Tag Archives: Cervical Retractions

Posted on

What to Do When You Can’t Look Up

After releasing a video post on How to Quickly Fix a Kink in Your Neck, I received positive feedback on YouTube about how simple and effective the method I demonstrated was to self-treat a painful stiff neck. This method helped to fix the problem with looking left and right, but viewers began to ask what they should do if they can’t look up without pain.

In this video post, I address the common problem of what to do when you can’t tilt your head backward (look up). This initially can be challenging to treat (even more challenging than fixing turning or rotating your head), but with these two self-treatment strategies you might be able to get some relief.

Most important, your posture matters. Poor posture puts your neck in an extended and compromised position. Your upper thoracic is a critically in maintaining proper cervical mobility (including the ability to look up).

The key to eliminating pain is to improve the mobility of the thoracic spine, so the neck and shoulders no longer have to compensate for the lack of thoracic mobility. Be sure to subscribe to my e-mail list to gain immediate access to My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain for foam roller mobilizations and stretches that are designed to counteract the stresses and postures of daily life and to restore the normal mobility to the upper back.

In this video, I demonstrate the McKenzie method for cervical retractions in order to improve your neck motion. This secondary technique, called the side bend with rotation, may also help you to look up without pain if the problem is in your upper cervical area. I highly recommend the following book, Treat Your Own Neck, by Robin A. McKenzie.

CLICK HERE TO WATCH NOW

Ideally, you should be able to self-treat your problem of not being able to tilt your head up by improving your posture (with my recommended foam roller mobilizations and stretches) in addition to using these two techniques (cervical retractions and the side bend with rotation) that I demonstrate in the video.

If you’re not experiencing relief after trying these self-treatment techniques, contact your local physical therapist for an assessment and help in managing the condition. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Which of these two techniques (cervical retractions and the side bend with rotation) worked the best for you? Please share below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

Posted on

How to Quickly Fix a Kink in Your Neck

Have you ever woke up from a good night of sleep with a kink in your neck? How about not being able to move your head without pain? Yeah, me, too. How about a sore neck or a stiff neck after exercising or doing an activity like painting? Yep, I have had that, too.

So often this “kinked neck” or “stiff neck” feeling is easily self-treatable. In the following video, I demonstrate a very simple and effective method to self-treat that painful stiff neck feeling that we all get from time to time.

CLICK HERE TO WATCH NOW

If you want a more detailed explanation of neck pain and ways to prevent it from occurring, be sure to read my post on neck pain, headaches, and the “core” muscles of your neck. You will discover why it’s important to insure proper cervical core strength in order to not only alleviate neck pain and headaches, but also to prevent them from reoccurring.

For additional ways to easily improve your posture and reduce pain in the neck and shoulder, be sure to subscribe to my e-mail list to gain immediate access to My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain for step-by-step exercise instructions and photos.

Also, please refer to my video, What to Do When You Can’t Look Up.

Have you ever suffered from a stiff or painful neck? Which treatments have worked the best for you? Please share below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. In case you haven’t already, be sure to subscribe to my e-mail list and YouTube channel as well as join our community on Facebook by liking The Physical Therapy Advisor!

Posted on

Neck Pain and Headaches? Work Your Core?!

You may have heard that if you suffer from low back pain (LBP) that you need to work your “core” muscles, but what if you suffer from neck pain (cervicogenic pain) and/or headaches?  Well then yes, you would need to work the core muscles of the neck.  Like the lumbar spine, the neck also has a group of core muscles that are specifically designed to insure proper cervical segmental stability and to maintain proper head posture.  When weakness and dysfunction are present within this group of muscles, there is often ongoing neck pain that can lead to headaches.

Muscles of the cervical neck “core” include the deep neck flexors and deep neck extensors.  Most people don’t know the names or how to spell these rarely talked about muscles.  For those who like the nitty gritty details, the deep neck flexor muscles include the longus colli and longus capitis.  The deep neck extensor muscles include the multifidus and the semispinalis cervicis.  The sub occipital muscles (including the rectus capitus posterior major and minor) and the obliquus capitus superior and inferior also play a role in cervical stability.  These muscles as a group make up the core muscles for the cervical spine.

When classifying muscles, and especially the cervical muscles, it can be useful to think of them conceptually as global movers and local stabilizers. 

Global movers are involved in the generation of torque and produce movement.  They function more like a light switch, either moving your head or not.  When dysfunctional, there are spasms, pain, and a restricted range of movement.

