients to focus on three areas of activity—flexibility, strength and cardio. All three are needed for optimal health. My advice to all MS patients is to find some activities you enjoy that will address one or all of the above areas. Physical activity may be the key to maintaining cognitive sharpness and keeping weakness and spasticity at bay.

Below are some recommended exercises for MS patients:

  • Swimming (or just walking in a pool)
  • Walking (on the ground or a treadmill, even short durations are ok)
  • Stationary bike or rower (if your legs are not working well, an upper body ergo meter is another option)
  • Yoga
  • Pilates
  • Resistance training (either with weights or resistance bands)

The key is to keep moving, while staying cool and managing your fatigue. This could mean 10-minute workouts, several times a day. Some alternatives may include keeping up with regular daily activities that can also provide exercise, such as: gardening, vacuuming, sweeping or practicing standing from a variety of seat heights.

Overall, remember to keep moving, stay cool (especially as the summer months approach), and manage fatigue by shortening workouts or increasing daily activity frequency.

Below you can find some other resources that may be helpful:

Visit the Multiple Sclerosis Association of America for information on the following resources:

  • My MS manager application for phones
  • My MS Resource locator
  • S.E.A.R.C.H. program for navigating various medications/therapies

The National Multiple Sclerosis Society has a great online community with resources and information including:

Consortium of Multiple Sclerosis Centers is another good resource.

  • NARCOMS (North American Research Committee on Multiple Sclerosis)

If you don’t have MS, but know someone who does, consider fundraising for research via an MS walk or bike ride! Check out the National Multiple Sclerosis Society for more information.

- Kathy Bolstorff, PT, NCS, MSCS

Pregnancy with Low Back Pain or Sciatica

March 27, 2013 in Baby/Infant, Rehabilitation with 0 Comments

Screenshot_3_27_13_6_52_AMMany pregnant women with low back pain feel they will have to suffer with the pain until their baby is born. After delivery, some mothers continue to have symptoms, but their schedule doesn’t allow them to receive any treatment. Months and even years pass before they can find the time to address their back pain. The repetitive bending, lifting and nursing can further exacerbate their symptoms leaving the patient to feel helpless and limiting the amount of care they can provide to their new baby.

At St. David’s Spine and Sports Therapy, we advocate starting physical therapy for pregnant women as soon as symptoms commence. Injections and medications are not an option for this population; therefore, physical therapy is often their only attempt at conservative treatment. Many pregnant women respond very quickly to mechanical therapy and require no more than 6-8 visits to resolve their problem. Furthermore, most of these patients display directional preference which dictates the treatment plan giving these patients immediate pain relieve with just a few simple exercises. Often, these patients are fearful of exercise worsening their symptoms or harming the baby, so guidance from their physical therapist is essential to their recovery. By increasing awareness that early intervention is an option, these patients can avoid chronic problems and be able to enjoy their new baby without having to suffer from back pain or sciatica. A specialized therapist can also help the post-partum mother with more chronic problems. Consulting a therapist with advanced training in spine care can help alleviate back pain and allow you to focus on your new baby. 

Kim Greene, PT Dip. MDT
St. David’s Spine and Sports Therapy
Diploma in Mechanical Diagnosis and Therapy

3000 N. IH-35 Suite 530
Austin, TX 78705
Phone: 512 544-5092

Maximize your Balance

March 11, 2013 in Rehabilitation with 0 Comments

Screenshot_3_11_13_12_24_PMApproximately 12.5 million Americans over the age of 65 have a dizziness or balance problem that significantly interferes with their lives. The ability to maintain one’s balance is controlled by 3 major sensory systems that provide information for the brain to process—the visual, vestibular and somatosensory systems, also known as, the eyes, ears and feet.

The vestibular (ear) system is the first sensory system to develop. It is visible at two months gestation and fully formed by the fifth month of gestation. The semi-circular canals, the saccule and utricle are housed in the inner ear. The semi-circular canals, utricle and saccule provide information on head rotation, position and body direction, and speed of movement to assist the brain’s processing of our orientation in space and to coordinate associated eye movements. As we age, beginning at approximately 55 years old, the number of vestibular nerve cells and blood flow to the inner ear decreases. This may manifest as slow, gradual changes in the quality of balance. One may start to notice imbalance with standing or walking in various conditions, such as, dim or dark lighting, across thick carpet, grass or sand or on uneven surfaces like gravel, cobblestone, ramps and stairs.

