Tag Archives: Biofreeze Pain Relieving Gel

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Neck Pain and Headaches? Work Your Core?!

You may have heard that if you suffer from low back pain (LBP) that you need to work your “core” muscles, but what if you suffer from neck pain (cervicogenic pain) and/or headaches?  Well then yes, you would need to work the core muscles of the neck.  Like the lumbar spine, the neck also has a group of core muscles that are specifically designed to insure proper cervical segmental stability and to maintain proper head posture.  When weakness and dysfunction are present within this group of muscles, there is often ongoing neck pain that can lead to headaches.

Muscles of the cervical neck “core” include the deep neck flexors and deep neck extensors.  Most people don’t know the names or how to spell these rarely talked about muscles.  For those who like the nitty gritty details, the deep neck flexor muscles include the longus colli and longus capitis.  The deep neck extensor muscles include the multifidus and the semispinalis cervicis.  The sub occipital muscles (including the rectus capitus posterior major and minor) and the obliquus capitus superior and inferior also play a role in cervical stability.  These muscles as a group make up the core muscles for the cervical spine.

When classifying muscles, and especially the cervical muscles, it can be useful to think of them conceptually as global movers and local stabilizers. 

Global movers are involved in the generation of torque and produce movement.  They function more like a light switch, either moving your head or not.  When dysfunctional, there are spasms, pain, and a restricted range of movement.

Local stabilizers are the deeper muscles that control segmental movement and neutral positioning of a joint and the head.  Their activity is tonic (always on).  It’s like a light switch that is always on, but with a dimmer controlling the intensity.  Local stabilizers operate at much lower levels of contraction for long periods of time.  Dysfunction in the local muscles results in the inhibition of muscle function, delayed timing or recruitment of when the muscle is stabilizing which causes loss of segmental control and poor cervical vertebral joint positioning.  This is often associated with chronic neck pain and headaches as well as muscle spasms in some of the larger muscles (such as the upper trapezius) as it attempts to compensate for the underlying muscle inhibition.

The neck presents a unique challenge of both mobility and muscularly speaking.  It requires intricate muscular control to balance the weight of the head in space.  The neck also moves the head through a large range of motion available; all while positioning it accurately to allow us to use our senses (sight, smell, hearing, and taste) most effectively.

Mobility and stability are both vitally important to how the neck functions.  This is why the deep segmental stabilizing muscles are extremely important.  These deep core muscles (also known as the “inner unit”) have been shown to weaken in the presence of neck pain or injury regardless of the cause.  As part of a compensation pattern, one will often find that the prime mover muscles at the front of the neck, called the SCM (sternocleidomastoid muscle), become overactive trying to protect the neck.

Unfortunately, this creates excessive shear and compression forces on the neck which brings the head forward into the poking chin posture.  This dysfunction pattern tends to persist even when the pain subsides unless properly retrained.  This may explain why so many people experience recurrent episodes of neck pain.  Discover why it’s important to insure proper cervical core strength in order to not only alleviate neck pain and headaches, but also to prevent them from reoccurring.

Most of the time neck pain is mechanical in nature.  This means that there is a structural or mechanical issue affecting proper motion in the neck leading to either neck pain or headaches.  Since the trigger is mechanical (starting or worsening with certain movements), it can just as easily be reduced or eliminated if the correct movements can be initiated.  Mechanical neck pain is often experienced as cervical pain, headache pain or other correlated pain patterns in your upper back and down your arms (even to your fingers).

Neck Pain (Cervicogenic Pain) Symptoms include:

  • Pain in the front of your head, behind your eyes or side of your head.
  • Pain which begins from your neck that extends between your shoulder blades and upper shoulders.
  • Pain which is exacerbated or changed by certain neck movements or neck positions.
  • Pain which is triggered by pressure applied to the upper part of the neck near the base of the skull (known as the sub occipital area) or in the upper trapezius area.
  • Pain down one or both arms.  It can be felt as far as your fingers.
  • Stiff neck.
  • Altered or blurred vision as well as nausea, vomiting, and/or dizziness.

Potential Causes for Cervicogenic Headaches

There are plenty of reasons why one might develop neck/cervical derangements or dysfunction.  Examples include: motor vehicle accidents; sports; falls; sleeping on a poorly fitted pillow; poor posture; and carrying items that are too heavy (such as a backpack).  Chronically sustained non-symmetrical postures, stress, and a sedentary lifestyle are also potential causes.

The actual pain generating structures of the neck (listed below) vary wildly and can be difficult to pinpoint.

  • Nerve related injury or pain
  • Muscle spasms
  • Trigger points
  • Facet joint dysfunction
  • Cervical mal-alignments
  • Cervical disc issues
  • Postural dysfunction

Cervicogenic pain and headaches tend to be more common in women than men.  In general, women experience this due to minor anatomical differences.  Men tend to have muscular necks. Women tend to have longer more slender necks with less muscle to provide support to the head (meaning that there is less muscle strength for support).

Treatment for Neck Pain (Cervicogenic Pain) and Headache Pain

Research suggests the most effective management of neck pain conditions include both manual therapy (hands-on mobilization) and manipulation with specific exercises.  If you have to choose one or the other, I find that a correctly designed and implemented exercise program to be the most effective over the long term.

The first step to designing a treatment plan is by identifying a pattern to the pain.

Which head motions change or alter your neck or headache pain?  Does the pain get worse or does it improve when you turn your head?  What happens when you look up, look down, slouch or sit up straight?  What happens when you repeat this movement?

Determine how your pain responds.  This is also known as establishing a directional preference.  You might be moving in the wrong direction if the pain spreads away from the spine and down into the upper back or arm.  Stop that particular movement, and try the opposite direction.

In my experience, most episodes of cervical pain and headaches tend to respond better to cervical extension biased movements and improvements in posture.  Gaining extension in the thoracic spine is also critical to treatment.

In order to determine if extension biased (cervical retraction or extension) movements help you, I recommend starting with this exercise (as shown below).  Sit up straight, and retract your chin straight back.  Repeat 10-20 times.

Carefully monitor symptoms for peripheralization or centralization.  The rule of thumb for movement:  If the pain worsens by spreading peripherally down the arm into the hands, fingers, shoulder blade/upper back or the headache gets worse, then the condition is worsening (peripheralizing).  Stop that activity.  If the pain centralizes and returns back toward the cervical spine, and the headache pain improves (even if the pain in the neck worsens slightly), then keep moving as the condition is actually improving.

If you are unable to help or change the pain in any way, then you may need assistance from a medical provider.  For a thorough discussion and an excellent treatment resource, please refer to Treat Your Own Neck  by Robin A. McKenzie.

