Got neck pain or tension headaches? Discover ... - ECA World Fitness

Evan Osar

Do you train clients suffering from chronic neck pain and/or headaches? Are they constantly rubbing that irritating trigger point at the superior aspect of their shoulder blade after doing upper body exercises? Do they blame their job, spouse, or their uncomfortable pillow for their tension headaches? Unfortunately, for many individuals suffering from these problems, there doesn?t seem to be a great solution outside of taking more medication. However, in this article, I will show you a very simple, easy-to-implement stabilization solution that will solve the majority of your clients? chronic neck problems and even help improve tension related headaches so you can be the solution your clients need and want.

Common causes of neck pain and headaches

Before we get started, it is important to understand the mechanisms that lead to neck pain and headache issues in our clients. Neck pain is so pervasive that it is estimated that 70% of us will experience neck pain at some time in our life and nearly $90 billion is spent every year in the United States treating neck and back pain. What about headaches? Nearly 45 million Americans suffer from headaches including tension, migraine, and sinus. We will discuss tension headaches specifically since these are the types of headaches that are generally biomechanical in origin, in other words, related to how an individual is stabilizing and moving.

Neck pain and tension headaches have a variety of causes including, but not limited to, stress, previous whiplash injuries, and traumas such as a fall on the head. However, as mentioned above, the majority of our clients experience these conditions from how they are stabilizing and moving during their every day life. And many of these individuals are actually suffering from these conditions because they are not stabilizing their neck or shoulder appropriately during exercise.

There are two common dysfunctional movement patterns that lead to neck and tension headache issues while exercising. The first has to do with scapular stabilization during upper extremity patterning. The scapula should be primarily stabilized along the thorax during upper extremity motion. In clients with poor scapular stabilization, the scapula elevates, anteriorly tilts, and downwardly rotates and the neck is asked to bear the brunt of stabilization for the upper extremity. The client over-recruits their rhomboids and levator scapula to stabilize the scapula, which increases the tension on the neck and upper thoracic spine. You will notice over-recruitment of the downward rotators of the scapula and increased levator scapula activity by the ?levator scapula sign? especially as clients perform exercises such as rows, pull downs, and push ups (see image to right).? The client will generally complain of tightness, ?knots?, and/or stiffness in this region of the neck and upper back after their workout or activity that requires lifting. They can also complain of headaches because of the compressive forces these muscles place on the joint structures of the neck and upper back. Additionally, chronic myofascial contraction in the cervico-scapular muscles can restrict blood flow and myofascial tension in this region can pull on the dura mater surrounding the brain and upper spinal cord thereby creating and/or exacerbating tension headache symptoms.

The second common cause of neck pain and headaches is the forward head position. This common posture increases stress on the lower cervical and upper thoracic spine and contributes to disc problems and joint stress that lead to chronic neck pain and headaches. While sitting at a desk, computer work, and poor head and trunk alignment while exercising all contribute, poor respiratory patterns are the strongest factor driving this dysfunctional posture. When an individual does not use a primary diaphragm breathing strategy, they will over-recruit the accessory muscles of respiration including the scalenes, sternocleidomastoid, and pectoralis minor with each muscle contributing to pulling the head and shoulder forward. The bigger issue with an upper airway dominant breathing strategy is that it increases the compressive load on the neck which is exacerbated during exercise when the breathing demands are increased. Consider the ramifications of this stress over the course of an hour of weight training and/or cardio session.

SUPER SIMPLE STABILIZATION SOLUTION

It is rather simple to correct these issues if you have the knowledge, strategies, and discipline to help your clients improve their patterns. After improving diaphragmatic breathing, posture correction is the most important step to improving stabilization and movement issues that lead to neck pain and tension headaches. There are two simple corrections for these issues: 1. Elongate the cervical spine to activate the deep neck flexors; 2. Reposition the scapula upon the thorax to activate the scapular stabilizers.

The forward head posture is created by shortness of the suboccipital, sternocleidomastoid, and scalenes and ?inhibition and subsequent elongation of the longus coli and longus capitis (deep neck flexors). To improve this posture, the client is cued to elongate the posterior aspect of her neck while performing a slight chin tuck. She is instructed to think of a string pulling the back of her head lightly towards the ceiling. The therapist can help cue this posture by gently lifting up on the occiput to elongate the neck while gently bring the forehead down to facilitate deep neck flexion (image above left).

In the forward shoulder, the scapula is positioned anteriorly and is often in downward rotation by shortness of the pectoralis minor, rhomboids, and levator scapula. The serratus anterior, upper and lower trapezius are inhibited and over-lengthened in this posture. These muscle imbalances encourage the scapula to be stabilized more at the cervical-thoracic junction rather than on the mid to lateral aspect of the upper thorax which increases the stress on the neck.

Scapular positioning can be improved by placing one hand on the front of the shoulder and one hand under the inferior aspect of the scapula and gently tilting the scapula up and back (upward rotation and posterior tilt) to bring the scapula around the thorax (image above right). This position will help facilitate activation of the serratus anterior as well as the upper and lower trapezius.

Once these positions are achieved, the client must be cued to incorporate this posture into their functional movement patterns. For example, this posture can be encouraged during a push up pattern by having the client retain the long spine and posteriorly tilted scapular position (image to right). She should maintain this position throughout the pattern both through the concentric as well as the eccentric phases of the pattern. In many clients with stabilization issues of the spine and shoulder, you will have to lower the load of their exercises and/or regress their pattern (as in this case of the push up) to allow the stabilizers an opportunity to be strengthened without reverting to the compensatory patterns that they are used to.

CONCLUSION

This article outlined two common causes chronic neck pain and tension headaches ? faulty stabilization and posture of the neck and shoulder. By improving alignment of the cervical spine and scapula and grooving this alignment through proper progressions of their movement patterns, your client will be able to activate their inhibited stabilizers while decreasing the overutilization of the tight, short muscles. If you encourage your client to improve their breathing, if you empower your clients with positive postural cues, and if you are disciplined in implementing this strategy throughout your clients exercise patterns, you just may become known as the corrective exercise expert in your area. At the very least, you will help many individuals with chronic neck pain and tension headaches.

About the Author

Audiences around the world have seen Dr. Evan Osar?s dynamic presentations.? His passion for improving movement and helping fitness professionals think bigger about their role can be felt in every course.? His background in fitness and clinical expertise enables him to bridge the gap between rehabilitation, corrective exercise, and conditioning. Dr. Osar has become known for taking challenging information and putting it into useable information the fitness professional can apply immediately with their clientele.

He is the creator of over a dozen resources including the highly acclaimed Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction. He is a regular presenter at ECA conventions and is the developer of the Integrative Movement Specialist? certification. For more information, please visit www.fitnesseducatioseminars.com.

Source: http://www.ecaworldfitness.com/featured-article/neck-pain/

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