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Headaches – From the Neck Up

We have talked before about headaches from a massage perspective previously. However, there are many reasons for headaches that may be cause to see a physiotherapist as well. Check out this case study for headaches from the neck!

Case Study NP

What does it feel like?

NP comes into the clinic, he is a 35 year old father of 3 and works a desk job for the past 5 years. Before that he was working on-site in construction, often looking overhead. In the past 2 years since his third child was born he is noticing he is getting more frequent headaches. Often his headache is is on the right side behind his eye and in the temple. As NP gets talking he realizes that he also has some dull pain in the shoulder and arm; but this pain is occasional compared to the headaches. He finds that when he is working at his desk by the end of the day the headache is nearly unbearable. By the time he gets home he has difficulty playing with his kids, and it’s starting to impact his ability to work around the house and cabin.

He doesn’t recall a specific injury to his neck, but NP does have a cabin and boat at the lake and loves trying new water sports. Just before his third child came friends came to the lake and decided to take the tube out where he was flipped multiple times.

This all-too-familiar story can have multiple ways that it could have begun – a whip lash injury, strain of the neck or shoulders, etc. Let’s focus on this case study and some of the possible reasons WHY this happens, what we can do about it, and how you can start your road to recovery TODAY! 

What Causes Headaches?

The neck is actually a highly complex unit. We have multiple bones in the neck (seven to be exact!), nerves that travel from the neck up into the scalp and down into the arms, plus all the ligaments, tendons and muscles. The body is an amazing thing when you think of all the moving parts. Generally speaking we are able to maintain a pain-free lifestyle; however sometimes we need a little help.

One of the reasons that we can develop headaches is because of neck dysfunction. In this instance NP is experiencing referral from the upper cervical spine (C1-3). This is why he has pain near his eye. Increased stress and posture issues can also significantly impact headaches.

If you have headaches, a physiotherapy assessment could benefit you!

What does an assessment look like?

NP came for an appointment at the beginning of the day because it worked better with his schedule. He was worried that not being severely symptomatic would be a problem for the assessment. He was relieved when he heard that the therapist would be able to evaluate the neck regardless of the amount of current pain.

The assessment took a look at his overall neck range of motion. NP was surprised to discover that he had more difficulty tipping his right ear to his right shoulder, and shoulder checking over the right. When the therapist had him lay down to evaluate the neck movement and muscle tension he was significantly more tender on the right side at the base of the skull.

During the assessment the therapist identified some specific muscle weakness and tension that would need to be addressed.

NP was surprised that during the appointment the therapist was able to recreate his headache symptoms and shoulder pain. He wanted to make sure that he could get back to his normal home-life routines. NP booked his next 4 appointments weekly and was sent home with exercises and stretches to get him started.

Over the next four weeks NP attended his appointments for some manual therapy from the physiotherapist and updates to his home program. He was pleased that by week 3 his headaches seemed to be significantly better.

NP resolved his headaches within 6 weeks, and returned for a flare-up 4 months later. The flare-up lasted 2.5 weeks and after resolving has not returned since he is able to manage any issues with his home program.

How long until I am better?

The recovery period usually varies from client to client, depending on the severity and frequency of signs and symptoms. Other factors include:

  • How long the headaches have been going on, how severe they are
  • What areas are contributing (neck mobility, muscle tension, etc)
  • Commitment to the home exercise program

Straightforward cases we tend to see client’s 1x/1-2 weeks for a total of 4 to 6 sessions. These sessions include manual therapy to help restore joint and muscle mobility as well as exercises for their home program.

Don’t delay! Schedule your assessment today to get started your journey to recovery!

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Pain With Intimacy

Often pain with intimacy is brushed off “oh you’ve had kids”, “just relax”, “have a drink and you’ll be fine”. If you have heard this rhetoric be the one to stop the narrative! Here we go through a case study on dyspareunia after having kids!

Case Study PD

What does it feel like?

A mom of two comes into the clinic, we will refer to her as PD. She is anxious and unsure of what to expect for her first appointment, but she knows she can’t continue to live like this. PD says that she started having pain with intimacy (specifically with intercourse also known as dysparuenia) after she delivered her first baby. It wasn’t bad then, just some burning and pinching right at the opening. It wasn’t too painful and didn’t stick around but definitely wasn’t pleasant.

Since having her second more trouble with intimacy began. PD recalls having some tearing during delivery with her second but she didn’t need a referral. Her and her partner have tried multiple times to be intimate but she has 8/10 pain. Her pain now is a pulling, burning, pinching at the opening and she also experiences sharp pains deep in her belly as well. PD has pain that persists after attempts at intimacy and it seems to be taking longer before it goes away now. She tells the therapist that she continues to attempt to be intimate for her partner and to see if it still hurts.