Local stabilizers are the deeper muscles that control segmental movement and neutral positioning of a joint and the head.  Their activity is tonic (always on).  It’s like a light switch that is always on, but with a dimmer controlling the intensity.  Local stabilizers operate at much lower levels of contraction for long periods of time.  Dysfunction in the local muscles results in the inhibition of muscle function, delayed timing or recruitment of when the muscle is stabilizing which causes loss of segmental control and poor cervical vertebral joint positioning.  This is often associated with chronic neck pain and headaches as well as muscle spasms in some of the larger muscles (such as the upper trapezius) as it attempts to compensate for the underlying muscle inhibition.

The neck presents a unique challenge of both mobility and muscularly speaking.  It requires intricate muscular control to balance the weight of the head in space.  The neck also moves the head through a large range of motion available; all while positioning it accurately to allow us to use our senses (sight, smell, hearing, and taste) most effectively.

Mobility and stability are both vitally important to how the neck functions.  This is why the deep segmental stabilizing muscles are extremely important.  These deep core muscles (also known as the “inner unit”) have been shown to weaken in the presence of neck pain or injury regardless of the cause.  As part of a compensation pattern, one will often find that the prime mover muscles at the front of the neck, called the SCM (sternocleidomastoid muscle), become overactive trying to protect the neck.

Unfortunately, this creates excessive shear and compression forces on the neck which brings the head forward into the poking chin posture.  This dysfunction pattern tends to persist even when the pain subsides unless properly retrained.  This may explain why so many people experience recurrent episodes of neck pain.  Discover why it’s important to insure proper cervical core strength in order to not only alleviate neck pain and headaches, but also to prevent them from reoccurring.

Most of the time neck pain is mechanical in nature.  This means that there is a structural or mechanical issue affecting proper motion in the neck leading to either neck pain or headaches.  Since the trigger is mechanical (starting or worsening with certain movements), it can just as easily be reduced or eliminated if the correct movements can be initiated.  Mechanical neck pain is often experienced as cervical pain, headache pain or other correlated pain patterns in your upper back and down your arms (even to your fingers).

Neck Pain (Cervicogenic Pain) Symptoms include:

  • Pain in the front of your head, behind your eyes or side of your head.
  • Pain which begins from your neck that extends between your shoulder blades and upper shoulders.
  • Pain which is exacerbated or changed by certain neck movements or neck positions.
  • Pain which is triggered by pressure applied to the upper part of the neck near the base of the skull (known as the sub occipital area) or in the upper trapezius area.
  • Pain down one or both arms.  It can be felt as far as your fingers.
  • Stiff neck.
  • Altered or blurred vision as well as nausea, vomiting, and/or dizziness.

Potential Causes for Cervicogenic Headaches

There are plenty of reasons why one might develop neck/cervical derangements or dysfunction.  Examples include: motor vehicle accidents; sports; falls; sleeping on a poorly fitted pillow; poor posture; and carrying items that are too heavy (such as a backpack).  Chronically sustained non-symmetrical postures, stress, and a sedentary lifestyle are also potential causes.

The actual pain generating structures of the neck (listed below) vary wildly and can be difficult to pinpoint.

  • Nerve related injury or pain
  • Muscle spasms
  • Trigger points
  • Facet joint dysfunction
  • Cervical mal-alignments
  • Cervical disc issues
  • Postural dysfunction

Cervicogenic pain and headaches tend to be more common in women than men.  In general, women experience this due to minor anatomical differences.  Men tend to have muscular necks. Women tend to have longer more slender necks with less muscle to provide support to the head (meaning that there is less muscle strength for support).

Treatment for Neck Pain (Cervicogenic Pain) and Headache Pain

Research suggests the most effective management of neck pain conditions include both manual therapy (hands-on mobilization) and manipulation with specific exercises.  If you have to choose one or the other, I find that a correctly designed and implemented exercise program to be the most effective over the long term.

The first step to designing a treatment plan is by identifying a pattern to the pain.

Which head motions change or alter your neck or headache pain?  Does the pain get worse or does it improve when you turn your head?  What happens when you look up, look down, slouch or sit up straight?  What happens when you repeat this movement?

Determine how your pain responds.  This is also known as establishing a directional preference.  You might be moving in the wrong direction if the pain spreads away from the spine and down into the upper back or arm.  Stop that particular movement, and try the opposite direction.

