Cervicogenic Headache: Neck Headache

Neck Headache, or as it is known medically - Cervicogenic Headache, is a secondary headache disorder. In other words, your headache is caused by a neck joint problem.

The good news is that by fixing your neck problem, your neck headache can be alleviated. Researchers feel that neck headache accounts for between 4% to 22% of all headaches seen clinically. (Racicki et al 2013; Watson 2014)

What's Causes Your Neck Headache?

Your neck headache can originate from a variety of musculoskeletal and neurovascular structures in your upper neck; including the upper three neck joints, C2/3 disc, spinal cord coverings and neck muscles. A dysfunction in these areas can trigger pain signals that travel to your trigeminocervical nucleus (TCN) in your brainstem. This information is then transmitted into your brain and interpreted as a headache (Bogduk 2003).

Upper Neck Joints

The most likely sources of your neck headache is dysfunction of either your upper neck joints, neck muscles or nerves, which trigger pain signals that travel to your trigeminal nucleus in your brainstem, where you interpret the pain signals as a neck headache.

The most common cause of neck headache is dysfunction of your upper three neck joints. The most common neck joints involved are your:

• Atlanto-occipital joint (O-C1), 
• Atlanto-axial joint (C1/2), and 
• C2/3 cervical spine joints.

In simple terms, your neck joints can cause a neck headache or pain if they are either too stiffor move too much (eg wobbly and unsupported by weak muscles) or are locked in an abnormal joint position eg. locked facet joint or poor posture. 

Once your neck joint becomes stressed and painful, the pain signals are referred to the trigeminocervical nucleus in your brainstem... and you start to feel a neck headache or, in some cases, face pain!

Your physiotherapist is expert in the assessment and correction of neck joint dysfunctions that result in neck headache. Their professional diagnosis and treatment is essential for neck headache sufferers.

Neck Muscles

Your neck and shoulder blade muscles that originate from your neck will cause pain if they are overworking, knotted or in spasm. 

Some of your neck muscles overwork when protecting injured neck joints. Other neck muscles become weak with disuse, which places further demand on your overworking muscles resulting in muscle fatigue related symptoms. 

Your neck muscles work optimally when they have normal resting tension, length, strength, power and endurance.

Your physiotherapist is expert in the assessment and correction of muscle imbalances that result in neck headache.

Cervical and Occipital Nerves

Nerves in your upper neck may be directly pinched by extra bony growths eg arthritis, disc bulges or swelling. The results can result in nerve irritation or a reduction in neural motion known as neuromechanosensitivity or abnormal neurodynamics. 

Irritation of your upper neck structures refer pain messages along the nerves and cause your headache.

In simple terms, your neck is the "switch", nerves are the "power cords" and your headache is where the "light" comes on.

What are the Symptoms of Neck Headache?

Neck headaches can often be misdiagnosed or confused with other sources of headache, including migraine, since the head pain is typically felt in the same area as a migraine. 

It is really the interpretation from your headache physiotherapist of the whole combination of your symptoms plus the findings of your physical examination that will confirm a neck headache diagnosis

Commonly, neck headache sufferers will usually notice:

• Tenderness at the top of their neck and base of the skull. 
• Neck stiffness or a mild loss of movement, although this is sometimes is only subtle and needs to be confirmed during your physiotherapist's physical examination.

One of the main differences between neck headache and migraine is that physiotherapy treatment of your neck is able to alter or relieve your headache immediately.

Common Characteristics of a Neck Headache?

The following symptoms are characteristics of a neck headache. You may experience any one or several of these symptoms:

• Your headache may seem to radiate from the back to the front of your head.
• Your headache is provoked or eased by a neck movement, a sustained posture, stomach sleeping or with your head turned to one side.
• Your headache normally appears to be worse on one side of your head. The side is normally constant and does not swap sides.
• Your headache appears to temporarily ease up when you apply pressure or you massage your neck or the base of your skull.

If you experience any of the above symptoms, you are more likely than not to be suffering a neck headache. Please inform your physiotherapist and they will assist you.

