Posted on Wednesday, July 26, 2017

21 Exercises for Better Posture

Cervical (neck), thoracic (upper back), and shoulder pain is often caused from stiffness in the thorax. We spend so much of our day sitting slouched or standing hunched over (in a forward flexed position for the thoracic spine) that we lose normal mobility. This stiffness in the thorax can cause compensation patterns in our cervical spine and shoulders. Over time, this can develop into painful areas.

The key to eliminating pain is to improve posture and improve the mobility of the thoracic spine, so the neck and shoulders no longer have to compensate for the lack of mobility.

In this guest post for Get Correct Posture, you will discover different exercises to help you achieve better posture.

Q. If you were to recommend just one exercise for someone to help them improve their posture, what would you recommend and why?

A. The number one exercise to improve posture? I don’t have just one exercise, but a series of exercises that I recommend. These stretches are designed to counteract the stresses and postures of daily life and to restore the normal mobility to the upper back.

I prefer to use a foam roller, but you could utilize several rolled up towels as well or possibly a water noodle with or without towels rolled around it. The key is to have a fairly firm surface which you can lay on that will not impede shoulder mobility.

Repeat the routine twice, at least 1-2 times per day as needed.

A variation of the foam roll stretches could also be to lie over a large Thera-Band Exercise Ball and perform the same arm positions.

When performing these exercises, it’s important to understand that stretching should never be painful. You should feel a mild to moderate stretching sensation. If you start to experience numbness or tingling in the hands or arms, you should discontinue the stretch at that time.

When performed regularly, these simple exercises will help you to improve poor posture and can be performed anywhere.

Continue reading for expert recommendations on which exercises to perform in order to improve your posture.

Posted on Wednesday, May 3, 2017

Why You Won’t Heal – Part 6

Risk Factors and Causative Factors are still affecting the Condition

During the recovery process, it’s important to reflect on how the injury or illness occurred. What were the causative factors that led to the specific injury? What choices did you make that would have caused this illness? In order to optimize the healing response, all risk factors and causative factors must be addressed. In the final Part 6 of the series, Why You Won’t Heal, you will learn how to discern if the risk factors and causative factors that led to the injury and/or illness are still present and affecting your current condition.

You may be getting the best quality care and treatment regime for your specific condition, but if the original causative factors are still present then your ability to recover is significantly impaired. When possible, always address the root cause of the problem and then determine the appropriate rehabilitation program.

The ultimate goal is to eliminate the leading causative factors and then establish the proper care and treatment. This includes addressing any potential psychological beliefs associated with the injury as well as insuring that you are consuming quality nutrients and getting enough sleep in order to recover properly.

As a physical therapist, I continue to see countless examples of individuals who may be getting the right treatment, but yet he/she still struggles to heal because the risk factors and causative factors that led to the injury and/or illness are still present and affecting his/her current condition.

The following example illustrates what happened to one of my prior physical therapy clients.

A 30 year old man presents with frequent headache pain and neck pain. Together we work on restoring proper thoracic and cervical (neck) range of motion as well as proper strength through the cervical and thoracic spine. He feels much better, but yet he continues to experience intermittent pain and headache symptoms.

His pain levels are worse while at work. He takes pictures of his office, and a coworker records a short video of him working at his desk. Upon viewing, I discover that his office set up is incorrect with the keyboard and monitor not properly positioned (poor ergonomics). He’s working in a slouched posture which causes a forward head and rounded shoulders.

If this is his typical posture throughout a majority of his work day, is there any wonder why his headaches persist? His posture is causing excessive strain on his neck and upper back every day while at work.

Once his work ergonomics were improved and he was more mindful about his posture, he was pain-free and headache-free. If the underlying reason for his ongoing pain and headaches hadn’t been correctly addressed, then his recovery would have been less than optimal and his symptoms would have likely persisted or eventually worsened.

The reasons why a person may not recover are vast and complicated. Your rehabilitation protocol will vary and is dependent on the type of injury or illness you have. Regardless of the specific injury or illness, it’s critical that the following six categories of common reasons why a person will not fully heal and recover or take an extended time are addressed.

6 Categories of Common Reasons Why You Won’t Heal:

You’re getting the wrong treatment for your condition.
The injury or condition isn’t capable of healing.
Physiological and social conditions are affecting your healing.
Poor nutrition.
Poor sleep quality.
The risk factors and causative factors that led to the disease and injury are still present and affecting the current condition.

The body’s ability to heal and recover is dependent on many things. To maximize your ability to heal and recover from illness and recovery, it’s important to be proactive and help your body in any way possible. Getting to the root cause by utilizing these strategies for recovery will insure that you will heal and recover and/or effectively be able to manage your injury or medical condition.

