Newsletter by Appalachian Physical Therapy, Inc.
July, 2020
NEWSLETTER
HEADACHES ARE A PAIN! DISCOVER RELIEF WITH PHYSICAL THERAPY
INSIDE: • Physical Therapy Can Relieve Headaches • Exercise Essentials • Patient Success Spotlights • The Lost Art of Communicating
July, 2020
NEWSLETTER
GAIN RELIEF FROMHEADACHESWITH PHYSICAL THERAPY
Whether you have pain or have been suffering for a long time, seeing a physical therapist at Appalachian Physical Therapy, Inc. can help you return to a more active and pain-free life. Give us a call at: • Broadway: 540-901-9501 • Harrisonburg: 540-209-8977 • Pinehurst: 910-215-0541 with a cerebral aneurysm that if not treated as a medical emergency would have been fatal. So now that I have your attention, I will be referring to the category of primary HA’s and mainly tension HA’s. I say this with tongue in cheek as we have treated a lot of HA’s that have been diagnosed as migraines that when treated have gone away completely. This should bring to your attention that not all HA’s are alike and react the same. It can be very difficult finding the cause or the root of the problem with some people. They may be having migraines that are caused by another trigger that can be controlled. The list goes on and on so again I will concentrate on tension HA’s. Dr. Janet Travell has several good books with illustrations on each muscle in the body (about 650). She spent her lifetime working with each muscle independently figuring out the referral patterns and intensity caused by abnormal tension within each of them and what that looks like in patients. Knowing referral patterns for each muscle is paramount in the treatment of tension HA’s. I can think of no other books on the market today that illustrates this any better. I believe her books were first printed in 1983 1 . (continued inside)
I have been involved with treating folks with headaches (HA’s) a very long time. It never ceases to amaze me when I have patients come into the office with tension in their neck or facial musculature that would be prone to having headaches and have them state they have never had a HA in their
lifetime. Really!! HA’s are reported to be one of the most common reasons for patients to seek medical attention and affects the vast majority of adults in their lifetime. The World Health Organization (WHO) reports that almost half of all adults worldwide will experience headaches in any given year. The International Headache Society (IHS) categorizes HA’s into two sections; primary when they are not caused by another condition and secondary when there is another underlying cause. Types of Primary HA’s are migraines, cluster and tension HA’s. Secondary HA’s include things like a brain tumor or bleed, stroke, concussion, carbon monoxide poisoning and the list goes on. One thing is for certain; if you are experiencing a HA that is the worst HA of your life, get medical help IMMEDIATELY! It could save your life. There have been many cases where spouses have called 911 when this has happened only to find a problem
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PHYSICAL THERAPY CAN RELIEVE HEADACHES
neat thing about all of this is the work that Dr. Travell has done led to trigger point dry needling (TPDN) and a friend that worked with her, Jan Dommerholt (a guy). Jan is a physical therapist fromDenmark with a company called Myopain Seminars in Bethesda Maryland who my BFF met online when performing her doctoral work on trigger points. This BFF is still my BFF as I asked her to partner with me to start Appalachian Physical Therapy in 1986 and married her in 1988. Colleen is indeed my BFF still to this day.
