Progress can be challenging for individuals in post total ankle replacement surgery. How can physical therapy help in recovery and restoring leg function?
Total Ankle Replacement Post Surgery Physical Therapy
Total ankle replacement surgery is a major procedure that takes time to recover. A total ankle replacement surgery or arthroplasty can benefit individuals with chronic ankle pain or disability. This procedure can significantly improve an individual’s overall pain and function with time. Physical therapy is essential to regaining movement in the ankle and restoring full mobility. A physical therapist will work with the individual to control pain and swelling, restore the ankle’s range of motion, train on walking gait and balance, and rebuild strength in the leg. This will help maximize the chances of a successful outcome after surgery.
Total Ankle Replacement
The ankle joint is the section of the lower leg where the shinbone/tibia meets the talus bone on the top of the foot. What can happen is the slippery surface/articular cartilage that coats the ends of these bones begins to thin or deteriorate. As the deterioration progresses, it can lead to significant pain, disability, and difficulty walking. (Cleveland Clinic. 2021) This is where a specialist may recommend total ankle replacement for the best results. Various conditions can be helped by this procedure, including:
During an ankle replacement procedure, an orthopedic surgeon removes the damaged ends of the tibia and talus bones and replaces them with an artificial covering. A polyethylene component is also secured between the two structures to support the smooth movement of the new joint endings. (Massachusetts General Hospital. N.D.) Following the procedure, individuals are typically placed in a protective boot or splint. The healthcare provider will recommend staying off the leg for 4 to 8 weeks to allow healing.
Physical Therapy
Outpatient physical therapy is usually initiated several weeks after the ankle operation. (UW Health Orthopedics and Rehabilitation. 2018) Physical therapy can last for five months or more, depending on the severity of the condition and injury. The physical therapist will focus on different areas to get the best results. (Cort D. Lawton et al., 2017)
Pain and Swelling Control
Post-operative pain and swelling are normal after a total ankle replacement. It is not unusual for an ankle to be swollen for even six to 12 months after the operation. (UW Health Orthopedics and Rehabilitation. 2018) The surgeon will normally prescribe medication to help manage discomfort early on, and physical therapy also plays an important role in addressing the symptoms. Treatments used can include:
Electrical stimulation – mild electrical pulses applied to the muscles.
Ice
Vasopneumatic compression, where an inflatable sleeve is used to create pressure around the area, is commonly utilized at the beginning of physical therapy to reduce pain or swelling.
Other modalities, such as stretching and targeted exercises, are combined with other treatments.
Range of Motion
Early after the procedure, the ankle will be very stiff and tight. This is due to several factors, including the inflammation and swelling after surgery and the time spent immobilized in a boot.
The physical therapist will employ various techniques to improve the ankle joint’s range of motion to rotate and flex.
The physical therapist may employ passive stretching induced by an outside force such as the therapist or a resistance band) to help improve mobility.
After multiple weeks of reduced movement and lack of bearing any weight on the ankle, the muscles that surround the ankle have often atrophied/weakened, which can impact balance.
When the individual can begin placing weight on the leg, the therapist will apply proprioceptive/sense of body position training to improve overall stability. (UW Health Orthopedics and Rehabilitation. 2018)
Balance exercises will be added to the home program and will progress from week to week.
Strength
The muscles in the leg, ankle, and foot become weak from the surgery and the time spent in a splint or boot. These structures have a significant role in balance, the ability to stand, walk, and go up or down the stairs.
Regaining the strength and power of these muscles is a critical goal of rehabilitation.
In the first weeks, the physical therapist will focus on gentle strengthening exercises.
Isometrics lightly activate the muscles but avoid irritating the surgical site.
As time passes and weight-bearing is allowed, these gentle moves are replaced with more challenging ones, like resistance bands and standing exercises, to accelerate strength gains.
Lawton, C. D., Butler, B. A., Dekker, R. G., 2nd, Prescott, A., & Kadakia, A. R. (2017). Total ankle arthroplasty versus ankle arthrodesis-a comparison of outcomes over the last decade. Journal of orthopaedic surgery and research, 12(1), 76. doi.org/10.1186/s13018-017-0576-1
Postural orthostatic tachycardia syndrome is a medical condition that causes lightheadedness and palpitations after standing. Can lifestyle adjustments and multidisciplinary strategies help reduce and manage symptoms?
