New Patient Journey HEADACHES Episode 2–Exam

(upbeat music) – Hey everybody, it’s Dr. Blake. Welcome back to A Patient’s Journey. We’re on episode two doing headaches and so, yes, we were talking
during the blood pressure so they’re redoing that right now. I believe it’s 139 over… – [woman] 82. 139 over 82. So a lot better. And so in this portion of the episode we’re gonna talk about, in this portion of the series, Jonathan did the interview of Courtney and he comes to me and
gives me highlights. He gives me the Cliff Notes. It kinda gives me… It starts my brain thinking about what’s causing these headaches and I start ruling out
things, kind of like, have you guys ever watched Sherlock and he talks about his brain
library, his brain castle, where he go back and pulls different bits of information out? That’s what’s happening when
Jonathan goes over this. So we’ll be right back with episode two. – What do you got going on? – We have Courtney here,
she’s complaining of neck pain and headaches. Headaches are daily. It didn’t start until her car accident back in May of 2016. – Did she get treatment for this? – She did not. – OK. – She did whiplash on highway, rear ended at 70 miles per hour. – Mmm hmmm. – And ever since then it’s
been constant headaches. – OK so, car accident going
70, did she go to the E.R.? – She did not. – OK, alright, and so
headaches since then? – Yes. – Headaches occur right after the accident or within a couple weeks? – Yep, and then they derive
more so on the right side in her lower trap going
up behind her neck, and to the front on the other side. – So it starts on the right side but it comes up into the left eye? – Mmmm hmmm. – OK, alright. – At this point Jonathan’s
kinda given me what’s going on. – Car accidents are a big
thing when we’re dealing with head or neck trauma. Were we involved in an injury? Were you involved in an accident? Was any whiplash? Was there any treatment,
was there no treatment? So those things are
kinda startin’ to think, OK maybe there’s some
trauma going on back there. I’m gonna pull this, can
you see this diagram? We have the patients kinda draw where they’re having pain and so this very helpful, kind of, before we go in and examine them to kind of see where their symptoms are ’cause, things… happen in specific areas,
and that helps us guide where we’re thinking or where we’re addressing
some of these issues. Is that blurry again? No, it’s come back again. Pains at between a seven and a nine, headaches every day? – Yes. – Worse at night or in the morning? – In the evening. – In the evening, OK. – Increased pain with long drives though. – OK, alright. She’s seen a neurologist,
no fractures or falls. She’s weightlifting, running. – OK, alright, let’s go do an exam. – So Courtney Jonathan says you’re coming in with some headaches. – I am. – And they’ve been going on for a little more than a year
and a half now, right? – Yes. – They start on your
left side and they start, do they start here and
go down to your trap or do they start in your trap and then come up behind your eye. – They start here, right, – Right behind, – The bottom of my skull,
right here, and they go down. And it actually does get
behind my eye as well. – Does it go behind your
right eye or left eye? – My right eye is worse. I feel like it is on this side, but this side just completely
masks any other pain. – OK, ok. Headaches every day? – Every day. – Every day. – I have one right now. – You have one right now? – I do. – Worse with activity? – No, it’s just persistent. – Like we were busy tonight,
we’ve been running around, was there a headache there? – Yeah, I mean I wake up with it and I go to sleep with it. – So it’s there all the time. – Yeah. – OK, alright. – Yeah. – You were in an accident, tell me about the accident please. – So we were goin’ on the highway, probably about 67 miles an hour, and there was a bale of hay in front of me so I had to slam on my breaks, and the guy behind me
just jammed right into us. – Oh, so a bale of hay had fallen down. – Yeah, there was no way of going around ’cause there was one in
the shoulder as well, and there were cars coming on my left, so I had to significantly slow down and then the car behind me wasn’t, didn’t stop at all. – It didn’t stop at all, it
just plowed right into you. – Yeah, luckily no one
was seriously injured. – OK. – No one had to go to the
hospital at the moment. – Was emergency… – Yes. – Like ambulances came on the scene and police and all that stuff? – Mmm hmm. – Did you get a police report? – Yes. – You did, OK, alright. Who was at fault? – He was. – He was at fault. – Yes. – OK, alright, what have you done to help the neck pain and the headaches? – Well I just started doing the stretches that you show to patients. – Oh yeah (laughs). – It actually, those help a lot. – Oh good. – But I take Excedrin for the headaches and it usually takes
it to a moderate level so I can function. – When you went to the neurologist, because that’s what I see on here, the neurosurgeon or a neurologist? – It’s the same, he does both. – He does both, OK. He does both specialties. – Yep. – And what did they say? – He said that, my, I guess
that’s the occipital nerve? – Mmm hmm. – It has, there’s some
type of damage to it. They couldn’t see anything
in the x-ray or the MRI. But he said that somehow it’s
been pinched a little bit and they recommended injections
which I’m not huge on, into the nerve. – OK. – So yeah. – Alright, so in our
next video we’ll go over, we’ll review your MRI
and your x-rays with ya. And we’ll take a look at it from a chiropractor’s perspective,
