Entries by dmiddaugh

How To Fix Lower Back Pain

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Hey there, welcome to the Stay Healthy El Paso Podcast. I'm your host, Dr. David Middaugh, physical therapist over at El Paso Manual Physical Therapy. And I'm going to cover with you today how to get rid of lower back pain. Now this is a simple explanation from the perspective of a specialist physical therapist. I'm going to get into the nitty gritty details about how back pain develops, how the medical field at large looks at it, and then a proper level headed way to move into fixing it for the long term.

I split this up into seven pieces. So I’m going to cover each one by one.

Number one, understand that it’s a process and not a procedure to fix a lower back pain problem.

What I mean by that, just to unpack it a bit more, is many people even in the medical field believe that fixing a lower back pain problem is just a matter of having a procedure done or a technique or a medication. In other words, they have this belief that you do this one thing, and when you’re done with that one thing, then you come out with the back pain gone or resolved. And it’s just not the case.

The fact of the matter is, it is a process to properly fix a lower back pain problem for the long term. Now it can be a procedure or a technique or surgery or something like that, to get short term relief of back pain, it is possible to get pain gone today or maybe even for a few days or maybe even for a few weeks or months. But to properly fix it for the long term where you feel like you have control over the back problem, and you know what to do to make it stay healthy and not allow that problem to come back and turn into a worst problem as time goes on. That is a process.

I see it so many times where a patient comes in for their first appointment with us here in the clinic. And they’ve got a back problem. And they said, I’ve tried this, I’ve tried that, I’ve tried seeing this person and that person, this medical expert, and this medication and this exercise and this and this and that. And many times, I’m listening to them thinking, well, you’ve tried many aspects of the process, but haven’t really been guided on how to walk through all of those pieces in a structured strategic manner to fix the back pain problem.

And that’s part of the issue, it’s just not organized, and it’s not done well. And there’s a false expectation that this one thing that you do that one medication you take, or that injection, or that one visit to the doctor is going to fix it for good. But it’s just not the case. It is a process over time, and learning has to occur.

I’ve got small children now that are learning how to read. And it’s not just one class are learning the alphabet that gets kids to read, it’s practice and replicate and development. Once they learn how to read a three-letter word, and they’ve got to expand to a five-letter word, and then you have more complications to reading like plurals and conjunctions and irregular plurals. There are all kinds of different aspects to learning how to read. And it’s a process.

It’s a process that happens over time. But in one day, you might learn one aspect of it and then the next day, you want another aspect of it and as you keep building on that over time, then you develop a process that helps you meet the outcome, which for somebody with lower back pain, they want it gone forever and not ever have to step into a surgeon’s office to get something handle there, or to get injections or medications for the long term.

Number two, don’t be afraid of big words for medical people.

The same thing when we get patients in for their first visit for a back pain problem, oftentimes, they hear stuff like degeneration, osteoarthritis, osteopenia, facet arthroscopy, they throw all these big terms out there. And it’s quite scary for patients, especially if they’re not in the medical field or don’t have an understanding. It’s quite scary for patients to hear that.

And then inevitably, what patients will do is they may get an MRI report or, or some documentation from the doctor’s office where they just remember the word and they write it down, or they start googling it, and they find all kinds of terrible things that happen in extreme cases of those conditions that are described in those big words.

But the reality is that in nine out of ten back pain cases, where a doctor or a physician or some medical expert might tell you have facet arthropathy, or degenerative disc disease or so they throw out some of those big terms, and nine out of ten of those cases, they’re fixable. Without surgery, medications and injections, and they do stay better for the long term.

It’s really the minority of people that need to have some sort of procedure done or something invasive. Or where they have to face that they’re going to have some discomfort, or some level of their condition lasts for the rest of their lifetime. But that’s really just a small percentage of cases.

Number three, wait as long as you possibly can before getting an MRI.

