headache

This episode is all about headaches, it highlights one service dressed up and parading around as another sort of like it’s Halloween or something, and we’ll tell some personal stories about what we have seen in practice during our years of service to our patients. It should be a good one.

We are excited to welcome Dr. Tyce Hergert to the Chiropractic Forward podcast. Dr. Hergert has the distinct privilege of being the very first guest that we’ve ever had. Dr. Hergert was the Texas Chiropractic Association President, the head honcho, for 2016/2017 and, under his leadership the TCA was able to get 5 Chiropractic friendly bills through the legislation whereas we had failed to get even one through in all the years prior to that as far back as I had paid any attention so that was quite a feat.

Dr. Hergert is the owner/operator of Chiropractic Care Center of Southlake as well as the owner/operator of Southlake Physical Medicine in Southlake, TX

In addition, Dr. Hergert and myself both grew up in Perryton, TX. He was a couple of years younger than myself but we grew up on the same neighborhood, went to chiropractic school at the same time roughly, and have both served in the Texas Chiropractic Association at the same time. You could say that we know each other.

Welcome to the Chiropractic Forward Podcast Dr. Hergert. How do you feel about being the very first guest that we have ever had?

In this episode, I promise that we’re going to have more fun than being on the receiving end of a purple nurple.

This week, I want to discuss headaches and conservative, alternative headache treatment. It’s common for people to look at chiropractors as “spine people” and “back doctors”.

Is that your experience as well, Dr. Hergert?

What people don’t commonly know is that chiropractors can knock it straight out of the park when it comes to treating headaches. Yes, I said, “Knock it out of the park.” That’s an old metaphor comparing baseball players hitting home runs and I’m telling you, chiropractors mostly hit home runs on headache cases.

I have to admit that I was a terrible baseball player. I played college football and I’m Texan born and raised where football is King so I should probably put it in football terms.  In football terms, you might say that we chiropractors have a record of 80-yd touchdown passes when it comes to headaches. We return headache punts for a score almost every time. We pick-six those suckers. That’s probably enough to drive the point home.

Not every single headache of course. I’ve met my match several times over my 20 years in practice. But I don’t think it’s too bold to say that about 80%-90% of headache patients just improve. And not just improve, but DRAMATICALLY improve.

Before we get into the research, let me take a minute to give you just a couple of personal experiences in treating headache patients in my practice here in Amarillo.

Case #1: We will call this patient Andy McFuddlesticks just because I’m feeling a little goofy today. That sounds a little like a Harry Potter character, doesn’t it?

Andy had experienced migraines his whole life and was around 40 years old at the time we crossed paths. He had been to all of the medical doctors. He had endured injections if his suboccipital region. I don’t recall what the injection was exactly because this was about 18 years ago. I don’t believe they did botox for migraines at that point in time. He had gone through nuclear bones scans as well. Andy McFuddlesticks had been through it you might say.

He came to see me only a few times. It was frustrating that he didn’t finish his treatment plan but the reason he didn’t finish is satisfying. Andy only came a handful of times because the headaches were gone. After all of the years and procedures, just a few visits to a very new and green chiropractor made them vanish. How do I know? Well, I was in a civic organization with his brother who confirmed months later that his brother was doing great and had not had a headaches since seeing me. How is Andy 18 years later? I have no idea. I switched towns but I know he did great for a long time and we are putting that one in the “win” column.

Dr. Hergert, would you like to share one of your more memorable headache case stories with us?

Case #2: Sally McGullicutty I believe was her name. Red hair. Irish. Anyway, Sally had migraines for years. I actually knew Sally personally and had been friends for some time. Evidently I was not skilled at getting my message out on how successfully we can deal with headaches because it took Sally way longer than it should have taken her to make an appointment with us.

Sally shared with me that she had migraines, on average, several times a week and once or twice every month would find herself in a dark bathroom floor sitting my the toilet throwing up. How awful of an existence is that? I cannot even imagine being forced to live that way. I say it often but it bears repeating, “Pain can absolutely change a person.” Not only the person but it can change everyone around the person that is consistently in and out of contact with them.

After approximately 2-4 weeks of working with Sally, she just started to not have the migraines anymore! I would say she “magically” recovered but chiropractors know this isn’t accurate. We got the right joints moving, we got the right muscles to relax, and we got out of the way and let the body do the rest. There’s no magic in that. It’s just common sense to chiropractors.