What if Your Neck Isn’t Sore?

Even if your neck isn’t sore or painful, you can still experience neck headaches. It is important to remember that your neck joints may NOT be sore at REST, but they may be tender to touch or painful on movement. 

Neck joints that are sore at rest will normally be very tender to touch and painful at the extreme of movement. Obviously, this scenario is a more severe neck headache.

If your headache or a migraine has been present for years and your neck has not been examined, then a thorough neck examination is recommended and is appropriate to eitherconfirm and treat your neck headache or exclude a neck disorder as the cause of your headache.

How is a Neck Headache Diagnosed?

Accurate diagnosis is important to guide the correct treatment and management your neck headache. Headache and head pain can have many causes, not just neck headache or migraine. Correctly identifying the cause will lead to better treatment.

This article originally appeared p physioworks.com.au and was written by John Miller.

Photo by Jacob Morrison on Unsplash

Depression is a physical illness which could be treated with anti-inflammatory drugs, scientists suggest

Depression could be treated using anti-inflammatory drugs, scientists now believe, after determining that it is a physical illness caused by a faulty immune system.

Around one in 13 people in Britain suffers from anxiety or depression and last year the NHS issued 64.7 million prescriptions for antidepressants, double the amount given out a decade ago.

Current treatment is largely centred around restoring mood-boosting chemicals in the brain, such as serotonin, but experts now think an overactive immune system triggers inflammation throughout the entire body, sparking feelings of hopelessness, unhappiness and fatigue. 

It may be a symptom of the immune system failing to switch off after a trauma or illness, and is a similar to the low mood people often experience when they are fighting a virus, like flu.

A raft of recent papers, and unexpected results from clinical trials, have shown that treating inflammation seems to alleviate depression.

Likewise when doctors give drugs to boost the immune system to fight illness it is often accompanied by depressive mood - in the same way as how many people feel down after a vaccination.

Professor Ed Bullmore, Head of the Department of Psychiatry at the University of Cambridge, believes a new field of ‘immuno-neurology’ is on the horizon.

“It’s pretty clear that inflammation can cause depression,” he told a briefing in London to coincide with this week’s Academy of Medical Sciences FORUM annual lecture which has brought together government the NHS and academics to discuss the issue.

“In relation to mood, beyond reasonable doubt, there is a very robust association between inflammation and depressive symptoms.  We give people a vaccination and they will become depressed. Vaccine clinics could always predict it, but they could never explain it.

“The question is does the inflammation drive the depression or vice versa or is it just a coincidence?

“In experimental medicine studies if you treat a healthy individual with an inflammatory drug, like interferon, a substantial percentage of those people will become depressed. So we think there is good enough evidence for a causal effect.”

Scientists at Cambridge and the Wellcome Trust are hoping to begin trials next year to test whether anti-inflammatory drugs could switch off depression.

“There is evidence to suggest it should work,” added Prof Bullmore.

The immune system triggers an inflammatory response when it feels it is under threat, sparking wide-ranging changes in the body such as increasing red blood cells, in anticipation that it may need to heal a wound soon.

Scientists believe that associated depression may have brought an evolutionary benefit to our ancestors. If an ill or wounded tribal member became depressed and withdrawn it would prevent a disease being passed on.

However a link has taken so long to establish because until recently scientists believed the brain was entirely cut off from the immune system, trapped behind a ‘Berlin Wall’ known as the blood brain barrier.

But recent studies have shown that nerve cells in the brain are linked to immune function and one can have an impact on the other. Around 60 per cent of people referred to cardiologists with chest pain do not have a heart problem but are suffering from anxiety.

One in 13 people in Britain suffers from depression CREDIT: ANNA GOWTHORPE 

Figures also show that around 30 per cent of people suffering from inflammatory diseases such as rheumatoid arthritis are depressed - more than four times higher than the normal population.

Likewise people who are depressed after a heart attack are much more likely to suffer a second one, while the lifespan for people withcancer is hugely reduced for people with mental illness.