Have you experienced a prolonged recovery or rehabilitation process? If so, can you share any strategies that helped you to handle it? Please leave your comments 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 Wednesday, January 25, 2017

Preventing Knee Pain

There isn’t a shortage of promising lotions, braces, taping techniques, exercises, and electric modalities when treating knee pain. Many of these fancy options may or may not work to prevent and/or reduce pain. There are many potential reasons for experiencing knee pain. However, an often overlooked cause is the lack of a normal range of motion and tightness in the quadriceps and/or hamstrings. Getting back to the basics can be an integral component to successfully treating knee pain or preventing further injury.

Potential Risk Factors for Knee Pain:

Poor quadriceps strength (particularly, the inner/medial quadriceps).
Poor hip abductor and/or hip external rotator strength.
Prior knee injury.
Over use.
Obesity.
Poor foot biomechanics including overpronation (when the feet excessively roll inward, which causes the knee to roll inward during each step).
A larger “Q-angle” which is the associated angle between the hip and knee.
Even anomalies in the shape of one of the bones that make up the knee joint could predispose you to knee pain.

The most obvious (yet rarely talked about) reason for experiencing knee pain directly relates to your range of motion (ROM). In its simplest form, the knee is a hinge joint. It bends and straightens (flexes and extends). If your knee isn’t able to fully bend or straighten because of either excessive quadriceps tightness and/or hamstring tightness, then you’re at an elevated risk for many common knee pain diagnoses including Patellar Femoral Pain Syndrome (PFPS) and Patellar Tendinitis.

Quadriceps Tightness

Poor range of motion in the quadriceps can be associated with a higher risk for developing knee pain. One potential reason for this is that the quadriceps muscle blends into the quadriceps tendon. Eventually it attaches to the patella (kneecap) before becoming the patellar tendon where it attaches to the tibial tubercle on the tibial bone (the main lower leg bone).

Excessive tightness will cause alterations in force and tracking of the patella. This can lead to inflammation and ultimately, pain in or around the structures of the knee (including the patella, quadriceps tendon, patellar tendon, the patellar femoral joint or the infrapatellar fat pad). The following four muscles make up the quadriceps: vastus lateralis; vastus medialis; rectus femoris; and the vastus medialis. The rectus femoris is most likely to be tight as it crosses two joints–both the hip joint and the knee joint. The other muscles only cross one joint–the knee joint.

Normal range of motion in the quadriceps will vary from person to person (especially, the older you get or if you have a history of injury). For most healthy and younger to middle aged people, normal range of motion could be defined as the ability to touch your heel to your buttocks with your hip and low back in a neutral (not flexed or extended) position (as demonstrated below).

Regular static stretching and mobilization will help you to improve your range of motion in the quadriceps and ultimately, avoid knee pain.

Static Stretch

Static stretching is best performed post workouts. (Static stretching prior to a work out or activity has been shown to decrease performance.) Hold the following stretch for at least 60 seconds, and perform two to three repetitions.

Quadriceps “Tack and Floss” Mobilization

You can use a foam roller to help mobilize the quadriceps while working on your range of motion. Position your upper thigh onto the foam roller. Roll around until you locate a particularly tight and/or restricted area, and then very slowly bend your knee back and forth. If this is painful, do not exceed more than a mild to moderate amount of pain. Perform 1-2 minutes on each leg once per day.

Hamstring Tightness

Hamstring tightness can often restrict full knee extension (particularly, during functional activities). The most common reason for poor hamstring mobility is chronic poor posture while sitting and standing. Most of us sit for a good portion of the day. This results in tight hamstrings and increases your risk for experiencing knee pain as well as low back pain.

Poor range of motion can also be a contributing factor to muscle imbalances. A hamstring that is either too long (over stretched) or a hamstring that is too short and contracted will not generate as much force and strength as a hamstring within its optimal length. The ability for a muscle to contract optimally is dependent on it being at an optimal length. This is known as the length tension relationship.

Many people (women in particular) struggle with adequate hamstring strength in relationship to quadriceps strength. This muscle imbalance can lead to pain and is a major risk factor in suffering an ACL tear. Therefore, one way to insure proper hamstring strength is to insure proper hamstring length.

Hamstring Stretch in Doorway

Static stretching is best performed post workouts. (Static stretching prior to a work out or activity has been shown to decrease performance.) Find a doorway and place one leg on the frame and stretch the opposite leg through the doorway. Try to keep your back with a neutral arch. As your hamstring relaxes, slowly move closer to the wall or doorframe. Hold for at least 1 minute per side, and preferably two repetitions per side.