There are other imaging procedures that are done x- rays, CT scans, and those are a little lower level than an MRI. And what you have to understand about getting an MRI is that it’s, it’s pretty detailed, but there’s also a high risk for what we call false positives. Meaning they found something that’s on the MRI, but if we were to open up the body and look inside, it’s not really there. It’s just the way the MRI image was produced. It looks like there’s something there that isn’t, so that’s a false positive.

The reason a MRI report might say, you have arthritis at this level. And in reality, you don’t, it was just a distorted image on the MRI. So if you go get an MRI, what it does is it opens you up to potentially having conversations with the doctor about getting procedures done in parts of the lower back, that may not even need anything done.

The reality of this, and we have it proven in research is, that it’s rarely the case that where there’s a problem on an MRI, that’s the source of pain. They’ve done research studies where they have found that they’ll do MRIs on everybody, on a bunch of people that have back pain and they’ll do MRIs on people that have no back pain. And they’ll find that across the board, whether they have back pain or not, there’s positive findings are they find stuff that’s wrong with their MRIs in their low backs.

Doctors can’t really categorize who has pain or who doesn’t, if they’re just purely looking at MRIs because somebody that has no back pain could have arthritis in their MRI or some disc problem on their MRI, but they’re okay, they don’t have any problems in real life and they’re able to do everything that they want to do.

So this is good news because it is possible for you to go get MRI if you’ve already had an MRI, have some positive findings on there have some disk issues some arthritis problem, but then it resolves, it gets better. But if you had an MRI after the fact it might still be there on the MRI because you’ve converted into one of those people that no longer has back pain but has a positive finding on an MRI.

Your best bet is to pursue natural treatments, pursue noninvasive treatments so that you can avoid having the MRI and then having to end up, because doctors are recommending you to go into some sort of invasive treatment or some medicinal treatment that has some side effects potentially for you.

Number four, exercise is king.

When it comes to lower back pain across the board, if you look at all the medical literature, all the scientific research studies, some form of exercise tends to produce positive results in people that have lower back pain.

Now that’s a big huge generalization. And the fact is we get patients to come into the clinic all the time that say, they’re listing out all the things, they try to try this, I’ve tried that. Some of those are, I’ve tried crunches, and I’ve tried squats. and I’ve tried this exercise I found on YouTube and this other one that was recommended to me for my friend, and my family member who resolved their back pain, but it didn’t work for me.

The fact of the matter with exercises, finding the right ones for your specific back problem is what needs to be done. There’s likely some muscle that needs to be strengthened, or some exercises you need to start out with, and then over time work into harder exercises, because it’s a process it’s not a procedure. In order to fully resolve a back problem and keep it gone for good.

And number five, if exercise is king, then habits are queen.

What I mean by that is, what you tend to do in the body position and the way that you move when you’re doing those things. If you have a desk job and you tend to sit for longer periods of time, or if you love watching shows on TV, then you probably also sit for long periods of time. Now where you sit, the way your chair is set up, the support on the chair, if you drive a lot, the car seat that you’re in its support as well, might affect the position of your back. And it could affect the health of your back.

The habits that you’re in, greatly affect your back problem. It’s also the movement, how you move through life, the way that you walk, the way that you get up. your exercise routine that you keep or don’t keep, the habits that you do are a big deal.

Here in the clinic, when we see patients with back pain, we’re often asking them about their daily routine about their lifestyle, so that we can get the information we need to better guide them on how to modify those things, the way they sit the way they move their exercise routine so that they can build good habits or tweak their mediocre habits so that they become good habits so that it benefits your back problem.

Number six, there will be ups and downs in getting your back pain problem taken care of.

Just understand that. And I tell this to patients all the time, whenever they start out here in the clinic, that you’re probably going to get better right away, you’re going to start feeling better here within the next couple of weeks, and then expect a flare up. Because inevitably, as people feel better, they get a little more confident they start wanting to do the things that they love to do before they had back pain. And they’re not quite ready for it unknowingly, and the back pain flares up again.