Once you have determined a directional preference, then you can focus on the deep core and stabilizer muscles.  For my initial neck core strengthening exercises, please refer to Deep Neck Flexion Exercises.

Once you’re able to engage the deep neck flexors, you can next progress into strengthening your scapulothoracic and postural muscles.  Be sure you are engaging the deep neck flexors during these exercises to insure proper stability of the neck.

For the I’s, T’s, and Y’s exercises (as shown below), work up to holding each position for 30 seconds.  Repeat 3 times.  Keeping the correct posture and deep cervical flexor muscles engaged during this exercise is critical to engaging the full core of the neck.

Other Treatments for Neck Pain (Cervicogenic Pain) and Headache Pain:

  • Focus on your posture.  Poor posture is the bane of modern society.  The most common example of poor posture is a forward head with rounded shoulders.  This causes excessive muscular tension throughout the cervical spine, upper trapezius region, and mid-thoracic area.  Over time, this leads to muscle weakness and dysfunction in the cervical spine and upper thoracic area.  Proper posture allows for the optimal alignment of your spine.  Neurologically speaking, this allows for your muscles to down regulate by reducing tension.  Poor posture is almost always associated with muscle knots and trigger points.  My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain is a downloadable .pdf file with my recommended stretches using foam roller exercises to address posture.  These simple exercises (with complete instructions and photos) will help you to improve poor posture and can be performed at home.

DOWNLOAD NOW: My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain

  • Manual Therapy.  An osteopathic physician, physical therapist or chiropractor can use manual therapy techniques.  This includes joint mobilization and manipulation which can be beneficial in reducing pain and addressing some of the mechanical causes.  However, manual therapy is a passive treatment.  For long term treatment and prevention, an active approach needs to be taken.  I would encourage you to perform proper exercises to insure that you have adequate cervical and upper thoracic strength and mobility.  Also, address any precipitating factors (such as poor posture).
  • Massage.  Although massage can be a form of manual therapy, it can also be thought of as separate intervention.  There are many types of body workers that can utilize many different forms of massage or manual treatments.  Many trigger points and muscle spasms will refer pain into the head (which causes the headache).  It’s important to actively and physically address the muscle tension.  This is the time to contact a massage therapist, body worker, physical therapist, athletic trainer or friend who is skillful in body work or massage to relieve the area in spasm.  The specific massage technique to use will vary according to your preference.  Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.  This can also be an effective prevention strategy.
  • Other self-mobilization tools.  Many times, a friend or massage therapist isn’t available to assist when you need the help the most.  A foam roller cannot effective reach places in the upper back or arms, so other self-mobilization tools may be necessary.  You can get creative and use a tennis ball or golf ball, but I like a specific tool called the Thera Cane Massager.  This tool allows you to apply direct pressure to a spasming muscle.  When held for a long enough period of time, the Thera Cane Massager will usually cause the muscle spasms to release and provide much needed pain relief!
  • Topical agents.  Many topical agents can help to decrease and eliminate muscle spasms.  They can also mediate the pain response helping to reduce neck pain or headache pain.  You can apply a small amount of topical agent directly over the pain area if it’s accessible and not near your eyes.  (Please use common sense).  You may find that one product works better than another.  Some of my favorite products in my medicine cabinet include:  Biofreeze Pain Relieving Gel, Arnica Rub (Arnica Montana, an herbal rub), and topical magnesium.
  • Magnesium bath.  The combination of warm water with magnesium is very soothing and relaxing.  Magnesium is known to help decrease muscle pain and soreness.  Options include:  Epsoak Epson Salt and Ancient Minerals Magnesium Bath Flakes.  I find that the magnesium flakes work better, but they are significantly more expensive than Epson salt.
  • Acupuncture.  I am personally a big fan of acupuncture.  It is very useful in treating all kinds of medical conditions.  It can be particularly effective in treating headaches, muscle trigger points, muscle cramps, spasms, and pain as it addresses the issues on multiple layers.  Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  • Medications.  Medications can be an effective short term solution to headache pain, but I strongly encourage you to transition off of medications over time.  In some cases, prescription medications may be used initially to help you tolerate the pain as you work toward prevention.  Please speak to your physician regarding prescription options.
  • Speak with your Physical Therapist (PT) or Physician (MD or DO).  If you are suffering with neck pain and headaches, there are options.  Please speak to your medical provider to determine if other causes are contributing to the problem.  Physical therapy is very effective treatment for those suffering with neck pain and headaches.  The American Physical Therapy Association (APTA) offers wonderful resources to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Don’t give up hope!  Neck pain and headaches can be difficult to manage, but with proper care, most of the pain can be cured or effectively managed.  Begin by implementing one or two of these treatment tips, then assess how well they worked for you.  If the technique helped, continue with it then implement another strategy.

If you suffer from neck pain and headaches, which treatments have worked the best for you?  Please share below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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Cervicogenic Headaches: A Real Pain in the Neck (and Head)

Cervicogenic headaches are a certain type of headache in which the head pain is specifically caused by an issue in the cervical spine.  Cervicogenic pain is often a trigger for other types of headaches, such as migraines or tension headaches.  As a physical therapist, I find it more effective to classify cervicogenic headaches separate from tension headaches.  Tension and cervicogenic headaches may be treated similarly, but in many cases, it depends on the actual dysfunction present.

Young man experiencing neck pain against a white background

Cervicogenic headaches are almost always mechanical in nature.  This means that there is a structural or mechanical cause in the neck which is leading to the headache pain.  Since the trigger is mechanical, these headaches can come on very suddenly with certain movements and can also be reduced or eliminated quickly if the correct movements can be initiated.  When the cervical spine is the cause of the pain, you may experience cervical pain, headache pain, and other correlated or referred pain in your upper back or down your arms (even to your fingers).

Cervicogenic Headache Symptoms include:

  • Pain in the front of your head, behind your eyes or side of your head.
  • Pain which begins from your neck and extends to between your shoulder blades or upper shoulders.
  • Pain which is exacerbated or changed by certain neck movements or neck positions.
  • Pain which is triggered by pressure applied to the upper part of the neck near the base of the skull (known as the suboccipital area) or in the upper trapezius area.
  • Pain down one or both arms and can be felt as far as your fingers.
  • Stiff neck.
  • Blurred vision.
  • Nausea, vomiting, and/or dizziness.

Potential Causes for Cervicogenic Headaches

There are plenty of reasons why one might develop cervical derangements or dysfunction.  Examples include:  motor vehicle accidents; sports; falls; sleeping on a poorly fitting pillow; poor posture (especially when texting); and/or carrying items that are too heavy (such as a backpack).  Chronically sustained non-symmetrical postures, stress, and/or a sedentary lifestyle are also potential causes.

