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Most people have at some time or another suffered from headaches or know of someone close to them that have. For a lot of us though it’s not a regular thing, maybe we partied a bit too hard the night before or are just having a really stressful day, and we take some pain killers and carry on with our day to day lives. But for some it is a devastating condition that impacts on every part of their life, as well as the lives of those close to them. How many of you husbands out there have come home after a long days work and all you want to do is get “close and comfortable” with your wife, only to hear….not tonight honey…. I have a headache! Classic example.

The effects of headaches go a lot deeper than just the pain in the head. People suffer from a large amount of psychosocial factors, such as functional disability and loss of concentration, making work and studies a nightmare. They have a decreased productivity and emotional handicap which has a negative impact on close relationships and can lead to anxiety, anger and eventually depression. I mean when you are in pain you become miserable, and nobody wants to be around miserable people or even worse…..be that miserable person.

But there is hope, through a multi-disciplinary approach a lot of headache sufferers can be helped to lead normal, productive, happy lives.

Ok let’s talk a little bit about headaches. Firstly you get Primary headaches, which are not associated with other diseases and are the most common kind and then you get Secondary headaches, which are a symptom of an underlying ominous disease. Obviously these types of headaches are a lot more serious and here is the “Red Flag” list of things to look out for:

RED FLAGS

• Sudden onset of a new severe headache
• Progressively worsening headache
• Onset after exertion, straining, coughing or sexual activity
• Onset of first headache after 50 yrs old

If you have any of these symptoms please go and see your doctor immediately as your headache could be a warning sign of something a lot more serious!

PRIMARY HEADACHES

Why do we get headaches? How does it all work?

Well there are a lot of different triggers, both internally as well as externally that can lead to a headache. i.e.  Muscular, Vascular , Temporomandibular  joint (TMJ) or cervical dysfunction, stress, posture, certain foods, dehydration, sinuses, bright light, alcohol, hormonal changes, sleep disturbances and the list goes on.

These triggers are not necessarily what are causing the pain they just set it off, like a landmine. I was at a headache lecture the other night and the doctor explained it like this.

In your brain you have the trigeminocervical nucleus ,and what that big fancy name does is that it’s the principle centre of the head and neck involved in the transmission of nociceptive information .i.e  “the headache generator”

So basically what all these different triggers do is sensitize the “headache generator” more and more until eventually it explodes like a landmine and sets of a headache. They have also found that in chronic headache sufferers the “headache generator” part of the brain is more sensitive to the incoming messages from the different triggers than non sufferers. So what we need to do to prevent these headaches from developing is to try and desensitize the “headache generator” by cutting down the amount of stimuli it is receiving from the triggers. But in order to do that you firstly have to identify your own individual triggers.

A good way of doing this yourself (and I highly recommend this), is to keep a headache diary, in order to discover your own individual headache pattern.

This will help you start picking up trends and understanding your headache better.

Two of the major internal triggers are firstly Muscular .i.e.  trigger points (a hyperirritable spot in a taut band of muscle) mainly in the head and neck muscle groups, causing the Tension type headaches. Secondly the Vascular system, where the arteries in the scalp and skull vasodilate causing Migraines. Some migraine suffers experience either a visual disturbance, vertigo, numbness, weakness etc, prior to the onset of a headache. We call this an aura, which is caused by the blood vessels in the brain vaso-constricting. It is still unclear why this happens prior to the onset of these migraines.

Stress, Ergonomics and Posture are very big external triggers that need to be looked at and corrected.

Physiotherapy plays a major role in treating both the internal as well as external triggers along with a multi-disciplinary team of course. Helping to correct the muscular system and looking at correct ergonomics and posture as well as core stabilising exercises and manipulation therapy have  been proven to give lasting relief to headache sufferers.

