Head and Stomach Aches with Dr. Jono Taves

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[00:01:18] Welcome back to Untold Physio Stories Podcast.

[00:01:20] I'm your host, Dr. E with modern manual therapy and edge mobility system.

[00:01:23] Dr. Andrew Rothschild is not with me, but I have a very special guest, Dr. Jono.

[00:01:29] Jono.

[00:01:30] Jono, yep. You got it.

[00:01:32] You got it.

[00:01:33] Like John. Like John with an L.

[00:01:34] Yep. John with an L.

[00:01:36] Oh, man. Dr. Jono Taves. How's it going today?

[00:01:40] Good. Yeah, I'm excited to be on the podcast. Thanks so much for having me.

[00:01:44] Yeah, no problem.

[00:01:45] So give us a quick background, what you do and tell us your story.

[00:01:51] Yeah, yeah. Thanks.

[00:01:53] I so I graduated from the Mayo Clinic in 2016 from their DPT program.

[00:02:01] And essentially, I got introduced to a physical therapist out in Minnesota and then connected to some good clinicians out in Colorado and really was attracted to manual therapy.

[00:02:15] Even your work, Dr. E, was something that I was following early on, like right out of school.

[00:02:22] And so that first year of practice was a lot of spine and treating specifically like the neck headaches.

[00:02:34] And and I loved it.

[00:02:35] I mean, it was life changing.

[00:02:36] It really felt like I was having impact on people's lives.

[00:02:39] What happened was I would have an occasional patient come across my schedule with the diagnosis of migraine.

[00:02:45] And at first I thought, like, this is something the neurologist needs to see.

[00:02:50] This is different.

[00:02:51] This is out of my wheelhouse.

[00:02:52] These patients would say, well, I've seen three or four neurologists tried all the medication.

[00:02:56] Nothing really seems to help.

[00:02:58] And and they had a neck issue.

[00:03:00] So I started treating their neck and their migraines would improve.

[00:03:03] And so this kept happening over and over.

[00:03:05] Did some research, dug into what are these what are these patients receiving is what are these neurologists looking at these patients?

[00:03:12] Like, what's the lens?

[00:03:13] And I realized there was really nothing objective that they were going off of.

[00:03:17] And symptom management was the primary goal.

[00:03:19] And then seeing that there was something objective and understanding how this problem could be missed.

[00:03:24] It really just motivated me to create Novera Headache Center.

[00:03:28] So we're a specialty practice in Colorado Springs.

[00:03:31] All we do is treat headaches and migraines.

[00:03:33] You can think of it as just head, neck, jaw specialists.

[00:03:36] And and we've come up with like a system that's helped nearly every type of headache and migraine.

[00:03:43] And and so I'm excited to share a little story with you today.

[00:03:48] That's crazy.

[00:03:49] Actually, even before your story, I'm just thinking, wow, they I mean, I guess you would think that they would go on some kind of objective information, but it must be.

[00:03:58] Because what else if they're not trained to look at the neck, then I guess you're describing meds based on symptoms, right?

[00:04:06] Yeah.

[00:04:06] So currently in our health care system, a migraine would be classified as a spontaneous neurological event.

[00:04:13] So they stop at the neurological system.

[00:04:15] Um, there's nothing objective that they're using to say this is actually the initial trigger for the responses that you're seeing, whether that's the pain, the visual disturbance, uh, sensitivities, delights and sounds nausea.

[00:04:28] Uh, these are all strange things that occur.

[00:04:31] I mean, symptoms outside of like as a physical therapist, we think, okay, like pain in your knee, like that's pretty straightforward.

[00:04:38] We think knee and, uh, we know how to treat that when it comes to the head and face and having these referral patterns.

[00:04:44] And intense debilitating pain combined with visual disturbances, uh, potentially even numbness tingling.

[00:04:51] We have patients that have stroke-like symptoms, but are not having strokes.

[00:04:55] Um, these, these are symptoms that are confusing, uh, and seem scary.

[00:05:01] And so our health care system has pushed these people to neurologists.

