PhysiotherapyCenterLTD_Outsmart Your Neck Pain & Headaches

Health &Wellness The Newsletter About Your Health And Caring For Your Body

May 2019

Find Out the Connection Between Your Neck Pain and Headaches SIMPLE SOLUTIONS TO OUTSMART YOUR PAIN

Health & Wellness The Newsletter About Your Health And Caring For Your Body

May 2019



• The Neck Pain & Headache Connection • The Problem With Posture • Relieve Neck Pain In Minutes • Quick & Easy Healthy Recipe • Practice News CALL IN! Call for your FREE BACK PAIN ANALYSIS Call us today to schedule your first step out of pain! (345) 943-8700

The Neck Pain & Headache Connection Headacheshaveabadhabitofmaking theirappearance at the most inconvenient times. The middle of the workday, early in the evening when you have hours of responsibilities ahead of you, or even first thing in the morning when you are trying to pay attention to your morning meeting — headaches don’t care how important the work ahead of you is. When they start, they are hard to stop. you know it, your experience of neck pain is something you are dealing with daily. It isn’t always the result of something large. While being in a car accident or experiencing another sort of injury can definitely lead tochronicneckpain, thecauseof the issue isn’talways as simple to identify. Sometimes it is a bad habit that you don’t really think twice about, like your habit of watching TV as you fall asleep, keeping your neck at an odd angle as you rest for the evening, or maybe as a result of your posture as you type at your desk every day, hunched over at the shoulders with your neck catching the brunt of your slouch.

There are all sorts of reasons why headaches may develop. From environmental factors like weather changes and exposure to certain perfumes or other scents, to stress and allergies, headaches happen to the best of us. However, there are some headaches thatmay bea bit morepredictable than others. Factors like your posture, the type of mattress you sleep on, the pillow you use, or even the desk chair you sit in at work can all impact your risk for experiencing regular headaches because of the intricate network of nerves and muscles in your neck. When Neck Pain Leads to Headaches The majority of the time, neck pain starts out as a seemingly small concern. A crick in your neck here or there may start to develop more frequently, and before

Thesepoorhabitsarecommon,andmostofusconsider them to be harmless. Sure, you know it isn’t great for you,butwhat isactuallygoing tohappen? It’sa loteasier to slouch as you type, and who doesn’t want to catch a few late-night laughs as they fall asleep? But the reality is that theseseemingly irrelevanthabitscouldbeputting unduestressonyourneck,and ifyouaren’tcareful, this could translate to regularanduncomfortableheadaches that are difficult to remove from your daily life.


Working with a physiotherapist can help you to identify whether or not your headaches may be the result of neck pain or strain. One of the most common causes of headaches due to neck pain is forward head position. Forward head position means that when you are resting your head, you are continuing to hold your head slightly forward, which is a type of slouching position. You can identify whether or not you have a forward head position by standing straightagainst thewallanddeterminingwhetherornotyourhead restsagainst the wall as your back does. If your head does not touch the wall when you are standing straight, then you aren’t fully standing up straight! As years go by and day after day you continue to hold your head in this forward position, you can start to experience pain as a result of strain in the muscles of the neck. When this is an issue, working with a physiotherapist may be able to help. Stretching the muscles in your neck to alleviate neck strain can reduce the severity and regularity of your headaches. Stretching the muscles that have grown tight along the back of your neck as well as those along the shoulders can help you find relief from the tension that is causing your pain. When dealing with neck pain, it is important to remember that safety has to come first. While there are many simple activities you can try at home to begin stretching your neck muscles, working with a physiotherapist is the only way to ensure that you are stretching in a way that won’t potentially lead to greater injury.

If you have neck pain and headaches, call us today at 345-943-8700. We can aid in tackling the cause of your pain and get you feeling better!

Refer A Friend Care enough to share how physiotherapy helped you? Who do you know that could benefit from therapy? Send them our way! They will thank you, and so will we.

Relieve Pain In Minutes Try this movement if you are experiencing pain.

Decreases Neck Pain

Refer a friend to our clinic and receive a FREE 1/2 Hour Therapeutic Massage .

CHIN TUCK SUPINE Lie down with a towel roll under the curve of your neck. Without lifting your head, tuck chin gently toward chest. Keep the large muscles in the neck relaxed. Hold for 2 seconds. Repeat this movement 5 times.

Aches & Pains? We Offer FREE Screenings Helping You Get Back To Better Again!

25 Eclipse Drive, P. O. Box 10742 George Town, Grand Cayman, KY1-1007 Phone: (345) 943-8700



Call Today (345) 943-8700



Happy Birthday to Vanessa Williams, James Crooks, & Jordan Crooks!