Fast forward a few years and Sally is still a patient and Sally comes here for other reasons and conditions from time to time but she doesn’t visit because of migraines anymore. She just doesn’t have them.

How about one more story Dr. Hergert?

I’m pretty sure we could both absolutely go on and on with examples from personal experience in practice. I have 20 years of dealing with headaches and I can tell you, Chiropractors are modern day headache whisperers.

Let’s dive into a little research just to show you what I’m talking about. There are more we will go over in the future episodes but I want to touch on two this week. One new study and one older.

The first one is the more recent research paper and comes to us from a group in Spain. The lead author was Miguel Malo-Urries, PT, PhD with the University of Zaragoza Aragon Spain and it was published in Journal of Manipulative and Physiological Therapeutics in the November-December 2017 issue, Volume 40, Issue 9, Pages 649-658. The study was titled “Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial.” What a name.

Did you catch that word, “Translatoric?” Dr. Hergert, have you run across this term prior to this interview?

I’m going to define that word for everyone. Translatoric is not commonly in the Chiropractic verbiage or vernacular. At least I don’t recall it from my education at Parker University in Dallas but that was eons ago. I have gray sideburns now. It has been a while. The authors of the paper all have PT behind their names so we have physical therapists setting the terms for the research project. Understanding this, then the use of translatoric makes more sense.

I found a site that gives a pretty good definition of Translatoric Spinal Manipulation. The term Translatoric Spinal Manipulation or TSM “consists of a series of high and low-velocity manipulative spinal techniques, which emphasize the use of small amplitude, straight-line (or translatoric) traction and gliding impulses delivered parallel or perpendicular to an individual vertebral joint or movement segment. Furthermore, TSM emphasizes the use of either direct manual stabilization or the use of spinal pre-positioning to restrict the amount of motion occurring at adjacent spinal segments during the translatoric impulse.” The website goes on to say, “Delivering translatoric impulses (in the form of disc traction, disc glides, facet traction and facet gliding) to an individual joint or spinal motion segment while using stabilization provides the manual therapist with a manipulative tool that has a predictable effect in terms of pain reduction and motion restoration with minimal potential risk of patient injury.”

Do you know what that sounds like to me? Dr. Hergert, what does it sound like it’s describing to you?

It sounds like a “Chiropractic Adjustment.” Another term it sounds like is “Spinal Manipulative Treatment/Therapy.” Something we chiropractors have been doing for over 100 years and have been called crazies and quacks for doing. It sounds like the exact thing that the medical world has touted as being responsible for strokes for years and years. Of course, research proves that they don’t have a clue what they’re talking about on the storke issue but translatoric spinal manipulation is nothing more than a Chiropractic Adjustment.

Now that that is clear, let’s get back into the research.

Why They Did It

The good folks in Spain performing Translatoric Spinal Manipulation rather than Chiropractic Adjustments wished to assess the response in terms of range of motion and pain in patients suffering cervicogenic headaches.

How They Did It

• It was a randomized controlled trial
• The paper included 82 patients.
• The patients ranged in age from about 25-55 or so.
• All patients suffered from cervicogenic headaches.
• The patients were randomly split up into two groups. One was a control group and one was a treatment group.
• The treatment group received Chiropractic Adjustments…..I’m sorry…Translatoric Spinal Manipulation.
• The control group received no treatment or sham treatment.
• The researchers tested Cervical range of motion, they tested the pressure pain thresholds over the upper trapezius muscles, the C2-3 zygapophyseal joints and sub occipital muscles were tested, and the current headache intensity were all measured on the Visual Analog Scale prior to the Chiropractic adjustment and right after.
• The testing was done by two blinded investigators

What They Found

• Afterward, the Chiropractic Adjustment group had significantly increased range of motion in the neck region overall as well as in the flexion-rotation test.
• And, while there was no changes in the pain thresholds, patients reported significantly lower intensity in their headaches!

Wrap It Up

The quote from the authors themselves reads as follows, “Upper cervical translatoric spinal mobilization intervention increased upper, and exhibited a tendency to improve general, cervical range of motion and induce immediate headache relief in subjects with cervicogenic headache.”

Dr. Hergert….do the findings in the study surprise you at all?

What are your initial impressions of the study?

