Posted on Wednesday, August 31, 2016

How to Prevent and Treat Migraine Headaches

Migraine pain is the second most common type of headache (with tension/cervicogenic type headaches being the most common). Up to 16-17% of the population complains of migraines. These headaches can be very debilitating. Migraine pain is often in combination with other forms of headaches. It can even be triggered by a tension headache or sinus headache. Migraines can also be caused by menstruation or hormonal imbalances.

Migraine headaches are just one of many types of headaches. Migraines sufferers are more common in women. Certain statistics conclude that women are up to three times more likely to have migraine type symptoms. Presently, the exact causes of migraines are not well understood. Migraines are often associated with a trigger, but you can have one or multiple triggers.

Migraines also have a genetic component. If you have a parent or sibling who experiences migraines, you will have a higher likelihood of developing them as well. It’s also not entirely known if the familial component to migraines is due to something anatomical in regard to brain or other physiological factors or if the predisposition is based on the living environment or other factors that could be causing the trigger.

There are two categories of migraines. Episodic is when you experience 14 or less days with a headache. Chronic is when you have 15 or more headaches per month.

The Four Phases of Migraine Pain:

Although symptoms of a migraine will differ for everyone, symptoms tend to progress through the following four major phases.

Prodromal Phase

This is the pre-headache phase that can occur hours or up to a day in advance. Initial symptoms and patterns can be found up to one to two days prior to the actual migraine. Typical symptoms may include: excessive energy or excitability; possible depression; overly fatigued; irritable; thirsty; frequent urination; and cravings for specific foods.

Aura Phase

Not everyone experiences this phase. Approximately one in five people will describe feelings of an aura (a visual disturbance) which can include any change in vision from experiencing blind spots, hallucinations, and different arcs of light. Other associated symptoms include a pins and needles feeling which can be felt in your face or other areas of your body. You may experience changes in speech. Many of the initial symptoms can mimic symptoms of a stroke. (Please refer to signs of a CVA).

Attack Phase

This phase occurs when the pain starts to develop, and it can last hours to days. Most typically it will be behind your eyes and will affect one or both sides of your head. Symptoms include: throbbing pain on one side of your head (although pain can be present on both sides); pain behind your eyes; difficulty performing typical activities; pain that worsens with activity or heat; nausea; vomiting; and sensitivities to light, noise, and smells.

Postdromal Phase

This is the phase after the migraine has ended, but some symptoms linger which can last for hours or up to a day or so. Symptoms include: fatigue; sluggishness; lack of mental sharpness; and intermittent pain (particularly, if you move too much or rapidly).

How to Manage Migraine Headaches:

Typical medical management of migraine headaches starts with a diagnosis from a medical doctor. Your doctor may refer you to a neurologist or specialist for treatment and/or diagnosis. A thorough examination should be completed. A CT Scan or MRI may also be performed to check for other more serious pathology in the brain.

Medications are often prescribed and are categorized the following two groups:

Acute Medications. These medications are taken after the migraine pain and symptoms have already begun. These may include both over the counter (OTC) or prescription medications (including opioids or NSAIDS, such as Ibuprofen or Naproxen or even stronger anti-inflammatory medications).

Preventive Medications. The medications are typically taken hours to days prior to the migraine pain and symptoms. Such medications are prescription based. A common family of medications used is known as Triptans. These medications are only for treating migraine headaches and are meant to be taken immediately upon the first sign of one. They cause the brain to release more serotonin. This causes the blood vessels in your brain to narrow and reduce swelling which helps to control symptoms. These medications are often prescribed with other pain medication and/or anti-nausea medications. The following is a partial list of Triptans:

eletriptan (Relpax®)
frovatriptan (Frova®)
naratriptan (Amerge®)
rizatriptan (Maxalt®)
sumatriptan (Imitrex®, Alsuma®, Onzetra™, Sumavel™, Zecurity®)
zolmitriptan (Zomig®)

In the initial phase of treatment, it’s imperative to have an accurate account of the symptoms, type of pain, and suspected triggers. This will be an important first step in guiding treatment as in almost all cases successful treatment will be multifocal.

Initially, I always recommend that you start a thorough headache log or diary. Don’t perseverate over every little detail of your headaches, but you need an accurate account of frequency and triggers.

Often, triggers can occur from hours up to a day in advance. Log each of your activities and meals for up to a month. Look for patterns. Try to establish patterns to the headaches. When do they occur? Do certain foods trigger the headache? Which activities will cause a headache? What makes the symptoms better or worse? Are they associated with certain movement patterns, activities or even certain times of the day or month?

Be thorough about what occurred prior to the headache and which treatments helped the most to resolve the headache. Once you have completed a thorough headache log, the treatment will focus on the following two major categories: prevention and the actual treatment of symptoms.