What can you do to combat these age-associated changes in the inner ear?

  • Have hearing and vision check-ups regularly. If hearing and vision are impaired, important cues that help maintain balance can be lost.
  • Hearing tests can be used to detect inner ear disorders that affect both balance and hearing.
  • Keep your contact lenses or eye glasses prescription current. An article from the Journal of Physical Therapy stated that a visual acuity of 20/40 can cause imbalance. For those who have presbyopia (where you experience blurred near vision), you may want to consider having a specific pair of glasses for reading and a separate pair for intermediate/far distances to minimize conflicts in depth perception (that affect balance) that can occur with bifocal or progressive lenses.
  • Take care of your feet. Remember the feet also provide information to the brain on position in space. Have your primary care physician or podiatrist assess your foot health, especially for diabetics. They can monitor your feet for any changes in sensation. If you notice any numbness or tingling in the feet, for instance as seen in peripheral neuropathy, contact your doctor to perform a comprehensive sensory examination to the feet.
  • Stay Active! Join a T’ai chi, Yoga, dance class or activities designed to promote flexibility, sharpen coordination and balance. Many of these activities can be modified for individuals of various physical levels and ability. According to the British Journal of Sports Medicine, a regular exercise program may improve protective responses in case of a fall. Being sedentary may not only put you at risk for obesity, heart disease and a whole host of other diseases, it prevents stimulation of the vestibular system, and it may also lead to decreased flexibility and strength, which are necessary for having good balance.

If you suspect difficulties in maintaining your balance, speak to your doctor about prescribing vestibular rehabilitation, a type of therapy specific to balance and dizziness disorders.

-Natasha Johnson, Sr. Physical Therapist
Certified Vestibular and Vision Specialist
St. David’s Rehabilitation Hospital

Early Aquatic Therapy Following Total Knee Replacement Improves Outcomes

February 11, 2013 in Lifestyle Tips, Rehabilitation with 2 Comments

Screenshot_2_11_13_6_57_AM 2Aquatic physical therapy after a total knee replacement surgery is often used in conjunction with land-based physical therapy to reduce pain and swelling, increase a joint’s range of motion, improve strength and balance, and restore a normalized walking pattern. The principle of buoyancy allows a clinician to adjust the amount of weight bearing appropriate for each client’s particular needs/restrictions. Deeper water could be used for decreasing pain or adhering to a person’s weight restrictions following surgery. A person can also work on improving their walking pattern without an assistive device early on and decrease compensatory movements that may develop on land due to weakness edema and discomfort.

A recent peer-reviewed research study conducted in Germany investigated whether early participation in an aquatic therapy program following a total knee replacement had any effect over later initiation of aquatic therapy. Patients were randomly assigned to start aquatic therapy either 6 days or 14 days after their knee replacement surgery. Validated tests for joint stiffness, pain and physical function were evaluated at 3, 6, 12 and 24 months after the surgery. All measured outcomes in the group that started aquatic therapy early were better than the group that started later. The lead researcher hypothesized that the amount of joint effusion present inside the repaired knee capsule after surgery was less due to the hydrostatic force of the water during pool therapy. Higher levels of joint effusion generally result in more pain and decreased range of motion.

Screenshot_2_11_13_6_57_AMBob Rambusek, Senior Physical Therapist
St. David’s Rehabilitation Hospital

10 things that will make your home a NO FALL ZONE

January 15, 2013 in Rehabilitation, Tips with 0 Comments

Screenshot_1_15_13_7_05_PM(Guest Post: Lynelle Evans, PT Supervisor, St. David’s Rehabilitation Hospital)

How to equip your home to be a NO FALL ZONE – This is an issue for all generations whether you are in your 20s and thinking of your grandparents, or you are in your 70s and thinking of your own safety. Here are 10 things that will make your home a NO FALL ZONE:

  1. Make sure you have rails or grab bars for any steps or stairs.
  2. Remove all throw rugs in all rooms and your bath rooms. If you have one in your bathroom, put it away when you are not bathing.
  3. Do not allow any electrical cords to stretch across walk ways.
  4. Clear pathways throughout the house.
  5. Leave a night light or the bathroom light on at night.
  6. Phones – either carry one with you at all times or have voice mail on your home phones, so you do not have to rush to answer a phone.
  7. Be aware of your pets – those that might get between your feet and cause a fall or that might be big enough to knock you off balance.
  8. Toys – if you have young children or grandchildren in your home, be aware of their toys on the floors; also pet toys.
  9. Be aware of raised thresholds that may cause you to trip if you catch a toe.
  10. Place grab bars around your bathtub or shower areas.

This is by no means an exhaustive list on how to prevent falls, but this is a start to having a NO FALL ZONE in your house or a house of a loved one.

10 Reasons Why St. David’s Rehabilitation is the Top Performing Rehabilitation System in the Central Texas Region.

September 12, 2012 in Rehabilitation with 0 Comments

via flickr

(post via Diane Owens, PT, FACHE - Assistant Administrator - St. David’s Rehabilitation Hospital)

  1. Our three neurologists have 100+ years of cumulative experience in Rehab Neurology. The experience of our combined medical staff exceeds 165 years.
  2. Our spinal cord and amputee programs are led by a fellowship-trained physical medicine specialist.
  3. 24/7 Internal Medicine coverage is provided by our experienced internists.
  4. Our facility has served the Central Texas area for twenty-seven years.
  5. All our facilities are located on the campus of comprehensive medical centers and have access to a full complement of physician specialists as well as the latest technology for diagnosis and treatment.
  6. Services provided are the most comprehensive in the area and include driver’s training in one of two behind-the-wheel Adaptive Driving programs in Texas, two Neurological Day Programs, five support groups, a Wheelchair Fitness program, outpatient therapy, the largest aquatic program in the region and 107 inpatient rehabilitation beds.
  7. Research at St. David’s Rehabilitation Hospital and the NeuroTexas Institute focuses on improving knowledge of neuroscience and rehabilitative care. Two current projects evaluate the outcomes for the WalkAid and Body Weight Supported Treadmill Training.
  8. Professionals at St. David’s Rehabilitation have achieved the highest levels of certification in their fields. Our staff includes Masters’ level physical and occupational therapists with post-graduate training in neurodevelopmental treatment, the gold standard approach for treatment of neurologically compromised patients. In addition, the majority of our RN staff are Certified Rehabilitation Registered Nurses.
  9. In the Press Ganey Patient Satisfaction Survey, patients ranked us in the top ten percent nationally for Likelihood to Recommend our Facility.
  10. Outcome scores measuring a patient’s amount of overall functional improvement are consistently well above national and regional averages and in the top quartile as compared to all rehabilitation facilities nationally.

3 Things You Can Do to Help Avoid West Nile Virus

September 9, 2012 in Children, Community, Exercise, Outdoors, Rehabilitation, Sports, Tips with 0 Comments

via flickr

West Nile virus illnesses in Texas continue to rise dramatically, with the number of cases this summer rising to 1,013 — with 40 deaths. That is a 58 percent increase in cases and 74 percent increase in deaths. State officials warned that the infections may continue until the first hard freeze of the year. To protect yourself and your family from exposure to mosquitoes infected with West Nile virus:

  1. Be sure to wear long pants and long sleeves during dusk and dawn.
  2. Apply a repellant with DEET.
  3. Remove all standing water from the yard.

West Nile virus is asymptomatic in 80% of those infected. 20% of patients present with clinical disease. West Nile virus can cause a neuro-invasive disease or West Nile fever. In addition, a recent research study completed by Dr. Art Leis indicated that 40% of West Nile fever patients also had markers for the more serious West Nile illness indicating the effects of West Nile fever may be more extensive than previously thought.
In the more severe cases, patients can develop a variety of neurological deficits including meningitis, encephalitis and polio-like limb weakness. Rehabilitation at an intensive rehabilitation hospital and the expertise of neurology may be required. Patients may require physical therapy for strengthening and training to learn to walk again, occupational therapy to relearn activities of daily living such as bathing, dressing and toileting and speech therapy to address any deficits in cognitive function, memory, swallow or communication.