I’d say that, if you have issues with chiropractors, now you can just take it straight from physical therapists with PhD’s that are performing chiropractic adjustments but calling it something else.

I want to be honest here: the frustrating part of this for me isn’t necessarily the fact that PTs are doing cervical chiropractic adjustments. Heck, chiropractors have been doing PT for years but the physical therapists claim ownership of the term so the chiropractic industry just call it exercise rehab.

Although, their doing adjustments may be irritating on some level, the most irritating thing is that a certain aspect of the physical therapy community and a larger aspect of the medical community have spent years ridiculing, mocking, and belittling generations of chiropractors. And now, doctors of osteopathy and physical therapists are trying to do the exact same thing without going through any chiropractic training. You would think they would at least release a statement saying, “You know, we have thrown rocks at chiropractors for years but it turns out they were right all along so, since we can’t beat them, we’re going to just join them.”

Wouldn’t that be refreshing?

Can I get an amen on that Dr. Hergert? Do you have any other thoughts on that?

I’m geting all bothered over here so let’s go over the older study before I start getting too ugly about the whole deal.

This one is by GV Espi-Lopez et. al. and is called, “Do manual therapy techniques have a positive effect on quality of life in people with tension-type headache? A randomized controlled trial.” It was published in the European Journal of Physical and Rehabilitation Medicine  on February 29th of 2016.

Why They Did It

Although there have been lots of studies that prove the impact of manual therapy and spinal mobilization for frequency and intensity of pain suffered from tension type headaches, there have been no studies in regards to the effectiveness of the same therapies for the quality of life for the people suffering from them.

The authors of this paper wished to focus on patient quality of life.

How They Did It

•The study was again, a randomized, single blinded, controlled clinical trial.

•Comprised of 62 women and 14 men.

•Aged between 65 years old all the way down to 18 years old.

•All subjects suffered from chronic tension type headaches or episodic tension type headaches.

•The subjects were categorized into four separate groups: suboccipital inhibitory pressure, suboccipital spinal manipulation, a combination of the two together, and then a control group.

•An SF–12 questionnaire was used to help assess the subjects’ quality of life at both the beginning of treatment, the ending of the treatment, as well as at the one month follow-up.

What They Found

•The suboccipital inhibition group improved significantly in their quality of life at the one month mark as well as improvements in moderate physical activities.

•Not the control group, but all other treatment groups had an improvement in physical activities, pain, and social functioning at the one month mark.

•After treatment, as well as that the one month mark, the combined treatment category had improved vitality.

•Following treatment and at the one-month mark, both groups that had manipulation to the sub occipital region also showed improved mental health.

Wrap It Up
All three therapy approaches showed significant effectiveness toward improving the quality of life, however the combined treatment therapy had the most dramatic change for the good.
In short, manual therapy techniques and manipulation applied to the sub occipital region for four weeks or more showed great improvement and in effectiveness for several aspects that measure the quality of life of a patient having suffered from tension type headaches.

Dr. Hergert…you like apples? Lol Do these findings reflect what you have seen over the years there in Southlake, TX?

These are just a couple of studies to get us started off on the right foot for headache discussions on the Chiropractic Forward Podcast. There are several more I will be sharing in the future so stay tuned.

When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

I mentioned this in episode #1 but Dr. Hergert and myself spend some time trying to generate a concise, responsible statement regarding chiropractic care in general. A statement that could easily be shared. An elevator speech for the profession if you will. You will find it at the end of every blog, every video, and every chiropractic forward podcast. It is as follows:
Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic. Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!

Thank you to Dr. Hergert for spending his valuable time with us today. We look forward to many more guest appearances.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or if you have any suggestions for future episodes.

From Creek Stone in Amarillo, TX and the flight deck of the Chiropractic Forward podcast, this is Dr. Jeff Williams saying upward, onward, & forward.

https://www.jmptonline.org/article/S0161-4754(16)30281-0/fulltext?elsca1=etoc&elsca2=email&elsca3=0161-4754_201711_40_9_&elsca4=Physical%20Medicine%20and%20Rehabilitation%7CHealth%20Professions

https://www.optp.com/Translatoric-Spinal-Manipulation-for-Physical-Therapists-Book-and-DVD

https://www.amarillochiropractor.com/get-rid-of-migraines-and-headaches-once-and-for-all/