Prevention for Migraine Headaches:

Exercise. It’s well documented that mild to moderate intensity exercise can help to reduce or eliminate headache symptoms. The reason why it’s so effective isn’t entirely known. It may be because of the endorphin released during exercise, changes in blood flow to the brain, stress reduction, improvement in strength, and/or changes in hormonal regulation patterns. Regardless, regular exercise is a must. Find what works for you, and stick with it.
Yoga and other forms of similar exercise such as Chi Gong and Tai Chi are all excellent forms of exercise and can help to reduce stress levels which can affect migraine pain.
Meditate. Regular meditation or prayer can reduce stress and lower the frequency of headaches. Deep breathing can be a form of meditation. I often perform what is known as box breathing. I breathe in for four seconds, hold the air for four seconds, and breathe out for four seconds. Then I wait four seconds prior to breathing again. Repeat this for several minutes and focus only on your breathing.
Magnesium. A deficiency in magnesium is often associated with headache symptoms. Most people are deficient in the amount of magnesium they consume on a regular basis. You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.
Vitamin B2 (also known as Riboflavin). A deficiency in B2 can be associated with migraine symptoms. Supplementation has been proven to reduce the frequency of migraine headaches. B2 is important in the production of red blood cells and plays a role in how your body gets energy from carbohydrates, fats, and proteins.
Butterbur. This is an herb that is known to relieve muscle spasms and works as an anti-inflammatory.
Adequate Sleep. Proper sleep is critical. Poor quality sleep, including too much or too little of sleep, has been identified as a trigger for migraine headaches. Focus on getting a good quality of seven to nine hours of sleep nightly. To learn how to maximize your sleep, please refer to Michael Hyatt’s nighttime rituals.
Stay Hydrated. Dehydration can cause migraine pain. Dehydration can also affect sinus symptoms. Sinus pain can also be a trigger for migraine pain.
Manage your triggers. Common triggers include: loud noises, bright lights, dehydration, strong or specific odors, and high altitudes. Other triggers may be consuming red wine, aged meats or cheese, dairy products, and gluten. Addressing food triggers is a critical step in treatment. I recommend that you take an IgG food sensitivity test. IgG is an immunoglobulin antibody found in the body. This test can help to determine if certain foods are causing your body to react in a negative way. Addressing any sensitivities and possible gut or gastrointestinal issues can be very helpful in treating migraine headaches. This step is often overlooked, although it may be one of the most important. Please seek assistance from a functional medicine doctor who specializes in headaches and gastrointestinal issues if your migraine symptoms are correlated with any food triggers.
Eliminate caffeine. This can be very tough because caffeine tends to be helpful in reducing initial symptoms. Chronic caffeine use (particularly in headache suffers) is known to cause rebound headaches (another sub classification of headaches). Rebound headaches occur when the same substance that helps to reduce symptoms will also cause the next headache to happen. Eliminating caffeine initially is difficult as it may trigger another headache. However, long term elimination of caffeine from your diet can be very effective in preventing migraine pain. Just watch out for over the counter (OTC) medications that contain caffeine as an active ingredient.

How to Treat when you’re experiencing a Migraine Headache:

Ice. Try using an ice pack either on the forehead, scalp or neck, and/or directly over the area with the worst symptoms. The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a gel style Cold Pack. A bag of frozen peas can be ideal.
Caffeine. Although caffeine ultimately causes more harm than good for headache sufferers, it can be used in the short term to help to reduce symptoms.
Find a dark quiet area where you can rest, use a cold compress, and possibly perform meditation or box breathing.
Hydrate. Be sure you are properly hydrated as dehydration will make symptoms worse.
Do not exercise. Exercise is not advised during an actual migraine headache. However, it’s highly encouraged as a prevention method.
Medications. Be sure to use the medications properly as prescribed by your medical physician. The ultimate goal is to prevent headaches and lessen the dependency of medication use. During an actual migraine, the goal is to feel better fast so that you can work on these prevention techniques. Use the medications as a tool to help you progress through your treatment plan.

Migraine pain is a difficult to deal with and to treat. In almost all cases, successful treatment and management will be a multifactorial approach and differs for everyone. It’s important to hear from others on what works to help treat or prevent migraine pain, but don’t be discouraged if his/her treatment doesn’t work for you. Your goal is to devise a custom treatment plan that will work for YOU. Each person may progress differently, but many of the approaches are similar.

Be sure to work with medical professionals who you can talk to and trust in order to create a treatment plan. The focus of treatment should be on prevention and discovering what triggers your migraine headaches. Ideally, you will be able to reduce and/or eliminate the symptoms while optimizing your health. Medications should be thought of as short term tools to help you as you come up with a long term solution.

If you suffer from migraine headaches, which treatments have worked the best for you? Please share below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer: The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed. The use of information on this blog or materials linked from this blog is at your own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Do not disregard, or delay in obtaining, medical advice for any medical condition you may have. Please seek the assistance of your health care professionals for any such conditions.

Posted on Wednesday, August 24, 2016

Cluster Headaches, the “Suicide Headache”

Cluster headaches are sometimes referred to as the “suicide headache” because the pain can be so severe. They are rightfully named because they tend to occur in “clusters” for days or weeks at a time. They typically cause severe pain which lasts from 30 minutes to two hours, then diminishes or disappears. They can recur as frequent as a few minutes to hours or even up to a day or two later. Four or more cluster attacks may occur in one day, and these attacks can strike every day for weeks or months before going into a type of remission. During remission, no headaches occur for months (and sometimes, even years).

Cluster headaches are not something routinely dealt with in a physical therapy setting as the cause of the headache is typically not mechanical, nor is it associated with a trigger that would be amenable to physical therapy treatment. These headaches can be very frustrating as the cause of the headache is not entirely known which makes treatment difficult. In fact, experts are not entirely sure, but believe that the headaches are in some way associated with the hypothalamus (an area of the brain that controls body temperature, hunger, and thirst, and is associated with our internal biological clock).

Although cluster headaches are one of the most painful types of headaches, they are non-life threatening and rare (in general) when compared to other types of headaches. Cluster headaches are more common in men. People of African ancestry are twice as likely to suffer from cluster headaches when compared to Caucasian people. Cluster periods may be consistent and seasonal. For example, they may occur every spring or every fall.

Most people have episodic cluster headaches. In episodic cluster headaches, the headaches occur for one week to a year, followed by a pain-free remission period that can last as long as 12 months before another cluster headache develops.