It’s that vicious cycle that oftentimes kills people’s motivation to drive forward into something because they assume that what they were doing didn’t work because the pain returned. But in reality, that’s just the way life is. It’s never a linear improvement where each day is better than the last day, it gets better and better and better and better and it just goes straight up in a straight line. It’s more up and down like a like the waves are a roller coaster. One day may be good, the next thing might be bad.

But as long as you’re following the process of how to fix your back pain problem for the long term, then overall as time goes on, you’ll trend in the right direction and you should be able to take care of your back problem for good.

Number seven expert help will expedite the process.

This is where I want to recommend to you that you get in touch with an expert physical therapist or some specialist that you feel is best suited to handle your problem. Now if you’re looking for a natural solution, I definitely recommend the specialist physical therapist. If you’re seriously considering that your back pain problem might need surgery then please go talk to the orthopedic surgeon or the best person for you.

But if you’re looking to naturally resolve your back problem, an expert physical therapist can guide you on the exercises that you need to do, discuss with you the habits that you have, other aspects of your back pain problem, the history, old injuries that you’ve had, and also do have hands on work to make sure that any joints that are not moving well any muscles, tendons, ligaments, other soft tissues that need to be broken up or freed up, get freed up as fast as possible, so that when you go to do exercises, they’re their most successful for you and you can progress through them as fast as possible.

And going back to number one, it’s a process, not a procedure, so that you can shorten that the length of that process. fixing a back pain problem on your own very well could take you a year or more. Here in the clinic, we whittle it down to a couple of months, sometimes even shorter, depending on the severity and how many other factors are involved that may be longer. So getting in touch with an expert and working with them will tremendously speed up your process in order to get you the outcomes of getting rid of this back pain problem for good.

Well, thanks for listening to our podcast here. I hope that this podcast was helpful for you, I hope that my voice is getting into your head just a little bit. Whether you're running right now, exercising, or driving, or just doing chores around the house, I hope that you might stop to take a few notes and think about what it is that you're doing, and how you're handling your back problem if you've got one.

And if you don't, and you just thought this was helpful for you please share this podcast with somebody that you think needs to hear this. And one more quick request. If you've been listening to this for a while, or even if this is the first episode that you hear, and you thought that it was pretty good, please take a couple of minutes and just give us a five-star rating on the podcast platform that you're listening to this on. Whether it's the iTunes, Stitcher, any other podcast platform that we have out there, we're on all the major ones.

Please give us a review about how this was helpful for you. It helps us a lot so that we can get this podcast into the hands of other people that need to hear it so we can get more visibility or listen ability on this podcast. And as always, if you have any questions, you can call us at 915-503-1314.

If you're interested in working with us, that's a number to call and just begin to tell us a bit about your back problems so that we can see if it's the right one for us to help you with. You can also go to our website at www.EPmanualpt.com and find the cost and availability tab and you can inquire about what it takes to see us and if it's right for you to see us. And if you're just looking for more helpful resources on that same website go to the blog tab and you'll find tons of helpful blogs on how to fix a lower back pain problem in addition to other body parts that we serve as well. Thanks so much for listening and have a wonderful day guys.

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Common Causes For Tension Headaches & Migraines

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Hey, everyone, welcome to the Stay Healthy El Paso Podcast. I'm your host, Dr. David Middaugh specialist physical therapists over at El Paso Manual Physical Therapy, and today we're going to talk about the top eight reasons for tension headaches and migraines. Now, if you've ever suffered from a headache or migraine, you may have had symptoms like pounding pressure on the front of your head, like on the forehead area, sometimes on the top of the head. It can often appear also on the back of the head, you can get those symptoms that just feels tight at the base of the neck at the base of the skull. And it can radiate from there, onto the top of the head or onto the side of the head, over the ears, and over in the temporal area between your ears and eyes.