Hamstring Mobilization Using the Foam Roller

Place your leg on the foam roller. Roll your hamstring back and forth on the foam roll. Move slowly and spend extra time on the more painful areas. Be sure to mobilize the entire hamstring and feel free to work on other areas of the leg that feel tight or restricted. If this is painful, do not exceed more than a mild to moderate amount of pain. Perform for 1-2 minutes per leg.

Don’t forget the basics when it comes to self-treating knee pain. Lack of range of motion could be the most simple and obvious reason for why you’re experiencing knee pain. Implement my recommended exercises in order to address any tightness in the quadriceps and/or hamstrings. Getting back to the basics can be an integral component to successfully treating your knee pain and preventing further injury.

If you’re experiencing knee pain, do you think either poor range of motion and/or tightness in your quadriceps and/or hamstrings are causing it? Which strategy can you implement to alleviate your pain and prevent injury? Please share below.

Posted on Wednesday, January 11, 2017

Why Does My Shoulder Hurt?

Shoulder pain is one of the most common ailments treated by physical therapists. There are many potential causes of shoulder pain, but the two primary issues to consider include poor mobility and muscle imbalance. The key to treating most common shoulder related pain is to improve your posture while focusing on thoracic mobility, shoulder position, and proper shoulder strengthening.

Poor Mobility

The most common reason for mobility issues is poor posture. Poor thoracic mobility and tightness in the posterior capsule of the shoulder are the most common contributors to the lack of mobility which can ultimately lead to shoulder pain.

Mobility issues can occur if you adopt a chronic forward head with rounded shoulders posture. As this position becomes more chronic, the thoracic vertebrae lose backward mobility (extension). This happens in conjunction with shortening of the pec minor (which is located underneath the pec major) and causes the shoulders to roll forward. The forward shoulder posture causes the humeral head (arm bone) to be positioned more forward.

This causes tightness in the posterior (back) portion of the shoulder joint which affects the natural roll and spin motion of the joint. The alterations of the roll and spin motion combined with alterations in shoulder blade motion negatively affects the mechanics of the shoulder joint. The alteration in mechanics is what ultimately leads to pain as the rotator cuff or biceps tendons become impinged, irritated, and painful.

This is commonly referred to as Shoulder Impingement Syndrome. Shoulder impingement pain is often associated with pain reaching overhead, behind your back and/or out to the side. Those who experience it may feel weaker in the affected shoulder and experience pain when sleeping on the affected side.

Perform the following stretch to address shoulder posterior capsule tightness. Lie on the side of the affected shoulder. Be sure to support your head with a pillow. Your arm should be straight out from your body with your shoulder tucked under your body. The goal is to pin your shoulder blade down with the floor. Gently push your arm down (as shown). You should feel a gentle stretch. Hold for 30-60 seconds for two to three times. Perform once or twice per day.

In case you haven’t already subscribed to my e-mail list, please take a moment to do so in order to access 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 poor thoracic mobility and pec minor tightness. These simple exercises (with complete instructions and photos) will help you to improve thoracic mobility and can be performed at home.

GET MY FREE RESOURCE

Muscle Imbalance

Muscle imbalance is often an associated causative factor for shoulder pain. In addition to mobility issues, altered strength and muscle activation patterns are also related to shoulder pain and shoulder impingement syndrome. The reasons for muscle imbalance can vary, but are often associated with poor posture and/or cervical/neck related issues.

Two common muscles that must be strengthened in order to insure proper shoulder mechanics are the lower trapezius muscle and the supraspinatus muscle (which is one of four rotator cuff muscles).

The rotator cuff muscles are responsible for the stability of the shoulder and proper roll, glide, and spin of the ball and socket shoulder joint.

The lower trapezius muscle is responsible for proper shoulder blade timing and rotation during arm movements. It helps in maintaining a proper upright posture.

For three easy and effective exercises to perform to improve your lower trapezius and rotator cuff muscle strength, please refer to Exercises for Lower Trapezius and Rotator Cuff Muscle Strength.

Most shoulder symptoms typically resolve when thoracic mobility and strength in the shoulder is improved. Shoulder impingement is painful, but worse yet if left untreated. It can lead to fraying of the rotator cuff tendons (and ultimately, a rotator cuff tear). It’s always best to be proactive and address the causative factors early.

If you’re not improving or your symptoms worsen, consult with 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).