Cluster Headache Symptoms include:

A headache that typically begins several hours after falling asleep and wakes you up at night.
You may initially experience a warning signal with a mild, aching sensation on one side of the head.
Nasal congestion.
Flushed face.
Severe pain that lasts minutes to hours which then dissipates only to repeat later that day or the next.
Pain is typically associated around one eye and/or one side of your head, but it can radiate to other parts of the head and neck area.
Excessive restlessness.
Forehead and facial sweating.
Redness in the same eye as the headache pain.

Treatment for Cluster Headaches

Unlike many other forms of headaches, cluster headaches have only a few known triggers. Learning to avoid these triggers is an important for prevention and in order to extend periods of remission. Consuming alcohol, experiencing a sudden rise in temperature, and exercising in hot weather are known to trigger attacks. In addition, so can the medication nitroglycerin.

Management of cluster headaches is typically through a neurologist. Medication is typically used to help to manage symptoms. Opioids and other pain relievers are often used. As with migraine suffers, medications from the Triptan family are utilized as well as a medication known as Octreotide, which is an injectable synthetic version of the brain hormone somatostatin.

Local anesthetics such as lidocaine are often given intranasally through nose drops or a spray and seem to be effective. Dihydroergotamine is also given intranasal. Other medications potentially used include:

Calcium channel blockers
Corticosteroids, such as prednisone
Lithium carbonate

Some have found that dosing with melatonin is also helpful in reducing the frequency of headaches.

Besides medication, oxygen therapy is frequently utilized as a form of treatment. This type of therapy involves inhaling 100% oxygen through a mask at a high rate of at least 12 liters a minute. The benefits are usually felt within 15 minutes of starting the treatment. For more information and a summary of the research on oxygen therapy and headaches, please refer to Is Oxygen Therapy Effective for Anything?

A nerve block is another treatment to consult with your physician about. A nerve block is performed by a physician who would inject a numbing agent and corticosteroid around the occipital nerve in the back of your head.

Cluster headaches require treatment from a qualified medical specialist such as a neurologist. If you or a loved one suffers from this condition, please seek treatment assistance right away.

Do you or a loved one suffer from cluster headaches? If so, which treatments have worked for you? Please share below.

Posted on Wednesday, August 17, 2016

9 Treatment Tips for a Sinus Headache

Poor air quality? Allergies? A cold? There are many reasons to get a sinus headache, but what treatments actually work? Discover treatment tips that can help to lessen the symptoms of a sinus headache and speed up your recovery.

Your sinuses are located along your forehead, behind the bridge of the nose and under your cheek bones. Sinuses are basically hollow air filled cavities. Typically, they are lined with a thin mucus layer. Their purpose is to help humidify and filter air. They may also affect the sound of our voice. Sinus cavities are present at birth, but do not fully develop until late in the teen years.

Sinus pain typically occurs due to an infection or allergy which affects the mucosal lining and causes it to become inflamed (leading to pressure and pain). This results in headache type symptoms. Sinus headaches are often found in conjunction with other types of headaches (particularly, tension and migraine type headaches). In many cases, sinus pain is the initial trigger that causes an associated tension and/or migraine headache.

Sinus headaches are typically easy to diagnose. Typical symptoms include:

Pain and pressure along the cheekbones, forehead, and/or bridge of your nose.
Palpation over top of the sinus cavities is usually painful.
Worsening pain when straining (increasing your blood pressure via the Valsalva maneuver).
Worsening pain when bending or leaning over.
Accompanying symptoms of illness or allergy including: a stuffy or runny nose; earache or feeling of fullness in your ears; fever; and/or swelling in your face.
Dizziness.

9 Treatment Tips for a Sinus Headache:

Address the cause of the headache and treat with medication (if necessary). If you are suffering from an allergy or cold symptoms, then taking medication (such as an antihistamine or decongestant) may be appropriate to help reduce the mucosal buildup in the sinus and help elevate the pressure. You might also consider an anti-inflammatory medication to help reduce the swelling in the mucosal lining. In the case of a sinus infection, an antibiotic may be indicated. Please speak with your medical physician regarding medication treatment options. (You may consider using natural decongestants as noted below.)
Eliminate allergens. Many sinus headaches are not caused by illness, but from an allergy. The most common irritants are airborne, but even food allergies or sensitivities can worsen symptoms. An example of this is a milk allergy. Milk products are often associated with increased mucous production in those with allergies or sensitivities. This can lead to build up in the sinus cavity.
Utilize hot and/or cold compresses. Another option is to utilize a hot and/or cold compress over the sinus cavities. It can help to reduce pain and help the cavities to start draining. People tend to have very strong feelings on their preference for heat or cold, so choose what works best for you. I personally have found that alternating between heat and cold every couple of minutes works well.
Use a Neti Pot to cleanse and protect your nasal passages. This treatment has been around a long time. Essentially, you fill the Neti Pot with a warm fluid (typically, saline solution). Tilt your head and slowly pour the liquid into your nose so it can circulate into the sinus and then out the other side to help clear them of congestion. It’s basically a form of nasal irrigation.
Stay upright. Lying down on your back or especially your stomach especially tends to worsen symptoms because of the anatomy of the sinus cavities. Using gravity by remaining upright or staying semi-reclined can help the sinus cavities to remain clear.
Self massage. Gentle self massage around the sinus cavity can also be helpful. I typically advise the massage before and after utilizing either the hot/cold compresses or before and after using the Neti Pot. The technique is simple. Just slowly and gently massage over top of the sinus cavities. Initially, make small circles and finish with small swiping motions out and away from the cavity toward the ears and hairline. This should not be painful. If the pain worsens, then discontinue.
Use a humidifier. One of the purposes of the sinuses is to humidify the air you breathe. It’s important to not let the mucosal layer dry out. A humidifier can be very helpful in the treatment of sinus symptoms and may also be helpful in preventing symptoms if this is a chronic problem for you.
Use natural decongestants. Using essential oils or vapor rubs products that contain mint or menthol can be very helpful in temporally opening up the sinus cavities. Many are inhaled (by combining with a humidifier) or applied topically. In the case of topical application, the sensation of the product may also help with pain. Just be sure to follow the instructions and keep away from direct contact on the mucosal lining and your eyes.
Address other associated headache symptoms. Sinus headaches tend to trigger other types of headaches, so you will likely need to treat not only the sinus symptoms but also any other headache symptoms that occur. Generally, headaches are classified into four or five different categories. There are many potential sub categories as well. Please refer to Q & A: What Causes Headaches?

