Exercise Prescription for Patients With Neck Pain and Headaches
Recently I had the pleasure of Lecturing at the 2017 American Academy of Orofacial Pain 41st scientific meeting in Scottsdale Arizona. My topic was on Therapeutic Exercises for Patients with Headaches and Chronic Cervical Pain. Did you know:
- Almost 2/3 of adults will experience neck pain in any 6 months
- Approximately 5% will have substantial activity limitations
- ONLY 6.3% of individuals who suffered from neck pain in the previous year were free of recurrence (meaning 93.7% have reoccurring neck pain!)
- Tension-type headaches (TTH) are common, with a lifetime prevalence in the general population ranging between 30% and 78% in different studies
- Cervicogenic headache (pain referred to the head from a source in the cervical spine or neck) prevalence is estimated at 4%, but may be as high as 20% of patients presenting with severe chronic headaches
- Migraine is the third most common disease in the world (behind dental caries and tension-type headache) with an estimated global prevalence of 14.7% (that’s around 1 in 7 people).
So needless to say, there is quite a need to be able to evaluate, treat and manage patients complaining of neck pain and some type of headaches. My lecture did not cover many of the manual techniques we use to treat the above diagnosis, such as deep tissue massage, myofascial release, joint mobilization, joint manipulation, craniosacral therapy, or dry needling, just to name a few. Instead my topic focused on what structural, behavioral or functional deficits exist with regards to the neck flexor and extensor muscles, along with balance issues due to poor neck proprioception or disruption. For patients with neck or headaches, as a brief and general overview numerous studies have shown with MRI imaging there is atrophy of the deep and superficial neck flexors (muscles along the front of the neck) and neck extensors (muscles along the back of the neck). There can also be fatty infiltration of these important neck muscles and a change in muscle fiber type. Studies have indicated poor force generation, precision and endurance of the deep and superficial neck flexors and extensors. Finally, studies have shown poor balance and something called cervical proprioception. Using the best available research evidence helps guide physical therapists in treating these challenging cases. I will highlight just a few exercises that should be incorporated to take your chronic neck and headache clients to a new level of recovery and wellness. I have personally experienced, with our clients at Freedom Physical Therapy Services, a reduction in the severity of their pain, a reduction in the frequency of their headaches and definite improvement in function, by incorporating the appropriate exercises and progressing them accordingly.
Utilizing the Chattanooga Stabilizer as pictured below has been well researched and provides wonderful objective feedback on the ability of a patient to engage their deep neck flexors with precision, and indicates the status of the patient’s endurance of these specific muscles.
Next, focusing on the neck extensor muscles is crucial as well. An example pictured below allows the therapist to recruit different neck extensors based on where they place their hand/fingers to provide feedback to the patient:
Next focusing on various balance exercises with eyes open, eyes closed, narrow stance, one legged stance, tandem stance and then on a foam cushion to create an unstable surface are all important so they can someday walk a tightrope
Finally, incorporating exercises to improve cervical joint proprioception or head and neck position sense. At Freedom, we use a headlamp with a laser and do controlled grid exercises where the patient has to make sure the laser light stays on various lines and then gradually increasing the speed while still maintaining accuracy.
SO above is only a tiny example of the various exercise that can be done. The key is they must be specific exercises as performed in the research studies. The exercises must be done with great quality, control and oversight by an experienced physical therapist. In hopes that when you are all done maybe you can do this???? Here is to your healthy neck and zero headaches!