This all-too-familiar story doesn’t just happen just for women who have had children vaginally, but can also occur for women who have had c-sections as well as women without children. Let’s focus on this case and some of the possible reasons WHY this happens, what we can do about it, and how you can start your road to recovery TODAY! 

What Causes Pain with Intimacy?

There are many reasons why an individual may have pain during intimate encounters with their partner. In this instance PD is experiencing pain after child birth; which can be considered a trauma to the body. Since she had tearing during both her deliveries she will have scar tissue in the area that could be contributing. Couple this with the bodies natural response to pain (protect the area). The anticipation of pain causes the body to also move into a protective mode and it is a recipe for a pain cycle.

If you have pain with intercourse, a physiotherapy assessment could benefit you!

What does an assessment look like?

PD was seen for an assessment at the clinic where she was observed in how she moves generally through walking, squatting and bending movements. When evaluating her breathing PD had difficulty taking a deep breath down into the belly. The pelvic floor exam revealed a hypertonic/protective pelvic floor. At the time of the assessment she reported reproduction of “the pain”. The therapist was able to discontinue further evaluation while assisting PD in relaxing the muscles of the pelvic floor.

PD would be provided with a home program to improve deep breathing, pelvic floor muscle relaxation, and imagery/relaxation techniques to start.

Over the course of the next 3 months PD attended appointments at the clinic. Starting with once every 7-14 days, to stretching out as her symptoms improved. PD was thrilled with her improvements and adjustments to the home program and in-person techniques were made. These adjustments included home exercises and activity, discussion on optimal positions, and internal techniques as PD’s pain improved. After 6 appointments she reported being pain-free except when she was very stressed, but manageable with her home program. PD was also happy that the program also seemed to help with her light bladder leakage, and tailbone pain!

How long until I am better?

The recovery period usually varies from client to client, depending on the severity and frequency symptoms. Other factors include:

  • How long the pain has been present
  • Activity level
  • Ability to complete homework

Often with pelvic health issues resolution of straight forward cases occurs within 6-8 appointments. In some instances this could be shorter, and in others it could be longer.

Don’t delay! Schedule your assessment today to get started your journey to recovery!

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Knee Pain Keeping You on the Side Lines

At Warman Physio we love a good case study! Our case studies are all hypothetical scenarios and are not based on any one client interaction, but is rather a sum of expectations and experiences. This particular case study we will go through (front of the) knee pain!

Case Study KP

What does it feel like?

An 18 year old female complains of left anterior (front knee) pain. She plays volleyball, basketball, track and field and soccer throughout the year and has noticed for the past year the knee pain in the front has gotten progressively worse. She thinks it may have started after a volleyball tournament but doesn’t recall specifically hurting it. She’s feeling deep, dull aching pain to the front of the left knee that is worse with jumping, squatting, stairs, kneeling, crawling, and running. She has been occasionally putting on ice and taking Advil which helps for a bit, however this is not long lasting. This past summer, she took time away from sport and activities and the knee pain improved. However, when returning to volleyball and soccer this season, symptoms have returned. She is feeling frustrated, and is wondering if the knee pain will ever go away or if this is just “normal” now.

This all-too-familiar story doesn’t just happen at the knee, but can also happen with other areas of the body. Let’s focus on the knee and some of the possible reasons WHY this happens, what we can do about it, and how you can start your road to recovery TODAY! 

What Causes Anterior Knee Pain?

There are many reasons why an individual may have front knee pain. One of the most common causes that we see as Physical Therapist are strength/length issues to the lower extremity. What this means is, usually weakness throughout the gluteals, quadriceps, hamstrings and foot intrinsics (muscles just in the foot), can cause issues throughout the leg. These deficits can result in front knee pain, where the quads tendon attaches to the shin. Front knee pain does not require an injury to occur since it usually develops overtime. It often occurs due to overuse, or a training routine that does not include adequate stretching or strengthening. An overuse injury develops when repetitive stress to bone, muscle, and tendon structures uses tissues at a greater rate than the body can repair itself.

Many other factors that can lead to front knee pain such as: changing shoes or poor shoe support, improper exercise and running technique, falling directly onto the knee, Osgood-Schlatter disease, patellofemoral pain syndrome, patellar tendinitis/patellar tendinopathy, etc.

If you have front knee pain, a physiotherapy assessment could benefit you!

What does an assessment look like?