We are all likely to suffer from sinus headache symptoms at one time or another. Using these treatment tips can help to lessen the symptoms and speed up your recovery. If you are chronically experiencing sinus headache symptoms, it’s important to determine the cause and work on preventing symptoms. For those who experience chronic symptoms, addressing food sensitivities will be an important component to long term management.

What is your go-to remedy when treating a sinus headache? Please share your tips!

Posted on Wednesday, August 10, 2016

Q & A: What Causes Headaches?

Q. Several members of my family frequently get headaches. Thankfully, I rarely get them, but what causes headaches? Why do some people get them and others do not? Thanks, Ben! -Brad

A. Thanks for your question, Brad! Headaches are a very complicated subject. I will do my best to answer your question from a physical therapist’s perspective.

Headaches can range from mild to severe with symptoms varying wildly. Approximately 15-20% of the population will suffer from headaches at any given time. It’s one of the top medical ailments for which people seek treatment. Headache suffers are also one of the most heavily marketed to group. There are no shortage of scammers and snake oil salespeople trying to sell you the next great remedy to cure your headaches.

Although there are many potential sub categories of classifications a person could use (particularly, within the tension class), I tend to classify headaches in one of five categories: tension; cervicogenic; sinus; migraine; and cluster.

Classifications of Headaches:

Tension

These are the most common type of headache. These headaches are often related to tension in the muscles of the head, neck and jaw and are frequently stress related. The actual physical cause is still not fully understood, but it’s likely linked to how the brain and nervous system perceives muscular pain and stress.

Tension headaches are categorized as either episodic (meaning that you experience less than 15 headaches per month) or chronic (meaning that you experience more than 15 per month). Women tend to experience them more often than men. Many food or environmental factors can trigger tension or migraine headaches. Food and environment triggers for headaches could easily be a classification of their own.

Please refer to Prevention and Treatment Strategies for Tension Headaches.

Cervicogenic

Not everyone would say this is a separate class of headache, but I tend to classify cervicogenic headaches separately. Cervicogenic headaches are often associated with tension type headaches. There can be a lot of overlap with tension headaches, but in this class the underlying cause of the headache is from the cervical spine. There are many pain generating structures in the cervical spine. A few potential causes could be nerve related, trigger points, facet joint or cervical mal-alignment related, or cervical disc related. I find that postural dysfunction tends to go hand in hand with this type of headache as well as in tension headaches.

Cervicogenic headaches tend to be found more often found in women. This seems to be primarily due to the anatomical differences of men versus women. Men tend to have more muscular necks while women tend to have more long and slender necks with less muscle to provide support to the head (meaning that there is less muscle strength for support).

Please refer to Cervicogenic Headaches: A Real Pain in the Neck (and Head).

Sinus

Your sinuses are located on your forehead, behind the bridge of the nose and under your cheek bones. In cases of infection or allergy, the mucosal lining will become inflamed and causes pressure and pain. This results in headache type symptoms. Pain is often worse when bending over or straining.

Other than headache type pain, you may also be suffering from other symptoms of illness including a stuffy or running nose, earache or fever. Sinus headaches are often a trigger to other types of headaches such as tension and migraines.

For more information, please refer to 9 Treatment Tips for a Sinus Headache.

Migraine

Migraine pain is the second most common type of headache (with tension/cervicogenic type headaches being the most common). Up to 16-17% of the population complains of migraines. These headaches can be far more debilitating than the typical tension/cervicogenic type headache. Migraine pain is often in combination with tension headache pain. Migraines can also be caused by menstruation or hormonal imbalances.

Frequently, people will classify any type of severe headache pain as a migraine although it may or may not actually be the case. The severity of pain is not what leads to a migraine classification, but which symptoms are present.

Symptoms of a migraine will differ for everyone. Initial symptoms and patterns may occur one to two days prior to the actual migraine.

Typical symptoms may include:

Throbbing pain on one side of the head (but pain can be present on both sides)
Pain behind the eyes
Difficulty performing typical activities which worsen with activity or heat
Nausea
Vomiting
Sensitivity to light, noise, and smell

Less common symptoms may also include: difficult with speaking; tingling in the face, arms, and hands; and short term upper body weakness.

Migraines are more commonly found in women. Like tension headaches, migraines are often associated with known varying triggers like food, smells, excessive heat, fatigue, and dehydration.

Please refer to How to Prevent and Treat Migraine Headaches.

Cluster

This type of headache tends to appear in cycles (clusters) which last hours to days. By most accounts, these are the most painful type of headache. Typically, cluster headaches present with a sudden onset and usually subside as quickly as they start.