In my experience, most episodes of cervical pain and headaches tend to respond better to cervical extension biased movements and improvements in posture.  Gaining extension in the thoracic spine is also critical to treatment.

In order to determine if extension biased (cervical retraction or extension) movements help you, I recommend starting with this exercise (as shown below).  Sit up straight, and retract your chin straight back.  Repeat 10-20 times.

Carefully monitor symptoms for peripheralization or centralization.  The rule of thumb for movement:  If the pain worsens by spreading peripherally down the arm into the hands, fingers, shoulder blade/upper back or the headache gets worse, then the condition is worsening (peripheralizing).  Stop that activity.  If the pain centralizes and returns back toward the cervical spine, and the headache pain improves (even if the pain in the neck worsens slightly), then keep moving as the condition is actually improving.

If you are unable to help or change the pain in any way, then you may need assistance from a medical provider.  For a thorough discussion and an excellent treatment resource, please refer to Treat Your Own Neck  by Robin A. McKenzie.

Once you have determined a directional preference, then you can focus on the deep core and stabilizer muscles.  For my initial neck core strengthening exercises, please refer to Deep Neck Flexion Exercises.

Once you’re able to engage the deep neck flexors, you can next progress into strengthening your scapulothoracic and postural muscles.  Be sure you are engaging the deep neck flexors during these exercises to insure proper stability of the neck.

For the I’s, T’s, and Y’s exercises (as shown below), work up to holding each position for 30 seconds.  Repeat 3 times.  Keeping the correct posture and deep cervical flexor muscles engaged during this exercise is critical to engaging the full core of the neck.

Other Treatments for Neck Pain (Cervicogenic Pain) and Headache Pain:

  • Focus on your posture.  Poor posture is the bane of modern society.  The most common example of poor posture is a forward head with rounded shoulders.  This causes excessive muscular tension throughout the cervical spine, upper trapezius region, and mid-thoracic area.  Over time, this leads to muscle weakness and dysfunction in the cervical spine and upper thoracic area.  Proper posture allows for the optimal alignment of your spine.  Neurologically speaking, this allows for your muscles to down regulate by reducing tension.  Poor posture is almost always associated with muscle knots and trigger points.  My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain is a downloadable .pdf file with my recommended stretches using foam roller exercises to address posture.  These simple exercises (with complete instructions and photos) will help you to improve poor posture and can be performed at home.

DOWNLOAD NOW: My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain

  • Manual Therapy.  An osteopathic physician, physical therapist or chiropractor can use manual therapy techniques.  This includes joint mobilization and manipulation which can be beneficial in reducing pain and addressing some of the mechanical causes.  However, manual therapy is a passive treatment.  For long term treatment and prevention, an active approach needs to be taken.  I would encourage you to perform proper exercises to insure that you have adequate cervical and upper thoracic strength and mobility.  Also, address any precipitating factors (such as poor posture).
  • Massage.  Although massage can be a form of manual therapy, it can also be thought of as separate intervention.  There are many types of body workers that can utilize many different forms of massage or manual treatments.  Many trigger points and muscle spasms will refer pain into the head (which causes the headache).  It’s important to actively and physically address the muscle tension.  This is the time to contact a massage therapist, body worker, physical therapist, athletic trainer or friend who is skillful in body work or massage to relieve the area in spasm.  The specific massage technique to use will vary according to your preference.  Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.  This can also be an effective prevention strategy.
  • Other self-mobilization tools.  Many times, a friend or massage therapist isn’t available to assist when you need the help the most.  A foam roller cannot effective reach places in the upper back or arms, so other self-mobilization tools may be necessary.  You can get creative and use a tennis ball or golf ball, but I like a specific tool called the Thera Cane Massager.  This tool allows you to apply direct pressure to a spasming muscle.  When held for a long enough period of time, the Thera Cane Massager will usually cause the muscle spasms to release and provide much needed pain relief!
  • Topical agents.  Many topical agents can help to decrease and eliminate muscle spasms.  They can also mediate the pain response helping to reduce neck pain or headache pain.  You can apply a small amount of topical agent directly over the pain area if it’s accessible and not near your eyes.  (Please use common sense).  You may find that one product works better than another.  Some of my favorite products in my medicine cabinet include:  Biofreeze Pain Relieving Gel, Arnica Rub (Arnica Montana, an herbal rub), and topical magnesium.
  • Magnesium bath.  The combination of warm water with magnesium is very soothing and relaxing.  Magnesium is known to help decrease muscle pain and soreness.  Options include:  Epsoak Epson Salt and Ancient Minerals Magnesium Bath Flakes.  I find that the magnesium flakes work better, but they are significantly more expensive than Epson salt.
  • Acupuncture.  I am personally a big fan of acupuncture.  It is very useful in treating all kinds of medical conditions.  It can be particularly effective in treating headaches, muscle trigger points, muscle cramps, spasms, and pain as it addresses the issues on multiple layers.  Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  • Medications.  Medications can be an effective short term solution to headache pain, but I strongly encourage you to transition off of medications over time.  In some cases, prescription medications may be used initially to help you tolerate the pain as you work toward prevention.  Please speak to your physician regarding prescription options.
  • Speak with your Physical Therapist (PT) or Physician (MD or DO).  If you are suffering with neck pain and headaches, there are options.  Please speak to your medical provider to determine if other causes are contributing to the problem.  Physical therapy is very effective treatment for those suffering with neck pain and headaches.  The American Physical Therapy Association (APTA) offers wonderful resources to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Don’t give up hope!  Neck pain and headaches can be difficult to manage, but with proper care, most of the pain can be cured or effectively managed.  Begin by implementing one or two of these treatment tips, then assess how well they worked for you.  If the technique helped, continue with it then implement another strategy.