Guacamole & Tortilla Chips


CHIPS: •8 (6-inch) corn tortillas •Cooking spray •1/2 tsp salt •1/2 tsp chipotle chile powder GUACAMOLE: •3 tomatillos •1/3 cup chopped onion

•1/3 cup chopped plum tomato •3 tbsp chopped cilantro •1 tbsp fresh lime juice •3/4 tsp salt •2 ripe peeled avocados •2 jalapeño peppers, seeded and finely chopped •1 garlic clove, minced

Congratulations to Jordan Crooks, Corey Westerborg, Allyson Belfonte, & LiamHenry on their performances at the 2019 Carifta Swimming Championships!

DIRECTIONS Preheat oven to 375°. To prepare chips, cut each tortilla into 8 wedges; arrange tortilla wedges in a single layer on 2 baking sheets coated with cooking spray. Sprinkle wedges with 1/2 teaspoon salt and chile powder; lightly coat wedges with cooking spray. Bake at 375° for 12 minutes or until wedges are crisp and lightly browned. Cool 10 minutes. To prepare guacamole, peel papery husk from tomatillos; wash, core, and finely chop. Combine tomatillos, onion, and remaining ingredients; stir well. Serve guacamole with chips.

Izaak Bastian of Bahamas broke two individual CARIFTA records in the 15-17 boys division: 50 Breaststroke 28.20 and 100 Breaststroke 1:02.84. Best wishes to Izaak Bastian as his Carifta years come to a close. Thank you for inspiring our younger swimmers!

Attention Neck Pain Sufferers!

Do You Have Difficulty With Neck Pain?

• Decrease your pain • Increase your strength • Increase your activity level We can help:

• Increase your flexibility • Improve your health • Get back to living

Mention or Bring in This Coupon Today For a FREE Neck Pain Consultation

Call Today: (345) 943-8700

Offer valid for the first 25 people to schedule. Expires 6-31-19.


stance position without assistance. Tasks and obstacles are posed in the patient’s environment to facilitate them manipulating them without swaying, losing balance or falling. This is usually done with the necessary guarding and safety precautions. Balance training is best paired with core and postural exercises to stimulate and strengthen the same muscles responsible for keeping us upright and stable when we reach outside of our base of support. Electrical muscle stimulation (EMS) is popular for stimulating or improving the contraction of weak muscles. Our nervous system functions by electrical impulses being sent between the brain, spinal cord, muscles and internal organs, or what I like to term ‘bioelectricity’. With a disease or injury interrupting such signals, it is understood how an outside stimulus or circuit will directly affect the target body part, acting as a bypass to the damaged nerves. EMS can be applied to virtually any skeletal muscle that is wasted, weak or has abnormal tone, even to facial muscles. The intensity of the current is increased until desired twitches or contractions are observed, but still bearing in mind the patient’s pain threshold. Pain management is sometimes necessary for patient who suffer from inflamed sensory nerves or resulting joint and muscle contractures due to their condition. Nerve stimulators, hot/cold packs and ultrasound therapy are few modalities that can help to control pain. Range of motion and isometric exercises are a concern of the patient, with the misconception that they always make the pain worse. It will be initially uncomfortable but can improve tissue adaptability and blood flow to help the patient to sense less discomfort. Sometimes the simplicity of massage or stretches is all that is needed to relax a painful or tight area. With a patient being wholly immobilized or have at least a paralyzed limb, the biomechanical law has to be observed: ‘if you don’t use it, you lose it!’ Contractures (shortening/tightening) of joint and muscle, wasting (loss) of muscles and decrease in bone density are inevitable, especially if rehab is delayed, or limited attention is put on counteracting them. Frequent stretches would have to be done for the patient, and promoting weight bearing through affected limb to reduce bone mineral loss. Other complications of immobilization such as bed sores and chest infections can be prevented or managed with the help of the physiotherapist, usually through mobilization or appropriate manual techniques. For children being affected by neurological diseases too, such as Cerebral Palsy, Down Syndrome and Spina Bifida, a more playful and creative approach has to be taken towards rehabilitating this special cohort. Video games, puzzles, painting, and ball games can be incorporated in their treatment in order to get their desired focus and movement patterns. More patience is usually required.