Postural Orthostatic Tachycardia Syndrome – POTS
Postural orthostatic tachycardia syndrome, or POTS, is a condition that varies in severity from relatively mild to incapacitating. With POTS:
The heart rate increases dramatically with body position.
This condition often affects young individuals.
Most individuals with postural orthostatic tachycardia syndrome are women between the ages of 13 and 50.
Some individuals have a family history of POTS; some individuals report POTS began after an illness or stressor, and others report it began gradually.
It usually resolves over time.
Treatment can be beneficial.
Diagnosis is based on assessing blood pressure and pulse/heart rate.
Symptoms
Postural orthostatic tachycardia syndrome can affect young individuals who are otherwise healthy and can begin suddenly. It usually happens between the ages of 15 and 50, and women are more likely to develop it than men. Individuals can experience various symptoms within a few minutes of standing up from a lying or seated position. The symptoms can occur regularly and daily. The most common symptoms include: (National Institutes of Health. National Center for Advancing Translational Sciences. Genetic and Rare Diseases Information Center. 2023)
Anxiety
Lightheadedness
A feeling like you’re about to pass out.
Palpitations – sensing rapid or irregular heart rate.
Dizziness
Headaches
Blurred vision
Legs turn to reddish-purple.
Weakness
Tremors
Fatigue
Sleep problems
Trouble concentrating/brain fog.
Individuals may also experience recurrent episodes of fainting, usually without any trigger/s other than standing up.
Individuals can experience any combination of these symptoms.
Sometimes, individuals cannot handle sports or exercise and may feel light-headed and dizzy in response to mild or moderate physical activity, which can be described as exercise intolerance.
Associated Effects
Postural orthostatic tachycardia syndrome can be associated with other dysautonomia or nervous system syndromes, like neurocardiogenic syncope.
Individuals are often co-diagnosed with other conditions like:
Chronic fatigue syndrome
Ehlers-Danlos syndrome
Fibromyalgia
Migraines
Other autoimmune conditions.
Bowel conditions.
Causes
Usually, standing up causes blood to rush from the torso to the legs. The sudden change means less blood is available for the heart to pump. To compensate, the autonomic nervous system sends signals to the blood vessels to constrict to push more blood to the heart and maintain blood pressure and a normal heart rate. Most individuals do not experience significant changes in blood pressure or pulse when standing up. Sometimes, the body is unable to perform this function correctly.
If blood pressure drops from standing and causes symptoms like lightheadness, it is known as orthostatic hypotension.
If the blood pressure remains normal, but the heart rate gets faster, it is POTS.
The exact factors that cause postural orthostatic tachycardia syndrome are different in individuals but are related to changes in:
The autonomic nervous system, adrenal hormone levels, total blood volume, and poor exercise tolerance. (Robert S. Sheldon et al., 2015)
Autonomic Nervous System
The autonomic nervous system controls blood pressure and heart rate, which are the areas of the nervous system that manage internal bodily functions like digestion, respiration, and heart rate. It is normal for blood pressure to drop slightly and the heart rate to speed up a little when standing. With POTS, these changes are more pronounced.
POTS is considered a type of dysautonomia, which is diminished regulation of the autonomic nervous system.
Several other syndromes are also thought to be related to dysautonomia, like fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome.
It isn’t clear why the syndrome or any of the other types of dysautonomia develop, but there seems to be a familial predisposition.
Sometimes the first episode of POTS manifests after a health event like:
Pregnancy
Acute infectious illness, for example, a severe case of influenza.
An episode of trauma or concussion.
Major surgery
Diagnosis
A diagnostic evaluation will include a medical history, a physical examination, and diagnostic tests.
The healthcare provider will take blood pressure and pulse at least twice. Once while lying down and once while standing.
Blood pressure measurements and pulse rate lying down, sitting, and standing are orthostatic vitals.
Typically, standing up increases the heart rate by 10 beats per minute or less.
With POTS, heart rate increases by 30 beats per minute while blood pressure remains unchanged. (Dysautonomia International. 2019)
The heart rate stays elevated for over a few seconds upon standing/usually 10 minutes or more.
Symptoms happen frequently.