If you’re experiencing shoulder pain, do you think either poor mobility or a muscle imbalance is causing it? How can you improve your thoracic mobility and strength in your shoulder? Please share below.

Posted on Wednesday, September 21, 2016

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.

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.

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.

Posted on Wednesday, September 14, 2016

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.

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.

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.

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.

Posted on Wednesday, September 7, 2016

Prevention and Treatment Strategies for Tension Headaches

Approximately 15-20% of the population will suffer from headaches at any given time. Headaches can range from mild to severe with symptoms varying wildly. It’s one of the top medical ailments for which people seek treatment, and tension headaches are the most common type of headache. Tension headaches are often related to tension in the muscles of the head, neck, and jaw and are frequently stress related. The actual physical cause is still not fully understood, but it’s likely linked to how the brain and nervous system perceives muscular pain and stress. The good news is that tension headaches are very treatable!

Tension headaches are categorized as either episodic (meaning that you experience less than 15 headaches per month) or chronic (meaning that you experience more than 15 per month). They are nearly as frequent in children and teens as adults. Women tend to experience them more often than men by nearly two to one.

Tension Headache Symptoms include:

The pain tends to wax and wane in severity (sometimes, throbbing or pulsing occurs).
The pain is often described as pressure like and is typically felt on both sides of your head.
The pain typically impacts the whole head, but it may begin in the back of your head or above your eyebrows. It’s typically painful around the temple area of your head and/or back of your head and neck.
Many describe the pain as a severe tightness (like a vise grip) around the forehead or like a cap or band-like sensation which encircles their skull.
The pain tends to come on gradually. Even at maximum intensity, it isn’t typically incapacitating. (Most people are able to continue with their daily activities despite the pain.)

Potential Triggers for Tension Headaches include:

Stress
Anxiety
Impaired sleep (fatigue)
Low blood sugar from improper eating
Hunger
Eye strain
Overexertion
Muscle strains and pain
Muscle tension
Cervical dysfunction (cervicogenic)
Poor posture
Hormonal changes and/or menses
Foods such as processed meats, gluten, red wine, and dairy
Environmental factors such as poor air quality, certain smells, and different chemicals that are inhaled or applied topically on the body.

Treatment for Tension Headaches

In most cases, effective treatment needs to be multifactorial as there are likely multiple triggers causing the headache. In general, treatment needs to focus on both the prevention of the tension headache and methods of dealing with an active headache as both tend to interrelate.

Prevention for Tension Headaches:

To effectively manage (and ultimately, prevent) tension headaches, effective stress management and elimination of known triggers are primary treatment strategies.

Stress management. Effective stress management should not be overlooked as an important treatment modality. There are many different methods to help you manage stress more effectively. Common methods include meditation, journaling, and yoga. You may also need to reconsider certain friendships and relationships in your life. The key to effectively managing stress is to find an enjoyable activity, and then stick with it. This is a process–a journey (not a destination).
Eliminate food triggers. Many foods can trigger headaches. An effective management strategy will be to identify and then eliminate food triggers. We may not even be aware of how negatively certain foods affect us. If you choose to eliminate your trigger foods, you will be amazed about how well you start to feel in general. Common food triggers include: red wine, aged meats or cheese, dairy products, and gluten. Addressing food triggers is a critical step in treatment. I recommend that you take an IgG food sensitivity test. IgG is an immunoglobulin antibody found in the body. This test can help to determine if certain foods are causing your body to react in a negative way. Addressing any sensitivities and possible gut or gastrointestinal issues can be very helpful in treating both tension and migraine headaches. Please seek assistance from a functional medicine doctor who specializes in headaches and gastrointestinal issues if your symptoms are correlated with any food triggers.
Eliminate caffeine. This can be very tough because caffeine tends to be helpful in reducing initial symptoms. Chronic caffeine use (particularly in headache suffers) is known to cause rebound headaches (another sub classification of headaches). Rebound headaches occur when the same substance that helps to reduce symptoms will also cause the next headache to happen. Eliminating caffeine initially is difficult as it may trigger another headache. However, long term elimination of caffeine from your diet can be very effective in preventing headaches. Just watch out for over the counter (OTC) medications that contain caffeine as an active ingredient.
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 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

How to Treat when you’re experiencing a Tension Headache:

Fix your posture. Poor posture is one of the most common causes of muscle spasming and pain. This is particularly true if you spend a good portion of your day sitting. If you’re already experiencing a headache or you feel like one might be starting, I highly recommend that you initiate my stretching protocol (as noted above).
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. Most people are deficient in the amount of magnesium they consume on a regular basis. You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.
Topical agents. Many topical agents can help to decrease and eliminate muscle spasms 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.
Medications. Medications can be an effective short term solution to headache pain, but I strongly encourage you to transition off of medications over time. Many over the counter (OTC) medications contain caffeine which can lead to another type of headache called a rebound headache. This occurs when the medication wears off and triggers another one. This is common with medications such as Excedrin which contains caffeine. Other types of medications include acetaminophen, aspirin, Ibuprofen, and Naproxen. 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).

