Neck Pain, Headaches and Neck Extension Strength

by | Sep 3, 2021 | Headache, Migraine, Neck

The latest update on Physiotherapy and Headache management.

Back in 2016 Andrew wrote a great blog article on the role of physiotherapy in assessing and treating headache. Well with the headache that was 2020 behind us, I thought I would start the new year with the latest information and research on how physio can help that pain in your head.

What are the common headaches that physios see?

There are 3 common headache types that physios generally see:

  1. Cervicogenic
  2. Tension
  3. Migraine

Cervicogenic (headache coming from the neck) are generally one sided, will start with neck pain and progress to the head. You may also find neck stiffness and checking your blind spot whilst driving to be difficult.

A cervicogenic headache is essentially referred pain from the neck that, due to a miscommunication of the nerves that supply the head and neck, the pain is perceived in the head, rather than the true source in the neck.

The pathophysiological basis for the referred pain is a “convergence” of nerves. To try to put it simply, the nerves that supply the head come into close proximity to the nerves that supply the neck. As the nerves from the neck make there way into the brain to communicate the message of neck dysfunction, they “converge” with the nerves that are carrying messages from the head. The end result is that the brain thinks the message is coming from the head, rather than the neck.

Tension headaches feel like you’re wearing a swimming cap that’s a little too tight! It will feel like a tightening pain around your whole head. You may also have neck pain related to this headache.

Migraine headaches are commonly one sided and intensely painful. Most people say they either feel sick in the stomach or don’t like bright lights/sound. Some people will also get an aura (seeing bright lights and colour) before their pain comes on. Neck pain can occur with Migraine however is less common.

Signs that your headache may be coming from you neck

1) Neck stiffness

2) Your headache changes when your turn your head i.e may be worse when trying to turn your head in one direction

3) Tenderness of the upper cervical region. It may be sore and sensitive to push on the muscles and joints at the top of your neck.

Does posture affect headaches?

How many times have you heard or thought ‘Wow I’ve got bad posture’. Well, all your worrying may be for nothing. There has been some great research into posture and headache, which has found that people with headaches have many different postures.

There was not one posture that made people more likely to suffer from headache.

Additionally, other factors such as stress, lack of sleep and reduced physical activity have a much larger effect on developing headaches.

So, is there a good posture? The best evidence we have suggests that changing posture, rather than having one specific posture, is the best approach to take.

Can physiotherapy help your headache?

Short answer…yes! There has been lots of research into physiotherapy and headache, which shows that we can help reduce the intensity, frequency and duration of headache.

How do we do this?

Hands on treatment of the joints and muscles in the neck can be very helpful to reduce headache pain and stiffness. However, the effects of these treatments don’t always treat the common, underlying muscle problem.

A study on 52 women in 2019 in the Journal of Orthopaedic & Sports Physical Therapy found that “Women with migraine demonstrated decreased neck flexor and extensor muscle endurance compared to women without migraine.”

We have found that improving the endurance of the neck muscles helps to improve the ability to do simple things like…reading, texting or even just sitting/standing long periods.

 

Ankle dorsiflexion knee to wall measure for squat

How to Treat and Manage Stiff Ankles

If your ankle mobility isn’t up to par, the next steps depend on the source of the restriction. Generally, if the limitation is felt at the front of the ankle, it may be due to joint-related issues.

  • Banded Ankle Mobilizations: This technique involves using a resistance band tied to a stable surface while performing ankle flexing exercises on a step. Check out this quick helpful video for guidance.

Conversely, if the tightness is located in the back of your ankle around the Achilles tendon region, consider:

  • Contract/Relax Stretches: A simple exercise like the bent-knee calf raise can effectively relieve restrictions in this region.

Lastly, for an immediate solution, consider using a wedge or support under your heels during a squat. Two papers from The Journal of Strength and Conditioning Research have shown that wedges can enhance squat depth without negatively impacting biomechanics. While some may see this as a “cheat,” the science supports it. If you struggle to achieve that 12 cm in the knee-to-wall test and find it challenging to squat low, use that wedge!

Hip Range of Motion

How Much Flexibility Do I Need and How Do I Test It?

For effective squatting, studies have determined that achieving 125 degrees of hip flexion is necessary—this is 35 degrees beyond a right angle. To test your hip mobility, you can use an inclinometer available on your iPhone. Simply follow these steps:

  1. Lie down on your back with your legs extended.
  2. Place the inclinometer length-ways on your thigh,
  3. Gently lift your knee towards your chest to measure the maximum angle, without moving the opposite leg.

     

    measuring hip flexion

    How to Treat and Manage Stiff Hips

    The hip joint is mostly passive during a squat, so if you’re experiencing limitations, it’s most likely due to an issue with the hip joint itself. There is up to 20% of the population that may be limited by the shape of their hip joint and the way it developed during childhood and adolescence. If that is the case, it makes if very difficult to improve the range of motion. Things like acetabular retroversion or a lower femoral head/neck offset ratio cannot be changed.

    For the rest of the population, here are some effective strategies for improving hip mobility:

    • Banded Hip Mobilisations: These exercises can help increase the range of motion in your hips by stretching and mobilizing the joint. Look for a demonstration in this video.
    • Inner Range Hip Flexor Strengthening: Strengthening your hip flexors can counteract tightness and enhance your ability to squat lower.
    • Like with ankle mobility, adding a heel wedge can help. By elevating your heels, you may experience a reduction in trunk forward bend, minimizing the hip flexion required and facilitating a more comfortable squat position.

    Conclusion

    Mastering a deep squat requires more than just strength; it hinges on sufficient ankle and hip range of motion. The studies from 2015 and 2022 have made it clear: flexibility in these joints is paramount for optimal performance.

    By regularly assessing your mobility and implementing these targeted exercises and techniques, you can improve your squat depth, enhance your overall strength training, and reduce the risk of injury. Remember, every body is unique, so listen to yours and adjust your approach accordingly. Happy squatting!