Lasts more than a few days.
Positional pulse changes are not the only diagnostic consideration for postural orthostatic tachycardia syndrome, as individuals can experience this change with other conditions.
During this test, blood pressure and pulse are measured several times when lying on a table and when the table is moved to an upright position.
Differential Diagnosis
There are various causes of dysautonomia, syncope, and orthostatic hypotension.
Throughout the evaluation, the healthcare provider may look at other conditions, like dehydration, deconditioning from prolonged bed rest, and diabetic neuropathy.
Medications like diuretics or blood pressure medication can cause similar effects.
Treatment
Several approaches are used in managing POTS, and individuals may require a multidisciplinary approach. The healthcare provider will advise regularly checking blood pressure and pulse at home to discuss the results when going in for medical checkups.
Fluids and Diet
Drinking non-caffeinated fluids can keep the body hydrated.
A healthcare provider can calculate the right amount of fluids that are needed each day.
Overnight dehydration is common, so it is especially important to drink fluids first thing in the morning, preferably before getting out of bed and standing.
Exercise and physical therapy can help the body learn to adjust to an upright position.
Because it can be challenging to exercise when dealing with POTS, a targeted exercise program under supervision may be required.
An exercise program may begin with swimming or using rowing machines, which do not require upright posture. (Dysautonomia International. 2019)
After a month or two, walking, running, or cycling may be added.
Studies have shown that individuals with POTS, on average, have smaller cardiac chambers than individuals who don’t have the condition.
Regular aerobic exercise has been shown to increase cardiac chamber size, slow heart rate, and improve symptoms. (Qi Fu, Benjamin D. Levine. 2018)
Individuals must continue an exercise program for the long term to keep symptoms from returning.
Medication
Prescription medications to manage POTS include midodrine, beta-blockers, pyridostigmine – Mestinon, and fludrocortisone. (Dysautonomia International. 2019)
Ivabradine, used for the heart condition of sinus tachycardia, has also been used effectively in some individuals.
Conservative Interventions
Other ways to help prevent symptoms include:
Sleeping in the head-up position by elevating the head of the bed off the ground 4 to 6 inches utilizing an adjustable bed, blocks of wood, or risers.
This increases the blood volume in circulation.
Performing countermeasure maneuvers like squatting, squeezing a ball, or crossing the legs. (Qi Fu, Benjamin D. Levine. 2018)
Wearing compression stockings to prevent too much blood from flowing into the legs when standing can help avoid orthostatic hypotension. (Dysautonomia International. 2019)
Conquering Congestive Heart Failure
References
National Institutes of Health. National Center for Advancing Translational Sciences. Genetic and Rare Diseases Information Center (GARD). (2023). Postural orthostatic tachycardia syndrome.
Sheldon, R. S., Grubb, B. P., 2nd, Olshansky, B., Shen, W. K., Calkins, H., Brignole, M., Raj, S. R., Krahn, A. D., Morillo, C. A., Stewart, J. M., Sutton, R., Sandroni, P., Friday, K. J., Hachul, D. T., Cohen, M. I., Lau, D. H., Mayuga, K. A., Moak, J. P., Sandhu, R. K., & Kanjwal, K. (2015). 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart rhythm, 12(6), e41–e63. doi.org/10.1016/j.hrthm.2015.03.029
Chiropractic is more than just spinal adjustments. It is a whole-body therapy that may include health supplements, dietary modifications, and lifestyle changes that include exercise. By getting the patient to take specific steps, chiropractors make them a vital participant in their healing.
Exercise is outstanding for not only healing but also for the prevention of injury and certain health conditions. Regular exercise helps to reduce weight, improve flexibility, mobility, and balance, build muscle, and increase stamina. However, most people do not get enough exercise. The main reason they give is that they do not have the time. There is an exercise method, though, that can get incredible results in just 12 minutes a day or less: High-Intensity Interval Training, or HIIT.
What is HIIT?
High-intensity interval training is an exercise method that involves alternating segments of high-intensity activity and low-intensity activity.
After a 2-minute warm-up, you may try any of these HIIT exercises:
Sprint for 1 minute, walk for 2 minutes, repeat several times
On a stationary bike, pedal as fast as you can for 30 seconds, then slow it down for about 1 minute and repeat several times.
