Uncategorized – Page 5 – Dr. Abbate Physical Therapy

January 6, 2024January 6, 2024

Headache features

The below chart describes headache features and commonly associated, patient-reported experiences. These include tension-type headaches, migraine and cluster headaches. Very often, these symptoms overlap, or may have distinctive features.

Tension-type headaches are often described as painful pressure/tightness. Migraines are often associated with an aura and sensitivity to light or sound. Cluster headaches may be associated with a change in vision, nasal congestion or excessive facial sweating.

Headaches can be treated with pharmacological and non-pharmacological interventions.

Pharmacological interventions include medication. Non-pharmacological intervention can include physical therapy and cognitive-behavioral therapy.

Treatment options for physical therapy include strength training, joint mobility, manual therapy and dry needling.

These interventions are generally safe, effective and can provide long-lasting relief. They also eliminate the risk of side effects that are often observed with medication. Often, medication side-effects make the use of that intervention undesirable. Taking medication can often lead to worsening or the development of unrelated, and previously not experienced symptoms. These can include dryness of eyes/mouth, gastro-intestinal and cardiovascular issues.

It is always recommended that you communicate to your health care provider the most accurate information regarding your symptoms, past and current treatments, effectiveness of those treatments, and your preference for any specific intervention.

If you are interested in pursuing non-pharmacological intervention, physical therapy may be the right choice for you.

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January 6, 2024January 7, 2024

Headache Red Flags

While headaches often result in pain and disability, ruling out more serious pathology is an important part of a physical therapy examination. Physical therapists use a comprehensive history, patient reports and measurements within the clinic to determine pain and disability to develop a plan of care to address these impairments. Certain symptoms experienced by patients may require follow up by a medical doctor.

Further evaluation by medical professional include any from the following list:

Worsening headache with fever
Sudden-onset headache reaching maximum intensity within 5 minutes
New-onset neurological deficit
Change in personality
Impaired level of consciousness
Recent head trauma (within the past 3 months)
Headache triggered by cough, sneeze of valsalva (trying to breathe out the nose and mouth blocked)
Headache triggered by exercise
Orthostatic headache (headache that changes with posture)
Symptoms suggestive of giant cell arteritis (inflammation of the arterial walls)
Symptoms of acute narrow angle glaucoma (eye condition that results in blockage of fluid drainage from the eye)
A substantial change in headache characteristics

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January 6, 2024January 6, 2024

Can Physical Therapy Examination Help Improve Migraines?

Identifying neck impairments in people experiencing migraines may help lead to better outcomes. Physical therapy testing includes assessment of neck range of motion and posture to help diagnose mechanical neck pain in those experiencing migraines.

Migraines affect nearly 11% of people worldwide and is the third leading cause of disability in people under the age of 50. Neck pain is often associated with the onset of migraines. Non-pharmacological treatment is a promising treatment for migraines. Certain tests can help therapists identify muscle related impairments that can assist with determining treatment options.

This article reviewed the literature to identify what clinical tests are useful in determining the presence of muscle-related impairments in individuals experiencing migraines. While many tests were considered, only those that were easily performed and accessible to therapists without expensive equipment.

The review found that measurements including neck range of motion, flexion-rotation test and forward head posture were safe, effective and useful in determining muscle related impairments that may lead to experiencing migraines.

Conclusion: Therapists can perform safe examination techniques to determine the involvement of the musculoskeletal system and migraine experience. This may help determine which non-pharmacological treatment options are best for migraines.

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January 6, 2024January 7, 2024

Electric dry needling and manipulation vs Joint mobility and exercises for Cervicogenic Headaches

Electrical dry needling, spinal manipulations, joint mobility and exercises are effective treatment options for cervicogenic headaches (headaches originating from the neck). Electrical dry needling and manipulations are superior at improving headache intensity, frequency and disability compared to joint mobility and exercise. Benefits were observed at 3 month follow up after treatment.

Cervicogenic headaches (CGH, neck-related headaches), account for 20% of all headaches, and as high as 53% of headaches following whiplash injury. Whiplash injuries are often experienced after car accidents. Neck related headaches are defined as one sided headache or pain, made worse with pressure over the affected muscles, loss of neck range of motion, and triggered by awkward or sustained neck movements. Interventions that include a combination of treatments seem to be more effective at treating neck-related headaches than stand-alone treatments.