Practicing physiotherapy for the past 5 years has exposed me to the treatment of numerous neurological conditions. The nervous system is responsible for cognition, movement, sensation and autonomic functions, such as breathing, digestion, egestion/excretion, cardiac/circulatory functions etc. Neurological conditions can be diseases or disorders affecting the health or function of the nervous system. Examples of such conditions are Strokes, Spinal Cord Injuries, Guillain-Barre Syndrome (GBS), Myasthenia Gravis (MG), Multiple Sclerosis (MS), Neuromyelitis Optica (NMO), Parkinson’s Disease (PD), Traumatic Brain Injures (TBIs), Amyotrophic Lateral Sclerosis (ALS) and Brain/Spinal Cord Tumours. With over 600 diseases of the nervous system present (University of California San Francisco Health), no matter the rarity or onset, it is expected that there will be some degree of cognitive, sensory or motor/physical impairment. I appreciate that I have an integral role in the management and rehabilitation of the affected population, to restore function, mobility and improve one’s quality of life. Actually, it was when I was a second-year physiotherapystudent I fell in lovewithNeuroanatomy and Neurophysiology courses, which broke down how the brain, spinal cord and extending nerves worked together to form the nervous system. My passion for physiotherapy became steadfast when I realized how rehabilitation retrained my patients to walk and even feed themselves, functions lost that the unaffected population takes for granted. In the Beginning... Getting an affectionately called ‘neuro patient’ with a neurological diagnosis for the first time would prompt me to run a background check on their pathology, onset and course of condition, initial medical intervention or rehab and even other existing chronic illnesses they may have. Taking a proper medical and disease history indicates how a patient became ill or debilitated, necessary tests done to confirm or suspect a diagnosis, how they responded to prior treatment and if already existing conditions will contraindicate or complicate rehab. History taking in the initial session helps to form a picture to me of how much the patient is affected and how much they might benefit from this service. Physical Examination The next step in the initial interaction with a neuro patient is testing mobility, function, sensation, joint

and muscle flexibility, muscle strength, balance, coordination, bed mobility and muscle tone. Their level of independence must be established, in self- care activities (e.g. bathing, dressing, toileting and grooming hair) and transfers (e.g. moving between wheel chair and bed or toilet). Specific grading or rating tools or scales are usually used to better indicate the severity of impairment and allow for tracking of progress and reassessment in the following weeks or months. Description of posture and gait (walking pattern) help in identifying the overuse or under-use of associated muscles. Examining a patient will highlight which functions are affected, what type of treatment is necessary and how much improvement will be required for gain of adequate functionality. Non-physical attributes have to be assessed too, such as memory, attention span, speech, mood/personality changes and ability to follow commands, all of which will impact patient-therapist communication. Through a neurological examination, I may find partial or complete weakness to be the primary complaint, involving one limb, two or all four. I have had unique cases where patient has good muscular strength, but due to tremors or rigidity of limbs, they have difficulty initiating following through or stopping movement. A patient can also have good limb strength but poor stability or balance in staying stationary or moving. The greater the neurological damage, the greater the deficits patients will have. It is important to identify how these specific problems affect their daily life or function. For example, I recall a young woman with one sided weakness from a stroke, who was unable to work, drive or take care of her children. Treatment Based on the problems outlined, different treatment protocols or interventions can be used to improve a patient’s health and functionality. The bulk of rehab for strengthening weak muscles, involves the traditional use of weights, resistance bands and exercise machines, however alternative methods have tobeconsidered,suchashydrotherapy (moving with the support and resistance of water), mirror therapy, and game simulators or virtual therapy. The use of music and group exercise can make treatment more fun. These diversifying methods help to make physiotherapy more interesting and poses new stimuli for neuromuscular growth. Balance training is done for those who have decreased stability in doing activities in sitting or standing, or worse, maintaining a seated or

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Goals and Prognosis From initial assessment of the patient it is important to know what you want to achieve with your patient and how. The use of clinical and technical outcome measures is a part of my expertise, but having functional end goals for the patient, helps them to stay more focused and carry through with the provided interventions. For example, it had been goals of mine to get a patient to use hand(s) to dress himself in two weeks, or to get a bed ridden patient walking with a walker in 10 weeks. Even though goals will vary from patient to patient, based on their pre-morbid history and personal needs, they must be specific, realistic and achieved within a certain time. Goals that are not met, due to arising complications or just failure of the patient to improve, have to be reassessed, and new goals must be set taking the patient as close as possible to the previous goals. With physical reassessment done, improvements and limitations should be pointed out to the patient. If theneurologicaldeficitsaresevereor theoutcome of rehab is uncertain, I rarely tell the patient that they can or cannot return to a lost activity. On the other hand, I will take small steps at a time with the patient towards achieving that activity or an activity that is similar but less laborious. A better prognosis of a patient is proportional to good attendance, intensive therapy (frequent longer-duration repetition-based sessions), good family support, sometimes a comprehensive health insurance plan or adequate financial support, and good self-esteem or willpower. Spontaneous healing of the damaged brain, spinal cord or nerves must be depended upon, even though it occurs at much slower rate than bone or muscle regeneration. In the case that this is non-existent or negligible, despite surgical or pharmacological intervention, a process of acceptance would have to be embraced, indicating a plateau in neuromuscular growth or regeneration. However, maintenance of current function and prevention of complications is paramount for this patient, via ongoing physiotherapy or home exercise program. Unconscious patients have a poorer prognosis, as recovery via physiotherapy relies heavily on their volition or awareness. However, I have witnessed physiotherapy helping them too, via stimulation and mobilization, to optimize ventilation and keep in-bed complications to a minimum, whether they are in intensive care unit on life support or they are at home. Neurological rehabilitation can be completed in 3-6 months for some, while 1-2 years for others. No matter the type of patient, the ultimate goals of physiotherapy are to make them as functional or independent as possible and to re-institute them into society, family life, work, school, sports or