Jump rope, double time for 30 seconds, then jump-walk for 1 minute.
The thing that makes HIIT so appealing to so many patients is its adaptability. Patients can adapt it to any fitness activity that they enjoy doing. It also works much faster than most traditional exercise methods. Where most exercises must be done for an hour or more, HIIT only requires about 15 – 12 minutes, and it provides an excellent cardio workout, so it helps to increase metabolism.
In a few weeks, patients will see noticeable improvements, including weight loss, increased endurance, and more strength. It doesn’t require equipment unless the patient wants to use a bike, kettlebell, jump rope, or other devices to enhance their workout. The patient is also always in complete control. They can decide the workout level and intensity that is right for them.
Benefits of HIIT
HIIT has several tremendous benefits, including apparent weight loss and fitness-related perks. A 2012 presentation at the European Society of Cardiology revealed another advantage. Exercise activates an enzyme, telomerase, which slows the again process. HIIT stimulates the release of telomerase while reducing p53 expression, a protein that promotes premature aging, at the same time.
In other words, HIIT can help to slow or arrest the aging process. Other youth-oriented benefits of HIIT include:
Improved muscle tone
More energy
Firmer skin
Lower body fat
Increased libido
Fewer wrinkles
HIIT can also help to balance certain hormones in the body that contribute to unhealthy eating habits (such as stress eating) and weight gain. The hormones leptin and ghrelin are responsible for weight. Ghrelin, the hunger hormone, is often responsible for giving you munchies and causing cravings for salty, sweet, and fried foods. Leptin is the hormone that alerts your body when you’ve had enough to eat. It gives that full signal. When these two hormones are not acting as they should, it can result in obesity and other problems.
Staying fit and healthy is integral to maintaining a healthy body and spine. This is why chiropractors so often recommend HIIT. It helps to get the body healthy and fit so that when problems arise, it can significantly contribute to healing itself. If you need to drop a few pounds or want to be more appropriate, talk to your chiropractor about HIIT and get results fast.
For athletes, fitness enthusiasts, and individuals getting into regular exercise, can taking a workout break be beneficial if structured properly?
Workout Break
Giving oneself permission to take a break from exercising is necessary, especially to maintain a current fitness level. To stay fit at every level and injury-free, the body needs rest and recovery, especially to progress in performance levels. Regular exercise is important for:
Building endurance
Improving strength
Losing and maintaining weight
Relieving stress
What Is It?
A voluntary pause/workout break is a dedicated amount of time when the individual chooses not to work out. It is typically a response to individual body cues when the person knows their mind and body need to take a break from exercising. A workout break is different than a rest day as it may last one or two weeks from the regular training routine. Individuals may need to take a break because the workouts are becoming boring and/or the possibility of burning out or overtraining.
Fitness Impact
Studies on recreational soccer players showed that three to six weeks of inactivity did not change aerobic capacity and muscle strength. (Chang Hwa Joo. 2018)
Extremely fit individuals will experience a rapid drop in fitness during the first three weeks of inactivity before leveling off. (Chang Hwa Joo. 2018)
Medical experts provide terms for individuals who may be doing too much:
Overreaching is when the training becomes excessive, and performance begins to fall. It can be short- or long-term.
Overtraining occurs when overreaching is not addressed.
Overtraining syndrome/OTS lasts longer and results in more serious performance setbacks along with symptoms like hormone changes, depression, fatigue, and systemic inflammation. (Jeffrey B. Kreher. 2016)
Overreaching or overtraining feels like fitness progress is moving backward instead of forward. The more training, the slower and more fatigued the body becomes.
Endurance athletes have an increased risk of overreaching and overtraining. (Jeffrey B. Kreher. 2016)
The endurance mindset encourages pushing more hours of training to get stronger and faster. However, at a certain point, performance suffers.
Taking a break allows the restoration of balance to focus on work or school, manage various life events, and enjoy friends and family time. Studies have suggested that achieving a better work/life balance can improve:
Overtraining usually results from training too much and insufficient recovery.
Fitness and training experts recommend rest and light training as therapy for overtraining. (Jeffrey B. Kreher. 2016)
Signs The Body Needs A Break
A few signs and common symptoms may indicate a workout break may be needed.
