My ever evolving thought process on headaches Part deux

Sometime last year, I wrote a blog post on how I managed cervical headaches which you can find Here. Having often been at the receiving end of this mostly bad and sometimes extremely painful condition, I have played around with the position I suggested in my last blog post and I have realized that there may be an even better way to manage a painful acute flair up.
Before I proceed to discuss this position, I want to give full credit to my father for this light bulb moment. Here’s how it happened. He was suffering from some dull 2-3/10 pain at his right shoulder for a few years now which of course was intermittent. He would often also complain of tingling and numbness along the median nerve root on his right hand but only around the fingers and palm. So after some assessment I put him on a textbook McKenzie chin retraction and side bending program which did provide him relief but not completely. I noticed that as he wore a turban, the extra weight on the head along with the way it was tied, prevented him from getting into a retracted neck position. Now this, along with sitting at work for 8+ hours for six days a week (ya, that’s right, 6 days, maybe we should stop complaining about our long work weeks, maybe. Lol) was putting him in the dreaded rounded shoulders, blah blah blah … upper crossed posture. So apart from the exercise and manual therapy, I put him in my headache posture in supine hoping for the positive results that I was getting for me and some of my patients.
 
Alas, to my great dismay, this was only minimally helping him. He still complained of shoulder pain and in fact didn’t like to lie in that position for too long (he didn’t want to tell me it wasn’t helping so instead he just asked for a little break. He’s a solid dad). Now, I often saw him place both his hands over/behind his head on numerous occasions and when I inquired about it, he said this was the only position that made him feel better. This got my neurons firing; how could this simple position make him feel better when other advanced physiotherapy techniques had fallen short? This warrantied some investigation and the answer wasn’t too hard to figure out.
 
 
So lets try and break it down- what are some of the conmon postural dysfunctions that we suspect causes headaches, neck pain, shoulder pain and symptoms down the arm?

1. Forward head and upper cervical extension
2. Protracted rounded shoulders
3. Rounded kyphotic upper and middle back region
4. Downward rotated scapula
5. Internally rotated shoulders.

On careful observation of  his favorite ‘shoulder pain relieving position’ (For the sake of simplicity, I will use the term-Dad’s position) I realized that this position was putting his body in the exact opposite of some of the above mentioned shoulder dysfunction.

1. Minimum benefit in correcting forward head position.
2. Dad’s position forces the shoulders into retraction
3. Forces some extension at the thoracic spine.
4. Arm elevation causes scapular upward rotation.
5. Shoulders comfortably in an externally rotated position.

All of the above seem like thing we recommend to our patients all the time, no wonder his shoulders and arm were happy in this position. However, there were still a few things that had to be tweaked. I asked him to tuck his chin in and to avoid shrugging his shoulders so that the upper traps didn’t tense up. Even better, he reported after trying it a few times!!
Now if you have been following my blog posts from before, you’d know that I almost always consider a shoulder problem as a neck problem and vice-versa. They generally go hand in hand and are my ‘usual suspects’. So given this logic, I applied this on myself and some of my patients for neck related issues , headaches and got some extremely encouraging results. After all what better position to get the neck into retraction then in supine and gently force the thoracic spine into extension with a small pillow under it?? Adding heating packs could be the cherry on top if your a cherry person.
So with the explanation out of the way, I would like to present to you my modified position for cervicogenic headaches (also for neck and shoulder pain).
 
 
[wpvideo clCZlXsu ]
 

 
So after a through assessment, if your patients fit the bill, I recommend you try it out and please let me know your thought on this subject.  As always,
 
Pursue excellence
Abhijit Minhas PT
(BPT, MS, CMP, FMT)
 
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