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Neck Pain With Headache

Neck pain coupled with a headache can be debilitating.  It interferes with sleep leaving you exhausted all the time.  For some, this type of neck pain causes ache to radiate up the temple or forehead.  Grinding, popping or clicking upon movement is felt as well.  Range of motion (ROM) is limited and painful.  Pain is worse upon initial movement after a period of immobility such as after sleeping or prolonged reading in one position. If you have all these symptoms, you may have arthritis in the atlanto-axial and atlanto-occipital joints.

The atlanto-axial joint (C1-C2) is mostly responsible for turning your head side to side.  The atlanto-occipital joint is responsible for nodding or looking up or down.  With normal wear and tear or prior injury, the cartilage that lines the surface of these joints becomes worn out.  This is what doctors call “bone on bone”.  These joints are close to your ear so you can actually hear the popping, clicking or grinding.  Arthritis in these joints can cause pain in the neck, headache and/or pain up the temple, forehead, or top of the head.

This condition can be managed with Physical Therapy.  ROM exercises should take care of this problem.  However, by the time we see our patients in our office, their joints are stiff  that usual ROM exercises are not enough. They do benefit from careful, and specific spinal joint mobilization.  This is not the typical “cracking” of the neck you hear chiropractors do.  Mobilization is done one segment at a time.  The result is quite dramatic.  Symptoms of headache and pain radiating up the head are decreased in one or two visits.  Patients are taught the correct ROM exercises to maintain this increased flexibility. Pain from inflammation are addressed as well.  There are modalities just for this problem.

Call us if you have this condition.  We can help.

Dino Lontoc, PT



Knee pain

I have known people do heavy exercises thinking it will help their arthritic knee. Most of them tell me the exercises did not help.  In fact, the pain in the knee actually got worse. I tell them exercise is good but the level of exercise intensity can make a big difference whether the knee will feel better or worse.

For our patients with degenerative joint disease of the knee, we start them with mild and gentle range of motion (ROM) exercises .  An example is heel slides on the mat.  Heavy, weight bearing exercises such as squats, and lunges are done a few weeks later, depending on the severity of the arthritis of the knee.  Each person has his own level of threshold that when crossed will result in an inflammatory flare up.  Our rehab program focuses on staying below this threshold.  As the knee gets stronger and more flexible, this threshold goes up therefore allowing heavier exercises to be done without flare up.  “No pain, no gain” does not apply here.  This increase in threshold varies from person to person but it definitely improves with exercise.

In our practice, we document  every session the level of exercise our patients did.  If ever this threshold is crossed, we know exactly how much exercise this patient can tolerate.  We then go near it but not past it.  Eventually, patients see their progress and learn the proper way of advancing the exercises.  By the time we discharge them, they not only have a home exercise program but they have the knowledge of correctly doing and advancing the exercises.  Eventually, with better strength and flexibility, function improves.  Getting up from a chair will no longer be such an effort.  Getting in and out of car, stepping up on curbs or stair climbing will be easier.  Because the knee has a higher threshold for physical activity, flare up does not happen.   Patients stay pain free doing what they want and need to do.

Patients consult their doctors when something is hurting.  In the case of knee arthritis, they are given anti inflammatory medicines for their, well, inflammation.  For some who are referred to us, they show up in our office with persistent inflammation.  We have modalities just for this problem. In addition, they are educated on strategies to minimize strain on their joint . They are instructed, just to give a few examples, to avoid prolonged walking, to avoid stepping up on curbs, or to use their hands when getting up from a chair.

In closing, I would like to share a joke.

So there was this athlete who was being interviewed by a sports caster.

Sportscaster: Can you tell us how you train?

Athlete:  Well, I climb Mount Everest.  Then I swim the Ganges river.  And then I jog the Sahara desert.

Sportscaster:  Wow!  That’s quite a workout!

Athlete:  Yes, and I do all that in one week.

Sportscaster:  Amazing!  So what do you do the rest of the year?

Athlete:  I lie in bed sick.

Let us not be this athlete.   If you happen to need physical therapy, call us. We have two locations:  One in Land O’Lakes and the other in Zephyrhills, Florida.  Stay well.

– Dino Lontoc, P.T.

Back pain

Degenerative joint disease of the lumbar spine is the most common cause of back pain that we see in our practice.  As the name implies, it is the degeneration of the facet joints of the spine.  Normally, the surface of these joints are lined with cartilage.  But over time or previous injury, the cartilage becomes worn out and eventually, the bone of the joints are exposed.  This is what doctors mean when they say, “your joint is bone on bone.”  The body tries to fix this but it can not grow cartilage back. Instead, it lays down bone spurs and these end up on the edges of the joint.  We ‘ll go back to this later.

As we age, our discs dry up and become thinner.  This condition, by itself, does not cause the back pain.  The thinning of the discs causes the intervertebral foramen to become narrower.  Nerves exit through these foramina and when they become narrower, the likelihood of the nerves getting pinched increases.  When nerves get pinched, that’s when pain is felt.

Going back to the bone spurs around the facet joint, these spurs cause narrowing of the intervertebral foramen as well.  When you combine the presence of the bone spurs and the thinning of the discs, the foramen becomes much smaller making it really easy for the nerve to get pinched.

There are ways to mitigate this condition.  In our office, we educate our patients of what I just mentioned above.  We also teach them what to avoid to prevent the nerve from getting pinched.  Certain movements make the foramen bigger or smaller.   For example, forward bending causes the foramen to open up.  Backward bending does the opposite. Side bending and twisting will also cause a change in foramen size.  We have an articulated model of the spine which helps us demonstrate to our patients the change in foramen size with every movement.  They can therefore mentally visualize what’s going on with their spine every time they bend or twist.

When a patient has an impinged nerve,  we instruct him or her to avoid certain movements corresponding to the biomechanics of the spine.  In addition, they are taught posterior pelvic tilting and abdominal strengthening exercises.  Hip flexor muscles are stretched as well to minimize arching of the back.  Spinal mobilization is also done to loosen up the stiff and arthritic facet joints.  This is followed by gentle range of motion exercises.

Since the nerves are pinched, they are most likely inflammed and swollen. In our office, we provide our patients with modalities for inflammation. Once the inflammation and swelling go down, the nerves have more room in the foramen, making it less likely to get pinched.  In our profession, the use of these modalities is becoming unpopular because health insurance companies pay very little for these.  We believe in the effectiveness of these modalities and we provide them  despite the low insurance reimbursement.  In our office, we provide the best treatment for our patients regardless of insurance payments.

Armed with the knowledge of spinal biomechanics and corresponding precautions, our patients become pain-free and remain pain-free.

We have 2 offices to serve you.  One is in Land O’ Lakes Florida and the other is in Zephyrhills Florida.

– Dino Lontoc, P.T.