Sometimes it can even feel like a pain deep behind the eyeball. Sometimes it's one sided, sometimes both. And there are different types of headaches and there are differences between headaches and migraines, which I won't get into much here on this podcast episode, just because it really is a scientific medical diagnosis and there are slightly different reasons for each one happening.

But for the purposes of giving you the top eight, the top eight reasons for tension headaches, that's what we're going to do today. And migraines, I'm not going to get into the differences. If you've got head pain, then this is going to be helpful for you whether you label it a tension headache or a migraine, this is still going to be helpful information for you.

Just real quick, some of the minor differences. Migraines tend to have some light sensitivity, noise sensitivity, there's more sensory sensitivity versus a tension headache, which is not really associated with sensory as much as far as like light sensitivity or sound sensitivity. It's more like at tension was just like the name describes, pressure or tension that happens in the head. But I think that they all have root reasons for happening. So that's why I'm lumping them together in this podcast episode.

I'm going to go into the top eight reasons for tension headaches and migraines next.

The number one reason is muscle weakness.

Now there are tons of muscles that come off the neck and go to the shoulders. There’re tons of muscles in the front of the neck that help with swallowing, movement of your head, looking up and down, and all around. But there are some deep muscles to all those other muscles, the throat muscles, the movement muscles, we call them the deep neck flexors and those oftentimes are weak. And they're weak for a variety of reasons.

It could be other factors that we'll talk about, but overall, we find people that have frequent tension headaches and migraines, people that are suffering from those problems that we help here in the clinic. They have some overall weakness and then some severe weakness in just a couple of those muscle groups. And when we strengthen those muscles, oftentimes, well, pretty much all the time whenever we see clients, their headache symptoms, their migraine symptoms begin to diminish, and eventually they get under control to where they're not having to take a pain medication every day or whenever they get a migraine or headache to deal with it.

The second most common reason for tension headaches and migraines is neck stiffness.

This is kind of related to the strength issue that I was talking about just a second ago. But if you take a moment to turn your head in each direction, all the way like you're looking over your shoulder, so turn all the way to the right turn all the way to the left, as far as you can go and just assess and feel or look with your eyes how far you can go and then think about how your neck feels as well. If it feels stiffer to one side versus the other, than you've likely got a neck stiffness problem.

Now I'm looking at joints whenever I'm looking at a patient's neck in regards to a headache, or migraine, and whenever I find stiff joints, almost always, there are nerves that are being mildly compressed, there are muscles that are spasming just a bit to hold that joint to take some pressure off that joints and protect it, the ones that are stuck. And that's what's causing the stiffness.

It's a combination of the joints being not as mobile as it should be, and then the muscles around there protecting, and then the nerves getting aggravated as a result of that joint not moving and the muscle not moving. There is some sort of neck joint stiffness, muscle stiffness, that's contributing to that headache and migraine problem.

The third reason is poor posture.

Now, this can be related to a desk job or not, today in our American culture, we've got screens everywhere. We're probably attached to screens, whether it's a mobile device, a phone, a tablet, a computer, a TV, movie screen, there are all kinds of screens around us all the time. And as a result of that, we're fixated on a screen for a while.

So we might not have the best posture. And that carries over into our everyday conversations with other people. The way we sit and have a meal, it just the posture becomes our norm or default. And if it's not very good, it can promote the neck, muscle weakness, upper body weakness that I was talking about in those joints, and muscles getting stiff as well.

Posture has a role in it. But usually if we fix the stiffness, and if we fix the strength, the posture tends to improve. And truth be told, worrying about your posture constantly is not a good idea. It's better to worry about it just a few moments throughout the day. Typically, when you're in the worst posture, like maybe when you go sit in front of the computer, or if there's a time maybe if you're using your phone or reading books. People that read a lot that might be to really focus on the posture versus worrying about it all day.

Because some people that come into the clinic here, they're hyper aware of their posture and trying to fix it and, the reality is that it's just not practical to fix posture constantly all day long, and just it can get obsessive and bothersome for some people. So, yes, it is a contributing factor, but I wouldn't make it the main thing that anybody fixes to relieve a tension headache, or migraine problem.