(continued from outside) For instance, I remember having a patient referred to me that came in complaining of severe jaw pain. She had seen an eye, ear and nose physician who referred her to an oral surgeon that referred her to me. Like the others, I evaluated her jaw and face and came to the conclusion her jaw and face were fine. I really did not know what was causing her pain and told her so. I actually stated I would send a letter to her oral surgeon stating I found nothing wrong with her jaw and felt I had let this person down. As she was walking out, I noticed a slight limp in the way she walked and stopped her asking how long she had had the limp. She stated she was not limping and I informed her I would be the judge of that. I asked her to perform some simple testing of her calf musculature and found a very active myofascial trigger point (MTP) in her calf on the same side of her jaw complaint. AHA! I remembered reading about this in Dr. Travell’s book and quickly turned to the appropriate page showing the patient what I had found. She was pretty skeptical until I started working on her and within 30 minutes, her pain and symptoms were completely gone. To say she and I were both amazed was an understatement! Now we all know about referred pain as we are familiar with the symptoms of a heart attack. They are pain in the neck, jaw, arm, and chest. Dr. Travell was the one who educated us with this referral of heart pain as she was a cardiologist. This led to her interest in referred pain from other muscle origin. I remember first coming in contact with Dr. Travell’s work through a best friend forever (BFF) in 1985. This really got my attention and I began to start putting things together that had been a mystery beforehand. The
So you probably got more than you asked for regarding referred pain and HA’s. It is not simple however with trigger point (TP) manual work as well as TPDN, we have come a long way in successfully treating a multitude of HA’s. So if you have been diagnosed with HA’s and take medication or injections on a regular basis, it just might be helpful if we evaluated you to see if we can help in your case just as we have many who have been seen beforehand. What do you have to lose except your headache? 1: Travell Janet, Simmons David: Myofascial Pain and Dysfunction, The Trigger Point Manual, The Lower Extremities, Volume 1&2, Lippincott Williams & Wilkins, Philadelphia, 1983. 2: Travell Janet, Simmons David: Myofascial Pain and Dysfunction, The Trigger Point Manual, The Lower Extremities, Volume 2, page 430, Lippincott Williams & Wilkins, Philadelphia, 1983
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PATIENT SUCCESS SPOTLIGHTS
“I was able to begin performing tasks I thought I would never be able to do!” “This is the most wonderful place I have ever taken therapy. The people treat you like family. They gave me the best therapy I could have asked for on both my shoulder and hip. When I first started, I could only walk with help but now I can walk on my own with no assistance. Each therapist has the most up to date knowledge and I believe that this really aided in my strength and healing. Annie was most caring and kind and has a wonderful personality. With Annie’s creativity and knowledge I was able to begin performing tasks I thought I would never be able to do again. From the front office, Connie, Robin and Vicki to the techs Dan and Lauren, to all the therapist this place is truly amazing!!” - Elaine C.
“I was able to quit taking my pain medications!” “This is the second time Colleen has helped me get back on my feet. She is patient and kept working until I had significant improvement in my pain and ease of movement. Over the course of several months, I was able to quit taking my pain medications and resume my activities. I am very grateful to Colleen and the kind staff at Appalachian Physical Therapy for tirelessly helping me to recover. They never gave up on me.” - Mary Jane R. “They helped me meet my goals!” “I suffered from a broken hip and had to have therapy. My family doctor referred me to Appalachian Physical Therapy. Since that time I have been referred to physical therapy for my shoulder and knee replacements on both knees. There was never a question for me as to where I would go for physical therapy. I had seen Karen, Ray and Jon and they are absolutely professional. They helped me meet my goals. By having exercises at home and at the facility, I am able to resume my normal daily activities. I am thankful for the people who work at Appalachian Physical Therapy.” - –Helen B.
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FREE ROTATOR CUFF, HIP, & KNEE PAIN SEMINARS Attention Pain Sufferers!
Who is the Workshop For? The Rotator Cuff Workshop is for people suffering with shoulder pain. The Hip and Knee Seminar is for individuals having difficulty walking or having pain in either joint. If you are looking to feel normal again and heal naturally without medications, injections and surgery, don’t delay! Register today! Use the camera app on your smartphone to see the next workshop at the location nearest you. You may also call our office numbers listed on the front page of this newsletter. REVEALING HOW TO GET BACK TO NORMAL WITHOUT MEDICATIONS, INJECTIONS & SURGERY...