Constantly unmotivated or bored
Not looking forward to working out
Poor performance
Physical exhaustion
Fatigue
Soreness that does not resolve
Lack of progress in workouts
Alternate Activities
During the workout break, engage in other active things that work the body differently, like playing table tennis, for example, or activities that are fun but keep the body moving without doing hard workouts. Remember, the body doesn’t have to be completely inactive. Individuals can try out:
Leisurely bike riding
Dancing
Climbing
Easy yardwork
Yoga or Pilates
Stretching
Returning To Working Out
It could feel like starting over, but it won’t take long for the body to remember how to exercise. It just needs to get used to working out again. It can be tempting to jump into an all-out workout routine, but that is not recommended because of the risk of injury. Here are a few basic principles to keep the body strong and healthy while easing back into a regular workout routine.
Start Simple
Start with a lighter version of the regular routine using lighter weights and less intensity.
Give The Body Time
Use the first two weeks for the body to get used to the workouts.
It can take up to three weeks to get back, depending on workouts before and how much relaxation time has passed.
Take Extra Rest Days
Returning to exercise means the body is going to be extra sore.
Plan extra recovery days so the body can heal and gain strength.
Each week, gradually increase the intensity until it is back to regular performance.
Revolutionizing Healthcare
References
Joo C. H. (2018). The effects of short term detraining and retraining on physical fitness in elite soccer players. PloS one, 13(5), e0196212. doi.org/10.1371/journal.pone.0196212
St-Amand, J., Yoshioka, M., Nishida, Y., Tobina, T., Shono, N., & Tanaka, H. (2012). Effects of mild-exercise training cessation in human skeletal muscle. European journal of applied physiology, 112(3), 853–869. doi.org/10.1007/s00421-011-2036-7
Kreher J. B. (2016). Diagnosis and prevention of overtraining syndrome: an opinion on education strategies. Open access journal of sports medicine, 7, 115–122. doi.org/10.2147/OAJSM.S91657
Cadegiani, F. A., & Kater, C. E. (2019). Novel insights of overtraining syndrome discovered from the EROS study. BMJ open sport & exercise medicine, 5(1), e000542. doi.org/10.1136/bmjsem-2019-000542
Gragnano, A., Simbula, S., & Miglioretti, M. (2020). Work-Life Balance: Weighing the Importance of Work-Family and Work-Health Balance. International journal of environmental research and public health, 17(3), 907. doi.org/10.3390/ijerph17030907
For individuals looking for a quick healthy snack, can adding sunflower seeds to one’s diet provide health benefits?
Sunflower Seeds
Sunflower seeds are the fruit of the sunflower plant. They have been found to contain antioxidants, vitamins, and minerals, which can help maintain immune system health, heart health, and more. Regularly grabbing a handful as a snack or adding to salads, oatmeal, baked goods, tuna salad, pasta, and vegetable toppings can help increase energy levels, reduce inflammation, and support general body health.
The seed’s high vitamin E value, combined with flavonoids and various plant compounds, can help reduce inflammation.
Research suggests that eating seeds at least five times a week may reduce inflammation and lower the risk of developing certain diseases. (Rui Jiang et al., 2006)
Heart Health
They are high in healthy fats, like polyunsaturated and monounsaturated fats.
Plant sterols, or the natural compounds in sunflower seeds, are recommended for their cholesterol-lowering properties. (University of Wisconsin Health. 2023)
Data show sunflower and other seeds consumption may lower rates of heart disease, high blood pressure, and high cholesterol.
Energy
The seeds contain vitamin B, selenium, and protein, which can help energize the body throughout the day.
These nutrients support blood circulation, oxygen delivery, and food conversion into energy.
Immune System Support
Sunflower seeds contain minerals and nutrients like zinc and selenium that help the body’s natural ability to defend against viruses and bacteria.
These minerals translate into benefits like immune cell maintenance, inflammation reduction, infection protection, and an overall increase in immunity.