The fourth reason and it's related to the posture is bifocals and reading glasses.

If you're over the age that you need bifocals or reading glasses. And in case you don't know what bifocals are, they're glasses that have an extra lens in the bottom that's different from the normal lens that serves as a reading glasses so that you can see the two lenses and people will put on the bifocals and the reading lenses on the bottom, or they'll just get the reading glasses that tend to be smaller and tend to sit a little lower on the nose bridge.

Sometimes they slip down, or they just aren't as big as normal glasses. So they have to look down. Well think about the posture. If you pull up a book or a screen, people tend to do this, you tend to tip their nose up to stick their chin out to view, whatever they're looking at through the glasses, the reading glasses or the bifocals, and it puts their head and neck in not the best posture.

Now, that's fine if you do that for brief moments if you're just reading something real quick. But if you're sitting there reading a book, you're reading chapters, or you're reading some newspaper articles, or you're browsing the web, and you're just you're there for 10 minutes or more, and your head and neck is in this position trying to look through the bifocals or reading glasses. It is killing your posture.

You got to think about the position, the posture that you're in that makes sure that your glasses are on right. And I always encourage my clients that are heavily dependent on reading glasses, to get glasses that are different full size for reading. So, go to the eye doctor spend the money if you need to. It's typically not that expensive anyway. And you might even be able to find some that work for you at a department store like a Walmart or a place where you buy reading glasses that are full size.

You can just try out different ones and get the ones that fits you best. And keep those glasses handy so that you can have something whatever you're reading at the right level, you're not having to tip your head or adjust your head and neck posture. So be careful when choosing bifocals or reading glasses. And honestly, I would rather you not get the bifocals just get reading glasses unless you find that it just fits your personal situation the best but go with the big full reading glasses lenses not the bifocals that are small or the reading glasses that are small.

Reason number five is excessive computer use.

Now this this can be related to the glasses thing, that I was just talking about the bifocals and reading glasses, but even if you don't use bifocals, or reading glasses, using the computer a lot can lead to tension headaches and migraines.

And the reason is this, if the text on your screen or whatever you're doing, because it may not be text, maybe other things you're looking at, if you're having to focus and kind of strain your eyes just a bit to look at whatever's on your screen, then it requires extra energy from your eyes and your brain to really look in and understand everything that you're looking at and interpret what you're looking at.

And just look at your screen right now, if you're looking at this video on a computer screen, and there's text around you, how small is the font on the text, and if you had to read it, say go down and look at the description. This video might be smaller text, if you have to really focus to scan the text and read the text. And you do that for hours on end or even just an hour.

It takes a lot of energy from your eyes and what many people don’t realize is your eyes are part of your nervous system. It's an extension of your brain. It's an extension of nerves. In the medical field, eyeballs are classified as nerve tissue. Kind of weird, right? Because you can see your nerves that way. But it tires out and exhausts the tissue and when you exhaust nerve tissue, it can affect other tissues nearby. And of course, right behind your eyeballs is your brain.

So if you've spent a while straining to read text, or look at small things on a screen, you bet it's going to tire your brain out and it's going to probably develop a migraine more likely, or even a tension headache. Especially if your head's not the best posture, and you're using reading glasses or bifocals, like I just described. So think about making the text on your screen bigger or use zoom features on your computer screen or mobile device, whatever you're using.

I use Kindle a lot, so I'm looking at a Kindle device or Kindle app on a mobile device, you can modify the text size on those things, and work to find out those features and learn how to use those features so that you're not having to strain when you read, you can just scan and go through the texts a lot easier.

Reason number six is not getting enough sleep, or rest.