what we’re looking for. But for now, let’s continue with the exam. And in a general speaking, I like to interview the patient first and examine the patient first before I go look at images because, images will put a predisposed, like if I see something
drastic on your MRI, like we saw a really
scary MRI earlier today, but I already knew what was going on with the patient earlier. I like to look at the patient first so we’re going to examine you first and then we’ll look at your images, OK? – OK. – Let’s stand up and
let’s take a look atcha. – OK. – So we’re going to do
a basic posture first Just stand… – I’m standing normal, – That’s your normal posture? – This is how I normally stand. – That’s your normal posture? – Yes. – When I sit I kinda do this, but when I’m standing it’s like this. – That’s fine, shoulders
are even, ears are even. – Jonathan come over
here so you can see what we’re lookin’ at. So we’re lookin’ at,
are the shoulder even? I would say this shoulder
is slightly higher. That ear is slightly higher. Next let’s look at range of motion. Turn your head as far as you can please. It’s about 70 degrees. Any pain in your neck when you rotate out? – No. – Through this way please. About 70 degrees that way. Any pain in your neck? – Just some tightness. – Tightness where please? – Right there. – Yep, is that where it hurts
when you get the headaches? – Yes. Now back to me, bring your
chin down to your chest. Two fingers, bend your
head backwards please. – My bun… – Let’s get your hair out of the way. Put it back again as far as you can. About two fingers of extension there. Dees that hurt your neck to bend forwards or backwards? – Forwards a little. – A little bit? – A little bit. – So bend forward again for me please. Now turn your chin this way. I’m gonna push down,
any pain or discomfort? – A little bit, yeah. – Where? – On the same spot. – On the same spot? – Yep, right there. – This side. – No. – Bend your head backwards for me. – Let me get my bun. – Your bun out of the way. Does that bother you if I push down? – No. – If I take ya like this,
does that bother you? – A little bit. – If I take you like that,
does that bother you? – A little bit. – Worse goin’ over that
shoulder or that shoulder? – Worse probably with this one. – That one, OK. – Arms up like this for
me, I’m gonna push down, don’t let me push down. – Good, bring your arms in here. (Courtney laughs) – What? – I don’t know. – I’m gonna pull, don’t let me pull. – Yeah. – I’m gonna push, don’t let me push. I’m gonna pull, don’t let me pull. I’m gonna push, don’t let me push. – Good, OK, alright. Wrists back like this. I’m gonna pull, don’t let me pull. I’m gonna pull, don’t let me pull. Good, strong all the way down. If I touch you like this,
feel the same on both sides? – Yes. – Back here? – Yes. – Right here? – Mmm hmm. – Here? – Yes. – Here? – Yes. – Here? – Yes. – Here? – Yes. – And here? – Yes. – Yeah, good, OK, alright. So muscle strength looks
good, light touch looks good. Those tests that we did on you, when you bent your head this way, and I pushed down over this way, it’s really a test for the
c zero, c one, and c two; those top three vertebrae in your neck. So, um… It should glide like, your
skull sits in like this should glide like this like. When I take you down there, it puts the right amount
of stress into it. And if it’s jammed or locked on ya, it’s gonna feel uncomfortable, okay. So that’s what we’re
seeing on the exam there. Let’s stand on the black platform. Now let’s do the palpation exam where we’re gonna touch
the muscles and the joints, and see where the trigger points are. See where the tight
bands of the muscles are. See what joints are irritated. Just relax your head. So, I’m not gonna crack your
neck here or do anything, we’re just examining you right now. So just relax, OK? – Is that tender right there? – Yes, very. – Is that where your spot is, the pain? – Yes, extremely. – So that’s, Jonathan
can you see right here? So here’s your skull,
here’s the c zero, c one, and that’s tender, right? A little bit? – Yes, yeah. – But if we come down to c one? – Extremely – And c two? – Even more than that. – So c two, c three, c
three is right below it. Tender too right? – Yeah. – That whole right side
is really irritated. – Yeah. – And not only is it irritated,
it’s fixated, it’s stuck. The joint’s not moving right there. Now the sub occipital muscles,
there’s tension there. – Yes. – Yeah. Tension there too? – A little bit, not… – But not like the right side. – Yeah, not even close,
but there’s still is some. – Yeah, so suboccipital muscle tension. We got cervical spine erector
spinae muscles are tight. Levator scap and the trap
are, they’re tight too but, that’s where we’re seeing
a lot of our pressure there. OK, alright. Courtney if it wasn’t
7:12 on a Thursday night, and you were a patient,
what we’d do is say, what I want to do is for
right now is to calm down some of the muscles in her neck with some stim and som
ice, just to loosen you up. And while you’re doing that, I’m going to take a look at your images. So I’m going to take this exam, the history, the consultation, the exam, those bits of information and I’m gonna go look at
that other information that we have. We’re gonna see if we can put it together and come back with a solution for ya. OK, alright, so thank
you guys for watching on episode two of A Patient’s Journey, we’ll be back next week
with episode three, where we go into…we look at the imaging and we talk about what a treatment plan is gonna be for a case like this. Thanks for watching, guys.

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