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On today's episode, we have Dr. Sam Kelokates. Sam is the founder and physical therapist at Kelos Physical Therapy, a practice specializing in the non-pharmacological treatment of headache and migraine disorders with a focus on evidence-based therapies. Sam has developed a unique approach to helping patients manage and reduce the frequency of headache episodes, empowering them to reclaim their lives from chronic pain. Sam, welcome to the show. Hi, Ronak, thanks for having me. Yeah, absolutely. All right, so let's get right into it.
00:28
Just explain your role as a physical therapist and the management of migraines. Yeah, so as a physical therapist, I'm part of the treatment team that would help people with suffering from headache disorders, including migraine. I kind of work closely with their neurologists or other practitioners to help them really figure out how to best manage their migraine condition and decrease their frequency of headaches with a combination of pharmacological treatments, and then I specialize in the non-pharmacological side, so helping them.
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learn about exercises that might be beneficial for them, getting regular exercise, both aerobic and strength training that is known to help manage headache frequency for patients. We work together on finding what their triggers are that are able to be controlled and then educating them on different things they can do that might involve lifestyle management, sleep, and diet that helps them manage their disease better. Interesting. So, what led you to specialize in treating migraines?
01:23
So when I started my own practice in 2001, I started just seeing patients generally, and I started seeing some family and friends that had problems with headaches. And when I started like kind of reading up on those conditions, I was starting to realize that like the area of physical therapy, at least in this area, is kind of lacking. So I really wanted to start helping more patients in this area to really feel empowered, learn about their condition and how physical therapy can be beneficial to them because there was just a lack of providers in the area.
01:54
Is that something that you have to specialize in after you become a physical therapist? Yes. There's not really a big coursework in school for headache and migraine disorders. It's really thought of as more of a medical issue and they need a pharmacological treatment, but there's a growing body of research that manual therapy and exercise and lifestyle interventions can be very beneficial for those with migraine. As I started reading more and more about it...
02:22
and kind of doing self-education, that's how I started to specialize, but there's not really, it's kind of like a growing area in physical therapy, at least in the United States. Okay. And then how do migraines differ from other types of headaches in terms of PT treatment? Some of the treatments overlap with other headache disorders like cervicogenic or tension type headache. There might be a little bit more involved as far as educating patients on what is causing their pain and what's called the pathophysiology of that.
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and their relationship to their genetics, lifestyle management, and how we go about treating that. So we really focus on there might be some differences in manual therapy approach or exercise approach that differs a little bit, but during my examination with patients, I really helped tease out if there's going to be a beneficial, what would be beneficial as far as like manual therapy or exercises, or if that stuff will not be beneficial. And we'll talk more about like lifestyle education and how to manage it that way.
03:22
Okay. So what are some of the common physical triggers or contributing factors for migraines that patients should be aware of? For lifestyle factors, it tends to revolve around the primary three things that I talk about with patients, which would be sleep, diet, and physical activity. So it doesn't necessarily have to be exercise with physical activity. Just moving more often tends to be better for those with migraine disorder. And then sleep, if you're not sleeping well, you're not recovering well from each day.
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And then if you're not eating well, then you're not able to heal well while you sleep. So we kind of talk about those three things as far as like lifestyle management goes. And then for physical therapy during my examination, I'm trying to look at if there's areas of the upper cervical spine and the head and face, so like the jaw muscles are in the jaw, and if they are contributing in any way to their headache or migraine condition.
04:14
Usually, I'm looking for if those, if when I'm doing my assessment if I'm able to reproduce and resolve their headache if they're having one. And if that is possible, then I know that I'm able to provide physical treatments to that patient in reducing their headache frequency. Okay. Can you talk a little bit about the different exercises that you do with your patients? Yeah. There's several groups of, like I break exercise down into two different kind of categories. One is like...
04:41
specific musculoskeletal exercises. So I found an impairment, whether it's due to muscular weakness, motor control, or joint stiffness. And we create an exercise plan to address those physical impairments. And the other way I address exercise with patients, it's just generally increasing their overall level of physical activity. That might be more meant to improve their overall health and wellness that's related to migraine.
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If I'm a new patient, how would you first assess my condition and determine an appropriate physical therapy plan? Yeah. Usually when I sit down with patients, we really go through an in-depth subjective. I really talk about what their condition is like. Do they actually have more than one type of headache? How their headache is affecting them throughout their day? What other symptoms other than headache are they having that might be impairing them? Some patients that might also come to me that,
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While headache is a big problem for them, they might also have vestibular disorders or vestibular migraine where the headache is really bad and limiting, but that dizziness that they're getting with their symptoms is also bad. So that might change my plan of care and what symptom I'm going to try to address first and how we mitigate those symptoms both in clinic and then at home. Interesting. Can you share some success stories you've had with some of your patients?
06:04
Yeah, some of my patients when we're working together, they're getting complete resolution of their headaches or they're getting down to a frequency that is easily controlled with medication and having less than, usually my goal for most patients is having less than four headache attacks per month or one per week. So recently I've had a patient, they were having basically daily headaches and multiple migraine attacks through the course of the month.
06:30
probably having a daily headache every day. We've gotten to the point to where they're able to control their daily headache and reduce it on their own with daily exercise. And they're going from anywhere from zero to four migraine attacks per month. So that's been a big change for them after they're, this person had a head injury that resulted in a concussion and whiplash injury.