The actual pain generating structures of the neck (listed below) also vary wildly and can be difficult to pinpoint.

  • Nerve related injury or pain
  • Muscle spasms
  • Trigger points
  • Facet joint dysfunction
  • Cervical mal-alignments
  • Cervical disc issues
  • Postural dysfunction

Cervicogenic pain and headaches tend to be more common in women than men.  In general, women experience this due to an anatomical difference.  Men tend to have more muscular necks while women tend to have more long and slender necks with less muscle to provide support to the head (meaning that there is less muscle strength for support).

Treatment for Cervicogenic Headaches

In cases of mechanical pain, you should be able to alter and change your neck or headache pain within a short period of time.  The first step is to establish a directional preference by identifying a pattern to the pain.

Which head motions change or alter your neck or headache pain?  Does the pain get worse or does it improve when you turn your head?  What happens when you look up, look down, slouch or sit up straight?  What happens when you repeat this movement?

Determine how your pain responds.  If it spreads away from the spine and down into the upper back or arm, beware that you are moving in the wrong direction.  Stop that particular movement, and instead try the opposite direction.

In my experience, most episodes of cervical and headache pain tend to respond better to cervical extension biased movements and improvements in posture.  Often, gaining extension in the thoracic spine is also critical to treatment.

In order to determine if extension biased (cervical retraction or extension) movements help you, I recommend starting with this exercise (as shown below).  Sit up straight, and retract your chin straight back.  Repeat 10-20 times.

cervicalextensionexercise_collage_960pxwide

Carefully monitor symptoms for peripheralization or centralization.  The rule of thumb for movement:  If the pain worsens by spreading peripherally down the arm into the hand, fingers, down into the shoulder blade/upper back or the headache is worsening, then the condition is worsening.  Stop that activity.  If the pain centralizes and returns back toward the cervical spine, and the headache pain improves (even if the pain in the neck worsens slightly), then keep moving as the condition is actually improving.

If you are unable to help or change the pain in any way, then you may need assistance from a medical provider.  For a thorough discussion and an excellent treatment resource, please refer to Treat Your Own Neck by Robin A. McKenzie.

Other Treatments for Cervicogenic Headaches:

  • Exercise.  A primary treatment modality and prevention technique is exercise.  Exercise in general has been shown to be beneficial in treating and preventing cervical pain and headaches.  However, a specific exercise program designed to maintain cervical and thoracic mobility and strength should be the main portion of your treatment.  Focus on your thoracic mobility (particularly, into extension).  Work on cervical stabilization exercises that involve the muscles that support your head and neck.
  • Focus on your posture.  Poor posture is a bane of modern society.  The most common example of poor posture is a forward head with rounded shoulders.  This causes excessive muscular tension throughout the cervical spine, upper trapezius region, and mid-thoracic area.  Over time, this also leads to muscle weakness and/or dysfunction in the cervical spine and upper thoracic area.  Proper posture allows for the optimal alignment of your spine.  Neurologically speaking, this allows for your muscles to down regulate by reducing tension.  Poor posture is almost always associated with muscle knots and trigger points.  My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain is a downloadable .pdf file with my recommended stretches and exercises to address posture.  These simple exercises (with complete instructions and photos) will help you to improve poor posture and can be performed at home.

DOWNLOAD NOW: My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain

  • Massage.  Many trigger points and muscle spasms will refer pain into the head (which causes the headache).  It’s important to actively and physically address the muscle tension.  This is the time to contact a masseuse, physical therapist, athletic trainer or friend who is skillful in body work and massage to relieve the area in spasm.  The specific massage technique to use will vary according to your preference.  Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.  This can also be an effective prevention strategy.
  • Foam roller.  The foam roller allows you to perform self-massage and tissue mobilization.  The foam roller is a wonderful tool to prevent muscle cramping and spasms.  Please refer to the following posts for more information:  Foam Rolling For Rehabilitation and 5 Ways to Improve Range-Of-Motion.  I highly recommend a foam roller to help aid in your recovery.
  • Other self-mobilization tools.  Many times, a friend or masseuse isn’t available to assist when you need the help the most.  A foam roller cannot effective reach places in the upper back or arms, so other self-mobilization tools may be necessary.  You can get creative and use a tennis ball or golf ball, but I like a specific tool called a Thera Cane Massager.  This tool allows you to apply direct pressure to a spasming muscle.  When held for a long enough period of time, the Thera Cane Massager will usually cause the muscle spasms to release and provide much needed pain relief!
  • Magnesium.  A deficiency in magnesium is often associated with headache symptoms and can also heighten the pain response.  Take magnesium orally (such as Mag Glycinate in pill form) or apply it topically in order to help mediate the pain response.
  • Topical agents.  Many topical agents can help to decrease and eliminate muscle spasms or mediate the pain response which can help to reduce headache pain.  You can apply a small amount of the topical agent directly over the headache pain area if it’s accessible and not near your eyes.  (Please use common sense.)  You may find that one product works better than another.  Some of my favorite products in my medicine cabinet include:  Biofreeze Pain Relieving Gel; Arnica Rub (Arnica Montana, an herbal rub); and topical magnesium.
  • Magnesium bath.  The combination of warm water with magnesium is very soothing and relaxing.  Magnesium is known to help decrease muscle pain and soreness.  Options include: Epsoak Epson Salt or Ancient Minerals Magnesium Bath Flakes.  I find that the magnesium flakes work better, but they are significantly more expensive than Epson salt.
  • Acupuncture.  I am personally a big fan of acupuncture.  It is very useful in treating all kinds of medical conditions.  It can be particularly effective in treating headaches, muscle trigger points, muscle cramps, spasms, and pain as it addresses the issues on multiple layers.  Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  • Manual Therapy.  A physical therapist or chiropractor can use manual therapy techniques which can be beneficial in reducing pain and addressing some of the mechanical causes.  However, manual therapy is a passive treatment.  For long term treatment and prevention, an active approach needs to be taken.  I would encourage you to perform proper exercises to insure that you have adequate cervical and upper thoracic strength and mobility.  Also, address any precipitating factors (such as poor posture).
  • Medications.  Medications can be an effective short term solution to headache pain, but I strongly encourage you to transition off of medications over time.  In some cases, prescription medications may be used initially to help you tolerate the pain as you work toward prevention.  Please speak to your physician regarding prescription options.
  • Speak with your Physical Therapist (PT) or Physician (MD).  If you are suffering with headache and muscle tension/pain, there are options.  Please speak to your medical provider to determine if other causes are contributing to the problem.  Physical therapy is very good at assisting those suffering with these types of headaches.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Don’t give up hope!  Headache pain is difficult to manage, but with proper care most headache pain can be cured or effectively managed.  Begin by implementing one or two of these treatment tips, and then assess how well they worked for you.  If the technique helped, continue with it and then implement another strategy.