Nutrition
Individuals don’t need to consume a lot of sunflower seeds to gain the nutritional benefits. Inside is a well-rounded mix of healthy fats, antioxidants, and other nutrients. Inside a 1-ounce portion of roasted sunflower seeds/without salt: (U.S. Department of Agriculture. 2018)
Calories – 165
Carbohydrates – 7 grams
Fiber – 3 grams
Sugar – 1 grams
Protein – 5.5 grams
Total fat – 14 grams
Sodium – 1 milligrams
Iron – 1 milligram
Vitamin E – 7.5 milligrams
Zinc – 1.5 milligrams
Folate – 67 micrograms
Female Health
When it comes to female reproductive health, there are aspects that the seeds may be able to help support.
The seed’s rich amounts of vitamin E, folate, phosphorus, and healthy fats are crucial for fetal development and maternal health.
Sunflower seeds naturally do not contain high amounts of sodium, but they are often packaged with added salt that can potentially sabotage their nutritional benefits.
The shells are usually coated in salt for flavor, as much as 70 milligrams for every 1 ounce of seeds.
High in calories, individuals should consider moderating portions to one-quarter cup and eating the unsalted varieties. (U.S. Department of Agriculture. 2018)
Other Ways To Incorporate Seeds Into Meals
Other ways to add sunflower seeds to meals include:
Sprinkling them on chicken or a tuna salad.
Salad topping.
Topping for cereal and oatmeal.
Mixing them into batter for baked goods, like cookies.
Adding them to homemade or grocery store trail mix.
Grinding the seeds for a flour coating for meat or fish.
Sprinkling them into vegetable dishes, casseroles, stir-fries, and pasta.
Sunflower butter can be an alternative to peanut or other nut butters.
Sports Injury Rehabilitation
References
Adeleke, B. S., & Babalola, O. O. (2020). Oilseed crop sunflower (Helianthus annuus) as a source of food: Nutritional and health benefits. Food science & nutrition, 8(9), 4666–4684. doi.org/10.1002/fsn3.1783
Petraru, A., Ursachi, F., & Amariei, S. (2021). Nutritional Characteristics Assessment of Sunflower Seeds, Oil and Cake. Perspective of Using Sunflower Oilcakes as a Functional Ingredient. Plants (Basel, Switzerland), 10(11), 2487. doi.org/10.3390/plants10112487
Jiang, R., Jacobs, D. R., Jr, Mayer-Davis, E., Szklo, M., Herrington, D., Jenny, N. S., Kronmal, R., & Barr, R. G. (2006). Nut and seed consumption and inflammatory markers in the multi-ethnic study of atherosclerosis. American journal of epidemiology, 163(3), 222–231. doi.org/10.1093/aje/kwj033
For individuals affected by headaches that occur 15 or more days a month for more than three months, can knowing the signs and symptoms help healthcare providers help treat and prevent chronic tension headaches?
Chronic Tension Headaches
Most individuals have experienced a tension-type headache. The pain is usually described as a dull tightening or pressure on both sides of the head, like having a tightening band around the head. Some individuals experience these headaches frequently, a condition known as chronic tension headaches. Chronic tension headaches are uncommon but can be debilitating, as they can interfere with a healthy quality of life and daily living.
Tension headaches are typically caused by stress, anxiety, dehydration, fasting, or lack of sleep and usually resolve with over-the-counter medications. (Cleveland Clinic. 2023)
This is a primary headache disorder that affects around 3% of the population.
Chronic tension headaches can occur daily and negatively impact the quality of life and daily functioning. (Cleveland Clinic. 2023)
Symptoms
Tension headaches can be referred to as stress headaches or muscle contraction headaches.
They can present with dull, aching pain and include tightness or pressure across the forehead, sides, or back of the head. (Cleveland Clinic. 2023)
Additionally, some individuals experience tenderness on the scalp, neck, and shoulders.
Chronic tension headaches materialize 15 or more days a month on average for more than three months.
The headache can last for several hours or be continuous for several days.
Causes
Tension headaches are typically caused by tight muscles in the shoulders, neck, jaw, and scalp.
Teeth grinding/bruxism and jaw clenching can also contribute to the condition.
Headaches can be brought on by stress, depression, or anxiety and are more common in individuals who:
Individuals experiencing headaches that interfere with daily life or need to take medication more than twice a week are recommended to consult a healthcare provider. Before the appointment, it can be helpful to keep a headache diary:
Record the days
Times
Description of the pain, intensity, and other symptoms.
Some questions the healthcare provider may ask include:
Is the pain pulsating, sharp, or stabbing, or is it constant and dull?