“You can’t separate the mind from the body,” said Prof Sir Robert Lechler, President of the Academy of Medical Sciences.

“The immune system does produce behaviour. You’re not just a little bit miserable if you’ve got a long term condition, there is a real mechanistic connection between the mind, the nervous system and the immune system.

“Our model of healthcare is outdated. We have a separation. Mental healthcare is delivered by mental health professionals, psychiatrists, mental health nurses and so on, often in separate premises from where physical health care is delivered and that is simply wrong and we need to find ways to ever more closely integrate and train amphibious healthcare professionals who can straddle this divide.”

Research has also shown that people who have suffered severe emotional trauma in their past have inflammatory markers in their body, suggesting their immune system is constantly firing, as if always on guard against abuse.

This article originally appeared on www.telegraph.co.uk and was written by Sarah Knapton.

Photo by: Photo by Nik Shuliahin on Unsplash

What is Sacroiliac Joint Pain?

SI Joint Pain

Your Sacroiliac Joints (SIJ) are a critical linkage system between your lower spine and pelvis. The sacrum (tailbone) connects on the right and left sides of the ilia (pelvic bones) to form your sacroiliac joints.

Your sacroiliac joints should be a fairly stiff or rigid link between the pelvic bones, and allow only a few degrees of movement. In some people due to trauma or just extra mobility, your sacroiliac joints have too much uncontrolled motion. This allows your sacroiliac joints to adopt an abnormal or stressed joint position, which may result in SIJ pain. 

When your sacroiliac joints are not moving normally due to either stiffness or excessive movement, it is referred to as Sacroiliac Joint Dysfunction, which normally results in sacroiliac pain.

It is vital that you have both normal SIJ movement and muscle control around this area to avoid SIJ pain and injury. 

Commonly sacroiliac dysfunction can cause lower back, hip, buttock and sciatic pain.

What Causes Sacroiliac Joint Pain?

There are two main groups of sacroiliac dysfunction that cause SIJ pain:

1. Hypermobility / Instability 
2. Hypomobility / Stiffness

Hypermobility issues are the most common and will be discussed further in this article.

Hypomobility is normally associated with pathologies that tend to stiffen your sacroiliac joints such as in Ankylosing Spondylitis.

What Causes Sacroiliac Joint Hypermobility?

Your sacroiliac joints should move a few degrees for normal movement. Like most joints, your surrounding muscles act to stabilise your sacroiliac joints during stressful or vulnerable positions. The most important sacroiliac stabilising muscles are your deep abdominal core muscles and your deep gluteal muscle groups.

Your core muscles: specifically the transversus abdominis and oblique abdominals through their attachments to the iliac bones help closure of the pelvis and improves the position, control and stability of the sacroiliac joints.

Researchers have discovered that contraction of the transversus abdominis muscle significantly stiffens and supports your sacroiliac joints. This improvement is larger than that caused by an abdominal bracing action using all the lateral abdominal muscles (Richardson etal 2002).

Further to this, researchers have discovered that your deep gluteal (buttock) muscles are important for controlling the lateral and rear aspects of the pelvis and hip. (Grimaldi et al).

When these muscle groups are weak or lack endurance your sacroiliac joints are vulnerable to excessive movement, which can lead to SIJ hypermobility dysfunction or instability and subsequent sacroiliac joint pain.

What are the Symptoms of Sacroiliac Joint Dysfunction?

• Sacroiliac joint dysfunction can mimic numerous other back and hip injuries. 
• Sacroiliac joint dysfunction can cause lower back, hip, groin, buttock and sciatic pain. 
• Sacroiliac pain is typically worse with standing and walking and improved when lying down, but not always. 
• It can sometimes be painful to sit cross legged and is normally painful to lie on your side for extend periods. 
• Bending forward, stair climbing, hill climbing, and rising from a seated position can also provoke sacroiliac pain. 
• Sacroiliac pain is  sometimes reported to increase during sexual intercourse and menstruation in women.