These headaches are the least common and only affect approximately 1% of those who suffer from headaches. The first onset for this type of headache is usually between 20-30 years old.

Please refer to Cluster Headaches, the “Suicide Headache” for more information.

When to Seek Emergency Care:

Although most headaches do not require emergency medical attention, the following signs and symptoms indicate when to seek emergency care.

If you have any of these signs or symptoms, please seek emergency care:

Abrupt, severe headache
Severe unrelenting pain
Headache with a fever; stiff neck; mental confusion; seizures; double vision; weakness, numbness; and speaking difficulties
Headache after a head injury (especially, if the headache gets worse)
Muscle weakness/paralysis and/or face drooping (signs of a CVA)

How to Determine the Cause and Design an Effective Course of Treatment:

The symptoms of headache pain are nearly as diverse as the causes of headache pain. Regardless of the onset whether sudden (such as from an injury, from a fall or motor vehicle accident) or more subtle and chronic, there are few aspects of care that are important for all headache suffers to consider.

Start a headache log or diary. I always recommend beginning the process by keeping a diary in order to determine the most likely culprits prior to working on less common scenarios. There are many obvious and common potential causes to address first. Sometimes, it takes some serious detective work to rout out the cause and design an effective course of treatment. The patterns noted in the diary will be clues to guide you down the right treatment path. Don’t perseverate over every little detail of your headaches, but you need an accurate account of frequency and triggers.
Look for patterns. Try to establish patterns to the headaches. When do they occur? Do certain foods trigger the headache? Which activities will cause a headache? What makes the symptoms better or worse? Are they associated with certain movement patterns, activities or even certain times of the day or month?
Which treatments work for you? Everyone has his/her preferred cure, but what really works for you? Don’t feel bad if someone else’s cure doesn’t work for you as we are all different.
Leave no stone unturned. When looking for patterns, consider all aspects including: food, medications, and supplements. Also, consider your living environment. Could there be mold in the home? Other unknown allergens? How is your micronutrient status? Dental issues?

Don’t give up hope! Headache pain is difficult to manage, but with proper care most headache pain can be cured or effectively managed. The most frequent mistake I see people make is to not stick with a thorough plan. Jumping around from one treatment to another rarely works.

With severe and/or chronic headache pain, a very thorough and specific plan of addressing all aspects of your health and wellbeing will need to be addressed for long term success. This process can be slower than desired, but when executed properly, it will almost always leads to significant success.

Thanks, Brad, for the question! I hope you and your family members find this information helpful and that they are able to experience some relief from headache pain! Stay tuned as I will profile typical self-treatment strategies for each type of headache in upcoming posts.

Do you or a loved one suffer from headaches? Which treatments have worked the best for you? Please share your experience. Together we can all grow and learn how to best manage this condition.

Posted on Wednesday, August 3, 2016

Exercise as Medicine

The United States health care system is set up to manage ongoing chronic disease and illness–not to promote health. It often seems as if there isn’t any incentive to actually cure disease at all, but only to manage and extend the latent period of the disease.

Meanwhile, there is an ironic dichotomy in which the national media loves to cover the lifespan revolution. Some believe that we are the cusp of significantly advancing the length a person can live. Sadly, the actual average number of years a person is expected to live remains stable or in many cases, actually decreasing. This is entirely due to poor nutrition, lack of physical activity, and environmental factors. The United States continues to not even rank in the top 25 in world health statistics.

Yet, we spend more money on healthcare per capita and per person than any other country in the world! Health care costs in the United States continue to increase without actual positive change in health status. It is imperative that we all take a leadership role in our own health care by continuing to be proactive.

American society today is not healthy. We continue to live in a fast paced, stressed out, and chronically ill environment. People continue to suffer from preventable diseases such as diabetes, osteoporosis, and heart disease. Even diseases such as cancer, Parkinson’s, and Alzheimer’s can potentially be prevented with the right health choices.

The promise of a long life is appealing. But is a long life really what you want if it’s lacking quality? Increasing the number of years you live is not as important as increasing the way you can live those added years. Spending an extra 5 or 25 years alive, but ill, is a curse not a blessing.

We all must take an active role in taking charge of our health and wellbeing. Prevention must be the focus. I believe that each one of us should develop our own health plan which will allow us to improve health span and lifespan. There are very simple and scientifically proven techniques that can help you to address and prevent many of the most common chronic illnesses affecting the population in the United States and the Western World. A new approach to health and medicine must be to understand that exercise is medicine. When exercise is properly dosed for the individual, both lifespan and health span will improve.

Physical factors that address health span, which is the period of time during one’s life that you are generally healthy and free from disease, include strength, balance, flexibility, and endurance. These same factors all contribute to your body’s physical resiliency and generally, your mobility. Maintaining your mobility is critical for all body functions and is fundamental in avoiding chronic illness.

Physical factors that address health span include:

Strength

The importance of strength training cannot be overstated in helping your body prevent chronic disease and illness while maintaining resiliency and mobility. Properly dosed strength training programs are critical in avoiding chronic illnesses such as diabetes, osteoporosis, and osteopenia. It provides positive effects to your muscular and cardiovascular system which can reduce the risk of dementia and Alzheimer’s disease. Strength training also plays a critical role in proper hormone regulation throughout your life which can affect almost every process occurring in the body.

The guiding principle for strength training is The Overload Principle. Resistance or strength training is commonly used to produce an overload of the body’s system. An example would be any type of pushing or pulling exercise that exerts a force on the muscle, which causes it to work harder than it would normally.