[00:05:04] Neurologists aren't trained to understand what is happening in the neck, but we see this relationship between the upper cervical spine and these symptoms.

[00:05:11] And then we're treating that and it's, it's, uh, leading to good results.

[00:05:15] So it's kind of exciting.

[00:05:16] Yeah, I would agree with that.

[00:05:17] Back when I used to, uh, be in network and I would rely on physicians at a neural, I would just teach neurologists and dentists who I worked with just a super simple cursory screen that I knew was going to have some positive, like just palpate the upper cervical spine or the upper traps.

[00:05:33] Is there pain or tension there?

[00:05:35] And then is there any pain or limited range?

[00:05:37] And I would just tell them like, you know, they could, you should be able to go chin to chest.

[00:05:41] They should be able to do forehead parallel to ceiling.

[00:05:43] Is there any pain or stiffness with any cervical range of motion?

[00:05:46] And if there is, then you just refer them to me.

[00:05:48] And I would get a ton of referrals just because they had symptoms and especially the pain of palpation or pain of palpation in a jar or something like that.

[00:05:56] You know, it was just an easy screen that added no time to their, to their eval, but they trusted me enough to say like, oh, this is a good enough screen to know whether or not I should refer to me.

[00:06:05] I love that.

[00:06:06] Good for you.

[00:06:06] I I've, uh, personally had a hard time breaking through the, uh, the physician referral route.

[00:06:11] So our, our model's a little bit different, but, um, yeah, I, I do think it was luck.

[00:06:17] It was luck.

[00:06:18] Okay.

[00:06:18] What ended up happening was that I either treated enough patients from one doctor that they started to recognize their name, my name, or I ended up.

[00:06:26] I started treating the doctor or the doctor's mother or the doctor's spouse or something like that.

[00:06:31] So after I got the way in, then I was able to meet with the doctor and say, Hey, this is my, this is my screen that I want you to add to let you know whether or not they're, they're a referral, uh, referral appropriate for PT.

[00:06:43] Right.

[00:06:43] Right.

[00:06:43] And that's, and it's very prevalent.

[00:06:45] So I'm sure there are a lot of patients who are like, oh, this is happening all the time.

[00:06:48] So sure.

[00:06:49] All right.

[00:06:50] So what's the story?

[00:06:51] Yeah.

[00:06:51] Yeah.

[00:06:52] So what we're seeing, um, I mean, we see different demographics, but one of the ones that's kind of a little bit more, um, like tugs on your heartstrings are these little kids that are coming in with, uh, debilitating symptoms.

[00:07:06] So typically it's going to be a daily headache.

[00:07:09] So I had, um, last year I had a nine year old came in with a constant headache.

[00:07:14] Um, generally it's going to present more of a diffuse pattern.

[00:07:18] So this was both sides, more frontal, maybe presents like attention type headache.

[00:07:23] Um, she had gone the traditional route.

[00:07:26] Parents really couldn't figure it out.

[00:07:28] So, and it was interrupting her ability to, um, do schoolwork, play her instrument.

[00:07:33] Her mood had changed.

[00:07:35] She had lost energy just, uh, like she wasn't herself.

[00:07:39] And so parents had taken her to a neurologist at a children's hospital.

[00:07:44] They basically just said like, take Advil and relax.

[00:07:47] You know, that was pretty much it.

[00:07:49] Um, that answer wasn't good enough for the parents.

[00:07:51] And so they kept searching.

[00:07:52] This family was, um, already a little bit more like holistic and how they thought about things.

[00:07:57] So had pursued, uh, a DO, um, which I think had provided, um, maybe some relief, not much though.

[00:08:06] And so this little girl was dealing with a constant, maybe two to seven out of 10 pain.

[00:08:12] Um, and so if, if it was at its best, it was still there, but still kind of this nagging,

[00:08:17] annoying pain.

[00:08:18] And then it was daily getting up to about a seven typically is worse in the afternoon playing

[00:08:23] her instrument.