Tension headaches are a common and debilitating problem. Although this is not an exhaustive list of treatment options, it offers many different and effective methods for you to consider. In many cases, the techniques utilized to treat an active headache are also effective in prevention.

In nearly all cases, the frequency of tension headaches can be reduced and eliminated in general. The key is to acknowledge that you are not powerless when addressing this type of headache. However, there isn’t just one magic cure for the headache either. Effective treatment will likely be multifactorial. Begin by implementing one or two of the strategies, and then assess how well they worked for you. If the technique helped, continue with it and then implement another strategy. Create a plan with specific strategies for prevention in addition to knowing beforehand as to how you will treat an active headache. This will empower you to recognize that you have control and are not destined to have headaches forever.

Can you share any prevention tips or treatment techniques that have worked for you when dealing with a tension headache? Please leave your comments below.

Posted on Wednesday, August 31, 2016

How to Prevent and Treat Migraine Headaches

Migraine pain is the second most common type of headache (with tension/cervicogenic type headaches being the most common). Up to 16-17% of the population complains of migraines. These headaches can be very debilitating. Migraine pain is often in combination with other forms of headaches. It can even be triggered by a tension headache or sinus headache. Migraines can also be caused by menstruation or hormonal imbalances.

Migraine headaches are just one of many types of headaches. Migraines sufferers are more common in women. Certain statistics conclude that women are up to three times more likely to have migraine type symptoms. Presently, the exact causes of migraines are not well understood. Migraines are often associated with a trigger, but you can have one or multiple triggers.

Migraines also have a genetic component. If you have a parent or sibling who experiences migraines, you will have a higher likelihood of developing them as well. It’s also not entirely known if the familial component to migraines is due to something anatomical in regard to brain or other physiological factors or if the predisposition is based on the living environment or other factors that could be causing the trigger.

There are two categories of migraines. Episodic is when you experience 14 or less days with a headache. Chronic is when you have 15 or more headaches per month.

The Four Phases of Migraine Pain:

Although symptoms of a migraine will differ for everyone, symptoms tend to progress through the following four major phases.

Prodromal Phase

This is the pre-headache phase that can occur hours or up to a day in advance. Initial symptoms and patterns can be found up to one to two days prior to the actual migraine. Typical symptoms may include: excessive energy or excitability; possible depression; overly fatigued; irritable; thirsty; frequent urination; and cravings for specific foods.

Aura Phase

Not everyone experiences this phase. Approximately one in five people will describe feelings of an aura (a visual disturbance) which can include any change in vision from experiencing blind spots, hallucinations, and different arcs of light. Other associated symptoms include a pins and needles feeling which can be felt in your face or other areas of your body. You may experience changes in speech. Many of the initial symptoms can mimic symptoms of a stroke. (Please refer to signs of a CVA).

Attack Phase

This phase occurs when the pain starts to develop, and it can last hours to days. Most typically it will be behind your eyes and will affect one or both sides of your head. Symptoms include: throbbing pain on one side of your head (although pain can be present on both sides); pain behind your eyes; difficulty performing typical activities; pain that worsens with activity or heat; nausea; vomiting; and sensitivities to light, noise, and smells.

Postdromal Phase

This is the phase after the migraine has ended, but some symptoms linger which can last for hours or up to a day or so. Symptoms include: fatigue; sluggishness; lack of mental sharpness; and intermittent pain (particularly, if you move too much or rapidly).

How to Manage Migraine Headaches:

Typical medical management of migraine headaches starts with a diagnosis from a medical doctor. Your doctor may refer you to a neurologist or specialist for treatment and/or diagnosis. A thorough examination should be completed. A CT Scan or MRI may also be performed to check for other more serious pathology in the brain.

Medications are often prescribed and are categorized the following two groups:

Acute Medications. These medications are taken after the migraine pain and symptoms have already begun. These may include both over the counter (OTC) or prescription medications (including opioids or NSAIDS, such as Ibuprofen or Naproxen or even stronger anti-inflammatory medications).