Well – that depends! In most cases what you may expect your therapist to complete a postural evaluation to look at your alignment. In addition flexibility of the lower extremity muscles, strength of the hip, thigh, calf and foot muscles, mobility of the kneecap and knee joint will be completed. Stability of the knee and range of motion of the knee, hip, and ankle will be addressed depending on the specific information provided.
Once an assessment is complete, your physical therapist will have a good understanding as to why there is persistent front knee pain. If there are restrictions of the patella (knee cap) or knee, the therapist may recommend manual care to help restore the mobility of the knee joint. If there is muscle weakness and muscle shortening, the therapist may recommend stretches and strengthening as a home program. Strengthening can occur in both non-weight bearing and weight-bearing environments, with the use of theraband, if appropriate. Exercises are progressed when appropriate into activity and sport specific movements over time. The client will also be educated on proper technique and alignment to complete squats, step ups (such as with stairs), running, and possibly gait (walk) re-patterning.

Occasionally, front knee may persist during sport, and a patellar brace to support the patellar tendon may be recommended. This is discussed during your appointments with your physical therapist as to whether a brace would be beneficial.

How long until I am better?

The recovery period usually varies from client to client, depending on the severity and frequency of signs and symptoms. Other factors include:

  • How long the pain has been present
  • activity level
  • commitment to the home exercise program

Straightforward cases we tend to see client’s 1x/1-2 weeks for a total of 4 to 6 sessions. These sessions include manual therapy to help restore joint and muscle mobility as well as exercises for their home program.

Don’t delay! Schedule your assessment today to get started your journey to recovery!

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Are We Ever Ready?

Thank YOU!

In a blink we are nearly into June 2020. Halfway through the year. Nearly half of that time spent in a pandemic. Feels weird to some days be “ok” while others feeling like you can barely hold it together long enough to get through that next task.

It has felt like from the moment we announced the clinic closure to in-person care March 18 we have been consistently adjusting, moving, re-planning. Through it all we have been forever grateful to the community and our clients for your understanding and grace you have given us during this time. I don’t think we can ever over-state how deeply we appreciate your support during these many transitions!

In-Person Care

Although things are still seeming to be ever changing, we have settled on some specifics for those that are appropriate for our in-person appointments we are providing for Physiotherapy & Massage services at this time.

  1. Ensure you have completed your online COVID screening questionnaire and re-book if you are feeling at all unwell
  2. When you arrive please stay in your vehicle! Our team will call you when they have your personal waiting room ready
  3. We are required to have everyone who enters the building to wear a mask (please bring one with you to your appointment)
  4. There will be hand sanitizer available for you to use once you enter the building
  5. The bathrooms at this time are closed to public use
  6. Contact-less payment is preferred whenever possible

*Please note that depending on the type of appointment you are scheduled for, your therapist may have differing levels of PPE on

 

PPE (Personal Protective Equipment)

At the clinic the therapists and staff have access to approved PPE for all levels of available services. This means various levels of equipment will be used for different treatment types, in addition to personal protective measures that each therapist feels necessary to take for their own/family safety.

You will always see your therapists and staff in a mask if they are unable to remain physically distanced (this includes Laura until our fancy new sneeze guard comes!) – which of course will be the case for any in-person/hands on appointments. You may also see: protective eye wear, a gown/specific lab jacket (we have special ordered some), and/or gloves.

It must be noted that at this time we are not completing any assessment or treatment intraorally. This means that until further notice appointments for TMJ will not be able to evaluate the muscles within the mouth. We can however, still provide assessment and treatment of any additional factors that would be related to the neck and external to the mouth!

 

Why are we so diligent?

We are so fortunate to have such understanding clientele at the clinic, and haven’t had any issues with our new protocols and procedures. It is important that we ensure that our clients understand why it is important that we follow the guidelines, are honest in our COVID screening questionnaires for a couple main reasons.

1) There are hefty fines for not following the proper protocols

Businesses that do not comply with the government or association guidelines are at risk of fines up to $250,000. We have been so grateful to persevere through this pandemic to date. Fines during this time not only for our business, but any business, could prove catastrophic for any business.

2) We need to protect those that are at risk that are coming in to provide care

There are some individuals at the clinic that are at-risk themselves or have family members that are at greater risk for COVID.

Although I am a generally private person, I have felt that now is the time to let our clients and community know that I have been diagnosed and started treatment for cancer. COVID has thrown a real wrench in the entire process and brings a new element to have to navigate during an already challenging time. As many people know, my dad has leukemia and has for years so I am very familiar with the increased protective measures required for a compromised immune system during a typical flu season. I am confident in our team’s ability to navigate these uncertain times and continue to provide the high level of care that we have become accustomed to.

~Haylie Lashta

Our top priority is the health and safety of our staff, the clients, and the community. We appreciate that we are all working together through these processes.

Thank you for choosing us to help you, help yourself!

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Re-open Sask at Warman Physio

The Saskatchewan Government announced the plan to re-open Saskatchewan on April 24 at 11am. We are so grateful to have been included in Phase 1 and Phase 2 with the services provided at the clinic. Many of our clients and community members reached out and flooded us with calls, emails, and messages asking what the plan was. We are happy to have an initial first announcement of our re-opening plans available.