[00:08:23] Piano harp, uh, was also an aggravate.

[00:08:26] Um, and then she would sit, uh, do schoolwork.

[00:08:31] Uh, that was aggravating as well.

[00:08:32] Family was active, like to hike.

[00:08:35] She was unable to hike.

[00:08:36] And, uh, and so came to see us and she, uh, her chief complaints were the headache itself.

[00:08:44] Uh, but she also had mid back pain, uh, shoulder tension, neck pain, and, uh, sensitivities

[00:08:51] to lights and sounds and stomach pain.

[00:08:54] Um, and so essentially the reason I wanted to highlight her stories, one is her age.

[00:09:01] She had been dealing this with this, uh, for a few months before she came to see us.

[00:09:06] Uh, sometimes these can be like a quick onset, meaning like the child basically has nothing

[00:09:11] and then they wake up one morning and they have a daily headache.

[00:09:14] Uh, and hers was similar.

[00:09:15] It just sort of started and never went away.

[00:09:18] Um, so her, these other symptoms of like stomach pain, light and sound sensitivity, uh, sometimes

[00:09:24] for providers, these can be a little bit odd, uh, maybe feel like they're in a different

[00:09:29] category.

[00:09:29] For us with these little kiddos, we've seen this as, uh, and I'm not sure why kids are

[00:09:36] in this category, but the stomach pain is definitely a part of their presentation that does tend

[00:09:41] to connect and improve once we start treating, uh, the underlying problem.

[00:09:46] And so what we're, what we saw in her presentation, uh, was a significant restriction in her upper

[00:09:52] cervical spine.

[00:09:53] Uh, she had lots and lots of tension through like her shoulders and her mid back.

[00:09:57] And so basically her neck was telling us like, it's really hard to hold up this head and,

[00:10:02] uh, and we're tired, we're fatigued.

[00:10:04] Uh, the mobility was restricted, as I said.

[00:10:07] So even just a little bit of pressure palpation through the suboccipitals, um, she was extremely

[00:10:12] sensitive and that's another key sign for these kiddos, just a little light, even light pressure

[00:10:17] through the suboccipital area and they get squirmy.

[00:10:21] They have a hard time tolerating it.

[00:10:23] Uh, and that's an indication like the, the OA segment, C1, C2, there's just no mobility

[00:10:29] there.

[00:10:29] And so, uh, we treated her with manual therapy.

[00:10:35] I mean, a lot of like joint mobilizations to the upper cervical spine.

[00:10:39] That was a big focus, uh, focus on restoring shoulder stability.

[00:10:43] Um, making sure that her shoulders weren't contributing to this neck tension.

[00:10:47] We see a lot of the like levator scapula, upper trap connection into the cervical spine is like

[00:10:53] those shoulders not being stable causes a lot of tension in the neck.

[00:10:56] So we worked on that and we worked on like mid back.

[00:10:59] Uh, and within, I think it was a matter of, uh, two to three weeks, her pain had dropped

[00:11:05] to about a one out of 10.

[00:11:07] And, uh, she was just seeing like increases in her symptoms based on like what her activity

[00:11:12] was.

[00:11:12] So this would be, uh, a little bit clear as far as like, okay, what is actually causing

[00:11:19] increased tension?

[00:11:20] Sometimes when people start out with us, they have no idea.

[00:11:22] It just feels like everything hurts all the time.

[00:11:24] And so we make some progress.

[00:11:25] We get an idea of what is actually, um, going to be an irritant to their, their neck tension.

[00:11:32] What's going to increase the amount of stress through their system.

[00:11:35] Uh, and then after about four weeks, she was down to a consistent one out of 10.

[00:11:40] Um, and then about six to eight weeks in, we, we basically got her headache to go away.

[00:11:46] Um, the thing that popped up later though, uh, which makes this one even more interesting

[00:11:50] is that stomach pain.

[00:11:52] So her headache was gone.

[00:11:54] And then about eight weeks late, uh, so eight weeks into pair.

[00:11:59] So her headache's gone.