A lot of people turn to the medicine cabinet when a headache is knocking on the door to try and mask the pain. The medications used are either Preventative or Rescue medication. Rescue medication you take once you already have the headache e.g Simple analgesics (Asprin, Paracetomol), Triptans (Imigran, Maxalt) etc

Preventative medication on the other hand you take before the headache starts and is only prescribed for severe, regular headaches when nothing else is helping. Some examples are Trepiline(Anti-depressant), Epilum, Atenolol(beta-blocker) .

The problem with all these drugs is that some people don’t respond to them and many of them have really bad side effects. If patients get depend on the medication and are using them regularly they can also develop Medication Overuse Headaches which a lot of the times are worse than their original headache that they started with.

Myself being a physiotherapist, I believe that medication has a role in headache treatment but there are many other ways than just  “popping a pill’(which just masks the pain and doesn’t deal with the true cause of the problem) to cure your headaches.

For instance I was at another course where the lecturer explained just by advising his patients to drink more water [(30ml/kg body weight /day) so if you weigh 60kg you should drink 1.8L of pure water a day] and keeping their blood glucose levels constant (by eating more low GI foods and smaller, regular meals during the day), almost all of their headaches had improved. Something small to think about…

Thank you for taking the time to read through this article. I hope it has benefited you in better understanding your headache and how to treat it.

Andrew@PhysioPRO

Many patients come to my practice having heard something about inner core stability, but the majority have a very skewed perception of the core muscles and how to exercise these.

As an example, I asked a patient of mine (a provincial rugby player) if he does core exercises. “Yes”, he replied, “I do 100 crunches every day!”

You may think that this is the ideal response, but in fact he had very poor core stability when tested, and by the end of this article you should realise that he was in fact not training his core muscles.

To understand the concept of the “core”, one first needs a basic understanding of the muscles that make it up. The core can be related to a cylindrical can.

• The lid of the can is the diaphragm
• The bottom is the pelvic floor
• The front and  sides are made up of a deep stomach muscle (you’ve probably never heard of it) called Transversus abdominis
• Lastly the back is a muscle called Multifidus

These muscles all act together to increase the pressure inside the stomach cavity, and in so doing increase stability around the mid-section. A good way of visualising this is to try imagine squeezing a new tube of toothpaste with the cap on. The tube keeps its basic shape and is quite difficult to compress. Now remove the cap or make a hole in the side of the tube and suddenly the tube collapses.

The deep stomach muscle and Multifidus also have connections to the spine itself and when contracting, prevent excessive movement at the spine during activity.

So why was the rugby player not training his core you ask?

Well, most people only train the top three layers of stomach muscles during regular stomach exercises. Crunches, sit-ups and similar exercises all involve movement of the torso and so you tend to only train the “mobilising” muscles. These may look good when your shirt is off, but do very little for your back.  The deep stomach muscle is a “stabilising” muscle, so in order to train it, you need to challenge your bodies’ stability.

This is where Physio-balls, Bozu-balls (half a physio-ball) and Pilates come in. Using this equipment under the supervision of a trained Physio or other health professional will help you train your core correctly by challenging your balance and stability. Most of the exercises that use this equipment will be static exercises (i.e. holding a certain position with as little movement as possible) and then at a more advanced stage, movement can be added. Ever seen a person doing a full squat whilst standing on a Physio-ball? These people have phenomenal core stability and its quite amazing to watch.

One last thing worth mentioning is that if you do go to Pilates, PLEASE make sure your instructor shows you how to isolate Transversus Abdominis before you commence any exercises. If you have not been shown how to do this, you could do more harm than good. For this reason, Pilates classes at the gym down the road is probably not the best place to start this form of exercise unless you can get individual attention.

There is so much more to be said about core stability and its importance, but I hope this short explanation will help you to better understand your body.

If you need more info or would like to check and train your core, give us a call and let us bulletproof your back.

Ric@PhysioPRO

Recently we’ve seen the emergence of a new fashion trend. One that has taken the world by storm!! But trust me, it’s nothing more than a fashion statement. I’m talking of course about the Power Balance bracelets.