Preventive Medications. The medications are typically taken hours to days prior to the migraine pain and symptoms. Such medications are prescription based. A common family of medications used is known as Triptans. These medications are only for treating migraine headaches and are meant to be taken immediately upon the first sign of one. They cause the brain to release more serotonin. This causes the blood vessels in your brain to narrow and reduce swelling which helps to control symptoms. These medications are often prescribed with other pain medication and/or anti-nausea medications. The following is a partial list of Triptans:

eletriptan (Relpax®)
frovatriptan (Frova®)
naratriptan (Amerge®)
rizatriptan (Maxalt®)
sumatriptan (Imitrex®, Alsuma®, Onzetra™, Sumavel™, Zecurity®)
zolmitriptan (Zomig®)

In the initial phase of treatment, it’s imperative to have an accurate account of the symptoms, type of pain, and suspected triggers. This will be an important first step in guiding treatment as in almost all cases successful treatment will be multifocal.

Initially, I always recommend that you start a thorough headache log or diary. Don’t perseverate over every little detail of your headaches, but you need an accurate account of frequency and triggers.

Often, triggers can occur from hours up to a day in advance. Log each of your activities and meals for up to a month. Look for patterns. Try to establish patterns to the headaches. When do they occur? Do certain foods trigger the headache? Which activities will cause a headache? What makes the symptoms better or worse? Are they associated with certain movement patterns, activities or even certain times of the day or month?

Be thorough about what occurred prior to the headache and which treatments helped the most to resolve the headache. Once you have completed a thorough headache log, the treatment will focus on the following two major categories: prevention and the actual treatment of symptoms.

Prevention for Migraine Headaches:

Exercise. It’s well documented that mild to moderate intensity exercise can help to reduce or eliminate headache symptoms. The reason why it’s so effective isn’t entirely known. It may be because of the endorphin released during exercise, changes in blood flow to the brain, stress reduction, improvement in strength, and/or changes in hormonal regulation patterns. Regardless, regular exercise is a must. Find what works for you, and stick with it.
Yoga and other forms of similar exercise such as Chi Gong and Tai Chi are all excellent forms of exercise and can help to reduce stress levels which can affect migraine pain.
Meditate. Regular meditation or prayer can reduce stress and lower the frequency of headaches. Deep breathing can be a form of meditation. I often perform what is known as box breathing. I breathe in for four seconds, hold the air for four seconds, and breathe out for four seconds. Then I wait four seconds prior to breathing again. Repeat this for several minutes and focus only on your breathing.
Magnesium. A deficiency in magnesium is often associated with headache symptoms. Most people are deficient in the amount of magnesium they consume on a regular basis. You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.
Vitamin B2 (also known as Riboflavin). A deficiency in B2 can be associated with migraine symptoms. Supplementation has been proven to reduce the frequency of migraine headaches. B2 is important in the production of red blood cells and plays a role in how your body gets energy from carbohydrates, fats, and proteins.
Butterbur. This is an herb that is known to relieve muscle spasms and works as an anti-inflammatory.
Adequate Sleep. Proper sleep is critical. Poor quality sleep, including too much or too little of sleep, has been identified as a trigger for migraine headaches. Focus on getting a good quality of seven to nine hours of sleep nightly. To learn how to maximize your sleep, please refer to Michael Hyatt’s nighttime rituals.
Stay Hydrated. Dehydration can cause migraine pain. Dehydration can also affect sinus symptoms. Sinus pain can also be a trigger for migraine pain.
Manage your triggers. Common triggers include: loud noises, bright lights, dehydration, strong or specific odors, and high altitudes. Other triggers may be consuming red wine, aged meats or cheese, dairy products, and gluten. Addressing food triggers is a critical step in treatment. I recommend that you take an IgG food sensitivity test. IgG is an immunoglobulin antibody found in the body. This test can help to determine if certain foods are causing your body to react in a negative way. Addressing any sensitivities and possible gut or gastrointestinal issues can be very helpful in treating migraine headaches. This step is often overlooked, although it may be one of the most important. Please seek assistance from a functional medicine doctor who specializes in headaches and gastrointestinal issues if your migraine symptoms are correlated with any food triggers.
Eliminate caffeine. This can be very tough because caffeine tends to be helpful in reducing initial symptoms. Chronic caffeine use (particularly in headache suffers) is known to cause rebound headaches (another sub classification of headaches). Rebound headaches occur when the same substance that helps to reduce symptoms will also cause the next headache to happen. Eliminating caffeine initially is difficult as it may trigger another headache. However, long term elimination of caffeine from your diet can be very effective in preventing migraine pain. Just watch out for over the counter (OTC) medications that contain caffeine as an active ingredient.