06:54
So for them, they went through daily headaches for five to seven years and frequent migraine attacks that started worsening up to prior to seeing me for care. And we were able to figure out what was going on as far as their neck involvement and their lifestyle management. And it took about six months for us to really figure out the exact protocol that worked for them. But through that trial and error, we were able to really get their headaches down to no more daily headaches and very few migraine attacks.
07:22
That's impressive. I mean, that has to be pretty debilitating to have a headache or migraine every single day. Yeah, this person's been out of work for a few years because of that, and now we're working on a plan for how do we get them back to work. Wow. Great job with that. So the future of migraine treatment, is there any new research or studies out there to help with engaging with new treatments?
07:49
Yes, there's new pharmacological treatments that are coming out that are helping the CGRP medications and they're been really effective on helping reduce patients' migraine frequency and improving their quality of life. There's also advances in what are called neuromodulation devices. So these would be like TENS units or other similar devices that provide a lateral stimulation either to the forehead, the upper arm, or the sub-occipital areas.
08:19
that have been shown to not just help with acute migraine attacks, but also been used to help prevent migraine attacks as well. So the landscape keeps changing and then there's more and more research growing on physical therapy interventions around the upper cervical spine and the influence of those upper cervical nerves on the trigeminal cervical nucleus and how they can refer pain. Wow. Is there a lot of people that specialize in this?
08:46
In the United States, I don't know many physical therapists that specialize in it. Off the top of my head, I think I can name five therapists. But there is more physical therapists around the world, especially in Europe and in some other countries around the world that they kind of do focus on specializing in headache disorders and orofacial pains.
09:15
kind of just proposition to patients, right? And I've seen you, I've seen you grow in Fishtown and growing into other locations. So just tell us a little bit about your experience and starting your own practice. Yeah, so I started kind of as like a side hustle in 2021, where I kind of was still working part time slash full time for another company. And as I was like growing my own practice, I was kind of just messaging people that I had worked with, colleagues about what I was doing.
09:45
Then over time, I've started to build up my own caseload and then decrease the caseload at the other job I had, which I had worked at for seven years at the time. Over time, I've built up my own caseload and over the last few years, there's been a grind doing that. Yeah. I think that's the best way of doing it, because you have that stable income that allows you to take a risk with your own practice.
10:10
You know, having a strong foundation, I feel like, is really important whenever you're starting any new business, because you just don't know where it's going to go, right? You don't know the demand, you don't know so many different things. So speaking of the challenges, what are some of the bigger challenges that you have to deal with? Obviously, the time management aspect when you're starting out is one, but what are some of the other obstacles? Well, starting out, so I was a clinician for seven years before deciding to start my own practice.
10:38
And one of the things I was like, I'm a good therapist, I can run my own practice, but that's not really how it works. Just because you're a good clinician doesn't mean you're a good business owner, you're a good marketer, you're good at running operations. And that's really stuff that I needed to take time to learn and I'm still learning to be more effective at. So as I've gone from a clinician and learning how to market my services and businesses, both to patients directly, but also to other referral sources.
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So learning how to network, like before, I felt like I was always good at networking with other professionals, but it's different when you're networking to referral sources and kind of asking them to send you referrals. It's a little bit different skill and there's a reason why bigger organizations have people that are business managers or in business development that really help go and get you referrals and that's their entire job because it's a big undertaking.
11:36
Yeah, no, absolutely. What advice would you give to other PTs that want to go private? I would definitely have a plan going forward on what you want to do marketing-wise. It doesn't have to be everything all at once. You don't have to go out and do YouTube and Instagram and blogs and do all of it at once, but find something that you're comfortable doing, whether it's writing blogs or it's going in marketing with physicians.
12:00
Find something you're good at and stick with that and then start building your skill upon that. And then when you feel like you have a good routine with that and like a good plan about how you operate with that, then start layering in the other forms of marketing that help really grow your practice. Yeah. I mean, you're pretty active on LinkedIn and I follow you and I see your posts all the time. Do you recommend social media to...
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to people going private and then if so, like what are some of the better platforms to advertise on? Yeah, I've been doing LinkedIn a lot more recently because I've been wanting to engage more with more physicians and other referral sources about how I can benefit their patients and their practices and really help improve outcomes for those with migraine. And it has been helpful to connect with those professionals and build relationships.
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But if I was going more direct to consumer or direct to the patients, I'd probably want to spend more time on YouTube or Instagram or TikTok where you're going to be more patient facing at that point. Yeah, absolutely. Any additional tips or resources for listeners who are dealing with migraines and might be considering physical therapy? Yeah, so I have a YouTube channel called Active Headache Recovery that I post content on regarding
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different exercises where I, you know, recent series I've been doing is finding studies online that have looked at exercise protocols for those with migraine and other headache disorders, talking about what those studies came out with results wise and then demonstrating the exercises so people have an example of, you know, what the research says and how to do those exercises. I also demonstrate some neuromodulation devices, so like tens units on how to use them and set them up and the parameters to be used for patients.
13:45
They can also go to my website, which would be kilo They can look through the different content I have there on my blog about different things related to headache disorders and treatments and how they can find maybe some self-treatment or how they can find a provider near them that might provide more care. Okay. Sam, so thank you so much for coming on. Patients can find you in our MedCoShare Fishtown location.
14:10
and you're thinking of opening up in our New Jersey location as well. So that's great. So now you're serving two states. But this was great. So thanks. Thank you for coming on. Thank you for having me. I appreciate it.