If you suffer from neck pain and headaches, which treatments have worked the best for you?  Please share below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on

What to do about TMJ Pain

Pain in your jaw or side of your head is often associated with temporomandibular joint syndrome which is also known as TMJ pain.  It’s often referred to as TMJD or temporomandibular joint disorder.  The causes of TMJ pain can be highly variable and are often multifactorial.  Pain can be mild to very severe.  Learn how to recognize the symptoms of TMJ pain and how to determine the possible cause so that you can implement simple treatment techniques.

Symptoms can include:

  • Pain in your jaw near the ear
  • Clicking or locking of the jaw
  • Pain can be on one side or both
  • Pain in the ear, face or neck
  • Pain while chewing (particularly, more difficult to chew food such as meat or raw vegetables like celery)
  • Headache pain

Potential Causes and/or Risk Factors for TMJ Pain:

  • Direct trauma, where the jaw was directly injured
  • Grinding your teeth
  • TMJ can develop rather quickly if there are other precipitating factors.  For example, if you were to eat a series of meals that required excessive and difficult chewing.
  • Over extending the jaw
  • Hypermobility (in the jaw or in general) which allows for excessive movement in the temporomandibular joint
  • Postural dysfunction (poor posture)
  • Muscle spasms within the muscles of mastication or the chewing muscles
  • Cervical mal-alignments
  • Rheumatoid arthritis
  • Osteoarthritis
  • Certain connective tissue diseases

Although TMJ is diagnosed in both men and women, it appears to be more prevalent in women.  This may be due to gender differences as women tend to have more laxity and movement in joints than men.  It may be due to a combination of other anatomical and genetic differences.

Treatment for TMJ Pain

In most cases, a combination of interventions from your dentist and from a physical therapist (PT) is the best approach.  The most important aspect of treatment is to determine which factors lead to the pain originally.  Was there one direct causative factor, such as trauma, or is the pain associated with multiple risk factors?  Due to the multifactorial nature of TMJ, often multiple treatment interventions are needed.

It’s important to have a thorough dental examination to determine if there are any specific tooth or jaw alignment issues.  The dentist can also take an X-ray of the jaw to help confirm that the diagnosis of TMJ is in fact orthopaedic in nature and not related to something more serious (such as an infection or abscessed tooth).  If grinding or clinching your teeth at night is associated with the pain, then the dentist can make a night splint.

From a physical therapy standpoint, it’s important to not only to address the TMJ joint, but also the head, neck, and spine.  Any muscle pain or dysfunction issue can be treated with massage and soft tissue mobilization.  The treatment may be intraorally to gain access to some of the deep muscle of mastication or may include addressing muscles on the outside of the head, neck, and face.  Proper cervical vertebral movement will also be checked and any cervical dysfunction should be addressed.