The key to all training is that the system must be properly overloaded to produce the desired effect. Too little, and you will not receive a positive benefit. Too much, and you risk injury. The overload principle must guide all exercise routines if there is to be actual success and benefit from the program. The overload principle must include a progressive linear model to adding resistance to insure ongoing stimulation of the body’s systems and to avoid injury or plateau of benefits.

Although any properly dosed/prescribed form of resistive exercise would be beneficial, the most effective exercises either activate large muscle groups and/or load the skeletal system. Examples include squats, lunges, and dead lifts.

Balance

Balance is affected by many of the body’s systems. Like muscle, balance can be a use it or lose it proposition and therefore, must be part of any health plan program. Improving your balance is critical to avoiding falling as you age. Falling continues to be a top cause of injury and debility in the older population.

A quick daily balance routine can greatly reduce your risk of falling. Please refer to the following resources to get started: How Do I Improve Balance? (Part I), How Do I Improve Balance? (Part II), and Improving Balance by Using a Water Noodle.

Flexibility

A range-of-motion (ROM) or flexibility program should include many components including gentle mobility exercises as well as static or dynamic stretching to insure proper body mobility. Stretching is ideally performed 10-15 minutes at a time five days per week. An excellent time to work on a flexibility program is after a workout. Static stretching is an excellent method to maintain flexibility, and it’s ideal to perform during a cool down.

Tai Chi is an excellent form of exercise that positively affects your flexibility, strength, and stability while stimulating the somatosensory system. Yoga, like Tai Chi, also addresses many of these same areas.

Foam rolling is also an excellent method to improve flexibility. Individuals taking blood thinning medications or with blood clotting disorders should consult his/her physician prior to using a foam roller for mobilization.

For more information on flexibility, please refer to How to Maintain Healthy Joint Motion.

Endurance

The research on the effectiveness of HIT continues to grow. Even more impressive are the findings that HIT can be safely performed at any age and with almost every medical condition. It is now even being implemented in many progressive Cardiopulmonary Rehabilitation Programs, where people are recovering from all kinds of cardiac and pulmonary disorders such as COPD, heart attacks, and heart valve replacements.

Perform your cardio activity in short bursts (ranging from 30-60 seconds at a time) followed by a one to two minute recovery. The 30-60 seconds should be at a high intensity, meaning your rate of perceived exertion (RPE) is high. You should be breathing heavy.

Accommodations can be made for almost any type of medical condition. For example, HIT may be performed while using a stationary bicycle, an upper body only bicycle, a rowing machine or in the pool. You can also walk uphill at a quick pace, then stop and rest. The point is to get your heart rate up, and then bring it back down for a full recovery prior to repeating.

The exercise as medicine concept needs to be embraced by health care consumers and healthcare practitioners alike. The only way to truly affect your health span and age well is to take responsibility for your own body. The key to any longevity or healthy aging program is to remain engaged in all aspects of your life (including your physical, mental, and emotional health).

When implementing your own health plan, which of the four physical factors (strength, balance, flexibility, and endurance) will you take action on in order to improve your health span and life span? Please leave your comments below.

Posted on Wednesday, July 27, 2016

5 Strategies to Train Smarter for your next Obstacle Course Race (OCR)

I recently spent time training with Ben Greenfield, a renowned triathlete, obstacle course racer, health guru, author, and Internet health celebrity. He organized an eight hour obstacle course race training program recently in Spokane, Washington. Participants trained together and were taught the best practices to compete at a higher level in the sport of obstacle course racing.

The interesting thing about obstacle course racing is the diversity found within the sport. There are athletes who compete at the highest level and capacity as well as those who are just beginners. If you are a beginner, a coach can help to insure that your improvement is not hampered by poor training techniques that will ultimately lead to injury. If you perform at an elite level, a coach can help fine tune your training and get you on the winner’s podium.

Regardless of your fitness level, a good coach can help you take your training to the next level. The following five strategies that I learned from Greenfield will help me to both train and compete at a higher level.

5 Strategies to Train Smarter for your next Obstacle Course Race (OCR):

1. Improve your grip strength.

Proper grip strength is important when competing in an OCR. In most cases, the number one reason to fail or not complete an obstacle is due to poor grip strength. Easy exercises to train grip strength include: dead lifts, pull ups, and farmers carries. Greenfield recommends hanging from a pull up bar for time as a way to judge your fitness while gaining strength and endurance in your grip.

He also highly recommends working on wrist and finger extension strength. In my physical therapy practice, I have concluded that it’s critical for clients to keep the appropriate balance between wrist flexors and wrist and finger extensors strength to lessen the risk of certain wrist and elbow overuse injuries (such as tennis elbow or golfer’s elbow).

Your grip strength will improve more rapidly as your wrist and hand muscles find their optimal length tension relationship (which allows for maximum strength production). Like Greenfield, I often recommend using a thick rubber band as a way to improve finger extension strength (as demonstrated below). Work on extending each finger equally when performing two sets of 10-15 repetitions multiple times per week.

If you want to be more precise and have the ability to exercise one finger at a time, try a device such as the CanDo® Digi-Extend® Hand Exerciser. This is an excellent tool to improve finger extension strength. It allows you to work the fingers in multiple ways including individually for rehabilitation purposes and as an important hack to improve overall grip strength (as described above). It also allows for customization of resistance so you can track progress.

2. Work on your running.

Greenfield and I both agree that obstacle course races are still primarily a running event. You run, perform an obstacle, and run some more. In order to better prepare for any OCR event, a good portion of your running should contain a heavy dose of trail running with a focus on hills. For further information, please refer to Are Obstacle Course Race (OCR) Athletes Finally Getting It?