[00:12:00] And then a couple of weeks later, she says, my stomach hurts and I have a hard time.

[00:12:03] Um, like every time I eat, uh, the, the pain increases.

[00:12:07] And so she had a hard time eating.

[00:12:08] She was just, uh, always like fearful.

[00:12:10] I mean, it was kind of debilitating because it was like an eight out of 10 pain, like pretty

[00:12:16] significant.

[00:12:17] Um, she had again, gone the traditional route.

[00:12:20] They had set up an appointment for like a GI doc.

[00:12:22] Mom wasn't convinced, like they were going to find anything.

[00:12:25] And so what I did was basically say like, let's look at your, um, TL junction.

[00:12:29] Let's look at your QL.

[00:12:30] Let's look at your low back.

[00:12:32] See if there's any referral patterns here.

[00:12:34] Cause, um, this stomach pain hasn't resolved, even though all these other symptoms have gotten

[00:12:38] better.

[00:12:39] Um, and even after that first session, she had a couple hours of relief.

[00:12:44] It took about five to six sessions working through her, her low back in order to see

[00:12:49] that resolve.

[00:12:50] But apparently it's, it's, so if I back up and say, okay, there's a series of symptoms,

[00:12:56] primary one being daily debilitating headache, uh, in she's nine years old.

[00:13:03] So like, we think the body should be pretty resilient at this age.

[00:13:06] Um, a lot of these kiddos are involved in whether it's pretty sedentary activities.

[00:13:11] I mean, she was harp, um, playing the piano.

[00:13:15] She's relatively active though.

[00:13:16] And, and so even like jumping on the trampoline dance, um, we're seeing these, these little

[00:13:21] girls in particular, um, that are going through, like their bodies are developing, they're growing

[00:13:27] and they're just putting them under a ton of stress.

[00:13:30] And, uh, and we're seeing these very debilitating headaches that are just like, they're unremitting.

[00:13:36] I mean, they, they, they don't really give them a break, uh, and we're finding a significant

[00:13:40] amount of tension, but we're, we're seeing these good results if we actually treat that.

[00:13:44] Um, and then one more thing, Dr. E.

[00:13:47] And then, uh, so our, our framework that we set up here, so we are a manual therapy focused

[00:13:53] clinic and, uh, but we have a three spoke framework.

[00:13:56] So the, the thing we want to find and treat is the actual source of what these symptoms

[00:14:01] are coming from.

[00:14:02] So in this scenario, it would be, I mean, most of her spine, but the upper cervical spine.

[00:14:07] Um, the second part of that framework is developmentally.

[00:14:10] So we look at things like airway, her teeth were really crowded.

[00:14:14] She had a small mouth, high upper palate.

[00:14:16] And so her tongue didn't have space.

[00:14:18] She wasn't very good at breathing through her nose.

[00:14:21] It was more natural for her to breathe through her mouth.

[00:14:23] And so we look for things like tongue ties.

[00:14:25] And so I've recommended she go see an airway specialist to help improve her, uh, her, her

[00:14:31] airway.

[00:14:31] Uh, that means expanding the upper palate room for the tongue, potentially looking at a tongue

[00:14:36] tie release, stuff like that.

[00:14:38] And then we look at things.

[00:14:39] So that's developmentally and, and airways, one of the big ones there.

[00:14:43] Like what, uh, might someone have that sort of prevents them from finding relief through

[00:14:48] our, our, uh, approach.

[00:14:49] Uh, and then it's systemically.

[00:14:51] So what is the environment that the pain's experienced in and what might the, the patient

[00:14:56] have that is sort of a limiting factor?

[00:14:59] Uh, meaning whether it's their gut health and they have like systemic inflammation or maybe

[00:15:05] they're not sleeping properly, uh, or maybe their hormones are imbalanced or maybe it's

[00:15:09] stress.

[00:15:09] And so all these, these three things come into play when we take someone through our approach.

[00:15:14] Uh, and this is what we've seen to work time and time again, uh, with all different types

[00:15:19] of headaches or migraines.