General treatment strategies for TMJ pain include:

  • Night splints.
  • Use of NSAIDs, such as Ibuprofen, to address pain and inflammation.
  • Ice to address pain and inflammation of the joint.  I recommend icing no more than 3-5 minutes at a time because the joint is small and superficial.
  • Massage.  Many trigger points and muscle spasms will refer pain into the head and/or jaw.  Since the likely areas of dysfunction are either cervical or intraoral, it’s best to contact a physical therapist or bodyworker that is specifically trained to treat this condition.  Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.
  • Exercise.  A primary treatment modality and prevention technique is exercise.  This can be broken down into two primary areas: jaw mobility and cervical dysfunction. 
    • Specific exercises to address jaw mobility:  In this exercise, you will hold your tongue at the roof of your mouth and slowly open your jaw.  Only open as far as you can while keeping the tongue at the roof of the mouth and stopping before any clicking or grinding.  It’s best to perform this exercise while looking in a mirror to insure symmetry of your mouth when opening and closing it.
    • Specific exercises to address cervical dysfunction (if present):  Often TMJ pain is associated with a cervical related issue.  I often have my clients perform this cervical retraction exercise.  Sit up straight, and retract your chin straight back with your mouth lightly closed with your tongue resting on the top of your mouth.  Repeat 10-20 times.

  • Focus on your posture.  Poor posture is a bane of modern society.  The most common example of poor posture is a forward head with rounded shoulders.  This causes excessive muscular tension throughout the cervical spine, upper trapezius region, and mid-thoracic area which will directly affect the positioning of the jaw.  Proper posture allows for the optimal alignment of your spine, head, and jaw.  This is particularly important when eating.  Poor posture is almost always associated with muscle knots and trigger points.  Subscribe to my e-mail list to gain immediate access to my FREE resources including My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.  It’s a downloadable .pdf file with my recommended stretches and exercises to address posture.  These simple exercises (with complete instructions and photos) will help you to improve poor posture and can be performed at home.
  • Acupuncture.  I am personally a big fan of acupuncture.  It’s very useful in treating all kinds of medical conditions.  It can be particularly effective in treating headaches, TMJ pain from muscle trigger points, muscle cramps, spasms, and pain as it addresses the issues on multiple layers.  Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  • Relaxation.  TMJ associated pain is often a condition associated with individuals with a high amount of emotional stress.  This is likely due to associated jaw clinching.  It’s important to address the underlying emotional stress that maybe contributing to the condition.  This may include counseling, deep breathing techniques or performing my recommended stretches and exercises for neck and shoulder pain to generally help alleviate tension.  The importance of addressing any and all contributing factors (including any psychological factors or emotional stress) cannot be overstated.
  • Speak with your Physical Therapist, Physician, and/or Dentist.  If you are suffering with TMJ pain, there are options.  Please speak to your medical provider to determine if other causes are contributing to the problem.  In severe cases, there are a myriad of surgical procedures that can be attempted to address the issue.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your dentist and/or physician’s opinion as well).

Although TMJ pain can be difficult to manage, don’t give up hope!  Most TMJ pain can be cured or effectively managed with proper care and by addressing the likely causative factors.  Begin by implementing one or two of these treatment tips, and then assess how well they worked for you.  If the technique helped, continue with it and then implement another strategy.

Have you ever experienced TMJ pain?  If so, which treatments strategies have worked the best for you?  Please share below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on

Got Text Neck?

With the ever increasing obsession over portable technology devices, it isn’t surprising that cases of “text neck” are also increasing exponentially.  Text neck is a term used to describe pain that is felt in the head, cervical spine (neck), and/or thoracic spine (upper back region) from chronically poor posture associated with using mobile technology such as smart phones and E-readers.  This tends to go hand in hand with “text thumb” (or what was once called “BlackBerry thumb”) pain.

poorposturewhiletexting

With over 90% of Americans currently using mobile phones, it’s not surprising that cases of text neck are skyrocketing.  People are spending hours hunched over their hand held devices.  This is causing chronically poor posture.  This forward head and rounded shoulders posture is responsible for causing headache pain, neck pain, upper back pain, and even shoulder pain.

The average sized head weighs approximately 10-12 pounds.  Imagine bending over or looking down.  At even 30 degrees, the relative weight of the head as felt by the neck and upper back is up to 40 pounds.  Increase the flexion to 60 degrees, and the weight goes up to 60 pounds.  Over time, the extra strain fatigues the muscles of the neck and thoracic spine.  It causes excessive strain on the muscles as well as the ligaments and the discs and joints of the cervical and thoracic spine (ultimately, leading to pain).

When left untreated, you could experience ever increasing levels of pain.  Pain in combination with poor posture can place ongoing stress that can lead to pre-mature degeneration of the cervical spine and development of osteoarthritis and other degenerative conditions.