HARRISONBURG, VA ROTATOR CUFF WORKSHOP
ROTATOR CUFF WORKSHOP
PINEHURST, NC ROTATOR CUFF WORKSHOP
BROADWAY, VA
HARRISONBURG, VA KNEE PAIN WORKSHOP
HIP PAIN WORKSHOP BROADWAY, VA
PINEHURST, NC KNEE PAIN WORKSHOP
HARRISONBURG, VA HIP PAIN WORKSHOP
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THE LOST ART OF COMMUNICATING
and we have to readdress these on our initial contact. That does take a little time and it can feel like we are filling in the blanks. One must understand the information we receive on these forms can make a significant impact on the way we will evaluate and treat you from day one. You see, we here at Appalachian Physical Therapy feel anything that has happened with your health has had an impact on your wellbeing. You might have experienced a broken arm when you were just a youngster and feel it really did not cause any problems later on in life. Maybe not however what about that rotator cuff strain you are experiencing right now or that tingling you are having intermittently when you grasp items? I could go on but I think you get the idea. A good history is very important in helping us figure out problems that “just happen” without a cause and effect. It is very important for you to come prepared to talk with us regarding your history of the problem or perceived problem along with your other health issues. Our bodies are wonderfully made and we understand the relationship when one part suffers, the whole body suffers. It is all related and you remember the song that states the leg bone is connected to the hip bone and so on. Everything is connected. You might get a physical therapist asking you questions while entering in data on their computer however they have had the talk that this should not be the main focus of attention. If they can have a good evaluation with you by asking questions, listening and then asking the next best question, then that is wonderful. Me, I am unable to do that. Call me old, seasoned or just too ornery to change. I prefer talking with patients face to face without having a computer to get in my way. Again it should be personal preference but the results are the same. You should feel like you are being listened to and experience a thought provoking conversation involving the physical therapist asking sometimes pointed questions to get to the proper place of making a decision regarding your plan of care (POC). Remember it is your POC and you should want to be involved in it. The less you are involved with it will result in less than desirable results; all the time. Communication is the key to successful treatment and completing your POC. Come prepared with your forms filled out so we can focus our time and energy on asking you pertinent questions regarding your issue. Your first day with us is your most important one as we sift through all the information to come up with the best way to treat your condition. Help us help you with listening, pondering and asking the next best question. Every day you are seen will begin with us asking questions and filtering out the important from ordinary information. When we have successfully communicated and reacted to this information, you will experience the very best in patient care. Thank you in advance for coming prepared to talk, listen, and ask questions as well as converse as we travel down this path of wellness. And just know there are other folks out there with the same name!
Communication is a two way street. It is a sharing of information from one person to another to have a better understanding of certain information. I know I have been in a place of talking to someone who was on a total different wave link than I was and it seemed we were just getting further apart. Heck, just this past week I had a situation happen tome that illustrates this perfectly.
We were having a webinar on shoulder pain since our face to face in-house seminars have been postponed to COVID-19. I was the moderator, the person who answers question in the background while the presenters go through the information online. Themoderator is able to communicate with a registrant one on one privately or involve a larger group communication such as giving out a contact email or reference that would benefit all. The moderator also gets to see everyone’s first name as they log onto the webinar. You need to know my wife Colleen who is also a PT, came by our office a few minutes before we started to get this webinar rolling and wished us good luck. She was going home to get on her computer to get some things done for a webinar she was organizing and presenting on a later date. A fewminutes into the webinar, I see a notice where Colleen pops up as a participant on our webinar. Dan, one of our employees helping with the webinar nods as I do when we recognize Colleen’s presence. I smile and being the devious husband that I am sent off a private note to Collen saying “hey baby”. I kind of smirked knowing that I had sent her a message that would get a response back. Nothing happened from that and a few minutes later, she asked a question regarding her shoulder. It was one that was open ended, not really specific in my interpretation and I just sent her another