Untold Physio Stories 127 – TMD, Headaches, Central Sensitization, or Something Else

Untold Physio Stories 127 – TMD, Headaches, Central Sensitization, or Something Else


welcome to Untold Physio Stories a
podcast that informs and educates by connecting you to rehab industry leaders
who share their candid successes and failures in business and
practice welcome back to another awesome episode
of Untold Physio Stories, I’m one of your hosts Dr. E with The Eclectic Approach
Modern Manual Therapy, Modern Rehab Mastery our new online mentoring program
EDGE Mobility System and UpDoc Media and my co-host is Dr. Andrew Rothschild
physical therapist with Modern Patient Education how you doing tonight Andrew? I’m doing well Erson how are you? good, having a good work week this week yeah
it’s bit as a shorter work week with spring break if this was a this
recording first week in April so I was off first couple days it’s been a little
bit of time away with my family that’s right you were actually a little bit
more talkative on our slack channel during the day than normal the first
couple days that’s right yeah well I have an interesting case
this time around a patient was referred to me just recently for TMJ a friend of
the family and knowing that I have been a TMJ specialist in the past I’d like to
say I’m still a TMJ specialist just said I don’t it’s not the majority of my
caseload anymore but she had headaches and earache so initially when I saw her
was bilateral earache and I tried some just really gentle inhibitory techniques to
her temporalis some really light inhibitory and pressure based
mobilizations to her occiput which was really sensitive on one side and
anything I did even like my most light techniques flared up her headaches and
her earache within maybe 10 seconds and the flare-up lasted probably four hours
for the first couple of sessions so I still just kind of educated her on
postural correction just some light nods certain repeated motions kind of brought
her back down the baseline but upon further questioning she had a bit more
than just ear ache and unilateral headaches she also said that a onset of the unilateral headaches she
was seeing just like weird bright flashes intermittently throughout today
and also the entire time she had a unilateral headache the right side which
is on the right side the right side of her throat also hurt so considering I
was pretty much applying 0 to 1 gram of pressure and that was actually flaring
up for masters and her suboccipital and her temporalis I just decided it was
non-mechanical and she also was not really responding that well to repeated
motions I said you know I think you need to go see your primary at first and then
see what else is happening so long story short the primary basically looked at
her sinuses and said that she had allergic sinusitis and one of the things
that she’s most allergic to is dust so just like my family she had a baby
probably in the last couple of months and they normally had regular house
cleaners that would come in but since there was flu that went through the
family the house cleaners just hadn’t come in like 6 weeks so dust has just
been accumulating and naturally she taking care of a newborn wasn’t keeping
up with the house cleaning duties so dust was just accumulating so that was
definitely affecting her sinuses and her sinuses were very irritated which would
also explain why her ears and her throat were hurting the headaches it turns out
she also saw an ophthalmologist and the headaches were because of a stigmatism
she has had perfect vision her entire life except for just recently for it
ever reason now her right eye is weaker and she was getting eyestrain from kind
of reading her iphone when she was nursing at night so that was giving her
headaches and both the primary and the ophthalmologist said the bright flashes
that she was seeing are because sometimes she was seeing them without
headaches it she they just said that they were a part I forget the exactly the diagnosis some
sort of ocular migraine but that they can she can just basically see auras
without having the migraine interesting yeah I thought was interesting too
because it seemed like it could be TMJ like the ear hurt or face hurt unilateral
headache some neck tension yeah yeah I think it’s a good example of you
know almost kind of kind of a diagnosis by exclusion when someone does not
respond to an intervention that you’d expect a response based on you know
symptomology or provoking you know positions or maneuvers that sometimes
starts to help identify maybe it’s a non mechanical or non musculoskeletal
driver of the symptoms yeah I mean initially to upon history-taking I knew
that she wasn’t getting the greatest sleep she was nursing a lot at night and
sitting a lot nursing so I just thought it could easily have been blamed on a
lack of sleep and looking at the phone a lot bright light at night you know we
tried things like blue light filter turn down the brightness but considering that
I was trying my lightest techniques and and she was so sensitized that she
couldn’t even handle like slacking and inhibition techniques and that was
really flaring her up plus just I couldn’t really
I could I could reproduce it an exacerbate it but not alleviated at all
it just really didn’t seem like a standard MSK type problem and was it’s
also a good thing I think someone else could easily potentially chalk it up to
again lack of sleep we know it but that what that does to pain sensitivity
stress you can easily chalk it up maybe to like a you know a just an overly
sensitized nervous system and kind of forget differential diagnosis and I
think you know especially as you know direct access and a lot of seeing
patients who have not seen other physicians first we can it’s it’s good
to make sure that we rule those other things out and do a
thorough differential before jumping to label someone with like central
sensitization or something like that yeah for sure I mean it really seemed
like it it was just a stressful time and a lack of sleep so poor recovery and
overall sensitivity but I’ll tell you what after she followed up with me a
couple weeks later she had several days of flonase and then just after going on
naproxen she’s been one hundred-percent symptom free
nice flonase is my go-to as well this time of year right yeah yeah it’s funny
the doctor said oh it takes like three or five days for it to work and I’m like
really but yeah like that that fourth day she said combining that with the
naproxen and it was just everything was pretty much gone I mean she’s still
exhausted and everything but you know none of those odd symptoms excellent all
right so where can people find you people could find me on Twitter and
Instagram mostly at at spear_physio and modernpatienteducation.com all right
and Andrews going through his first cohort and I hope that’s going well I
just finished up my first cohort or modernrehabmastery.com, the Modern Manual
Therapy section and in pretty soon Kyle be taking over mentoring so if you guys
are interested in a one-of-a-kind online mentoring program that combines all
three of our approaches to check out modernrehabmastery.com, make sure to check
out EDGE Mobility System all my products BFR, IASTM, a couple new products coming up
and a pipeline very very soon with the next couple weeks to date this podcast
and early April and i hope to see you at a live Eclectic Approach course soon
make sure to subscribe to our email list or go to untoldphysiostories.com you
can check us out on your favorite podcast provider google podcasts, iTunes,
Spotify, stitcher and hopefully Pandora when they let us in give us a
five star rating on iTunes and I’ll see you later

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