If you suffer from cervicogenic headaches, which treatments have worked the best for you? Please share below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

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Prevention and Treatment Strategies for Tension Headaches

Approximately 15-20% of the population will suffer from headaches at any given time.  Headaches can range from mild to severe with symptoms varying wildly.  It’s one of the top medical ailments for which people seek treatment, and tension headaches are the most common type of headache.  Tension headaches are often related to tension in the muscles of the head, neck, and jaw and are frequently stress related.  The actual physical cause is still not fully understood, but it’s likely linked to how the brain and nervous system perceives muscular pain and stress.  The good news is that tension headaches are very treatable!

Young woman having migraine

Tension headaches are categorized as either episodic (meaning that you experience less than 15 headaches per month) or chronic (meaning that you experience more than 15 per month).  They are nearly as frequent in children and teens as adults.  Women tend to experience them more often than men by nearly two to one.

Tension Headache Symptoms include:

  • The pain tends to wax and wane in severity (sometimes, throbbing or pulsing occurs).
  • The pain is often described as pressure like and is typically felt on both sides of your head.
  • The pain typically impacts the whole head, but it may begin in the back of your head or above your eyebrows.  It’s typically painful around the temple area of your head and/or back of your head and neck.
  • Many describe the pain as a severe tightness (like a vise grip) around the forehead or like a cap or band-like sensation which encircles their skull.
  • The pain tends to come on gradually.  Even at maximum intensity, it isn’t typically incapacitating.  (Most people are able to continue with their daily activities despite the pain.)

Potential Triggers for Tension Headaches include:

  • Stress
  • Anxiety
  • Impaired sleep (fatigue)
  • Low blood sugar from improper eating
  • Hunger
  • Eye strain
  • Overexertion
  • Muscle strains and pain
  • Muscle tension
  • Cervical dysfunction (cervicogenic)
  • Poor posture
  • Hormonal changes and/or menses
  • Foods such as processed meats, gluten, red wine, and dairy
  • Environmental factors such as poor air quality, certain smells, and different chemicals that are inhaled or applied topically on the body.

Treatment for Tension Headaches

In most cases, effective treatment needs to be multifactorial as there are likely multiple triggers causing the headache.  In general, treatment needs to focus on both the prevention of the tension headache and methods of dealing with an active headache as both tend to interrelate.

Prevention for Tension Headaches:

To effectively manage (and ultimately, prevent) tension headaches, effective stress management and elimination of known triggers are primary treatment strategies.

  • Stress management.  Effective stress management should not be overlooked as an important treatment modality.  There are many different methods to help you manage stress more effectively.  Common methods include meditation, journaling, and yoga.  You may also need to reconsider certain friendships and relationships in your life.  The key to effectively managing stress is to find an enjoyable activity, and then stick with it.  This is a process–a journey (not a destination).
  • Eliminate food triggers.  Many foods can trigger headaches.  An effective management strategy will be to identify and then eliminate food triggers.  We may not even be aware of how negatively certain foods affect us.  If you choose to eliminate your trigger foods, you will be amazed about how well you start to feel in general.  Common food triggers include:  red wine, aged meats or cheese, dairy products, and gluten.  Addressing food triggers is a critical step in treatment.  I recommend that you take an IgG food sensitivity test.  IgG is an immunoglobulin antibody found in the body.  This test can help to determine if certain foods are causing your body to react in a negative way.  Addressing any sensitivities and possible gut or gastrointestinal issues can be very helpful in treating both tension and migraine headaches.  Please seek assistance from a functional medicine doctor who specializes in headaches and gastrointestinal issues if your symptoms are correlated with any food triggers.
  • Eliminate caffeine.  This can be very tough because caffeine tends to be helpful in reducing initial symptoms.  Chronic caffeine use (particularly in headache suffers) is known to cause rebound headaches (another sub classification of headaches).  Rebound headaches occur when the same substance that helps to reduce symptoms will also cause the next headache to happen.  Eliminating caffeine initially is difficult as it may trigger another headache.  However, long term elimination of caffeine from your diet can be very effective in preventing headaches.  Just watch out for over the counter (OTC) medications that contain caffeine as an active ingredient.
  • Focus on your posture.  Poor posture is a bane of modern society.  The most common example of poor posture is a forward head with rounded shoulders.  This causes excessive muscular tension throughout the cervical spine, upper trapezius region, and mid-thoracic area.  Over time, this also leads to muscle weakness in the cervical spine and upper thoracic area.  Proper posture allows for the optimal alignment of your spine.  Neurologically speaking, this allows for your muscles to down regulate by reducing tension. Poor posture is almost always associated with muscle knots and trigger points.  My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain is a downloadable .pdf file with my recommended stretches and exercises to address posture.  These simple exercises (with complete instructions and photos) will help you to improve poor posture and can be performed at home.

DOWNLOAD NOW: My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain

How to Treat when you’re experiencing a Tension Headache:

  • Fix your posture.  Poor posture is one of the most common causes of muscle spasming and pain.  This is particularly true if you spend a good portion of your day sitting.  If you’re already experiencing a headache or you feel like one might be starting, I highly recommend that you initiate my stretching protocol (as noted above).
  • Massage.  Many trigger points and muscle spasms will refer pain into the head (which causes the headache).  It’s important to actively and physically address the muscle tension.  This is the time to contact a masseuse, physical therapist, athletic trainer or friend who is skillful in body work and massage to relieve the area in spasm.  The specific massage technique to use will vary according to your preference.  Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.  This can also be an effective prevention strategy.
  • Foam roller.  The foam roller allows you to perform self-massage and tissue mobilization.  The foam roller is a wonderful tool to prevent muscle cramping and spasms.  Please refer to the following posts for more information: Foam Rolling For Rehabilitation and 5 Ways to Improve Range-Of-Motion.  I highly recommend a foam roller to help aid in your recovery.
  • Other self-mobilization tools.  Many times, a friend or masseuse isn’t available to assist when you need the help the most.  A foam roller cannot effective reach places in the upper back or arms, so other self-mobilization tools may be necessary.  You can get creative and use a tennis ball or golf ball, but I like a specific tool called a Thera Cane Massager.  This tool allows you to apply direct pressure to a spasming muscle.  When held for a long enough period of time, the Thera Cane Massager will usually cause the muscle spasms to release and provide much needed pain relief!
  • Magnesium.  A deficiency in magnesium is often associated with headache symptoms.  Most people are deficient in the amount of magnesium they consume on a regular basis.  You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.
  • Topical agents.  Many topical agents can help to decrease and eliminate muscle spasms which can help to reduce headache pain.  You can apply a small amount of the topical agent directly over the headache pain area if it’s accessible and not near your eyes.  (Please use common sense.)  You may find that one product works better than another.  Some of my favorite products in my medicine cabinet include:  Biofreeze Pain Relieving Gel; Arnica Rub (Arnica Montana, an herbal rub); and topical magnesium.
  • Magnesium bath.  The combination of warm water with magnesium is very soothing and relaxing.  Magnesium is known to help decrease muscle pain and soreness.  Options include:  Epsoak Epson Salt or Ancient Minerals Magnesium Bath Flakes.  I find that the magnesium flakes work better, but they are significantly more expensive than Epson salt.
  • Acupuncture.  I am personally a big fan of acupuncture.  It is very useful in treating all kinds of medical conditions.  It can be particularly effective in treating headaches, muscle trigger points, muscle cramps, spasms, and pain as it addresses the issues on multiple layers.  Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  • Medications.  Medications can be an effective short term solution to headache pain, but I strongly encourage you to transition off of medications over time.  Many over the counter (OTC) medications contain caffeine which can lead to another type of headache called a rebound headache.  This occurs when the medication wears off and triggers another one. This is common with medications such as Excedrin which contains caffeine.  Other types of medications include acetaminophen, aspirin, Ibuprofen, and Naproxen.  In some cases, prescription medications may be used initially to help you tolerate the pain as you work toward prevention.  Please speak to your physician regarding prescription options.
  • Speak with your Physical Therapist (PT) or Physician (MD).  If you are suffering with headache and muscle tension/pain, there are options.  Please speak to your medical provider to determine if other causes are contributing to the problem.  Physical therapy is very good at assisting those suffering with these types of headaches.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Tension headaches are a common and debilitating problem.  Although this is not an exhaustive list of treatment options, it offers many different and effective methods for you to consider.  In many cases, the techniques utilized to treat an active headache are also effective in prevention.

In nearly all cases, the frequency of tension headaches can be reduced and eliminated in general.  The key is to acknowledge that you are not powerless when addressing this type of headache.  However, there isn’t just one magic cure for the headache either.  Effective treatment will likely be multifactorial.  Begin by implementing one or two of the strategies, and then assess how well they worked for you.  If the technique helped, continue with it and then implement another strategy.  Create a plan with specific strategies for prevention in addition to knowing beforehand as to how you will treat an active headache.  This will empower you to recognize that you have control and are not destined to have headaches forever.

Can you share any prevention tips or treatment techniques that have worked for you when dealing with a tension headache?  Please leave your comments below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

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Q & A: Spinous Process Fracture

Q.  My son was recently injured in a weight room accident that resulted in a C7 spinous process fracture. The neurosurgeon says not to worry about it and that he can return to sport in six weeks.  He is a very talented athlete, and he’s trying to get a college football scholarship.  I’m concerned for his safety and scholarship prospects.  Do you have any advice? -Jennifer

A.  I am so sorry to hear about your son’s injury, Jennifer. Weight lifting is such a critical component to any training program as well as for those who are trying to maintain muscle mass and general health. Sadly, accidents happen and can be very serious. However, weight training will be an ongoing critical training component if your son is to compete in football at a collegiate level.

Thank you for letting me share his imaging pictures. Viewing the imaging allows for a better discussion, but please note that I have not evaluated your son.  The following advice is only for the purpose of general discussion.

Spine_Collage

(Left: X-ray of C7 fracture. Right: CT Scan of C7 fracture.)

As you can notice on the imaging provided, only the spinous process was injured. Although close to the lamina of the vertebra (which has a primary role of protecting the spinal cord), it was not injured.  This was confirmed by the physician’s physical exam, X-rays, and CT Scan. I’m glad that the injury was taken seriously with appropriate medical follow up.  One should never take unwarranted risks when evaluating spinal injuries.

This particular fracture is also known as a Clay Shoveler’s Fracture. This occurs when the end of the spinous process is either broken off by a physical impact (as in the case of Jennifer’s son when the barbell hit his neck) OR as a result of the muscle pulling so hard that it breaks the bone and literally tears off part of the spinous process.  The role of the spinous process, particularly in the cervical region, is to help limit cervical hyper extension.  More importantly, the spinous processes are there as an attachment point for muscles and ligaments.

C7 is the largest cervical vertebrae in the neck. The C7 vertebra is right in the middle of transition from the cervical spine to the thoracic spine and is home to many fascial attachments and muscular attachments from the neck and shoulder girdle.  Many of the deeper neck extensors and rotators such as the splenius capitus and splenius cervicis as well as the trapezius, rhomboids and serratus posterior muscles have C7 attachment points.

Typical Symptoms

In most cases, there is pain immediately after the injury which is often described as a burning or “knife-like” stabbing pain.  Other symptoms include muscle tightness and sharp pain that increases with repeated activity and movement of the neck or shoulder girdle. The pain is often described as feeling similar to a severe muscle strain in the upper back.  The area of fracture as well as the nearby spinous processes is typically very tender as are the nearby muscles.

If only the spinous process is injured, you should not see any neurologic symptoms. You will likely see loss of cervical motion and possibly shoulder motion as those motions will cause muscles to pull directly on the site of injury which limits one’s desire to move.  Symptoms are typically worse with the head down or when the arms are active in front of the body (such as driving or working at the computer).

Treatment Considerations

Bone healing is a complex process and will differ significantly among individuals. Factors affecting bone healing include:  the type of fracture and the patient’s age; underlying medical conditions; and nutritional status.  For a person with good health status, the bone will take on average six to eight weeks to heal to a significant degree.  In general, children’s bones heal faster than those of adults.

However, with a spinous process fracture that is separated to this degree, the bone will most likely never heal. The bone will not re-attach itself back to vertebrae.  When this occurs, it’s known as a non-union.  Scar tissue and fascia will surround the injury site and in most cases, form a solid fibrous pseudo-union between the two pieces of bone.  In most cases, there will be no deleterious effects from the injury and healing process.  Like bone healing, this process typically takes six to eight weeks for most individuals.

Acutely there is likely to be pain, but long-term pain typically subsides. However, as with all injuries, there is the risk of chronic pain or long-term irritation to the area associated with the muscle and tendon that insert/attach onto the spinous process involved in the injury.