How to Treat when you’re experiencing a Migraine Headache:

Ice. Try using an ice pack either on the forehead, scalp or neck, and/or directly over the area with the worst symptoms. The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a gel style Cold Pack. A bag of frozen peas can be ideal.
Caffeine. Although caffeine ultimately causes more harm than good for headache sufferers, it can be used in the short term to help to reduce symptoms.
Find a dark quiet area where you can rest, use a cold compress, and possibly perform meditation or box breathing.
Hydrate. Be sure you are properly hydrated as dehydration will make symptoms worse.
Do not exercise. Exercise is not advised during an actual migraine headache. However, it’s highly encouraged as a prevention method.
Medications. Be sure to use the medications properly as prescribed by your medical physician. The ultimate goal is to prevent headaches and lessen the dependency of medication use. During an actual migraine, the goal is to feel better fast so that you can work on these prevention techniques. Use the medications as a tool to help you progress through your treatment plan.

Migraine pain is a difficult to deal with and to treat. In almost all cases, successful treatment and management will be a multifactorial approach and differs for everyone. It’s important to hear from others on what works to help treat or prevent migraine pain, but don’t be discouraged if his/her treatment doesn’t work for you. Your goal is to devise a custom treatment plan that will work for YOU. Each person may progress differently, but many of the approaches are similar.

Be sure to work with medical professionals who you can talk to and trust in order to create a treatment plan. The focus of treatment should be on prevention and discovering what triggers your migraine headaches. Ideally, you will be able to reduce and/or eliminate the symptoms while optimizing your health. Medications should be thought of as short term tools to help you as you come up with a long term solution.

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

Posted on Wednesday, August 10, 2016

Q & A: What Causes Headaches?

Q. Several members of my family frequently get headaches. Thankfully, I rarely get them, but what causes headaches? Why do some people get them and others do not? Thanks, Ben! -Brad

A. Thanks for your question, Brad! Headaches are a very complicated subject. I will do my best to answer your question from a physical therapist’s perspective.

Headaches can range from mild to severe with symptoms varying wildly. Approximately 15-20% of the population will suffer from headaches at any given time. It’s one of the top medical ailments for which people seek treatment. Headache suffers are also one of the most heavily marketed to group. There are no shortage of scammers and snake oil salespeople trying to sell you the next great remedy to cure your headaches.

Although there are many potential sub categories of classifications a person could use (particularly, within the tension class), I tend to classify headaches in one of five categories: tension; cervicogenic; sinus; migraine; and cluster.

Classifications of Headaches:

Tension

These are the most common type of headache. These headaches are often related to tension in the muscles of the head, neck and jaw and are frequently stress related. The actual physical cause is still not fully understood, but it’s likely linked to how the brain and nervous system perceives muscular pain and stress.

Tension headaches are categorized as either episodic (meaning that you experience less than 15 headaches per month) or chronic (meaning that you experience more than 15 per month). Women tend to experience them more often than men. Many food or environmental factors can trigger tension or migraine headaches. Food and environment triggers for headaches could easily be a classification of their own.

Please refer to Prevention and Treatment Strategies for Tension Headaches.

Cervicogenic

Not everyone would say this is a separate class of headache, but I tend to classify cervicogenic headaches separately. Cervicogenic headaches are often associated with tension type headaches. There can be a lot of overlap with tension headaches, but in this class the underlying cause of the headache is from the cervical spine. There are many pain generating structures in the cervical spine. A few potential causes could be nerve related, trigger points, facet joint or cervical mal-alignment related, or cervical disc related. I find that postural dysfunction tends to go hand in hand with this type of headache as well as in tension headaches.

Cervicogenic headaches tend to be found more often found in women. This seems to be primarily due to the anatomical differences of men versus women. 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).

Please refer to Cervicogenic Headaches: A Real Pain in the Neck (and Head).

Sinus

Your sinuses are located on your forehead, behind the bridge of the nose and under your cheek bones. In cases of infection or allergy, the mucosal lining will become inflamed and causes pressure and pain. This results in headache type symptoms. Pain is often worse when bending over or straining.

Other than headache type pain, you may also be suffering from other symptoms of illness including a stuffy or running nose, earache or fever. Sinus headaches are often a trigger to other types of headaches such as tension and migraines.

For more information, please refer to 9 Treatment Tips for a Sinus Headache.

Migraine

Migraine pain is the second most common type of headache (with tension/cervicogenic type headaches being the most common). Up to 16-17% of the population complains of migraines. These headaches can be far more debilitating than the typical tension/cervicogenic type headache. Migraine pain is often in combination with tension headache pain. Migraines can also be caused by menstruation or hormonal imbalances.