Everyone has been wearing them. I’m sure you know at least one person who has one or maybe you’re even wearing one yourself? Why has it become so popular? How does it work? And more importantly does it really work?

Power Balance claims that by wearing the bracelet you will be more flexible, stronger and have a better posture. In this quick-fix age we live in this sounds perfect and fits in with our busy lifestyles. The hologram on the bracelet (same as the hologram on your credit card) has apparently been ‘treated’ with specific frequencies that allow it to interact with your body’s natural flow of energy.

Obviously a big concern for us as medical practitioners is that this supposed flow of energy through the body has never been scientifically proven. So if you can’t prove something exists, how can you claim to have developed a product that affects it? To prove my point, late last year Power Balance admitted that the claims they made were unsupported and they apologized for misleading the public. Here is the link to the official apology (http://www.powerbalance.com/australia/ca).

But I hear you scream, “I did the test where they push my arm down the first time and then after I wear the bracelet they can’t push it down anymore, so it must work.” I have only one answer to that. The mind is extremely powerful and the placebo-effect (unlike Power Balance bracelets) has been well documented and proven!!

My opinion, save the R300 you were going to spend on the bracelet and rather get a full musculoskeletal assessment done at your nearest PhysioPRO. We will determine where your muscle imbalance and postural faults lie and suggest exercises to best rectify the problems that might be affecting your life. This way we guarantee you will see results.

Sporting equipment can play a huge role in both the prevention and rehabilitation of sporting injuries.

At PhysioPRO, we stock Mueller Sports Care products. Mueller is an American based company that specialises in Sports Medicine Equipment. They supply a wide variety of bracing equipment for all body parts and also carry a range of sports related accessories.

A full product list can be viewed at www.muellersportsmed.com/SportCareRetail.htm

Contact your nearest PhysioPRO branch for more information or to order any of the Mueller Sports care range.

Recently, I’ve become very conscious of the fact that I need to address the issue of my personal health and wellbeing (Read: “I really have to shed some kilo’s because I feel like an inert morsel, experiencing unexplained discomfort at times” ). Tired of uncomfortable, boring and outdated workout routines and aiming to get new information in order to enjoy working out again, I came across a thought provoking article online…”

Correcting Posture: Myth or Reality? by Anoop Balachandran (originally published at MindandMuscle.net ). Also see: http://www.exercisebiology.com.

Physiotherapists perform a postural assessment as part of their initial assessments. Deviations from an ideal posture, such as an exaggerated anterior pelvic tilt – will definitely lead to low back pain. A forward head or grossly rounded upper back posture will end in shoulder, neck, and upper arm pain. We have all heard of examples where posture is definitely linked to pain.

The belief of posture related pain conditions is quite widespread. Surprisingly though, there is little scientific evidence to show that ‘bad’ posture will cause pain. We see people with ‘bad’ postures with no pain, and many more with ideal posture in a lot of pain, this shows that there is much more to pain than just posture.

Classifying postures and making people believe that certain postures and movements are bad and dangerous, instills fear of these postures, and enhances pain by fear-avoidance patterns. In short, casual conclusions about pain and posture could be doing more harm than good.

As Physiotherapists we are trained to look for common postural problems and then correct these where necessary. We are also focused on attempting to show a person struggling with pain that they are not doomed to a painful future because of their less than ideal posture but rather an aversion to mobility and normal function. So, the key to long-term alleviation of related pain is management by ‘physical therapy’ not just a passive reception of treatment.

In essence we must note that…

– There is no ‘perfect’ posture.

– Pain isn’t always caused by muscle imbalances (tightness or weakness).

– Pain is much more complicated than just stretching and strengthening the right muscles.

– The body doesn’t do well with prolonged periods of immobility.

– To break the immobility-pain cycle – we encourage movement and never restrain it.

– Corrective postural therapy (such as the various physiotherapy pain – relief modalities and ergonomics) can be effective but must always include movement and functional activities (commonly referred to as exercises).

