Thursday, 1 October 2015

Neck Pain and Posture
by Todd Snowdon

We have probably all experienced a headache at some point in our lives whether it be due to stress, hormones or staring at a computer screen for too long. This blog focuses on the role posture has to play on headaches and how muscular imbalances of the neck in particular, can contribute to cervicogenic headaches (CGH).

The Journal of the American Osteopathic Association describes cervicogenic headache as a syndrome characterized by chronic hemicranial pain that is referred to the head from either bony structures or soft tissues of the neck.

An interesting point I would like to make here is that although a headache is characterised by pain in the head; it is commonly due to referred pain from the cervical spine and surrounding musculature.
This is where posture plays an important role in the development of CGH. For example, if you place undue stress through your neck and shoulders by poking your chin out whilst looking at the computer screen; there is an increased workload placed on your neck extensors to hold your head in place. Patients we see in the clinic who present with CGH commonly (but not always) have tight neck musculature including sternocleidomastoid, upper trapezius, levator scapulae, scalenes, suboccipitals, pectoralis minor and pectoralis major due to posture.

It has been well reported in the literature the involvement of tight musculature of the neck contributing to CGH. Basically, if muscles are providing greater tension in one particular area of the neck, this can cause compression through the joints of the cervical spine. As you are probably well aware, there are numerous nerves exiting between these cervical joints that extend into the skull. As a result this compression on the nerves can lead to headaches.

If protraction of the head (poking chin out) becomes a habitual posture, poor deep neck flexor activation and control is common. Fernandez De-Las-Penas et al conducted a study looking at the impact of poor deep neck flexor musculature. Basically, they concluded that patients with CGH had a reduced holding capacity of their deep neck flexors and a forward head posture.  

So how can you relieve headaches?

Before you go popping the miracle pain killers or other pharmaceutical drugs for temporary relief; let’s have a look at fixing the problem long term. So we have established the role posture plays in headaches. In terms of treatment, correcting the abnormalities of joints and muscles that are related to postural abnormalities is the initial focus. Here at the clinic, we see a majority of patients who have been slumped over a desk punching the keyboard for copious hours. What we focus on with these individuals is correcting the muscular imbalances by stretching (commonly the cervical extensors) and strengthening (commonly the cervical flexors). This is beneficial initially, but not from a long term perspective.

Re-training the cervical muscles is very important in providing strength to support the neck and head in the correct position. We have had success with our patients and it has been reported in the literature that this re-training of cervical muscles is beneficial in reducing the incidence of CGH. This is because by supporting the cervical spine in an “ideal” position it de-loads the cervical spine and ligamentous structures thus reducing the likelihood of compression on neural structures.  
One area that is commonly overlooked with respect to headaches is the role of the scapular stabilisers. If scapulohumeral rhythm is poor or thoracic musculature is weak, there is a reliance on scapular elevators to hold the shoulder in place. This can increase the amount of tension required by these muscles which changes the alignment of the cervical spine.

In the clinic we aim to educate the patient on how to decrease the amount of cervical load by re-training appropriate musculature and by correcting posture. This is certainly an alternative to treating headaches with medication and I urge you to seek an EP or health professional to assist in overcoming chronic headaches and find a positive treatment option once and for all J

The Journal of the American Osteopathic Association, April 2005, Vol.105, 16s-22s

Fernandez-De-Las-Penas C, Perez-De-La-Heredia, Molera-Sanchez A, and Miangolarra-Page JC. Performance of the Craniocervical Flexion Test, Forward Head Posture, and Headache Clinical Parameters in Patients with Chronic Tension-Type Headache: A Pilot Study. Journal of Orthopedic and Sports Physical Therapy. February 2007.37(2):33-39