Your nervous system requires sleep and rest just like the rest of your body. What many people don't realize is the nervous system, the brain, the nerves, the eyeballs, all those nerve tissues are some of the highest energy demand tissues in the body. Did you know that the nervous system is only about 2% of your entire body weight, just 2%. In other words, for a 200 pound person like me, that's four pounds of tissue. It's not that much. Yet, It requires 25% of the oxygen that I breathe in at any given time. That's hugely disproportion!

So, if you're not getting enough rest to allow those tissues to recover and regenerate and be healthy, it can strain the nervous system and create aches and pains in different areas, it can create sub optimal use of the tissues, the nerves that connect to the muscles may not operate as good as they can. That can also contribute to the neck weakness, and eventually the joint stiffness as well. So, it is incredibly important that you get enough rest and sleep.

Now I'm a type of person that does not require a full eight hours of rest, in fact, I get uncomfortable in bed if I'm there that long. I’m more of like the six to seven-hour type. And I function very well off that. I think that's my normal amount of sleep and rest that I need. And there's even times where I'm physically tired. So if I've been exercising for a while, like a couple days in a row, then my body's physically tired, but mentally I am rested. There’re times where I will just lie in bed, I've slept my six, seven hours, but I can feel my body, my, the rest of my joints and muscles need to rest.

I'll just lay in bed for 30 minutes to an hour. And I will I'll try to not tax my nervous system as well I won't be on the screen, I'll just be there thinking to myself or, or even just trying to not think just trying to meditate or pray for a minute so that I can rest my body. So, it is important to get rest as well as sleep.

Reason number seven is chronic dehydration.

If you're not a lover of water, you just don't like to drink water very much. You tend to drink more other types of drinks, maybe coffee, teas, sodas, juices and you're not getting just pure water on a regular basis, then likely you could be chronically dehydrated, and not even feel it, that might just be your norm.

But if you're suffering from a tension headache or a migraine, try up in your water intake. A good rule of thumb is if you ever buy bottled water, or you enjoy bottled water even if you aren't a bottle water fan, but you can have a refillable water bottle and drink five of those in a day. Just make it a point to drink five bottles of water about 16 to 20 ounces a day. So you're looking at 80 to 100 ounces in one day.

And if it's a bit of a chore to drink that much water, then what you might do is fill up your water bottle or get five bottles and put them on your counter or on your desk or somewhere where you're going to run into them often. And make sure you hammer those down throughout the day or if you if you get to the end of the day and you have not finished your water pounded down chug it down and make sure you get all that water in.

You'll be surprised the difference in the headache and intention problem that the migraine problem that you've got it tends to reduce a bit, just give it a try. Now, yes, you'll have to visit the bathroom a bit more frequently. As long as you don't have any other issues stopping you from doing that, then it's okay just allow yourself to do that your bladder will eventually adjust to the metal out of the chair that you're drinking. And of course, if you're drinking 7, 8, 9, 10 bottles of water a day, you're going to go way more frequently. But five tends to be pretty manageable, and your bladder can adjust to that and it's not a huge deal for most people.

Some people have some bladder issues and I get that, but you have to start to weigh what's worse right now for you the tension headache, the migraine, or the bladder problem. But give that a shot. It can give you tons of relief, especially if you're suffering from a tension headache or a migraine on a regular basis. This can allow you to get off a pain medication that you've been relying on that's potentially harming your other organs, your liver, your kidneys, your brain tissue. You want to get off those medications if you can.

The final reason number eight, for two tension headaches and migraines, is not enough exercise.

If you have a desktop, especially if you tend to be sedentary, maybe you don't have a desktop, but your just not exercising on a regular basis. That's okay. There’re seasons of life where you might not exercise regularly. But if you've got a tension headache and migraine problem, it is important to get out and do some consistent exercise.

It doesn't have to be every day. But if you even just plan on doing every other day, three to four times a week, gets your heart rate up, get a little bit of a sweat going on, and allow yourself to feel tired a bit. It doesn't have to be exhausting, just a bit tired, you might go for a walk a longer walk than you're used to.