3. Implement High Intensity Training (HIT) or High Intensity Interval Training (HIIT) into your exercise routine.

Research continues to develop in support of the importance of High Intensity Interval Training (HIIT) for athletes. The ability to perform short bursts of high intensity activities has a significant positive effect on many of the body’s major systems. HIIT is a superior approach to increase cardiovascular fitness and improve hormonal regulation. When performed properly, one to three HIIT style workouts per week will be sufficient to see improvements.

CrossFit workouts are often an effective and relevant form of high intensity training (HIT). It’s an excellent method to train your legs and body to handle the hilly and variable terrain. The constantly varying movements and exercises performed in CrossFit can help you prepare for the varying types of obstacles.

4. Use sport specific training.

This is a concept that is often confusing. Every athlete needs to spend time training. Training is performing an activity, such as weight lifting, for the expressed purpose of making the body stronger.

The importance of sport specific training is different. This is training in your specific sport or activity with the expressed purpose of improving that activity. Training for a runner may also include very specific running drills designed to work on specific components of running.

In order to improve in the sport of obstacle course racing, you need to practice performing the different obstacles such as the following:

Picking up heavy objects and carrying them either in front or sometimes on your shoulders
Pulling sleds
Scaling walls
Swinging and climbing along monkey bars
Rope climbing
Crawling in mud

This training would be separate from your actual running training. However, you would combine both performing the obstacles with running as sport specific training. The take home message from training with Greenfield is that if you want to improve, then you will need to practice. There is nothing better than having a coach who is an expert at the sport.

5. Learn how to recover properly.

The eight hour obstacle course race training program was a long time for me to stay active and exercise. Just like any hard work out or race, it’s important to implement proper recovery strategies. When possible, avoid traveling a long distance right after an event or race.

By implementing many of the following strategies outlined in 14 Tips and Strategies to Self-Treat Muscle Pain and Muscle Cramping & Spasms – Treatment Options, I was able to quickly return back to my training and preparation for my next event.

As with any exercise and activity, obstacle course racing is not without risk. With proper training and recovery strategies, a majority of the risks can be eliminated. If an injury occurs, it’s important to take care of it quickly to avoid worsening symptoms and prolonging your recovery. Please consult with your coach or physical therapist so you don’t lose time on your training.

Which strategy can you implement in order to take your obstacle course race training to the next level? Please share your comments below.

A special thank you to Ben Greenfield for sponsoring a fantastic event! I highly recommend that you check out his popular fitness, nutrition and wellness website BenGreenfieldFitness, which features blogs, podcasts, and product reviews.

Posted on Wednesday, July 20, 2016

Why Your Upper Back Hurts When You Run

http://running.competitor.com/2016/06/injury-prevention/upper-back-hurts-run_151708

Competitor

June 13, 2016

As featured in this post for Competitor, I explain how poor technique or weak back muscles can contribute to upper back pain while running. You’ll learn why it’s important to get your body to do the opposite of hunching forward and to stretch out the neck and upper back muscles in order to eliminate pain when running. I also recommend a series of exercises to strengthen the lower and mid trapezius muscles, and the rhomboid muscles, along the spine at the base of the neck.

At the end of a long hard run, you expect your legs and lungs to be burning, but your upper back? No way.

Unfortunately, “it’s a very common thing,” said Nick Studholme, a sports chiropractor in Colorado. As the intensity and length of a run increases, many runners will often experience a worsening sharp pain in their upper back, in between or under the shoulder blades. It’s not quite debilitating, but it sure is painful and annoying.

It’s particularly common in novice runners, said physical therapist Ben Shatto, but it can happen to anyone with poor technique or weak back muscles. And that’s most of us. Continue Reading

Posted on Wednesday, July 13, 2016

Are Obstacle Course Race (OCR) Athletes Finally Getting It?

Obstacle course racing (OCR) is gaining in popularity as a sport. There are more and more organizations offering events like the Spartan Sprint, the Tough Mudder Mud Run, the BattleFrog OCR, and the Warrior Dash. As the sport evolves, there are notable trends and skill sets that OCR athletes should take note of to be successful.

I recently competed in the Boise Spartan Sprint. Although the field of racers was significantly smaller for the open registration group compared to last year, I chose to compete in the even smaller competitive group. Watching the other athletes and comparing the event to last year I noticed a few trends.

Running

Regardless of the organization hosting the event, the gist of the event remains the same. Run, perform an obstacle, and run some more. These OCR events are still primarily running events. The obstacles are the reason why many people participate in these types of events. They are fun and challenging, but the event still includes running. The most successful OCR athletes will also be proficient at running on trails.

Most events are set in more rugged outdoor terrain. To be successful, you must be comfortable running on uneven surfaces. In the case of the Boise Spartan Sprint, you must also be comfortable running hills.

To better prepare for any OCR event, I would recommend a heavy dose of trail running with a focus on hills. From my prospective, Boise Spartan Sprint participants seemed more comfortable running this year. Maybe the word is getting out that these events still require running as a skill set.

I recommend that you are capable of running whatever the expected distance you would be competing in (plus a couple of miles) on a similar terrain in order to insure your body has the endurance needed for both the running and the obstacles.

High Intensity Interval Training (HIIT)

The format of many OCR events is to run, perform an obstacle, and then run. This means there are times when your intensity will be high and times when you can lower the intensity during the event. Performing high intensity interval training (HIIT) or high intensity training (HIT) should be a mainstay in your exercise training. It will be particularly useful during an OCR event.