How to Prevent and Treat Text Neck:

  • Stop Looking Down.  The most obvious treatment for cases of text neck is to address the underlying postural dysfunction.  This means that you should stop looking down at your phone or mobile device.  Try to keep your devices at eye level.  Limit the amount of time spent looking down.  If you tend to spend 30-40 minutes at a time looking down at your device, work toward reducing that time in half.
  • Use Voice Text Options.  To avoid looking down so much, try to use voice text options or hands free options.  This can help limit your time spent looking down at the screen.
  • Reverse the Position.  In today’s society not using a mobile device is a difficult option.  Instead of not using a device or never looking down, be proactive by spending time moving in the opposite direction.  The neck and upper back are meant to move in many directions.  Be sure to extend your neck and thoracic spine frequently throughout the day.  Imagine how good it feels to stretch backward while yawning.  Perform that motion more frequently and after every prolonged period of looking at your device.
  • Perform Cervical Retractions.  After looking down for more than a minute, perform cervical retractions (as shown below).  Sit up straight, and retract your chin straight back.  Repeat 5-10 times.

cervicalextensionexercise_collage_960pxwide

  • Exercise.  Keeping the areas of your body which support your arms, neck, and thoracic spine strong is a critical step in preventing text neck pain.  Focus on the muscles that extend the neck and thoracic spine as well as stabilize the shoulder girdle (including the muscles of the rotator cuff).  Please refer to Rotator Cuff Exercises for two simple exercises that will work your shoulder girdle and rotator cuff muscles while using an exercise band.
  • Focus on Your Posture.  The chronic forward head with rounded shoulders posture associated with text neck causes excessive muscular tension throughout the cervical spine, upper trapezius region, and mid-thoracic area.  Over time, this also leads to muscle weakness and/or dysfunction in the cervical spine and upper thoracic area.  Maintaining proper posture allows for the optimal alignment of your spine.  Neurologically speaking, this allows for your muscles to down regulate by reducing tension.  Poor posture is almost always associated with muscle knots and trigger points.  Be sure to vary your positions frequently throughout the day.  My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain is a downloadable .pdf file with my recommended stretches and exercises to address posture.  These simple exercises (with complete instructions and photos) will help you to improve poor posture and can be performed at home.

DOWNLOAD NOW: My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain

  • Massage.  If you are already suffering from trigger points and muscle spasms, massage can be an excellent modality to reduce these symptoms.  It’s important to actively and physically address the muscle tension.  This is the time to contact a masseuse, physical therapist, athletic trainer or friend who is skillful in body work and massage to relieve the area in spasm.  The specific massage technique to use will vary according to your preference.  Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.  This can also be an effective prevention strategy.
  • Foam roller.  The foam roller allows you to perform self-massage and tissue mobilization.  Utilize a foam roller on a daily basis in order to avoid neck and upper back pain.  Please refer to the following posts for more information:  Foam Rolling For Rehabilitation and 5 Ways to Improve Range-Of-Motion.  I highly recommend a foam roller to help aid in your recovery.
  • Acupuncture.  I am personally a big fan of acupuncture.  It is very useful in treating all kinds of medical conditions.  It can be particularly effective in treating headaches, muscle trigger points, muscle cramps, spasms, and pain as it addresses the issues on multiple layers.  Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  • Manual Therapy.  A physical therapist or chiropractor can use manual therapy techniques which can be beneficial in reducing pain and addressing some of the mechanical causes.  However, manual therapy is a passive treatment.  For long term treatment and prevention, an active approach needs to be taken.  I would encourage you to perform proper exercises to insure that you have adequate cervical and upper thoracic strength and mobility.  Also, address any precipitating factors (such as poor posture).
  • Medications.  Medications can be an effective short term solution for pain, but I strongly encourage you to transition off of medications over time.  In some cases, prescription medications may be used initially to help you tolerate the pain as you work toward prevention.  Please speak to your physician regarding prescription options.
  • Speak with your Physical Therapist (PT) or Physician (MD).  If you are suffering with headache and muscle tension/pain, there are options.  Please speak to your medical provider to determine if other causes are contributing to the problem.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Whether you suffer from text neck or you’re experiencing pain from chronic poor postures, these prevention and treatment strategies will help you overcome the discomfort.  Begin by implementing one or two of these treatment tips, and then assess how well they worked for you.   If the technique helped, continue with it and then implement another strategy.