[00:15:22] Yeah, it's great.

[00:15:23] I was, I was going to ask you, cause it reminded me, um, about a case that I saw where her

[00:15:28] headaches only came back after doing manual therapy and giving her chin tucks and some

[00:15:33] cervical and scapula stabilization and stuff.

[00:15:35] Um, her headaches would only come back when she ate gluten.

[00:15:39] Yeah.

[00:15:40] Um, yeah.

[00:15:40] But also like the only thing that made her headaches go away in the first place, even though she

[00:15:44] was very compliant with her home exercise program is to go gluten free because I said,

[00:15:47] Oh, Hey, you know what, before I knew anything about nutrition, I would just say to just like,

[00:15:51] why don't you try going gluten free?

[00:15:52] And she's like, Oh, you know, my mom has celiacs.

[00:15:54] And I realized that, um, even though I, I don't have celiacs that she's, she has a gluten

[00:15:59] sensitivity.

[00:16:00] And the only time she ever got headaches ever again was when she had, when she ate gluten.

[00:16:06] But it's strange though, because like her mechanism of injury was her getting hit with

[00:16:09] two softballs on two separate injuries in her chin like this.

[00:16:12] So you think, Oh yeah, it's clearly a neck irritation.

[00:16:15] But was that just enough to like sensitize her upper cervical spine?

[00:16:19] And then the gluten kind of like prolonged the inflammation.

[00:16:23] So I'm surprised it wasn't something she was eating because it seems like it would have

[00:16:26] been something she was eating or some sort of something that would trigger it or, you

[00:16:31] know, whether it was gluten or nightshades or something like that, you know, something

[00:16:34] inflammatory.

[00:16:35] Yeah.

[00:16:36] Yeah, absolutely.

[00:16:37] I agree.

[00:16:38] And sometimes it is that way.

[00:16:40] Um, so the dynamics at play here, um, again, going back to that framework, like having eating

[00:16:47] gluten, you know, nearly everyone eats gluten.

[00:16:49] Most people eat gluten.

[00:16:50] I know it's common to, to restrict in our diet, but the, the gluten itself isn't going to cause

[00:16:56] like a, I mean, oftentimes people have a migraine presentation.

[00:16:59] It's like, I feel like there's a spike through my right eye and it wraps up and around or something

[00:17:03] like that.

[00:17:04] Well, gluten in your body doesn't cause like a one-sided pain pattern.

[00:17:09] Right.

[00:17:09] Yeah.

[00:17:09] Not your lateral.

[00:17:10] Yeah.

[00:17:10] And so like for you to have gluten as the source of the problem, that's not what's happening

[00:17:16] here.

[00:17:16] Gluten is impacting your threshold.

[00:17:18] And so that's where that systemic element comes into play.

[00:17:21] And with migraines, it gets especially confusion, uh, migraines and headaches.

[00:17:26] It gets especially confusing because, uh, people, uh, they'll change their diet.

[00:17:30] And, uh, I mean, they'll see the latest and greatest, uh, the best finish physicians out

[00:17:36] there, whether that's like Mayo Clinic, Johns Hopkins.

[00:17:38] And basically it's like a more in-depth, like look at your triggers and avoid them.

[00:17:43] And then they find the trigger that works and they say, okay, like if I avoid this, I'm

[00:17:48] good.

[00:17:48] So that must be what's causing it.

[00:17:50] Uh, but we gotta be careful using that word cause cause cause is usually something musculoskeletal

[00:17:55] that's actually sending a pain signal.

[00:17:58] Um, but when we look at triggers, oftentimes they fall into like, what is impacting the

[00:18:03] environment that your brain's experiencing this pain in?

[00:18:06] And it probably gets more into like pain science.

[00:18:09] Um, yeah.

[00:18:10] Yeah.

[00:18:10] I used to say that this like, uh, triggers or just something that fill up your cup, but

[00:18:14] it's not, it's not a diagnosis.