In this article, participants were an average of 40 years old, with most taking medication at least once per day or several times per weeks, experienced an average headache intensity of 6/10, with most headaches lasting between 11-24 hours. Participants were separated into two treatment groups. One group received dry needling with stimulation and spinal manipulation. The other group received joint mobility and strength training exercises. Measurements included neck pain, headache frequency and duration, disability and medication use. These measurements were taken at baseline (prior to therapy), 1 week, 4 weeks and 3 months after the last treatment session. Treatments consisted of twice weekly interventions for 4 weeks.

The findings demonstrated that both groups improved significantly in all outcome measures. However, the dry needling and manipulation group experienced much greater improvements in headache intensity, frequency and duration, less medication use and less disability compared to the joint mobility and exercise group.

Conclusion: Physical therapy can utilize non-pharmacological interventions to address neck pain, headaches and disability.

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January 6, 2024January 6, 2024

Neck pain, dry needling and balance

A change in tension of neck muscles may contribute to balance deficits often experienced in people with neck pain. One muscle in particular, the obliquus capitis inferior (OCI, seen in picture), plays an important role in facilitating coordination and balance. This muscle communicates joint position to the vestibular system and vision systems to maintain an upright posture. Dry needling this muscle improve pain, cervical range of motion and joint position sense.

Neck pain is often associated with balance issues. This may be attributed to an alteration in tension of specific neck muscles that are responsible for relaying information to the balance system (collectively the vestibular, ocular and proprioceptive systems). An interruption of this signaling process due to injury, or perhaps poor neck range of motion, can lead to poor balance or a change in posture. The resulting poor balance and loss of neck range of motion can exacerbate the underlying issue. Dry needling is an effective intervention for the treatment of to change signaling from this muscle.

In this article, 40 participants with an average age of 37, experiencing neck pain (>3/10 pain) for 3+ months, with a moderate to severe disability (measured by the Neck Disability Index), poor joint position, and limited neck motion were recruited and divided into two groups. Group one received dry needling to the OCI and group two received sham (fake) needling of the OCI. The participants measurements included neck pain, cervical range of motion, joint position error, standing balance and disability (Neck Disability Index). These measurements were taken at baseline, immediately after intervention and 1 week after intervention.

The findings demonstrated a significant improvement in pain, neck range of motion and an improvement in joint position. However, no improvements were demonstrated with standing balance tests. This may be attributed to limited follow up (1 week after intervention), limited treatment exposure (1 session), and possible involvement of multiple systems that weren’t addressed (vision, vestibular, proprioceptive). It is promising that moderate effects were seen with joint position sense (one aspect of balance).

Conclusion: Dry needling is a safe and effective intervention to address neck pain, improve neck range of motion and improve joint position sense.

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January 6, 2024January 6, 2024

Dry needling versus manual therapy in chronic neck pain

Dry needling and manual therapy are equally effective at treating pain and loss of neck range of motion that result in disability. Dry needling appears to improve sensitivity to touch better than manual therapy alone.

Between 50-80% of the population will experience neck pain at some point in their life. Of those that do experience neck pain, many will develop chronic symptoms. Both dry needling and manual therapy have been successful in resolving pain and improving function. This includes resolution of trigger points, or “muscle knots” that are hypersensitive to touch. However, superiority of one intervention over the other has not been demonstrated in the literature.

This article includes 94 participants, split into two groups, either receiving dry needling or manual therapy. Measurements included pain, disability, pressure pain threshold and cervical range of motion. Participants were measured before, immediately after, 1 week and 2 weeks after treatment.

The study demonstrated that while both groups experienced significant reductions in neck pain and improvements in range of motion, the dry needling group had a much greater improvement in sensitivity to touch. Neither group demonstrated any significant side effects.

Conclusion: Physical therapist can provide safe and effective treatment that includes dry needling and manual therapy for the resolution of neck pain, neck range of motion and disability.

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January 6, 2024January 6, 2024

Dry needling and acute neck pain

Dry needling intervention improves neck pain, hypersensitivity to touch, and neck range of motion in people experiencing mechanical neck pain.

Neck pain is often associated with the presence of trigger points, or muscle “knots” (hypersensitive, palpable nodules in the muscle) and loss of flexibility. Physical therapy is a safe and effective first-line intervention for mechanical neck pain. In addition to traditional physical therapy, dry needling can be used to treat mechanical neck pain.

This article included 17 participants experiencing neck pain and were separated into two groups. Group one received trigger point dry needling and group two was a “watch and wait”, or non-intervention group. Pain intensity, neck flexility and sensitivity to touch were recorded before, 10 minutes after and 1 week after treatment.