Which strategies can you implement in order to avoid and/or alleviate the discomfort of text neck?  Please share below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on

Cervicogenic Headaches: A Real Pain in the Neck (and Head)

Cervicogenic headaches are a certain type of headache in which the head pain is specifically caused by an issue in the cervical spine.  Cervicogenic pain is often a trigger for other types of headaches, such as migraines or tension headaches.  As a physical therapist, I find it more effective to classify cervicogenic headaches separate from tension headaches.  Tension and cervicogenic headaches may be treated similarly, but in many cases, it depends on the actual dysfunction present.

Young man experiencing neck pain against a white background

Cervicogenic headaches are almost always mechanical in nature.  This means that there is a structural or mechanical cause in the neck which is leading to the headache pain.  Since the trigger is mechanical, these headaches can come on very suddenly with certain movements and can also be reduced or eliminated quickly if the correct movements can be initiated.  When the cervical spine is the cause of the pain, you may experience cervical pain, headache pain, and other correlated or referred pain in your upper back or down your arms (even to your fingers).

Cervicogenic Headache Symptoms include:

  • Pain in the front of your head, behind your eyes or side of your head.
  • Pain which begins from your neck and extends to between your shoulder blades or upper shoulders.
  • Pain which is exacerbated or changed by certain neck movements or neck positions.
  • Pain which is triggered by pressure applied to the upper part of the neck near the base of the skull (known as the suboccipital area) or in the upper trapezius area.
  • Pain down one or both arms and can be felt as far as your fingers.
  • Stiff neck.
  • Blurred vision.
  • Nausea, vomiting, and/or dizziness.

Potential Causes for Cervicogenic Headaches

There are plenty of reasons why one might develop cervical derangements or dysfunction.  Examples include:  motor vehicle accidents; sports; falls; sleeping on a poorly fitting pillow; poor posture (especially when texting); and/or carrying items that are too heavy (such as a backpack).  Chronically sustained non-symmetrical postures, stress, and/or a sedentary lifestyle are also potential causes.

The actual pain generating structures of the neck (listed below) also vary wildly and can be difficult to pinpoint.

  • Nerve related injury or pain
  • Muscle spasms
  • Trigger points
  • Facet joint dysfunction
  • Cervical mal-alignments
  • Cervical disc issues
  • Postural dysfunction

Cervicogenic pain and headaches tend to be more common in women than men.  In general, women experience this due to an anatomical difference.  Men tend to have more muscular necks while women tend to have more long and slender necks with less muscle to provide support to the head (meaning that there is less muscle strength for support).

Treatment for Cervicogenic Headaches

In cases of mechanical pain, you should be able to alter and change your neck or headache pain within a short period of time.  The first step is to establish a directional preference by identifying a pattern to the pain.

Which head motions change or alter your neck or headache pain?  Does the pain get worse or does it improve when you turn your head?  What happens when you look up, look down, slouch or sit up straight?  What happens when you repeat this movement?

Determine how your pain responds.  If it spreads away from the spine and down into the upper back or arm, beware that you are moving in the wrong direction.  Stop that particular movement, and instead try the opposite direction.

In my experience, most episodes of cervical and headache pain tend to respond better to cervical extension biased movements and improvements in posture.  Often, gaining extension in the thoracic spine is also critical to treatment.

In order to determine if extension biased (cervical retraction or extension) movements help you, I recommend starting with this exercise (as shown below).  Sit up straight, and retract your chin straight back.  Repeat 10-20 times.

cervicalextensionexercise_collage_960pxwide

Carefully monitor symptoms for peripheralization or centralization.  The rule of thumb for movement:  If the pain worsens by spreading peripherally down the arm into the hand, fingers, down into the shoulder blade/upper back or the headache is worsening, then the condition is worsening.  Stop that activity.  If the pain centralizes and returns back toward the cervical spine, and the headache pain improves (even if the pain in the neck worsens slightly), then keep moving as the condition is actually improving.

If you are unable to help or change the pain in any way, then you may need assistance from a medical provider.  For a thorough discussion and an excellent treatment resource, please refer to Treat Your Own Neck by Robin A. McKenzie.