How is Sacroiliac Joint Pain Diagnosed?

Accurately diagnosing sacroiliac joint pain & dysfunction can be difficult because SIJ symptoms can mimic other common back conditions. These include other mechanical low back pain conditions like facet joint syndrome or a bulging disc.

X-rays are of minimal diagnostic benefit. MRI may show signs of sacroiliac joint inflammation or eliminate other potential pathologies. 

A thorough physical examination by your experienced musculoskeletal physiotherapist is the best method to assess for sacroiliac joint pain or instability.

This article originally appeared on physioworks.com.au and was written by John Miller

Consult with your Physician and / or Physiotherapist for a diagnosis and follow up with a Massage Therapist, Manual Osteopath, Acupuncturist, or Physical Therapist in conjunction with treatment plans.

Knee Pain: Patellofemoral Pain Syndrome

Patellofemoral pain syndrome is one of the most common knee complaints of both the young active sportsperson and the elderly.

Patellofemoral pain syndrome is the medical term for pain felt behind your kneecap, where your patella (kneecap) articulates with your thigh bone (femur). This joint is known as your patellofemoral joint

Patellofemoral pain syndrome, is mainly due to excessive patellofemoral joint pressure from poor kneecap alignment, which in time, affects the joint surface behind the kneecap (retropatellar joint).

What Causes Patellofemoral Pain Syndrome?

Your patella normally glides up and down through the femoral groove. As your knee is bent, pressure between your kneecap and the groove increases. 

This retropatellar pressure is further increased if the patella does not ride normally through the groove, but “mistracks”, meaning it travels more to one side, making it rub against the femur. 

Repeated trauma causes an increase in your retro patellar joint forces, which can lead to kneecap pain, joint irritation and eventually degeneration of your patella joint surface.

The most common causes of patellar malalignment are an abnormal muscle imbalance and poor biomechanical control.

Aching kneecaps (patellofemoral pain) affect 25% of the population at some time in their lives but it is more common in athletes. The sports where patellofemoral pain syndrome is typically seen are those when running, jumping and landing or the squatting position is required. 

Sports include running, tennis, netball, football, volleyball, basketball, skiing and other jumping sports. 

Untreated patellofemoral pain syndrome can also predispose you to patellar tendonitis.

What Causes a Muscle Imbalance?

Your quadriceps (thigh) muscles attach to the patella and through it to the patella tendon, which attaches to the top of your shin. 

If there is a muscle imbalance between the quadriceps muscles: vastus lateralis (VL), which pulls your patella up and outwards, and the vastus medialis oblique (VMO), which is the only quadriceps muscle that pulls your kneecap up and slightly in, then your patella will track laterally in the groove.

Common reasons for a weak vastus medialis oblique (VMO) include knee injury, post-surgery, swelling or disuse.

The longstanding tightness of your lateral knee structures (lateral retinaculum, VL, and ITB) will encourage your kneecap to drift sideways over time. Especially, if your VMO is also weak.

Hip muscles have been shown in the research to be very important in the control of your thigh. Poor buttock muscle control allows your knee to roll in and apply a relative lateral displacement of the the patella. Most successful rehabilitation programs require assessment and correction of your hip and buttock muscle control.

Patellofemoral pain syndrome is more common during adolescence, because the long bones are growing faster than the muscles, tendons and ligaments, putting abnormal stresses on the joints. Active children who do not stretch the appropriate muscles are predisposed to patellar malalignment.

What Biomechanical Issues Cause Patellofemoral Pain Syndrome?

Poor foot posture (eg flat feet) and weak hip control muscles can both allow your knee to abnormally twist and result in a lateral deviation of your patella.

When poor biomechanics are repeated with each step of your walking or running pattern that poor habit repeatedly traumatises your patellofemoral pain.

What are the Symptoms of Patellofemoral Pain Syndrome?

The onset of your kneecap pain is normally gradual rather than traumatic.

Patellofemoral pain symptoms are normally noticed during weight bearing or jarring activities that involve knee bending. 