Yours in Health

Mitesh

This month we welcome Riccardo Vacccaro, co-owner of PhysioPRO, to the world of blogging.

Riccardo Vaccaro received a BscPhysiotherapy (with Honours) from Wits University in 2007. He has always had a keen interest in sports medicine and rehabilitation.

Riccardo is a Fully Accredited Sports Physiotherapist registered with the South African Sports Medicine Association (SASMA). He is also a member of the Sports interest group of The South African Society of Physiotherapy (SASP).

Hi everyone,

Recently there has been a lot of interest shown in Elastic Adhesive Taping (EAT) as this multi-coloured tape has become a common sight in the sporting population. You only have to look as far as our National Rugby team to see how this tape has changed the taping world.

At our practice, patients are often amazed with the results they achieve using this tape. It is used to reduce pain, decrease inflammation and allow improved function.

It was created with the intention of “getting therapy between therapy sessions”. So let’s look at how and why it works.

There are currently many brands of this tape on the market and according to the brand, it may be referred to by different names, for example Kinesio tape, Kinesiology tape or K-tape etc.

Whatever the brand, they all work on the same basic principles, however not all tapes were created equally and there are differences in the adhesive properties of the different brands.  What about the different colours you ask? Well apparently this was done as colour therapy for patients, so for example blue should be used to try “calm down” tense patients. In my opinion, that’s about as usefull as wearing a hologram around your wrist to improve balance…but let’s leave that topic for another day.

So why does it work? Well, think of when you bump your head/knee/elbow or any other body part. What is your first instinctive reaction? After shouting ouch, you will most likely rub the area with your hand to help relieve the pain. This is because you are stimulating the skins mechano-receptors (which respond to touch) to send signals to the brain and in so doing, you close the “gate” on pain signals being sent.

This effect is known as The Pain Gate Mechanism and by applying tape over the skin, we are able to stimulate these mechano-receptors over a prolonged period thus reducing the body’s’ perception of pain.

Through this sensory stimulation, we are also able to effectively “switch” a muscle “on or off” depending on the direction of pull applied to the tape, and because the tape is applied over a prolonged time (3-5 days), this pull can be used loosen scar tissue.

It doesn’t end there though, because one of the other most valuable effects of this tape is the increase in lymph drainage, which is achieved through the tape microscopically lifting the skin, allowing fluid to flow easier and thus reducing inflammation.

I never get tired of seeing the expression on my patients’ faces when they see how a massive bruise is almost completely gone in 3-5 days after application of this tape.

As great as this tape may sound, it is really only as effective as the practitioner applying it. To get the best out of the tape, the practitioner has to assess each patient’s condition and then apply the appropriate taping technique, specific to the symptoms and cause thereof.

As with all great products, many companies are jumping on the band wagon, so please be wary of “do-it-yourself” taping, as you will probably be disappointed with the results and shocked at the price!

At PhysioPRO, our Physiotherapists are trained in the Kinesio Taping® Method and for more information on this subject please visit www.kinesiotapingafrica.co.za and click on the FAQ’s section.

“The new age sportsman or woman deserves a dynamic physiotherapist. Gone are the days of sticking someone on a machine for thirty minutes and massaging them for ten minutes. At PhysioPRO we pride ourselves on keeping up-to-date with current trends in Sports Medicine, to give you the patient, the best results possible.”

Riccardo

We care!! But you already knew that. In today’s post I’d like to show you the thought process that goes on, inside the head of a PhysioPRO physiotherapist, during assessment and treatment. As with anything in life, it’s always good to have some system in place, and often the more simple the system the more effective it becomes.

During our studies we were introduced to the SOAP format to give some logical order to our notes. So today let me walk you through this acronym and you will better understand what happens behind the scenes during your physio visit.

S – Subjective : This pertains to YOU!! The client. We want to know you. We want to know how you hurt yourself, how you’re coping  with  it and how it impacted your life. We want to know your hobbies and where you work. The subjective will continue throughout the treatment as details are important and the more we know the better we can treat you as a whole.