Frequently, people will classify any type of severe headache pain as a migraine although it may or may not actually be the case. The severity of pain is not what leads to a migraine classification, but which symptoms are present.

Symptoms of a migraine will differ for everyone. Initial symptoms and patterns may occur one to two days prior to the actual migraine.

Typical symptoms may include:

Throbbing pain on one side of the head (but pain can be present on both sides)
Pain behind the eyes
Difficulty performing typical activities which worsen with activity or heat
Nausea
Vomiting
Sensitivity to light, noise, and smell

Less common symptoms may also include: difficult with speaking; tingling in the face, arms, and hands; and short term upper body weakness.

Migraines are more commonly found in women. Like tension headaches, migraines are often associated with known varying triggers like food, smells, excessive heat, fatigue, and dehydration.

Please refer to How to Prevent and Treat Migraine Headaches.

Cluster

This type of headache tends to appear in cycles (clusters) which last hours to days. By most accounts, these are the most painful type of headache. Typically, cluster headaches present with a sudden onset and usually subside as quickly as they start.

These headaches are the least common and only affect approximately 1% of those who suffer from headaches. The first onset for this type of headache is usually between 20-30 years old.

Please refer to Cluster Headaches, the “Suicide Headache” for more information.

When to Seek Emergency Care:

Although most headaches do not require emergency medical attention, the following signs and symptoms indicate when to seek emergency care.

If you have any of these signs or symptoms, please seek emergency care:

Abrupt, severe headache
Severe unrelenting pain
Headache with a fever; stiff neck; mental confusion; seizures; double vision; weakness, numbness; and speaking difficulties
Headache after a head injury (especially, if the headache gets worse)
Muscle weakness/paralysis and/or face drooping (signs of a CVA)

How to Determine the Cause and Design an Effective Course of Treatment:

The symptoms of headache pain are nearly as diverse as the causes of headache pain. Regardless of the onset whether sudden (such as from an injury, from a fall or motor vehicle accident) or more subtle and chronic, there are few aspects of care that are important for all headache suffers to consider.

Start a headache log or diary. I always recommend beginning the process by keeping a diary in order to determine the most likely culprits prior to working on less common scenarios. There are many obvious and common potential causes to address first. Sometimes, it takes some serious detective work to rout out the cause and design an effective course of treatment. The patterns noted in the diary will be clues to guide you down the right treatment path. Don’t perseverate over every little detail of your headaches, but you need an accurate account of frequency and triggers.
Look for patterns. Try to establish patterns to the headaches. When do they occur? Do certain foods trigger the headache? Which activities will cause a headache? What makes the symptoms better or worse? Are they associated with certain movement patterns, activities or even certain times of the day or month?
Which treatments work for you? Everyone has his/her preferred cure, but what really works for you? Don’t feel bad if someone else’s cure doesn’t work for you as we are all different.
Leave no stone unturned. When looking for patterns, consider all aspects including: food, medications, and supplements. Also, consider your living environment. Could there be mold in the home? Other unknown allergens? How is your micronutrient status? Dental issues?

Don’t give up hope! Headache pain is difficult to manage, but with proper care most headache pain can be cured or effectively managed. The most frequent mistake I see people make is to not stick with a thorough plan. Jumping around from one treatment to another rarely works.

With severe and/or chronic headache pain, a very thorough and specific plan of addressing all aspects of your health and wellbeing will need to be addressed for long term success. This process can be slower than desired, but when executed properly, it will almost always leads to significant success.

Thanks, Brad, for the question! I hope you and your family members find this information helpful and that they are able to experience some relief from headache pain! Stay tuned as I will profile typical self-treatment strategies for each type of headache in upcoming posts.

Do you or a loved one suffer from headaches? Which treatments have worked the best for you? Please share your experience. Together we can all grow and learn how to best manage this condition.

Posted on Wednesday, June 29, 2016

The 3 Most Common Mistakes Runners make that can cause Low Back Pain

http://marathontrainingacademy.com/low-back-pain-2

Marathon Training Academy

May 25, 2016

In this guest post for Marathon Training Academy, you will discover the three most common mistakes runners make that can lead to low back pain (LBP), and you will learn prevention tips in order to avoid injury.

Low back pain (LBP) is one of the most prevalent medical conditions treated in the United States and throughout the western world. Avoiding the following most common mistakes can save you from costly medical visits, prescriptions, chiropractic visits, and physical therapy services. More importantly, avoiding injury and LBP insures that you can keep training and racing to your heart’s content! Continue Reading