There is no cure or treatment for West Nile virus. Until our first hard freeze, remember to protect yourself and your family from exposure to mosquitoes.

Diane Owens, PT, FACHE
Assistant Administrator
St. David’s Rehabilitation Hospital

Impact of Spinal Cord Injuries

May 30, 2012 in Lifestyle Tips, Outdoors, Rehabilitation with 1 Comment

Spinal cord injuries (SCI) occur when a traumatic event causes damage to cells within the spinal column/cord or severs the nerve tracts that send signals up/down the spinal cord. Approximately 250,000 Americans are spinal cord injured with almost 11,000 new injuries a year. Of these individuals, 52% are paraplegics (impairment of motor and sensory function to the lower extremities) and 47% are quadriplegic (impairment of both arms and legs). About 82% of the spinal cord population is males and 56% of the injuries occurring between the ages of 16 and 30.

As the summer months approach, pay particular care when participating in sports and recreation activities. Causes of spinal cord injury include:

  • Motor vehicle accidents. Auto and motorcycle accidents are the leading cause of spinal cord injuries, accounting for more than 40 percent of new spinal cord injuries each year.
  • Falls. Spinal cord injury after age 65 is most often caused by a fall. Overall, falls cause more than one-quarter of spinal cord injuries.
  • Acts of violence. As many as 15 percent of spinal cord injuries result from violent encounters, often involving gunshot and knife wounds, according to the National Institute of Neurological Disorders and Stroke.
  • Sports and recreation injuries. Athletic activities, such as impact sports and diving in shallow water, cause about 8 percent of spinal cord injuries.
  • Alcohol. Alcohol use is a factor in about 1 out of every 4 spinal cord injuries.
  • Diseases. Cancer, arthritis, osteoporosis and inflammation of the spinal cord also can cause spinal cord injuries.

Following a spinal cord injury, the length of stay in a hospital is about 15 days and an average of 44 days in a rehabilitation facility. The initial cost for the hospital stay alone is $140,000. Following healthcare, 89% of SCI patients are discharged from the hospital to home and 4.3% are discharged to a nursing home. Many times, families look to others dealing with the same challenges for support.

At St. David’s Rehabilitation Hospital, a support group led by Pamela Fletcher and Dona Carlson, provides education, resources and activities for spinal cord injury survivors and their families. The group meets at St. David’s Rehabilitation Hospital on the second Thursday of every month from 3:00 to 5:30. For more information, contact Pam Fletcher at 826-0813.

Barbara Lasiter, MBA
Director of Rehabilitation Operations

New Studies Highlight the Health Problems Related to Prolonged Sitting

May 9, 2012 in Exercise, Lifestyle Tips, Rehabilitation, Women with 0 Comments

A new study published in the Archives of Internal Medicine states that sitting for long periods of time increases your risk of all-cause early death. Those at greatest risk are people who sit more than eleven hours a day, followed by those who sit eight to eleven hours a day. If you sit four hours or less a day, you have the lowest risk.

This study is alarming considering the rise in sedentary jobs across the country. Don’t despair. For those with desk jobs, occupational health experts have developed a sit-stand workstation. These desks make computing comfortable for prolonged periods by allowing the flexibility to switch from sitting to standing with the flick of the wrist. Another option is the treadmill desk where you can slowly walk on the treadmill while working on the computer. If you don’t want to change your desk at work, incorporate standing and walking into your activities at least every hour. Climb the stairs. Bike or walk to work, if possible.

Prolonged sitting at work is not the only culprit. The average American sits for 90% of their leisure time. If an active lifestyle is not part of your leisure time, you are at risk for a number of health-related issues. For women, this includes diabetes and breast cancer. For all of us, it includes colon cancer, back pain and as stated above, risk of early death.

So whatever you do, get out of the chair and start moving. Consult a physical therapist if you need help establishing the right exercise program for you. Now, it’s time for me to walk my dog.

Diane Owens, PT, FACHE
Assistant Administrator
St. David’s Rehabilitation Hospital

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