O – Objective : During this part of the session you might be asked to undress if necessary. Your physio will start by examining the area, noting symptoms like swelling, redness or any abnormal structure. Next they will use their hands to palpate (feel) all structures involved to pinpoint and assist with the diagnosis. Last, you will be asked to move so we can see the extent of the injury. Range of motion also serves as a good measure to see if treatment is successful.

A –  Assessment/Treatment : Here the physio lists what he thinks might be going wrong inside your body. From the information gathered during the subjective and objective he can start gluing the pieces together to form a diagnosis. It might not always be one diagnosis, as often different condition present in a similar manner. Treatment options for the session will also be recorded in this section. This way he can gauge at your next treatment whether he is heading in the right direction, or if he needs to completely change his treatment plan.

P – Plan : Because we care and want you to get better, we need some kind of plan to get you there. Most conditions require at least 2-4 physio sessions to resolve and therefore your physio needs to lay down exactly how they going to progress with you in those sessions. They might also give you some homework in the form of exercises.

I hope you have enjoyed the little glimpse inside the mind of a physio and will be more relaxed at your next session, knowing that you are in capable hands (literally).

Drugs are not always necessary. Belief in recovery always is. – Norman Cousins

Erik

Hi guys,

In this first article we decided to review the principles of managing acute injuries. How an injury is managed within the first 24-48 hours after sustaining it will significantly influence the outcome and time needed to recover. The principles of PRICER and no HARM will help to prevent further injury and ultimately lead to better and quicker healing. The main aim of treatment at this stage is to manage pain, inflammation and swelling.

Let’s get started:

P – Protect. It’s important to protect the affected area from further injury. This can be done by using crutches or wearing a protective brace.

R – Rest. Immediately cease the activity that you are participating in and rest the affected body part for the next 24-48 hours. Movement should only happen in pain free range as excessive movement will only lead to more pain and swelling.

I – Ice. This might be one of the most important steps to follow. Ice should be applied for 10-15mins every 2 hours for the first 48 hours. It will aid in relieving pain as well as minimising swelling. You can apply it in various ways but avoid placing ice directly on to the skin as it could burn.

C – Compression.  If you have access to elastic bandage (crepe bandage) this should be used to provide compression to the joint, it will minimize swelling and provide extra stability. Ensure the bandage is not to tight – causing numbness, tingling or a blue tinge to the skin.

E – Elevate. Raise the injured joint above the heart at all times or at least 10mins every hour. This will reduce swelling and minimize pain.

R – Refer. As soon as possible go see a Physiotherapist or Doctor to evaluate the extent of the injury and to advise you on further management.

If followed correctly the above guidelines should help you on your way to a speedy recovery by minimizing inflammation, reducing swelling and controlling pain. Now that you have a list of things to do, here is a list of things NOT to do.

The no HARM principles:

No Heat – Avoid hot baths and showers as adding heat will lead to dilation of vessels and promote swelling.

No Alcohol – Alcohol has a similar effect to heat, promoting swelling and delaying healing.

No Running – Avoid running or any other aggravating activity, you could cause more damage.

No Massage – Massage will increase blood flow to the area and thus cause more swelling.

We are often asked about the use of anti-inflammatory medication following an acute injury. At PhysioPRO we do not advise using them in the acute phase because although we are trying to minimize inflammation we do want the process to take place to a certain degree. Inflammation is the body’s defense mechanism and plays a vital role in the healing process, so please don’t see it as a negative effect. Acute, controlled inflammation is ok (and needed) when it gets persistent then anti-inflammatory medication can be discussed with your treating practitioner. If the injury is quite severe anti-inflammatories could be prescribed by the practitioner immediately. Each injury should be assessed and treated accordingly as people and injuries are all unique. The above are merely guidelines.

We hope that this has given you an insight to managing any acute injury. If you are at all unsure about the severity of an injury please get to a trained healthcare professional as soon as possible.

Erik Kruger & Riccardo Vaccaro