Heather Purdin Goodell, M.S., P.T.
  • Graduate of Duke University 1995 with BS in 
   BioPsychoSocial Psychology, Health Psych, and 
   Neuropsych
  • Honors Thesis on Pain Behaviors in Children
  • Master’s Degree in Physical Therapy Duke University 1997
  • Special Initiatives award for “enhancing awareness of 
   cultural diversity in our program and profession”
  • Private practice owner with mission of providing holistic 
   care and large portion of patients having chronic pain
  • Personal experience with HEDS
         Common Orthopedic Problems
     • TMJ dysfunction present  • Early onset OA in hands 
       in > 70%                        and feet
     • Neck pain/tension             • Rib subluxation repeated 
       headaches/unstable              at certain levels
       segments/herniations          • Low Back Pain – unstable 
     • Shoulder                        segments, disc herniation
       sublux/dislocate/multidi      • Hip dislocation
       rectional instability and     • Patellofemoral syndrome
       tendonitis                    • Flat feet, “plantar fasciitis”
     • Elbow tendonitis              • Migraines
   Common Neuromuscular problems
   • Poor proprioception (sense of position) leads to 
    increased incidence of injuries, clumsiness
   • Pediatrics: Late walker, no crawling
   • Poor balance – possibly greater issue for geriatrics as 
    other factors begin affecting balance
   • Reduced sensation/muscle weakness
   • Increased peripheral neuropathy 
   • Increased pain sensitivity/reactivity possibly associated 
    with larger amygdalas and smaller anterior cingulate and 
    parietal lobes
    Common Biochemical Problems
   • Hyperadrenergia – too much adrenaline may be 
    associated with low blood pressure, possible mechanical 
    cause at adrenals or at receptors or due to different 
    brain make up, psychological response can lead to a 
    vicious feedback loop
   • Adrenaline ↔ Panic/overactivity 
   • Chronic exposure to adrenaline makes for “jumpiness”,  
    go-getter personality, “go ‘til you drop” mentality = poor 
    pacing and cycle of too much then too little activity
   • Chronic Fatigue, Adrenal Fatigue, Fibromyalgia
  Treatment – BioPsychoSocial Approach
  • “The best management program should 
   include drugs, physical therapy, cognitive-
   behavioral therapy, and adherence to a series 
   of lifestyle recommendations.” Castori 2012