Waiting patiently for the regulations from our licensing bodies after the announcement was difficult but necessary to ensure that we are able to meet the required protocol changes at the clinic in order to re-open. We will continue to monitor the requirements, as they are continually changing as well!

We will note that at this time we are still awaiting guidelines for the Massage Services. Once we have this information we will evaluate the ability to provide services and what the time line looks like. At this time all counselling and nutrition services will remain virtual services only as well.

Slow and Steady

We have been working diligently since the announcement to procure personal protective equipment (PPE) and creating policies and procedures to ensure that we meet, and exceed, the standards set. The health and safety of our clients, community, and staff are of the utmost importance. We are taking this re-opening seriously, ensuring that we are moving slowly, making significant adjustments, and allowing for as much physical distancing as we can allow.

This being said, physiotherapy and massage are a hands-on in-person appointment. If you are coming into the clinic we will be unable to maintain physical distancing. Having appropriate PPE and sanitization protocols between each client is how we will be mitigating the risk of the inability to maintain social distancing. We have been providing telehealth appointments to our current client base for over a month, and we are confident in the quality of the service that can be provided remotely to our clients. With the indication that physical distancing options are still considered the best options we will continue to have a primary focus on telehealth options. Telehealth services will remain a permanent offering at the clinic and will be utilized extensively during this time of re-opening in combination with in-person appointments as needed.

Just because we are permitted to re-open doesn’t mean it will be back to business as usual for us. There are going to be some significant changes moving forward, and some of these changes may remain well into the future.

What to Expect

Prior to booking an appointment you will be asked to complete a screening tool to determine the best-fit assessment/treatment option. This will help us to determine who is going to be seen in-person and who is ideal to be seen remotely. Having strict guidelines will ensure that everyone will receive the most appropriate and safest option for booking at this time. Once you have been deemed appropriate for in-clinic care you can expect to see the following measures in place:

  • Everyone will receive a COVID screening questionnaire via email prior to their appointment
  • Clients will be asked to wait in their vehicle and not come into the building until after your therapist calls you; they will ask you the screening questions again prior to entering the building
    • Should a client not pass the screening questionnaire they will not be permitted in the building
    • It is paramount for the health and safety of our staff and community that everyone answer the questions truthfully
  • Prior to entering the building please put on your face mask
  • Upon entering the building the client will sanitize hands appropriately
  • Your therapist will have all appropriate PPE in place and has been trained and tested on their ability to don and doff PPE
  • The therapist will guide you as to what PPE is required of you prior to your appointment
  • At the end of the appointment you will be able to pay online, or utilize the tap function on the machine at the clinic
  • Please do not attend an appointment if you are feeling sick or unwell
  • At this time the clinic will not be providing public washroom use
  • We are encouraging anyone who has the option to come alone to please do so, however, we understand that there are some limitations to this
    • If the client must come with additional individuals, the COVID questionnaire needs to be filled out for each person attending the facility

How we are protecting you

In addition to our usually stringent cleaning protocols, personal hygiene, and overall cleanliness, we at Warman Physio want you to know some of the additional measures we will be taking:

  • The door will be locked between clients to reduce the amount of foot traffic in the clinic
    • Contact us via phone (306-373-9355) or email (info@warmanphysio.com) to discuss booking an appointment
  • Clinicians will be completing the COVID questionnaire prior to coming into the clinic and will be unable to work if they are unsuccessful at completing it
  • Proper PPE has been procured and will be utilized appropriately throughout the appointment
    • All staff and therapists will be trained and tested in their ability to don and doff PPE properly and can instruct their clients in appropriate usage as well
  • The therapists are spreading out appointments to allow for physical distancing; there will be no overlap in clients in the clinic to allow for a complete sanitization of the common spaces
    • This may lead to some delays despite planning in advance and providing additional time between appointments, please be patient as we figure out the best practices!
  • All unnecessary items will be removed from the counter surfaces
  • We are only allowing scheduling of therapists at specific times and in specific combinations to allow for physical distancing
    • This may mean that until further notice that you may not be able to schedule appointments with different providers back to back as we are typically accustomed
  • At this time there is a significant increase in required PPE to provide appointments for TMJ and pelvic health. As such these appointments  will not be appropriate for in-clinic care at this time

Cautiously Optimistic

We cannot express enough how much providing care to our community and returning to in-person services means to us. We have been missing the connection and interaction that comes with in-clinic care. Of course we hope that the re-opening of Saskatchewan goes smoothly and we are able to maintain a controlled spread; and we understand the role that we play in making this dream a reality. Should there be indication or recommendation that we must again eliminate in-clinic care we of course will follow any and all recommendations. Knowing that our community supports us in our slow re-opening has been a huge weight lifted off our shoulders and for this we will be forever grateful.

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