Where is the pain most intense?
Is it all over the head, on one side, on the forehead, or behind the eyes?
Do the headaches interfere with sleep?
Is working or doing tasks difficult or impossible?
A healthcare provider will likely be able to diagnose the condition based on symptoms alone. However, if the headache pattern is unique or different, the provider may order imaging tests, like MRI or CT scans, to rule out other diagnoses. Chronic tension headaches can be confused with other chronic daily headache disorders like chronic migraine, hemicrania continua, temporomandibular joint dysfunction/TMJ, or cluster headaches. (Fayyaz Ahmed. 2012)
Treatment
Pharmacological therapy for chronic tension headaches usually involves preventive medication.
Amitriptyline is one medication that has been found to be beneficial in chronic tension headache prevention.
According to a meta-analysis of 22 published studies in the Journal of General Internal Medicine, these medications are superior to placebo in reducing headache frequency, with an average of 4.8 fewer headache days per month.
Additional preventive medications may include other antidepressants like:
Remeron – mirtazapine.
Anti-seizure medications – like Neurontin – gabapentin, or Topamax – topiramate.
A healthcare provider may also prescribe medication to treat headache episodes, which include:
Prescription non-steroidal anti-inflammatory drugs or NSAIDs, including acetaminophen, naproxen, indomethacin, or ketorolac.
Opiates
Muscle relaxants
Benzodiazepines – Valium
Non-Medication Treatment
Behavioral therapies are sometimes used on their own or in combination with medication to prevent and manage chronic tension headaches. Examples include:
Acupuncture
An alternative therapy that involves using needles to stimulate specific points on the body believed to connect with certain pathways/meridians that carry vital energy/chi throughout the body.
Biofeedback
In Electromyography – EMG biofeedback, electrodes are placed on the scalp, neck, and upper body to detect muscle contraction.
The process can be costly and time-consuming, and there is little evidence to support its effectiveness.
Physical Therapy
A physical therapist can work out stiff and tight muscles.
Train individuals on stretches and targeted exercises for loosening tight head and neck muscles.
Cognitive Behavioral Therapy/CBT
Involves learning how to identify headache triggers and cope in a less stressful and more adaptive way.
Headache specialists often recommend CBT in addition to medication when developing a treatment plan. (Katrin Probyn et al., 2017)
Teeth-grinding and jaw-clenching training/treatment can help when they are contributors.
Regular exercise, as well as practicing healthy sleep hygiene, can be beneficial in prevention.
Supplements
Some individuals with chronic tension headaches may find relief using supplements. The American Academy of Neurology and the American Headache Society report the following supplements can be effective: (National Center for Complementary and Integrative Health. 2021)
Butterbur
Feverfew
Magnesium
Riboflavin
If the headaches come on suddenly, cause waking up from sleep, or last for days, it’s important to consult a healthcare provider to rule out any underlying causes and develop a personalized treatment plan.
Ahmed F. (2012). Headache disorders: differentiating and managing the common subtypes. British journal of pain, 6(3), 124–132. doi.org/10.1177/2049463712459691
Jackson, J. L., Mancuso, J. M., Nickoloff, S., Bernstein, R., & Kay, C. (2017). Tricyclic and Tetracyclic Antidepressants for the Prevention of Frequent Episodic or Chronic Tension-Type Headache in Adults: A Systematic Review and Meta-Analysis. Journal of general internal medicine, 32(12), 1351–1358. doi.org/10.1007/s11606-017-4121-z
Probyn, K., Bowers, H., Mistry, D., Caldwell, F., Underwood, M., Patel, S., Sandhu, H. K., Matharu, M., Pincus, T., & CHESS team. (2017). Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components. BMJ open, 7(8), e016670. doi.org/10.1136/bmjopen-2017-016670
Individuals that have gone through a back injury may develop a synovial spinal cyst as a way to protect the spine that could cause pain symptoms and sensations. Can knowing the signs help healthcare providers develop a thorough treatment plan to relieve pain, prevent worsening of the condition and other spinal conditions?
Spinal Synovial Cysts
Spinal synovial cysts are benign fluid-filled sacs that develop in the spine’s joints. They form because of spinal degeneration or injury. The cysts can form anywhere in the spine, but most occur in the lumbar region/lower back. They typically develop in the facet joints or junctions that keep the vertebrae/spinal bones interlocked.