[00:18:16] Like, like what I was talking to you earlier last week about over-breathing.

[00:18:19] It's just something that fills up the cup, but it's not, it's not causative.

[00:18:22] Right.

[00:18:23] Right.

[00:18:23] All these things like sleep disturbance or eating any, anything that could potentially

[00:18:29] trigger it or prolonged heart playing or prolonged piano playing, or even the way that they play

[00:18:35] a harp.

[00:18:35] I don't know.

[00:18:36] It's probably asymmetrical.

[00:18:37] Same thing with piano.

[00:18:38] Many times they're like leaning off to one side if they're always reaching over for the

[00:18:41] high keys and they don't necessarily reach over to that side.

[00:18:43] So it's a lot of those things that I think those things are your average therapist pretty

[00:18:49] much only does things to desensitize this to desensitize system, but they don't look

[00:18:53] at the things that could actually sensitize it.

[00:18:56] Yeah.

[00:18:57] Yeah.

[00:18:57] And so I, our approach, I don't think it's like, um, it's not this extremely advanced

[00:19:04] application of techniques that no one else knows.

[00:19:06] It's really just, we plug and play with what is the underlying source?

[00:19:10] Like, what can we physically work on when you're in the clinic?

[00:19:13] We do a lot of active, um, or like education on how someone can be more active lifestyle

[00:19:19] changes.

[00:19:19] So we go over a sleep position.

[00:19:21] Um, we go over to like, how should she play the harp?

[00:19:24] So all these things that most physical therapists would think to do.

[00:19:27] Um, and then, yeah, we, we obviously talk about the specifics of exercises she can be doing

[00:19:33] at home.

[00:19:34] Um, but we, we kind of act as the quarterback of the coach when it comes to looking and screening

[00:19:39] for these other things that can be barriers.

[00:19:42] So whether that's diet airway stuff, um, and, and we kind of zoom out and look at general

[00:19:47] health and, uh, and, and that's a big factor when it comes to pain in general, but especially

[00:19:52] with these headache and migraine patients.

[00:19:54] Yeah.

[00:19:54] I would agree with that.

[00:19:56] All right.

[00:19:56] Hey, if people want to find you, whether it's online or they need help from you or listen

[00:20:00] to your podcast, where can they find you?

[00:20:03] Yeah.

[00:20:03] Yeah.

[00:20:04] So I have a podcast, uh, it's called the headache doctor podcast.

[00:20:07] It's, uh, geared largely toward, uh, those that have headaches and migraines, but, uh,

[00:20:11] can be a fantastic resource for, um, physical therapists if they want to listen.

[00:20:16] And, uh, no Vera headache center is my practice.

[00:20:19] Uh, I'll put in a plug for, um, uh, actually working for us.

[00:20:25] So one of my biggest struggles is, uh, finding good physical therapists.

[00:20:29] Uh, there's a lot of people with headaches and migraines and we're growing.

[00:20:32] And so we need people to, to hop on board, uh, this system that we're using.

[00:20:37] And it's a lot of fun because, um, patients do get better and it's pretty life-changing.

[00:20:41] For sure.

[00:20:42] Yeah.

[00:20:42] One of my mentors had said that if you get a low back pain patient better, that they'll

[00:20:47] be grateful.

[00:20:48] But if you got a headache patient better, they'll leave you in their will.

[00:20:51] Yeah.

[00:20:52] Yeah, absolutely.

[00:20:52] These, these people, we frequently get told that this is life-changing a miracle.

[00:20:57] I mean, it's, um, it's on our end, it feels relatively simplistic, but it's, it's revolutionary

[00:21:02] to these people.

[00:21:03] So.

[00:21:04] Sure.

[00:21:04] All right.

[00:21:05] You're doing, you're doing good work.

[00:21:07] All right.

[00:21:08] So, Hey, if you, if you enjoy this episode, make sure to give us five-star rating wherever

[00:21:12] you listen to podcasts, especially Spotify and Apple, as that helps our discoverability.

[00:21:16] And as always, you guys have a great day.