Stairs, squatting, kneeling, hopping, running or using stairs are commonly painful. As your patellofemoral pain syndrome progresses your knee will become painful while walking and then ultimately even at rest. 

You can also experience kneecap pain when you are in sustained knee bend eg. sitting in a chair. A nickname for this condition is “theatre knee”. 

Patellofemoral Pain Syndrome Treatment

Researchers have confirmed that physiotherapy intervention is a very effective short and long-term solution for kneecap pain.

Approximately 90% of patellofemoral syndrome sufferers will be pain-free within six weeks of starting a physiotherapist guided rehabilitation program for patellofemoral pain syndrome.

For those who fail to respond, surgery may be required to repair associated injuries such as severely damaged or arthritic joint surfaces.

The aim of treatment is to reduce your pain and inflammation in the short-term and then, more importantly, correct the cause to prevent it returning in the long-term.

There is no specific time frame for when to progress from each stage to the next. Your injury rehabilitation will be determined by many factors during your physiotherapist’s clinical assessment.

You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves. It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and the frustration of a delay in your recovery.

Phase 1 - Injury Protection: Pain Relief & Anti-inflammatory Tips

As with most soft tissue injuries the initial treatment is - Rest, Ice and Protection.

(Active) Rest: In the early phase your best to avoid all activities that induce your kneecap pain.

Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.

Protection: Your physiotherapist will normally apply kinesiology supportive taping or similar to help relieve your pain and commence your patellofemoral joint realignment phase. The patellofemoral taping is normally immediately effective in providing you with pain relief.

Your physiotherapist will utilise a range of helpful tricks including pain relieving techniques, joint mobilisations, massage, strapping and acupuncture to assist you during this painful phase.

Anti-inflammatory medication and natural creams such as arnica may help reduce your pain and swelling. Most people can tolerate paracetamol as a pain reliever.

Phase 2: Regain Full Range of Passive Motion

Your kneecap and knee must be able to glide through its full normal range of motion. Your physiotherapist will assess your motion and apply the necessary techniques to normalise your range of motion.

Phase 3: Restore Full Muscle Length

Your thigh, hamstring and calf muscles will require stretching as they are tight and are causing excessive tension or pressure on your kneecap. It is important to regain normal muscle length to improve your lower limb biomechanics.

Phase 4: Normalise Quadriceps Muscle Balance

In order to prevent a recurrence, your quadriceps muscle balance and its control should be assessed by your physiotherapist. In most instances, you will require a specific knee strengthening program.

Your physiotherapist will prescribe the best exercises for you.

Phase 5: Normalise Foot & Hip Biomechanics

Patellofemoral pain syndrome can occur from poor foot biomechanics (eg flat foot) or poor hip control.

In order to prevent a recurrence, your foot and hip control should be assessed by your physiotherapist. In some instances, you may require a foot orthotic (shoe insert) or you may be a candidate for the Active Foot Posture Stabilisation program.

Other patients may require a hip stabilisation program. Your physiotherapist will happily discuss what you require.

Phase 6: Normalise Movement Patterns

Kneecap pain commonly occurs from poor habits, whether they be an abnormal gait, jumping, landing, running or squatting technique. In order to prevent a recurrence, your walking pattern, jumping and landing technique, running style or squatting method should all be assessed and corrected as required.

Your physiotherapist will happily discuss what you specifically require.

Phase 7: Restore High Speed, Power, Proprioception and Agility

Most kneecap pain sufferers need to return to high speed or repetition activities, which place enormous forces on your knee. Your physiotherapist will guide you in your return to sports planning.

Balance and proprioception (the sense of the relative position of neighbouring parts of the body) are both known to be adversely affected by patellofemoral pain. To prevent a re-aggravation, both aspects need to be assessed and retrained.

Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepare you for light sport-specific training.

Phase 8: Return to Sport

If you play sport and depending on the demands of your chosen sport, you may require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.

This article originally appeared on physioworks.com.au and was written by John Miller