Pain Management

Initially, I don’t recommend treating with NSAIDS (non-steroidal anti-inflammatory medication) as there is research that indicates that the healing response could be delayed. Instead and whenever possible, I would recommend other alternatives for pain management like applying heat or ice. Typically no more than 20 minutes per hour would be recommended, and don’t apply heat or ice directly to the skin (use a towel as a barrier).

Pain medication, such as acetaminophen, is always an option if recommended by your physician. You may also want to consider utilizing topical agents, which can help to decrease pain and muscle spasms. The method of action varies greatly according to the product used.  You may find that one product works better than another.  Some of my favorite products in my medicine cabinet include:  Biofreeze Pain Relieving Gel; Arnica Rub (Arnica Montana, an herbal rub); and topical magnesium.

Another option is oral magnesium. You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates. Taking additional magnesium (particularly at night) can help to reduce muscle cramps and spasming.  It is also very helpful in reducing overall muscle soreness and aiding in a better night’s rest.  Most people are deficient in the amount of magnesium they consume on a regular basis.  I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose as needed.  I would caution you that taking too much magnesium can lead to diarrhea.  Mag Glycinate in its oral form is the most highly absorbable.  Although not as absorbable, Thorne Research Magnesium Citrate and magnesium oxide can also be beneficial.

Soft tissue massage of the adjacent muscles as well as electrical stimulation can both be used to reduce pain.  If pain persists, please discuss the options with your physician.

Activity Modification and Exercise Considerations

Activity involving the head, neck, and shoulders should be limited initially. In some cases, the physician may ask that a cervical collar be worn for several weeks.  Opinions on this vary greatly and will be dependent on the exact location of the fracture.

The basic idea is to avoid heavy use of the muscles that would specifically pull on the injury site. This would include muscles that flex, extend, rotate or side bend the head as well any arm movements that move the shoulder.  This would obviously include any type of heavy lifting or placing anything on top of the injury site like a barbell.

Although this seems very limiting, you can still move the neck and shoulders. Gently perform range of motion (ROM) of the neck and shoulders to maintain full mobility. This will also help to limit pain and muscle spasms of the surrounding tissues.  The idea is to limit extreme movement, limit the movement under load, and limit the speed of movement.

I would specifically limit most activity for at least six to eight weeks to insure an adequate amount of scarring has occurred. In addition to the above noted limitations, I also wouldn’t perform any activities that would be jarring to the body (such as jogging).  If you want to maintain your cardiovascular endurance, you could peddle on a stationary bike while keeping your upper body mostly relaxed.

At around the four to six week mark, I would slowly start working on the cervical extensor and shoulder girdle muscle exercises (as demonstrated below).  You will want to engage the muscles symmetrically as to not cause asymmetrical pulling over the injury site.  These exercises will help to engage the muscles (the cervical extensors and scapular muscles, including the rhomboids and trapezius muscle) specifically used to stabilize the injury site.

ITYExerciseCollage

Begin by performing these I’s, T’s, and Y’s exercises on a Thera-Band Exercise Ball. Start slowly without resistance.  Keep your chin tucked and head aligned with the body.  Move your arms slowly up and down in each position of I, T, and Y.  Start with 10 repetitions for 3 second holds, and then progress the number of repetitions as long as there is no pain.

Once you can easily and pain free perform 20 repetitions with 3 second holds, add a 1-2 pound weight in each hand and start the progression initially at 10 repetitions.  Be sure to always let pain guide the progression.  The exercise should remain pain free.

After the six to eight week mark, initiate a slow, but steady return to exercise. Start with lower extremity exercises such as the leg press, body weight lunges, squats or step ups.  During this time, progress with targeted exercises designed to strengthen the muscles of the mid trapezius, rhomboids, and neck extensors.

Let pain guide your progression. If you perform an activity that causes pain near the injury site, then that activity should continue to be avoided in the short-term.  Continue to perform exercises bilaterally to be sure that the force/pull over the injury site is symmetrical.  For example, when you start on rowing, then it should be a two-handed row and not a one-handed version.

Progression of exercise of the associated muscles should be slow and again, pain should be carefully monitored. Any pain provoking movements early in the rehabilitation phase should be avoided.  When returning back to weight training, start with a weight approximately 50% of your prior max.  Work within that weight for a week or two, and then slowly progress back to the prior weight used (depending on your symptoms).

You may also return to light jogging. If there is no increase in your pain level, then slowly progress back into full running and sprinting.

Exercises to avoid for at least twelve weeks include: barbell squats; overhead press; power cleans; squat cleans; and snatches.  Avoid anything that would put direct pressure over the injury site or exercises that include a speed and power component under load (such as the power clean).

Rehabilitation Recap

Due to the amount of information presented, I want to re-iterate the important parts of the rehabilitation process. Be sure that you have your physician’s clearance prior to resuming activity.

0-4 weeks: This is the time for pain management and activity modification. You want the area to scar down.  Exercise and activity should be limited although you should maintain full range of motion (ROM) of the neck and shoulder girdle if possible.

4-6 weeks: Initiate a cervical stabilization program and scapulothoracic exercises starting without any resistance.  Perform the I’s, T’s, and Y’s exercises on an exercise ball (as demonstrated above).  Progress with these exercises and continue with cardiovascular exercise such as riding a stationary bike.  You may also start bench pressing, but begin light and monitor your pain level.

6-8 weeks: Progress with shoulder and upper back exercises. Be sure to use two-handed movements.  Depending on your pain level and strength, lower body exercises can be initiated.  Begin with body weight exercises, and then progress to resistive exercises.  Continue to limit direct pressure over the injury site or asymmetric forces.  Lower body exercises, such as the leg press and dead lift, may be started.  Exercise should be mostly pain free.  If you experience pain during an exercise or movement, discontinue for now and then retry it in a week or two.

8-12 weeks: During this phase, slowly start tapering up on all activity.  During this time, you can progress your jogging to eventually sprinting as well as road bicycling.  You can progress back into lower extremity exercises as tolerated as long as there isn’t any significant associated pain at the injury site.  Focus on neck and upper extremities exercises with two-hands/arms bilateral exercises.  Focus on exercises that develop strength in the muscles surrounding the injury site without causing increased pain or asymmetrical force.  The preference is for two-arm movements for now.  This is also the time to start working on thoracic mobility to insure the entire vertebral chain can move freely.  Be sure to have full shoulder and cervical mobility.  Continue to avoid any specific pressure on the injury site.  If you haven’t already, you could start the following:  dead lifting; front squat; and lunges with load.

