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Craniofacial Therapy

Craniofacial therapy is a manual therapy technique used by physical therapists to mobilize neural tissue found within the skull.  The basic tenant behind craniofacial therapy is that the skull is essentially a pressurized vessel in which blood and cerebrospinal fluid exerts outward pressure.  The point of this therapy is to redirect pressure thorough accessory movements of the skull plates and facial bones to mobilize neural tissue and relieve symptoms.

Sometimes you can see the results of this pressure vessel phenomena in facial asymmetries of people you may have seen. One side of the jaw may be longer than the other, an eye may be higher or lower than the other, a cheek bone may be higher or lower. This does not necessarily indicate an immediate problem, but neurodevelopmental problems may develop in the young and jaw or hearing problems can occur in adults.

As a result of this stress-transducer system, neural tissue can become trapped, producing pain, headaches and even vertigo. This can happen in the part which holds the brain known as the neurocranium and the anterior facial bones, the viscerocranium. The therapist then evaluates the accessory movements of the facial or skull bones for immobility and therapy is directed to changing the abnormal accessory movement, thus releasing trapped nerve tissue. In the case of facial asymmetries, they may become less noticeable.

What is Cervical Radiculopathy?

Cervical radiculopathy occurs when a nerve root coming off the spinal cord becomes compressed. The compression can occur for various reasons. In younger people, it may occur when a cervical disc herniates due to trauma. In older individuals, it commonly occurs spontaneously as a result of arthritis or decreased disc height in the neck region.

When the spinal nerves are impinged, they cannot properly send messages to the muscles from the brain, nor receive proper sensation from the specific arm location the nerve travels. Everywhere the spinal nerve travels will be affected. That is why a pinched nerve in the neck can cause pain, weakness, and loss of sensation in the arm, even though the pinch is in the cervical region.

How Does it Feel?

Symptoms of cervical radiculopathy vary depending on the nerve root involved, and commonly occur on the same side of the body as the affected nerve. The symptoms may include:

Pain in the neck, shoulder blade, shoulder, upper chest, or arm, with pain possibly radiating into the fingers following the path of the involved nerve root.

Pain described as "sharp" or "pins-and-needles" or “popping sensation” in cervical region.

General dull ache or numbness anywhere along the pathway of the nerve.

Weakness in the shoulder, arm, or hand.

Pain that worsens with certain neck movements.

Pain that improves when the arm is lifted over and behind the head (relieving tension on the spinal nerve).

How Is It Diagnosed?

The most accurate diagnosis is done by magnetic resonance imaging (MRI) or electromyography (EMG). An MRI can show soft tissues, including the spinal cord and nerve roots. This test can determine what is causing the compression on the nerves, including disc bulges or disc herniation. An EMG measures the nerve and muscle function. This test can tell how well your spinal nerves are communicating to your muscles.

How Can a Physical Therapist Help?

Your physical therapist will develop an individual treatment plan based on the findings of your initial evaluation. The treatment plan may include:

Pain Management. The first goal is to reduce the pain and inflammation in the area. Ice packs and rest help within the first few days. A cervical contoured pillow may be recommended to properly support the neck, and allow you to sleep more comfortably.

Manual Therapy. Your physical therapist may use manual therapy techniques to relieve pressure in the cervical (neck) region. This procedure can provide immediate relief of pain and numbness radiating into the arm. Gentle massage may also be performed on the muscles of the cervical spine and scapular (shoulder blade) region. This technique helps the muscles relax and improves circulation to the area, promoting healing and pain relief.

Posture Education. Your physical therapist may suggest adjustments to your workstation and work habits, to promote good posture to protect your neck. In the early stages of recovery this may mean sitting only 15 to 20 minutes at a time.

Range-of-Motion Exercises. Your physical therapist will teach you gentle cervical mobility exercises to relieve your symptoms, and allow you to return to normal movement. In the beginning stages of recovery, it is important that none of these exercises increase the pain radiating down into your arm. If you spend many hours sitting at a desk during your workday, your neck may become stiff. Your therapist will teach you neck stretches to take pressure off of your neck from extended periods of sitting, to help improve your mobility.

Strengthening Exercises. Your physical therapist will help you determine which muscle groups need to be strengthened based on which spinal nerves are involved in your particular case. 

Functional Training. As your symptoms improve, your physical therapist will work on functional exercises to help you return to your job, sport, or other daily activities. For example, if your job duties require overhead reaching, pushing, pulling, and long periods of sitting, you will be taught ways to perform these tasks to reduce undue stress to the neck.