The amount of HIIT in preparation for your race will vary and is dependent on the distance. If the race course will be a shorter distance (under 5 miles), then a majority of your running could be HIIT and shorter distance recovery runs.

If you will be competing in longer distances (10 miles or more), then I would still incorporate a weekly longer run just so your body will be prepared for the mileage and time on your feet. I highly recommend that you run outside–preferably on a trail or uneven terrain to prepare your legs adequately. You will need to feel comfortable running downhill and on uneven terrain. Dominate the hills, and you will dominate the race. Please refer to my Training Plan that I used for Race to Robie Creek, a very steep half marathon 8.5 miles uphill and 4.6 miles downhill.

CrossFit

CrossFit as a form of high intensity training (HIT) is an excellent method to train your legs to handle the hilly and variable terrain. The constantly varying movements and exercises performed in CrossFit will also help you prepare to handle the following varying types of obstacles:

Picking up heavy objects and carrying them either in front or sometimes on your shoulders
Pulling sleds
Scaling walls
Swinging and climbing along monkey bars
Rope climbing
Crawling in mud

(Courtesy of Reebok Spartan Race)

Performing CrossFit style workouts is an excellent way to help to prepare for an OCR event. CrossFit teaches you how to prepare for these different obstacles by refining the skill sets necessary to tackle them. It also prepared me to perform the obstacles when fatigued.

Weight Training

Weight training (in particular, barbell training) is a critical component in physical resiliency. Lifting appropriately heavy weights is applicable for almost everyone regardless of age and/or present health status. Weight training has positive benefits on the following:

Muscle strength
Bone density
Cardiovascular performance
Neurologic performance and adaptability
Mental and cognitive function
Proper hormonal regulation

In the case of OCR racing, being stronger will always better prepare you for the terrain you will run on and the obstacles performed. Weight training will also help to increase your body’s margin for error when illness or injury occurs. To quote Mark Rippetoe, “Stronger people are harder to kill than weak people and more useful in general.”

(Courtesy of Reebok Spartan Race)

The key to all training (including weight training) is that the system must be properly overloaded to produce the desired effect. Too little, and you will not receive a positive benefit. Too much, and you risk injury. This overload principle must guide all exercise routines if there is to be actual success and benefit from the training. Although any properly dosed/prescribed form of resistive exercise would be beneficial, the most effective exercises to help you prepare include squats, lunges, dead lifts, and the overhead press.

Grip Strength

Many of the obstacles (rope climbing, monkey bars, bucket carries, and climbing walls) require adequate grip strength. Current research on successful aging has found a correlation to poor grip strength and frailty, so developing adequate grip strength is a good idea either way.

In prior years many athletes would fail an obstacle solely because of their grip giving way. Although this still occurs frequently, I didn’t see nearly as many failed obstacles this year during the Boise Spartan Sprint versus last year.

In order to perform at a high level, you must develop proper grip strength. Recommended exercises to train grip strength include dead lifts, pull ups, and farmers carries.

When working on grip strength, nearly everyone always focuses on finger and wrist flexion strength. If you remember to also work on your wrist and finger extension strength, you will find your grip strength will improve more rapidly. You will also lessen your risk of certain wrist and elbow overuse injuries.

Recovery Strategies

Once you complete the OCR, enjoy your accomplishment, but don’t forget to implement proper recovery strategies! Be sure to properly cool down after the race. Don’t sit! Stretch and continue to move. You will need to make sure that any scratches or wounds are properly cleaned and covered. Hydrate appropriately and begin working through your recovery process. For more information on how to quickly recover, please refer to the following posts: 14 Tips and Strategies to Self-Treat Muscle Pain and Muscle Cramping & Spasms – Treatment Options.

OCR events are a fun way to stay fit and promote general resiliency. The variety of skills needed to be successful is what makes it so fun. If you have the opportunity in your area to work out in a gym that is geared toward OCR racing, such regular practice on obstacles will be particularly effective when training for the more technical obstacles. Keep in mind that the most important skill sets are sometimes the ones most overlooked. Focus on your running; implement HIIT and HIT; weight train; and work on your grip strength.

Have you competed in an OCR before? Please share your experience by leaving a comment below.

Posted on Wednesday, July 6, 2016

The Number One Reason Why You Won’t Reach Your Training Goals

http://marathontrainingacademy.com/number-one-reason

Marathon Training Academy

June 6, 2016

In this guest post for Marathon Training Academy, you will learn how to effectively exercise and work the core muscles in order to prevent or treat low back pain (LBP) as well as other common running injuries affected by weakness in the core and pelvic muscles.

The number one reason why runners won’t reach their goals is also one of the most preventable reasons: injury! Nothing derails a perfectly developed training plan like an injury.

The most common injury to runners is also the most common injury for those in the western world: low back pain (LBP). LBP is estimated to affect nearly 80% of the U.S. population at one time or another. And worse yet, once you have experienced an episode of LBP you have a 90% chance of having a reoccurrence. Continue Reading

Posted on Wednesday, June 29, 2016

The 3 Most Common Mistakes Runners make that can cause Low Back Pain

http://marathontrainingacademy.com/low-back-pain-2

Marathon Training Academy

May 25, 2016

In this guest post for Marathon Training Academy, you will discover the three most common mistakes runners make that can lead to low back pain (LBP), and you will learn prevention tips in order to avoid injury.

Low back pain (LBP) is one of the most prevalent medical conditions treated in the United States and throughout the western world. Avoiding the following most common mistakes can save you from costly medical visits, prescriptions, chiropractic visits, and physical therapy services. More importantly, avoiding injury and LBP insures that you can keep training and racing to your heart’s content! Continue Reading