12+ weeks: Return to full activity. However, let pain and common sense continue to be your primary guide.  At this stage, you can return to light squatting.  I recommend a low-bar position as this typically lines up just below the spine of the scapula and should be below the C7 injury site.  Start single arm movements, such as a one-armed row, as well as power movements, such as the clean and snatch.  You can also initiate overhead lifting.  The key is to progress slowly and see how your body responds.  Begin with 50% of the load used prior to your injury.

If you don’t already own a copy, I would highly recommend that you purchase Starting Strength: Basic Barbell Training by Mark Rippetoe. This text should be regarded as the authority on strength training and should be used as a guide for beginners to advanced weight training enthusiasts.

Once a full return to weight training activities has been accomplished, a full return to sport should also be possible. Any sports that involve high impact, such as football or mixed martial arts, should have your physician’s approval in order to insure that the fracture is stable.  In most cases, the level of pain present will be a great indication of how stable the injury site is.

If you are unsure about how to properly progress in your training and rehabilitation, I recommend that you work with a highly qualified trainer or sports medicine professional to insure that you are performing your particular exercise and sport in a manner that will keep you safe and the fracture stable. The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it’s a good idea to hear your physician’s opinion as well).

Good luck to your son and you, Jennifer! I hope you find this information helpful.  Thankfully, this type of injury usually results in a full return to function without many long-term deleterious effects.  The key is to allow adequate healing time, and then slowly and strategically progress back into full activity.

Have you ever suffered from a spinal fracture or avulsion fracture? Have you experienced an accident while weight training?  Please share your story below.

If you have a question that you would like featured in an upcoming blog post, please email contact@thephysicaltherapyadvisor.com. For additional health and lifestyle information, join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

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How to Avoid Upper Back Pain when Running

MTA_UpperBackPain

http://marathontrainingacademy.com/upper-back-pain

Marathon Training Academy

January 24, 2016

In this guest post for Marathon Training Academy, you will learn how to improve your posture and thoracic (upper back) mobility while strengthening your upper back postural muscles in order to eliminate pain when running.

Young woman out jogging suffers a muscle injuryImagine how much the average person actually slouches during a day. Slouching during breakfast, then hunched over the kitchen sink to wash dishes, slouching while driving a car, and then slouching while sitting at work or at a school desk. Don’t forget about slouching while texting, watching TV or using the computer. When you are not slouching, you’re bending over to clean or pick up children and/or pets. The list of slouching possibilities is endless!

Now envision your running posture. Does it look any different? Many of us run in a forward head and rounded shoulders position–a slouched posture! Runners experience many of the same aches and pains as their sedentary counter parts. Upper back and neck pain is a common occurrence. The most typical cause is almost always poor posture.  Continue Reading

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Q & A: What to Expect after Breaking a Collarbone

Q.  I fell snowboarding last weekend, and I broke my collarbone. My doctor says that I don’t need surgery and that I will be fine in a couple of months.  I want to be more proactive than that.  What should I do? -Shawn

A.  Thanks for the question, Shawn. I’m sorry to hear about your snowboarding accident.  Fractures of the collarbone (clavicle) are actually fairly common and typically result from falling on the shoulder, the collarbone or an outstretched hand.  Collarbone injuries are also very common in toddlers, typically due to a fall out of bed or tripping when running.

The collarbone attaches the sternum to the scapula (shoulder blade). Many important structures, such as nerves and blood vessels, lie just below the clavicle. However, these vital structures are rarely injured when the clavicle breaks.  Diagnosing a clavicle fracture is typically performed via X-ray. In certain circumstances, a CT Scan may be performed for a more thorough image of the injury.

RightClavicleFracture

Symptoms of a Collarbone Fracture include:

  • Pain in the shoulder or over the collarbone.
  • Difficulty raising your arm due to pain.
  • Slumping or sagging of the shoulder, typically downward and forward.
  • A grinding sensation in the collarbone area when attempting to raise the arm.
  • A “bump” forms over the collarbone. In severe cases, the bump will be similar to a piano key sticking up and will be mobile.
  • Bruising and swelling over the collarbone area.

Surgical Intervention

Depending on the severity of the injury, surgery may or may not be indicated. In most cases, a simple fracture (where the bones are still aligned) will not require surgery.  Even in cases of minor malalignment, most people will not undergo surgery.

Surgical fixation is most common when there is a significant displacement or malalignment present. The purpose of surgical fixation is to hold the bones in place while they heal.  The physician will either utilize a metal plate and screws or small pins to hold the bones in place.  Although the surgical hardware can be removed once the bones have sufficiently healed, often it will remain throughout a person’s lifetime.

Rehabilitation post-surgery is fairly straight forward and is similar to the following nonsurgical treatment recommendations. Please follow your physician’s recommendations after surgery as each procedure can be different.  Variations in recovery and rehabilitation can occur and are dependent on: the area that was fixed; the severity of the fracture; and the stability of the bone and fixation.  These factors will determine how quickly you can progress through the rehabilitation.

Nonsurgical Treatment Recommendations

Most collarbone fractures do not require surgery (particularly, if the fractured area retains its alignment). Your physician will assess the severity of the fracture.  This will determine how quickly you can progress through the stages of treatment.

A general time frame for healing (with an initial return to function) is on average 6 weeks for adults and about 4 weeks for children. Complete bone healing, remodeling, and a full return to all activities will take longer.  This will depend on your age, health status, and the severity of the injury.

PRICE (Protect, Rest, Ice, Compression, and Elevation)

  • Protect. In many cases, you will be advised to wear a sling (particularly, during your daily activities). This will help to protect the area from too much motion and activity while allowing the bone to heal in its proper place. It will also indicate to others that you have an injury, so that they may avoid knocking into you.
  • Rest. Allow the arm and shoulder time to rest and recover. Do not utilize the arm for activities that cause pain. Avoid excessive motions and use. As the pain subsides, you can slowly taper up the use of the arm by starting with simple daily activities.
  • Ice. Apply ice to the painful area–typically the sooner, the better. The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a gel pack style. A bag of frozen peas can be ideal. Individuals with poor circulation or impaired sensation should take particular care when icing.
  • Compression. It’s not easy to apply compression in this area. In most cases, it’s not necessary. In some cases, a simple ACE wrap can be used around the shoulder and collarbone area to help reduce the pain. The wrap is typically applied to help hold the shoulder in a backward and slightly downward direction.
  • Elevation. Elevation is typically not necessary unless you are experiencing excessive swelling in the affected arm and hand. You can position the arm in a slightly elevated position by using pillows while lying on your back or on the non-affected side. This would be an excellent time to apply ice, too.

Sleeping

When sleeping, try not to lie on the affected side. Hug a small pillow for comfort.  This also promotes optimal blood flow to the shoulder area.