Other Treatments for Cervicogenic Headaches:

  • Exercise.  A primary treatment modality and prevention technique is exercise.  Exercise in general has been shown to be beneficial in treating and preventing cervical pain and headaches.  However, a specific exercise program designed to maintain cervical and thoracic mobility and strength should be the main portion of your treatment.  Focus on your thoracic mobility (particularly, into extension).  Work on cervical stabilization exercises that involve the muscles that support your head and neck.
  • Focus on your posture.  Poor posture is a bane of modern society.  The most common example of poor posture is a forward head with rounded shoulders.  This causes excessive muscular tension throughout the cervical spine, upper trapezius region, and mid-thoracic area.  Over time, this also leads to muscle weakness and/or dysfunction in the cervical spine and upper thoracic area.  Proper posture allows for the optimal alignment of your spine.  Neurologically speaking, this allows for your muscles to down regulate by reducing tension.  Poor posture is almost always associated with muscle knots and trigger points.  My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain is a downloadable .pdf file with my recommended stretches and exercises to address posture.  These simple exercises (with complete instructions and photos) will help you to improve poor posture and can be performed at home.

DOWNLOAD NOW: My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain

  • Massage.  Many trigger points and muscle spasms will refer pain into the head (which causes the headache).  It’s important to actively and physically address the muscle tension.  This is the time to contact a masseuse, physical therapist, athletic trainer or friend who is skillful in body work and massage to relieve the area in spasm.  The specific massage technique to use will vary according to your preference.  Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.  This can also be an effective prevention strategy.
  • Foam roller.  The foam roller allows you to perform self-massage and tissue mobilization.  The foam roller is a wonderful tool to prevent muscle cramping and spasms.  Please refer to the following posts for more information:  Foam Rolling For Rehabilitation and 5 Ways to Improve Range-Of-Motion.  I highly recommend a foam roller to help aid in your recovery.
  • Other self-mobilization tools.  Many times, a friend or masseuse isn’t available to assist when you need the help the most.  A foam roller cannot effective reach places in the upper back or arms, so other self-mobilization tools may be necessary.  You can get creative and use a tennis ball or golf ball, but I like a specific tool called a Thera Cane Massager.  This tool allows you to apply direct pressure to a spasming muscle.  When held for a long enough period of time, the Thera Cane Massager will usually cause the muscle spasms to release and provide much needed pain relief!
  • Magnesium.  A deficiency in magnesium is often associated with headache symptoms and can also heighten the pain response.  Take magnesium orally (such as Mag Glycinate in pill form) or apply it topically in order to help mediate the pain response.
  • Topical agents.  Many topical agents can help to decrease and eliminate muscle spasms or mediate the pain response which can help to reduce headache pain.  You can apply a small amount of the topical agent directly over the headache pain area if it’s accessible and not near your eyes.  (Please use common sense.)  You may find that one product works better than another.  Some of my favorite products in my medicine cabinet include:  Biofreeze Pain Relieving Gel; Arnica Rub (Arnica Montana, an herbal rub); and topical magnesium.
  • Magnesium bath.  The combination of warm water with magnesium is very soothing and relaxing.  Magnesium is known to help decrease muscle pain and soreness.  Options include: Epsoak Epson Salt or Ancient Minerals Magnesium Bath Flakes.  I find that the magnesium flakes work better, but they are significantly more expensive than Epson salt.
  • Acupuncture.  I am personally a big fan of acupuncture.  It is very useful in treating all kinds of medical conditions.  It can be particularly effective in treating headaches, muscle trigger points, muscle cramps, spasms, and pain as it addresses the issues on multiple layers.  Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  • Manual Therapy.  A physical therapist or chiropractor can use manual therapy techniques which can be beneficial in reducing pain and addressing some of the mechanical causes.  However, manual therapy is a passive treatment.  For long term treatment and prevention, an active approach needs to be taken.  I would encourage you to perform proper exercises to insure that you have adequate cervical and upper thoracic strength and mobility.  Also, address any precipitating factors (such as poor posture).
  • Medications.  Medications can be an effective short term solution to headache pain, but I strongly encourage you to transition off of medications over time.  In some cases, prescription medications may be used initially to help you tolerate the pain as you work toward prevention.  Please speak to your physician regarding prescription options.
  • Speak with your Physical Therapist (PT) or Physician (MD).  If you are suffering with headache and muscle tension/pain, there are options.  Please speak to your medical provider to determine if other causes are contributing to the problem.  Physical therapy is very good at assisting those suffering with these types of headaches.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Don’t give up hope!  Headache pain is difficult to manage, but with proper care most headache pain can be cured or effectively managed.  Begin by implementing one or two of these treatment tips, and then assess how well they worked for you.  If the technique helped, continue with it and then implement another strategy.

If you suffer from cervicogenic headaches, which treatments have worked the best for you? Please share below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.