private message that stated the way to treat her problem was to come home and take a stiff drink and prop her feet up. Again nothing from her and later on she asked another question I thought was appropriate for sharing to the group and showed it to the presenter and had it answered that way. I got home about an hour later and asked Colleen why she did not respond to my comments and she stated she had not been on our webinar. OH MY GOSH!!! What did I say? I quickly figured out it was pretty innocent and could have been a lot worse. I mean a whole lot worse. Thankfully I was able to contact the other Colleen and get this all straightened out. Lesson learned. Know who you are speaking and communicating with face to face or virtually. When a new client comes into our facility, we all know we must get some baseline information. The usual medical forms need to be filled out and the better they are filled out, the better we will know what is happening right from the start. I get it that some of these forms are a pain and seem to be poorly organized. We are always looking at ways to improve these however most of them are not filled out properly
ARTWORK AT THE OFFICE Gayle has volunteered her time and talent photographing newborns and children for a program called “Hand In Hand” at the local hospital. In her spare time when not behind the camera, you can find Gayle spending time with her family or riding her horses. She and her horses compete in 30 and 50-mile endurance rides throughout the state of Virginia. She is married 35 years to her husband, Douglas and they have 2 children and 3 grandchildren. Gayle and Douglas are members of Covenant Presbyterian Church in Harrisonburg and they live on their 30 acre farm in the beautiful Shenandoah Valley of Virginia with their sweet pup and 6 horses. View her website at https://gayledriverphotography.pass.us/gayledriverart/
HarrisonburgArtist: Gayle Driver, Digital Photography. In this body of work I concentrate on the facial expressions of my subjects (whether people or animals) trying to capture the emotion of the moment when my subject is looking directly at me. The eyes
Pinehurst Artist: Gwen Dumas. I graduated fromPeace College with an Associate of Art Degree and from Meredith College with a Bachelor of Science Degree in Interior Design with a minor in Art. After college, I worked in commercial interior design for Raleigh Office Supply in Raleigh, NC and Design Logic in Asheville, NC. I have also had the opportunity to work as an artist for Camden Field, a painted furniture company in the mountains of North Carolina. Currently, I live in Whispering Pines, NC. I love art and wake up every day ready to paint. Pinehurst Artist: Sarah Hendrix. I grew up on a beach in Southern California with an artist for a mother. My first training was absorbing her knowledge of painting. She would call me to ask if I had seen the clouds that day or looked at the sunset. Through her, I learned to look at the beauty that surrounds us. My paintings aremostly landscapes and I lean towards seascapes frommy beach bum days. Over the years, I have taken instruction from various artists-including Frank Pierce, Mike Rooney and recently Connie Winters.
are windows of the soul… a phrase that I think about as I am working with my subjects. There is something captivating tome about looking directly into someone’s eyes and knowing how that person is feeling. When that person or animal starts to feel comfortable with me is when I can capture that special image. I focus my camera on their eyes and by adding a soft blur behind the subject helps draw the viewer into the detail of the face. Of the animals that I photograph, the dogs and cows have a special place in my heart. I love their interesting, unique faces and I try to show their sweet personalities in my photograph.
EXERCISE ESSENTIALS Try these exercises to keep you moving... BILATERAL SUBOCCIPITAL STRETCH (HELPS STRETCH UPPER NECK) While lying on a flat surface, put both hands behind your head, cupping the base of your skull with your thumbs. Tuck your chin downwards and apply a firm force up your skull with both thumbs to feel a moderate stretch in the back of the upper neck. Hold for at least 30 seconds.
MAKE PAYMENTS ON OUR WEBSITE! Appalachian PT gives patients the option to pay online using our website. All payments are totally encrypted for security. Select the “Pay” tab at the top of the page. It’s just that easy.
Strengthens Upper Neck
RETRACTION | CHIN TUCK Slowly draw your head back so that your ears line up with your shoulders. Hold for 10 seconds and repeat 3 times.
Stretches Neck
Exercises copyright of
www.simpleset.net
Always consult your physical therapist or physician before starting exercises you are unsure of doing.
Why You Need To Come In For Another Check-Up:
� Move without pain � Bend and move freely � Balance confidently & securely
� Sit for long periods comfortably � Walk for long distances � Live an active & healthy lifestyle
TAKE CARE OF YOUR ACHES & PAINS BEFORE IT ’ S TOO LATE!
BROADWAY CLINIC 540-901-9501
HARRISONBURG CLINIC 540-209-8977
PINEHURST CLINIC 910-215-0541
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