If you’ve ever suffered from migraines or headaches that last longer than a day, you’ll know that they are horrendous! I see a lot of people complaining of migraines and headaches with pain that goes over their scalp and what feels like a stabbing pain behind their eye. Usually most people will go to their GP and get prescribed a series of painkillers and non-steroidal anti-inflammatories (NSAID’s – a common NSAID is Ibuprofen). Which is fine, it’ll relieve the symptoms suitably, but won’t necessarily fix the problem.
Now, writing about headaches is a bit of a minefield, as there are lots of different types of headache, some of which need to be taken very seriously as they can indicate a far more sinister pathology. But what we are talking about are the nice lovely fluffy little annoyances; migraines and what are known commonly as tension headaches.
Cervicogenic Tension Headaches… It’s all in the name: Cervico – generated from the neck or ‘Cervical Spine’, Tension – tension…., Headaches – aching in the head…. Simple right?
What we are dealing with here is a tension from the upper neck and upper back causing pain through the fascial connections over the scalp and to the front of the head: A little bit like you’ve been wearing a swimming cap that is far too tight. So, what we look for is a lack of range of motion in the neck and tension through the muscles in the back of the neck (like pillars either side of your spine) and upper back (the “traps”). The concept I’m about to explain might seem familiar to those that have read my blog on non-specific lower back pain. It almost seems far too simple right? Well you would be correct.
WHY is there a lack of range of motion in the neck? WHY are those muscles feeding into the back of your head tight?
The answer is quite simply, modern day life. Whether we are desk based or not, we all spend far too much time sitting down at desks, laptops, looking down at our phones, driving and generally just sitting with shoulders forward and head forward and looking down. (Bet you straightened up when you read that!). Most patients seem very surprised when I start talking about anatomy in the front of the neck. In fact, the muscles in the front of your neck are the muscles that have the biggest impact on the neck and head. Sternocleidomastoid is what I like to call the big ‘neck – sausage’ either side of your throat. This runs from the upper chest into the back of the head, naturally, if this gets tight (thinking back to the muscle shortening prices we spoke of previously), it’s going to impact the neck. Not only does it compress the neck, but it drags the head forward. Which makes your head very heavy, and therefore the neck has to work very hard to hold it up. This leads to that head and shoulders sticking forwards.
As you do this, which I’m sure you’ve done as you read that, you’ll realise that you are now looking down, so now you have to look up to look forward. As a result of this simple muscle shortening in one muscle group, we have just generated an extra 85lb of pressure through the neck and caused a whole new world of strain through the muscles feeding the neck from the upper back. Once again, these issues arise from the more and more sedentary lifestyle we lead – computer-based work and a lack of exercise that pushes our range of motion.
Breathing mechanics are also very important to look at. Most of us are far more stressed our than we should be. What happens when we are ‘stressed out’ is that the fight or flight part of our central nervous system is activated. When this happens, our upper ribs start moving. This is to create more lung capacity and draw as much breath, and therefore oxygen, in as possible to either run away from the threat/stressor or to fight it. However, most of our stressors aren’t physical threats. So, stress when our body is in a state of rest causes our breathing mechanics to change – less diaphragm action, nicely taking our lower-ribs in and out to the side, and more upper-ribs action, horribly being dragged up by accessory respiratory muscles and the shoulders lifting. How does this relate to the neck? I hear you ask: The Scalenes muscle group (snuggly tucked in underneath the sternocleidomastoid muscle mentioned earlier) attach from the back of the head and come down onto the upper ribs. The upper ribs are dragged up by these muscles, causing them to get tight and short. What’s more is that the upper back muscles engage to lift the shoulder as you try to get breath in without using your diaphragm. This is all contributing to the postural picture we painted earlier.
You see how it all adds up?
So next time you’re sat at a desk, think about posture. Try typing like a T-Rex – short little arms. Bring your keyboard and mouse closer to you. Tuck your elbows back and by your side.
From here you can’t really flex forward or lean into your computer, which means that your neck stays stacked nicely on top of your back. This lovely new posture pushes your shoulders back and takes flexion out of the upper back, which leaves plenty of room for your diaphragm to do its job properly and shoulders to stay down and relaxed. In one move you’ve made your neck and head nice and light which means less strain on the muscles in the area, which means less compression and joint approximation and less likelihood of cervicogenic tension headaches.
Start being kind to your neck, your head is heavy enough as it is – don’t make it heavier. Look up from your screen once in a while, you never know, you might enjoy what you see!