Symptoms
In most cases, synovial cysts don’t cause symptoms. However, the doctor or specialist will want to monitor for signs of degenerative disc disease, spinal stenosis, or cauda equina syndrome. When symptoms do present, they typically cause radiculopathy or nerve compression, which can cause back pain, weakness, numbness, and radiating pain caused by the irritation. The severity of symptoms depends on the size and location of the cyst. Synovial cysts can affect one side of the spine or both and can form at one spinal segment or at multiple levels.
Effects Can Include
Radiculopathy symptoms can develop if the cyst or inflammation caused by the cyst comes into contact with a spinal nerve root. This can cause sciatica, weakness, numbness, or difficulty controlling certain muscles.
Neurogenic claudication/impingement and inflammation of spinal nerves can cause cramping, pain, and/or tingling in the lower back, legs, hips, and buttocks. (Martin J. Wilby et al., 2009)
If the spinal cord is involved, it may cause myelopathy/severe spinal cord compression that can cause numbness, weakness, and balance problems. (Dong Shin Kim et al., 2014)
Symptoms related to cauda equina, including bowel and/or bladder problems, leg weakness, and saddle anesthesia/loss of sensation in the thighs, buttocks, and perineum, can present but are rare, as are synovial cysts in the middle back and neck. If thoracic and cervical synovial cysts develop, they can cause symptoms like numbness, tingling, pain, or weakness in the affected area.
Causes
Spinal synovial cysts are generally caused by degenerative changes like osteoarthritis that develop in a joint over time. With regular wear and tear, facet joint cartilage/the material in a joint that provides protection, a smooth surface, friction reduction, and shock absorption begins to waste away. As the process continues, the synovium can form a cyst.
Traumas, large and small, have inflammatory and degenerative effects on joints that can result in the formation of a cyst.
Around a third of individuals who have a spinal synovial cyst also have spondylolisthesis.
This condition is when a vertebrae slips out of place or out of alignment onto the vertebra underneath.
It is a sign of spinal instability.
Instability can occur in any spine area, but L4-5 are the most common levels.
This segment of the spine takes most of the upper body weight.
Epidural corticosteroid injections can reduce inflammation and could be an option to relieve pain.
Patients are recommended to receive no more than three injections per year.
Surgical Options
For severe or persistent cases, a doctor may recommend decompression surgery to remove the cyst and surrounding bone to relieve pressure on the nerve root. Surgical options range from minimally invasive endoscopic procedures to larger, open surgeries. The best surgical option varies based on the severity of the situation and whether associated disorders are present. Surgical options include:
Laminectomy – Removal of the bony structure that protects and covers the spinal canal/lamina.
Hemilaminectomy – A modified laminectomy where a smaller portion of the lamina is removed.
Facetectomy – The removal of part of the affected facet joint where the synovial cyst is located, usually following a laminectomy or hemilaminectomy.
Fusionof the facet joints and vertebra – Decreases vertebral mobility in the injured area.
Most individuals experience immediate pain relief following a laminectomy or hemilaminectomy.
Fusion can take six to nine months to heal completely.
If surgery is performed without fusion where the cyst originated, the pain could return, and another cyst could form within two years.
Surgery Complications include infection, bleeding, and injury to the spinal cord or nerve root.
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References
Wilby, M. J., Fraser, R. D., Vernon-Roberts, B., & Moore, R. J. (2009). The prevalence and pathogenesis of synovial cysts within the ligamentum flavum in patients with lumbar spinal stenosis and radiculopathy. Spine, 34(23), 2518–2524. doi.org/10.1097/BRS.0b013e3181b22bd0
Kim, D. S., Yang, J. S., Cho, Y. J., & Kang, S. H. (2014). Acute myelopathy caused by a cervical synovial cyst. Journal of Korean Neurosurgical Society, 56(1), 55–57. doi.org/10.3340/jkns.2014.56.1.55
Epstein, N. E., & Baisden, J. (2012). The diagnosis and management of synovial cysts: Efficacy of surgery versus cyst aspiration. Surgical neurology international, 3(Suppl 3), S157–S166. doi.org/10.4103/2152-7806.98576
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