The article found that trigger point dry needling demonstrated a significant improvement in neck pain, sensitivity to touch and neck range of motion immediately after treatment and 1 week later. The findings suggest that dry needling can be an effective first-line treatment for people experiencing neck pain. These changes can be due to several factors. These include normalizing muscle tone, an interruption of pain signaling from nerves, as well as how the brain perceives pain signals.

Conclusion: Dry needling is a safe and effective treatment for people experiencing neck pain and loss of neck range of motion that result in dysfunction.

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January 6, 2024January 6, 2024

Neck mobility and dysfunction

Manual therapy, hands on techniques performed by a skilled physical therapist, provide pain relief and improvement in neck flexibility with treatment. While a reduction in pain is experienced, it may not directly transfer over the improving disability scores. Mechanical neck pain of the upper cervical spine is often associated with loss of range of motion and poor function with daily activities. Self care often includes use of heat or ice, stretching and strength training exercises. Therapist provided mobility exercises may provide additional benefits, including pain reduction, improvement in neck flexibility and dysfunction.

This study included 78 participants with an average age of 60, diagnosed with chronic neck pain and limited neck flexibility. Measurements included neck disability score and neck flexibility. These were taken at baseline (before treatment), immediately after treatment and 3 months after the last treatment. Participants were placed into 3 groups. All groups received heat therapy, neck stretching, thoracic mobility and pain education. Groups 2 and 3 received additional hands-on treatment by a skilled therapist. Group 2 received a specific “hands-on” neck joint mobility intervention. Group 3 received a “hands-on” upper neck muscle release.

The findings demonstrate that the “hands-on” group experienced significant improvement in neck flexibility. Immediately after the treatment, 70% of the joint mobility group (Group 2) showed improvement, compared to 39% of those in the muscle release group (Group 3) and 20% in the “no-hands” group. At the 3 month follow-up, 80% of the joint mobility group, 46% of the muscle release group and 27% of the “no-hands” group demonstrated improvements. Not a single participant reported any negative side-effects with treatment.

Conclusion: Therapy can provide a safe and effective treatment for neck pain and limited flexibility.

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January 6, 2024January 6, 2024

Dry needling neck muscles for cervicogenic headaches

Muscle trigger points cause pain, headaches and dysfunction. Dry needling of the neck muscles may improve headache symptoms.

Between 0.5-2.5% of the population may experience cervicogenic headaches (CGH). Muscle trigger points (MTPs) are defined as hypersensitive muscles that provoke pain with pressure. These MTPs are often implicated in tension-type headaches, cervicogenic headaches, cluster headaches and migraines.

This study sought to answer the question: does dry needling of the neck muscles improve the CGH symptoms?

This study included 16 participants; 33 years old on average; experiencing CGH more than once/week for more than 3 months. The participants must demonstrate active trigger points of the sternocleidomastoid (see picture) that reproduces their headache symptoms. A headache questionnaire was completed 2 weeks prior and 2 weeks after a single dry needling treatment.

The researchers were able to significantly improve headache frequency, duration and intensity with a single session of dry needling. They hypothesized that dry needling improves muscle electrical conductivity, circulation and reduces central and local sensitization.

Due to the limited follow up (2 weeks after treatment), it is unknown if these improvements were maintained for a longer period of time.

Conclusion: Dry needling is a safe and effective intervention to address headache frequency, duration and disability.

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January 6, 2024January 6, 2024

Dry needling for trigger points

Dry needling is an effective intervention for reducing neck pain and sensitivity to touch of the neck muscles.

About 70% of the population will experience an episode of neck pain at some point in their life. Up to 50% of those with neck pain will develop chronic symptoms.

Muscle trigger points (MTPs) are described as a hypersensitive spots in the muscle belly. Active MTPs are hypersensitive spots that are aggravated with movement or positions. Latent MTPs are hypersensitive spots that are aggravated only with pressure. Trigger points can cause pain, limit movement and result in disability.

This article discusses the effects of dry needling if placed into an active or latent trigger point, or into a non-trigger point portion of the muscle. Participants were placed into three groups: (1) Active MTP, (2) Latent MTP and (3) No MTP. The needles were inserted into the active trigger point (group 1), latent trigger point (group 2) or into a non-trigger point muscle (group 3).

The researchers measured neck pain intensity, sensitivity to touch and levels of disability. Measurements were taken 1, 6, 12, 24, 48 and 72 hours, 1 week and 1 month after treatment.

The researchers found that all groups demonstrated significant improvements in neck pain, sensitivity to touch and disability regardless of their group. However, needles that were inserted into the trigger points experienced symptom relief for a greater time period.

Conclusion: dry needling is a safe and effective treatment for managing neck pain and disability.