Or you may be a gym goer and you'd like to go to the gym and do exercise in the gym or play some sort of activity with family or friends get do some sport or something that just gets your heart rate going. I've got small children and I'll just rough house with the children and play with them the way they like to play, chase them around the house. And I'll literally look at the clock and I'll say okay, It's, it's 5pm I'm going to play with them for a solid 30 minutes or even 45 or an hour if we can, and that's pretty tiring. It's pretty exhausting.

If we just keep going bring the energy, get your heart rate up, be okay with getting all sweaty, just plan on taking a shower afterwards. And that can be your form of exercise. I love going to the gym as well. I'll go to the gym for 45 minutes to an hour or a few, a few days a week. And that can make a big difference and it helps with getting rest and sleep.

Because if you haven't been getting enough rest and sleep, haven't been exercising on top of that, chances are your body gets thrown off its rhythms, it cycles. There are hormones that regulate all that. But if you begin to get some sort of consistent exercise routine, you bet your body tells you I need to rest, and you go lie down and sleep and you fall asleep pretty quickly most of the time.

So, make it a point to get some sort of regular exercise that fits your current fitness level and your schedule. It doesn’t have to be a long time, don't think that you have to go spend hours in the gym, it could be as simple as a 15 to 20-minute walk, you might just do briskly to get your heart rate up and get a bit of a sweat going. You could be indoors or outdoors. It just depends on your personal situation, but get some consistent exercise built into your schedule.

Thanks so much for listening to the top eight reasons for tension headaches and migraines. I hope that this podcast was helpful for you. If you think that you have a tension headache and migraine problem that is getting worse, and you can't really get it under control. And maybe you've already tried to fix some of these issues that I've talked about, and you're just not getting the traction that you're looking for the problems not getting that much better. Or worse yet, maybe this problem is spreading into your shoulders, or arm or even all the way down into your hand.

We often find people that have tension headaches and migraines, they get nerve radiation into their shoulder, it can decrease the function of their shoulder muscles and cause shoulder problems like rotator cuff issues. It can also send pain, numbness, tingling into the elbow area all the way down into the hand. And oftentimes people think that they're getting carpal tunnel problems in addition to their headache and migraine problem, and it radiates from the neck. We'll look at their neck problem and we'll find that it's, it's all that that's kind of the root issue, other headache migraine problem, as well as the problem that's going to their shoulder, elbow and hand.

So, if you think that it's that bad for you, then I strongly encourage you to talk to a specialist physical therapist. Here, at El Paso Manual Physical Therapy, we handle this type of problem all the time. If you're looking to talk to us specifically, the best thing to do is call us at 915-503-1314 or visit our website www.EPmanualphysicaltherapy.com and begin to talk with us.

If you call us just tell us that you heard about us on our podcast here. And tell us about your migraine problem, your headache problem, we'd love to hear all about it. My staff will take the time to talk to you about it and make sure that this is the best fit for you. If you go to our website, hit the cost and availability tab at the top of the website. Fill in the form and leave us your details, and my staff will call you back so that they can talk to you about your headache and migraine problem.

And if it's a good fit for you to work with us, if we think this is the type of problem that we can help you out and have success so you can get rid of this issue and quit taking pain medications avoid getting injections.

A lot of people go get injections in their neck for severe tension headache and migraine problems. And in real bad cases, they'll look to get a surgery to fix some neck issue that could be contributing to the migraine problem are the headache problem.

We want to help people avoid that situation because they are very fixable issues, headaches and migraines. We help people with that all the time. So my staff will talk with you about all that and let you know what the next best step is for you in how to fix this problem.

I hope this podcast was helpful for you. Please subscribe to our podcast here. We love subscribers and if you found this was helpful, share it with somebody else that you think could use this information and please give us a five star rating on whatever podcast platform you're listening to this on. We love those ratings. It helps us get more visible so we can get this information out to the people that might be suffering with a headache or migraine problem. Thanks so much and have a great day.

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