Management Services LLC.
KEVIN L. HASTINGS, JR., D.O.
ANDREW J. WHITTOCK, RPA-C.
KEVIN L. HASTINGS, III, FNP-C
153 Oakdale Rd, Johnson City, NY 13790
Our Commonly Treated Diagnoses
Migraine vs. Muscle Tension Headaches
These are two broad varieties of headaches. The majority of headaches actually end up being muscle tension variety. We tend inappropriately use the term migraine to denote severity as opposed to a garden variety of a simple muscle tension headache. Most people feel the headache starting from their shoulders involving the neck muscles and stiffness then suddenly they have very constrictive vice like headaches.
A migraine is a vascular specific headache with an early phase of symptoms such as visual disturbance, nausea, vomiting, and change of smell. These “aura” symptoms, that precede the headache, are due to vascular constriction of blood flow to the brain. Phase two is the actual pounding and throbbing from within. This is due to blood flow being restored to a vessel that has been deprived of blood supply itself and cannot maintain vascular tone against the resurging pulse. In fact, what I generally observe, is the biggest source of migraine headaches is the muscle tension headache causing the vascular constriction to begin with.
People show up in the ER for acute intervention because of the phase two headache, but never address the initial muscle tension headache. They go home and feel better for a few hours, but rebound with another headache. Our priority approach is to treat the muscle tension headache, which affects the bony structure compressing on the vascular supply leading to the migraine.
The simple challenge to the typical migraine dogma is… why would a piece of chocolate or cheese (food triggers that you digest and absorb systemically, therefore symmetrically) pick on one small vessel, usually one sided, in one section in the brain? It makes no sense at all until you view it as a functional mechanical problem.
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Thoracic Outlet Syndrome
With the exception of traumatic injuries, most TOS symptoms are born out of muscular decline of the shoulder girdle. This allows the shoulder to more easily overload, hang down, and exert leverage on the first rib, engaging the scalene muscles. Those scalene muscles happen to have all of the nerves of the brachial plexus, the subclavian artery, and the thoracic duct (lymphatic return), passing through their spastic compression.
Given the fact that it encompasses all of the nerves down the arm, it can mimic nerve dysfunction like carpal tunnel. It can also give the appearance of vascular compromise with varying temperatures of the hand or forearm, as well as edema from congestion of the lymphatic return.
Unfortunately, with the involvement of the nervous and vascular supply, yielding the appearance of vascular instability, this problem frequently gets misdiagnosed as Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy Syndrome (RSD).
When patients come to us with the diagnosis of RSD we challenge it with Thoracic Outlet Syndrome as a better explanation. In fact, we usually review RSD patients to make sure they are not indeed a thoracic outlet instead. TOS is also often confused with cervical disc disease, due to the nervous involvement passing through it.
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Complex Regional Pain Syndrome
It is normal sympathetic nervous system response to react to pain of an injured area. Its purpose is to increase vascular flow to an injured area to bring maximum healing responses. Unfortunately, wide open vasculature causes distension of tissue, which is particularly painful within itself.
The sympathetic nervous system will then react to it’s own distension pain, causing a cycle. If it goes on long enough, it can lead to constriction of vessels and atrophy of tissue, which causes the typical physical findings of RSD. These are shiny skin, loss of hair and nail growth, and bony atrophy. It is important, on the front end, to recognize that this could be Thoracic Outlet Syndrome. or Sciatica / Pelvic Obliquity / Piriformis Syndrome.
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RSD/CRPS can also be involved with:
Sciatica / Pelvic Obliquity / Piriformis Syndrome
The lumbar spine takes much of its stabilization off it’s muscular attachment to the pelvis. Dr. Hastings has personally never seen a lumbar spine injury that did not involve the pelvis, because that is it’s foundation, therefore it is consistently involved.
Specifically regarding sciatica, the pain is not coming directly from the lumbar spine. It is coming from the fact that the lumbar spine is stabilizing and involving the pelvis. Stabilizing the pelvis is the piriformis muscle, which then compresses on the sciatic nerve. This compression cannot be seen on an MRI, as there is no tissue injury or disruption. One can infer that if there’s been enough force to herniate a disc on the lumbar spine, the surrounding muscle spasm has involved the pelvis, therefore the piriformis, therefore the sciatic nerve.
What typically slips through the cracks are varying foot aliments, restless leg syndrome, night cramps, plantar fasciitis, post-op knee, hip and foot surgery with odd residual pain.
Aside from lumbar injury, causes of pelvic issues can range from leg injuries, seated falls, to hobbling from surgery that will affect the pelvis and yield sciatic symptoms.
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Failed Neck and Back Surgeries
While we see a fair amount of what are considered failed back and neck surgeries, we rarely find an actual failure of the surgery. The surgery did what it needed to do to stabilize the region and control the symptoms emanating from that spinal region. Ultimately, the problem was in the failure to fan out and look at regional structures such as Thoracic Outlet Syndrome and Pelvic Obliquity
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Failed Neck and Back Surgeries can also be involved with:
While the majority of our patients have at some point, been labeled “Fibromyalgia” as a cause for all of their pain, we generally find the root to be a failure in accounting for the compensation around a focus of injury. No matter how subtle it may be, if you shut down a painful area and allow it to decondition, it will stress other areas as they compensate. This then may appear to be a wild fire spread of symptoms.
Many of the 70 some odd associated symptoms of the fibromyalgia diagnosis, are symptoms common to any painful situation. Especially in chronic conditions, including IBS, chronic fatigue syndrome, depression, gastritis and peripheral neuropathy.
We do believe there is pain, but we don’t accept the current paradigm for a mysterious disease with no cure.
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Fibromyalgia can also be involved with:
Additional Chronic Pain Problems
Benign Positional Vertigo
Cervical Disc Disease
Failed Carpal Tunnel Surgeries
Post Concussive Syndrome
See muscle tension headache. Long after the brain concussion symptoms are gone, the lingering symptoms are typically muscle tension headache.
(Kevin Hastings has a great deal of experience treating post concussive syndrome due to his position with the Binghamton Senators AHL Hockey Team)
Restless Leg Syndrome: