Headaches can have many causes. They can often be a side affect of medication or a warning of some other lurking malady. However, if the headache is accompanied by a sore neck, myofascial imbalance of muscles supporting the cervical spine could be the culprit. It should be noted that the central nervous system uses the cervical spine as a conduit for neurological signals to the rest of the body. It should be noted that a persistent headache condition with neck pain should be checked out by a doctor.
Many Weekend Warriors spend long time
periods slouched over a computer or reading documents as a weekday job requirement. Or if they work manually, they are often using tools with their cervical spine flexed or extended in uncomfortable positions. This is known as ergonomics! After work and on
weekends these weekend warriors are pursuing hobbies or sports with the poor posture having a carry over effect. Those that are Sedentary Soldiers spending leisure time on a coach or back in front of a computer can further the muscular misalignment. Poor sleeping habits can also compromise the neck muscles.
It is not unusual that the mechanism of
injury is chronically poor posture over a long term. A physical assessment will help identify significant overactive and underactive muscles in
the cervical spine region. The myofascial front lines often exert greater pull than
the myofascial back lines. Prime movers such as the deep
cervical flexors tend to become weak and synergist muscle such as the
sternocleidomastoid and the levator scapulae can compensate and become
tight. The weakness of the spinal
extensors can cause overcompensation by the upper trapezius muscles. Tight
upper trapezius muscles have even been referred to as ‘the migraine maker’.
 |
| Less than ideal work ergononics can lead to postural misalignment. |
Symptoms that headache sufferers could experience include:
- Headache, light headed sensation, dizziness
- Sore eyes
- Neck pain, usually at the sides or just below the
skull at the back
- Lack of mobility of the cervical spine
Signs of the myofascial
issues causing headache and neck pain that a Personal Fitness Trainer might
notice include:
- Upper crossed syndrome; such as forward shoulder
slouch, forward head tilt
- An inability to perform physical assessments
without compensation
- Dysfunction at other kinetic checkpoints (e.g.
shoulder) as compensation for cervical spine instability
 |
| Poor sleeping position (see moonlighting Fitness Trainer) can cause neck muscle malfunction |
The first step would be determine if any muscular compensations can be observed using postural and movement assessments. Select assessments that are more
specific to the cervical spine and would show the common culprits for
overactive and underactive muscles. This should identify the misaligned
muscle groups most likely to be responsible for the headache and neck pain
issues.
Static Postural Assessment: This assessment places
the client in a position in which the anatomical kinetic checkpoints from the
feet up can be evaluated..
Overhead Squat: Observations that indicate
cervical spine instability would be a forward head tilt and the arms falling
forward during the squat. The shifting of the weight of the head anteriorly
could also be a factor in lower back arching of the lumbar spine and an
excessive forward lean. (
Push-Ups Assessment: Forward head migration indicates a weakness or
dysfunction, Scapular winging (the scapula protracts), and shoulder elevation
could be because the shoulders are compensating for the neck. A sagging lower
back may be an indication that dysfunction in the head/cervical kinetic
checkpoint is a factor in hip/pelvis compensation.
Standing Row Assessment: The usual
compensations observed are: the forward head migration, elevated shoulders, and
the consequential low back arching. Care should be
taken to keep the weight light enough to avoid further injury to the cervical
spine.
Upper Extremity Transitional Movement
Assessment: These movements assess shoulder mobility using shoulder abduction, rotation, and flexion.
Overactive and underactive shoulder muscles will affect the cervical spine just
as neck dysfunction can impair shoulder function. The compensations to be
vigilant for are shoulder elevation, protraction, and lack of full range of
motion during internal and external rotation.
Cervical Deep Flexor Muscle Assessment (Janda Method): This could be the most important assessment since it can determine if the deep cervical flexors are underactive. Weakness here can result in overactive muscles elsewhere in the upper anatomy. The lifting of the head without a chin tuck indicates weak neck flexors.
The National Academy of Sports Medicine has a corrective exercise continuum that is effective and useful for identifying and correcting muscular compensations. Overactive or tight muscles are inhibited or relaxed using self myofascial release or muscular pressure using foam rollers, balls or the fingers on knotted trigger points. They are then lengthened using static stretches. Underactive or weak muscles (especially prime movers) Are isolated and strengthened. A dynamic movement is then added to integrate the muscles and re-educate them to move in a proper coordinated manner. (see below)
Cervical Deep Flexor Muscle Assessment (Janda Method): This could be the most important assessment since it can determine if the deep cervical flexors are underactive. Weakness here can result in overactive muscles elsewhere in the upper anatomy. The lifting of the head without a chin tuck indicates weak neck flexors.
The National Academy of Sports Medicine has a corrective exercise continuum that is effective and useful for identifying and correcting muscular compensations. Overactive or tight muscles are inhibited or relaxed using self myofascial release or muscular pressure using foam rollers, balls or the fingers on knotted trigger points. They are then lengthened using static stretches. Underactive or weak muscles (especially prime movers) Are isolated and strengthened. A dynamic movement is then added to integrate the muscles and re-educate them to move in a proper coordinated manner. (see below)
National Academy of Sports Medicine (NASM) Corrective Exercise Strategies Template
INHIBIT
|
Sets
|
Duration
|
Notes
|
Thoracic spine
Alternate with
Latissmus dorsi
SMR
|
1
1
|
30-90 seconds
30-90 seconds
|
Do not roll below
the rib cage
Roll sideways on
foam roller
|
Sternocleidomastoid
SMR
|
1
|
30-90 seconds
|
Tigger point can be
anywhere along muscle belly. Use massage stick(or finger pressure)
|
Levator
scapulae
SMR
|
1
|
30-90 seconds
|
Trigger point - top
medial border of the scapula. Theraball
|
Upper trapezius
SMR
|
1
|
30 -90 seconds
|
Trigger point often
anterior and lateral.
Massage stick (or
finger pressure)
|
LENGTHEN
|
Sets /
Repetitions
|
Duration
|
Notes
|
Sternocleidomastoid
(Static stretch)
|
1-4 Reps
|
20 -30 seconds
|
Look away -raise
chin
|
Levator
scapulae
(Static stretch)
|
1-4 Reps
|
20-30 seconds
|
Lean on wall. Turn
chin to side.
|
Upper trapezius
(Static stretch)
|
1-4 Reps
|
20-30 seconds
|
Look forward -pull
head away
|
Pectoralis
major
(Static stretch)
|
1-4 Reps
|
20-30 seconds
|
Retract scapula to
stretch pecs. Tuck chin
|
ACTIVATE
|
Sets /
Repetitions
|
Duration
|
Notes
|
Mid /Lower
trapezius
Seated row
|
1-2 10-15 reps
|
1-2-4 Tempo
|
Retract scapula and
pull cord to chest.
Regression-bench
|
Deep cervical
flexors
Supine neck flex
|
1-2 10-15 reps
|
1-2-4 Tempo
|
Tuck chin towards
chest before lifting shoulders
|
Cervical extensors
spinalis
Head retraction with elastic/cord
|
1-2 10-15 reps
|
1-2-4 Tempo
|
Tuck chin in then
retract head.
|
Rhomboids
Scapular retraction
|
1-2 10-15 reps
|
1-2-4 Tempo
|
Turn thumbs upwards.
|
INTEGRATE
|
Sets /
Repetitions
|
Duration
|
Notes
|
Integrated
dynamic
Movement
Y-W-T-L sequence
|
1-3 sets 10-15 reps
|
Slow and controlled
|
Specific to neck but
integrates the whole body as a unit.
|
Exercise
Prescription
Inhibitory
Techniques - Self Myofascial Reflex - Relax the Tight Muscles
Thoracic Spine / Latissmus Dorsi: The client might benefit by rolling on the
upper spine and the side on alternate days. The back roll SMR targets the upper
trapezius and the upper lats. The side rolling SMR targets the lats. Both are
large and overactive muscles that compound the dysfunction.
Sternocleidomastoid: The client can use a
massage stick, or he can try to palpate with his finger until he finds a
trigger point. Some experimentation may be necessary to find what works best.
Levator Scapulae: It may take some practice for the client to find a
trigger point just above the scapula and lateral to the midline. A massage
stick is used or finger palpation if necessary.
Upper Trapezius: The trigger point is
likely to be close to the tie in with the rear base of the skull. If the
massage stick feels awkward, the client can palpate with the finger.
Lengthening
Techniques / Static Stretching
Sternocleidomastoid Static Stretch: Reach one hand behind
the back. With the other hand gently pull the head laterally. The chin should
turn slightly up and towards the direction of pull. This stretch will also help
lengthen the overactive scalene
muscles. I would wait until the client perfects proper
technique with the static stretches before adding a neuromuscular stretch.
Levator Scapulae Static Wall Stretch: The client leans into
the wall and tilts the head towards one shoulder until a stretch is felt in the
lower side of the neck.
Upper Trapezius Static Stretch: This is similar to the
sternocleidomastoid static stretch except that the client does not turn the
head or tilt the chin upwards. He just gently pulls the head laterally with the
other hand behind the back. Reaching further behind the back increases the
stretch. This can also be turned into a neuromuscular stretch by resisting the
hand push rather than pulling the head.
Behind the Neck Chest Stretch: The pectoralis major
is a powerful muscle. When overactive it can overpower the myofascial back
lines. The client should tuck the chin forward and not push forward on the back of the head during this static
stretch..
Activation
Techniques – Isolated Strengthening
Seated Row - Elastic/Cable: This can be done
seated on the floor. A progression would be to use a stability ball. The
isolated strength focus is on the middle/lower trapezius and also the rhomboids
which get overpowered by the pectoralis major causing compensation by the upper
trapezius. The client should not thrust the head forward during this movement.
Scapular Retraction: The client lies prone
and lifts the arms back as he retracts the scapula. Turning the thumbs upwards
finishes the movement. This targets the rhomboids and somewhat the middle
trapezius. A progression is to use light dumbbells. A further progression is to
add a stability ball.
Cervical Extension - Elastic: This movement focuses
on the spinalis: capitus division of the
erector spinae. Cervical extension is significant
because it is opposite
to the mechanism of injury which is chronic improper flexion.
Supine Neck Flex: This may be the most
crucial exercise since the deep cervical flexors are a neglected yet
significant muscle group. Despite its simplicity, the neck flex is often done
incorrectly which will compound the postural dysfunction. The chin tuck must be
emphasized.
Integrated
Dynamic Movement Techniques
Y-W-T-L Sequence on Stability Ball: This exercise is an
integrated dynamic movement, but it also emphasizes the weaker myofascial back
lines. The client uses light dumbbells and forms alphabet letters. Each set of
letters constitutes a repetition.
This exercise
prescription should alleviate the myofascial issues causing the headache and
neck pain. Adjustments to the program can be progressions or regressions
depending on how the client adapts.
Don't let a pain in the neck cause you a headache.
Little Bobby Strong
References
Clark, M.A Lucent S.C.
Sutton B.G.; NASM Essentials of Corrective Exercise Training; National Academy
of Sports Medicine; ,2014, Jones and Bartlett Learning
Hewlings Horak Kalman,
Klika Lucett McCall, Miller Rhea, Richey Robles Stull, Valency, Weinberg: NASM
Essentials of Personal Fitness Training, ,2017, Jones and Bartlett Learning
Myers, Thomas W.;
Anatomy Trains; ,2014, Churchill Livingston Elsevier
Page, Frank, Lander;
Assessment and treatment of muscle imbalance -the Janda approach.; Human Kinetics ,2010, Chapter 6
Links
www.fitnwell.com
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