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other leisure activities. The Psycho-Emotional Realm

Getting parents, guardians and teachers involved in rehab helps to reinforce positive behaviour, and steps should be taken to address any associated learning difficulties. The use of assistive devices and home modification are key for patients who have long term physical or sensory deficits. Rails, in-bath seats, raised toilet seats, commodes, urinals, walkers, canes, bed side steps and ramps are all instruments that can be installed or used to improve ease of mobility, transfers and self-care activities. Based on the limitations and needs of the patient, and the structure of their home environment, an assessment and recommendations can be made by the physiotherapist. I find education to be an old but promising tool of intervention. In my experience it has a four-fold effect: 1. Informing the patient about their condition, and what they need to do in managing it. Sensory disturbances including pain. Stroke patients may lose the ability to feel touch, pain, temperature, or position. 2. Educating caregivers, friends and family members about the limitations of the patient and what they need to do to support the patient’s well-being or recovery. 3. Sensitizing the public about such conditions/ limitations, so that they are more receptive and considerate to the affected population. 4. Upgrading my own pool of knowledge or skills through research or furthered education helps me to be adequately modern in my approach to neuro-physiotherapy. Educating other health care members about what I do through discussions or presentations gives them a more in-depth understanding of physiotherapy and encourages them to modify their management to facilitate rehab of the affected patients. A treatment program for a neuro patient has to be designed based on the individual. I may have gotten at least 5 stroke patients of the same age group, gender and section of brain being affected. However, I can guarantee you that they all will present with some difference, as everyone has different needs, goals and lifestyles. ‘Treat the patient and not only the condition’ I phrase. I also have not had exposure using state-of-the-art technology or equipment in neuro-physiotherapy, but I find that improvisation and creativity can compensate. Cueing, feedback and stimulation are key in neuro rehab whether tactile, verbal or visual, which expands their sensory awareness and bring about a more successful task or movement on the patient’s part.

With the unfortunate event of having a neurological condition, a patient may go through one of the five stages of grief (according to Elisabeth Kubler Ross and David Kessler): denial, anger, bargaining, depression and acceptance. A patient should be allowed to experience grief, but only to an extent, so that no major issues or events on their part arise in the later phase of rehab. My foundation psychology course at UWI Mona, might not have magically turned me in a ‘master of the mind’. However, a basic understanding of human thinking and how it affects behaviour have readied me in helping patients to have a better concept of their situation. Helping patients to internalize positive contextual factors, such as the presence of good family support or health care system and facilitating the exercise of their faith or spirituality have motivated these patients to perform well. I believe that the natural tendency of patients to worry or negatively think about their problems should be matched with optimism and effort. As a physiotherapist I have had to deal with my own thoughts and feelings towards managing my patients. In retrospect, neurological rehabilitation can be taxing and unrewarding. I have had cases of seeing children with brain cancer vomiting on themselves, to rehabilitating a young man with similar attributes as myself, only to see him regress into a coma. I have had to balance empathy with sympathy, patience with promptness, permissiveness with firmness, and optimism with reality. I have the concept that physiotherapists are more humans than super heroes, but we cannot afford to be depressed or negative around our patients. After all, they look forward for our expertise and motivation. All Stakeholders Aboard… I value my role as a physiotherapist, but the roles of others in rehabilitation have to be considered: neurologists, neurosurgeons, caregivers/nurses, general practitioners, psychologists/psychiatrists, occupational therapists, speech therapists, dietitians, teachers, employers, family members, and friends. A more holistic outcome will result from this with all members communicating among themselves and working together, making the rehab process quicker and more comfortable. The patient is the primary stakeholder as they are the ones affected the most, and their roles or responsibilities cannot be undervalued, whether it may be taking medication on time, attending treatment sessions regularly or complying to home exercise program. We will not be able to do everything for the patients or force them to get better, but we are here to help and guide them.

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