Benign Paroxysmal Positional Vertigo (BPPV)

Every year, millions of people in the United States develop vertigo, a sensation that you or your surroundings are spinning. The sensation can be very disturbing and may increase the risk of falling. If you've been diagnosed with benign paroxysmal positional vertigo (BPPV), you're not alone—at least 9 out of every 100 older adults are affected, making it one of the most common types of episodic vertigo. The good news is that BPPV is treatable. Your physical therapist will use unique tests to confirm vertigo, and use special exercises and maneuvers to help.

What is BPPV?

Benign paroxysmal positional vertigo is a common inner-ear problem affecting the vestibular system, a system used to maintain balance. BPPV causes short periods of dizziness when your head is moved in certain positions, relative to gravity. Benign means that this disorder is not life threatening, and generally, the disorder is not progressive. Paroxysmal means that the vertigo (spinning sensation) occurs suddenly. Positional means that the vertigo is triggered by changes in head position, most commonly when lying down, turning over in bed, or looking up. This dizzy or spinning sensation is called vertigo. Vertigo symptoms can last from seconds to a couple of minutes at a time. Vertigo episodes can occur frequently for weeks or months.

How Can a Physical Therapist Help?

Fortunately, most people can recover from BPPV with the help of a physical therapist. Your physical therapist will assess your vestibular system function, and choose an appropriate intervention to improve your symptoms. The treatment for BPPV usually consists of very specific head and neck maneuvers, performed by your physical therapist. If you think you may have symptoms associated with BPPV, please contact your physical therapist!

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Words that harm: Degenerative Disc Disease

Imagine this common scenario: you develop a case of low back pain and it doesn’t go away after a couple of weeks. You decide to see your primary care provider, who calls for standard X-rays. When the results come back your doctor diagnoses you with “degenerative disc disease.”

What runs through your mind when you hear this term?

Disease.

No one wants to be diagnosed with a disease, especially when it’s in your spine. How scary does that sound? This may lead you to seek injections, medications or even surgical management to “fix” the problem.

In actuality, degenerative disc disease is NOT a disease but rather a normal aging process, much like gray hair or wrinkles. Every human spine undergoes some degree of degeneration with age, the vast majority of which does not correlate with pain. A recent study found that 37% of people in their 20s who didn’t have symptoms showed some degree of degeneration through their discs. This increased to 96% in asymptomatic people in their 80s. Remember, all people in this studies did not have pain and spinal changes were found incidentally.

As a physical therapist, I see a lot of people who hear radiological diagnoses as a reason for people’s back pain. These terms create a lot of fear and mismanagement of what we know to be a normal aging process. In reality, degenerative disc disease may or may not be causing your back pain but is likely creating confusion and fear.

The American Academy of Orthopedic Manual Physical Therapists (AAOMPT) has taken the official stance that the medical community drop this misleading term. “The majority of spinal pain is self-limiting and can be managed appropriately without the need for medications or risky procedures (injection, surgery, etc.). For those individuals who do need care, AAOMPT supports and encourages early physical therapy interventions with known effectiveness instead of high-risk procedures and medication, and strongly recommends that clinicians avoid using the diagnosis of degenerative disc disease. Orthopedic Manual Physical Therapists are frontline providers for patients with low back pain who can provide early evidence-based low risk noninvasive care that empowers the patient to successfully manage their back pain.”

From Pregnancy to Menopause: 4 Ways Physical Therapy Helps Women’s Health

When you think of physical therapy, what comes to mind? You might think of treatment for replacement surgeries or sports-related injuries. But what about women’s health?

Here are four common ways that physical therapists (PTs) treat women’s health:

1. Childbearing

Supporting the weight of the baby, hormone changes, and lack of core strength can affect a woman during pregnancy. Many women assume these are permanent changes they must learn to cope with in the long-term. But that’s not true. PTs can help with many related issues, including:

Body mechanics and flexibility

Safe exercise plans before and after childbirth

Improving the function of pelvic muscles

Incontinence

2. Gastroenterological and urological conditions

Conditions that fall under these categories, such as bowel incontinence and constipation, are often ones that women do not feel comfortable discussing or may not even know that these issues can be treated. Women’s health PTs have specialized education and expertise and frequently help women with these issues.

3. Pelvic floor dysfunction and gynecological conditions

Pelvic organ prolapse, pelvic pain, and pain with sexual intercourse are some of the issues that many women deal with silently. PTs can help with solutions that often do not involve surgery or long-term use of prescription medications.

4. Menopause

Menopause can mean significant changes for a woman, including weight gain, insomnia, and hot flashes. PTs can design an aerobic exercise plan to help with those effects while also improving strength and balance, which in turn helps with building muscle and maintaining bone density.