Pain Management

Initially begin with PRICE (Protect, Rest, Ice, Compression, and Elevation).  Pain medication, such as acetaminophen, is always an option if recommended by your physician.  You may also want to consider utilizing topical agents, which can help to decrease pain and muscle spasms. The method of action varies greatly according to the product used. You may find that one product works better than another. Some of my favorite products in my medicine cabinet include: Biofreeze Pain Relieving Gel; Arnica Rub (Arnica Montana, an herbal rub); and topical magnesium.

Another option is oral magnesium. You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates. Taking additional magnesium (particularly at night) can help to reduce muscle cramps and spasming. It is also very helpful in reducing overall muscle soreness and aiding in a better night’s rest. Most people are deficient in the amount of magnesium they consume on a regular basis. I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose as needed. I would caution you that taking too much magnesium can lead to diarrhea. Mag Glycinate in its oral form is the most highly absorbable. Although not as absorbable, Thorne Research Magnesium Citrate and magnesium oxide can also be beneficial.

Supplements

Mt. Capra, an organic goat farm in eastern Washington State, offers superior quality products primarily utilizing goat based products. CapraFlex by Mt. Capra is the best bone and joint supplement I have found. It is a blend of natural herbs and spices along with glucosamine and chondroitin.  The herbal and spice formulation is designed to naturally decrease inflammation and support healing.  I recommend it to anyone recovering from an injury or attempting to prevent injury when performing at a very high level.  I personally use it, and in my practice, it has helped clients recover faster and prevent injury.  It can interfere with some blood thinning medication, so if you are on this type of medication, please check with your physician.

Vitamin D3, such as Viva Labs Vitamin D3, is critical to the absorption of calcium through the intestinal wall which is important for bone health.  Although calcium is a critical component of bone health, I cannot recommend extra supplementation because of the potential cardiac risks to over supplementation.  A healthy varied diet will typically supply adequate calcium levels (assuming that adequate Vitamin D3 levels are present for absorption and that you are avoiding drinking soda).  Vitamin D3 is also a critical nutrient in maintaining a healthy immune system.

Be sure to maintain a generally healthy diet. Give your body the needed nutrients to heal and recover quickly.

Range of Motion

Depending on the severity of the fracture, you will likely have to limit the range of motion (ROM) of the shoulder to less than 70-80 degrees of flexion (forward) and abduction (sideways) motion. You will also have to limit reaching behind your back. A person may typically wear a sling for 2-4 weeks while limiting the motion.

The initial treatment to maintain ROM is to perform the pendulum exercise (as demonstrated in the picture on the left down below). Bend forward at the waist, and let your injured arm hang down toward the ground. Make small circles with your hand, and let the momentum move your arm around effortlessly.  Try to make both clockwise and counterclockwise circles. For more instruction, please watch How to Properly Perform Pendulum Exercises.

PendulumExercise_ShoulderPulleyExercise

Around the 2-4 weeks mark, you can begin to work on regaining full forward flexion by using an over-the-door shoulder pulley (as demonstrated in the picture on the above right). Work slowly on motion for 5-10 minutes at a time. You may push though minor discomfort, but you should never experience significant pain during this process. For more instruction, please watch How to Use Shoulder Pulleys to Regain Shoulder Motion.

As flexion improves (typically after the 4 weeks mark), then you can begin to work on all other motions of the shoulder. This includes motion out to your side (abduction) and behind your back (internal rotation). The shoulder pulley can be utilized to regain these motions as well. Otherwise, you could walk your fingers up the wall when facing forward to regain flexion and sideways to regain abduction. You could use a towel to regain the motion behind your back.

Strengthening

Initially avoid lifting anything over 5 pounds. Typically around the 4-6 weeks mark (depending on severity of injury), you can begin a gentle rotator cuff strengthening program. These exercises should always be performed pain free and initially, the resistance will be very light. For specific exercises, please refer to Rotator Cuff Exercises.

The rotator cuff is a critical component to shoulder mobility. It is made up of four different muscles whose job is to make sure that the ball of the humerus (arm bone) rotates and slides properly in the socket, which is made up of the scapula. The rotator cuff allows the other major muscles of the arm, such as the deltoid and Latissimus dorsi (lats), to properly move the arm.

When there is weakness or dysfunction, it will cause rubbing of the muscle tendon on the bone. This can lead to impingement or eventually fraying and tearing. Insuring proper strength in the rotator cuff after a collarbone injury is an important component in avoiding shoulder impingement syndrome.

Return to Full Activity

Around the 8-12 weeks mark, you will likely consult with your physician to have another X-ray taken.  Once you’re cleared by your physician, you can slowly taper back into more strenuous exercises and a return to full activity.

If your injury was severe or required surgery, it may be closer to the 16 weeks mark before you can return to full activity and be cleared to lift heavier weights.  I recommend that you slowly taper back into your prior activities.  If you are experiencing pain, then back off that particular activity and try it again at a later date.

Help from a Physical Therapist (PT)

Every injury is different. If you’re experiencing pain or difficulty regaining your strength and shoulder range of motion, please consult with a physical therapist that is an orthopaedic certified specialist (OCS). The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Good luck, Shawn! I hope you find this information to be helpful and provide some relief from the pain you’re experiencing.

Have you broken your collarbone? What was your experience like?  Please share your best tips for recovery.

If you have a question that you would like featured in an upcoming blog post, please email contact@thephysicaltherapyadvisor.com. For additional health and lifestyle information, join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

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14 Tips and Strategies to Self-Treat Muscle Pain

Muscle pain is common and often occurs after exercise or activity.  Although the pain is uncomfortable, most types of muscle pain are benign and quickly pass.  Muscle aches and pains can affect your ability to compete or train at a high level.  It also can affect your sleep and mood.  Discover the possible causes of muscle pain as well as prevention and treatment strategies.

Possible Causes of Muscle Pain include:

  • Delayed Onset Muscle Soreness (DOMS). This soreness typically occurs 24-48 hours after an exercise session due to micro trauma within the muscle tissue. It tends to be worse after eccentric biased exercise where the muscle is lengthened.
  • Muscle Strain. If you strain your muscle either by over lengthening or over exerting the muscle capacity, muscle tearing may occur. Depending on the size and location of the tear, it may range from minor to severe (potentially needing surgical intervention).
  • Myofascial Issues. Layers of the myofascia (the dense, tough tissue which surrounds and covers all of your muscles and bones) may become bunched or knotted up and result in pain. This is typically due to poor posture, repetitive motion injuries or over exertion.
  • Neurological Issues. Many neurological disorders, including pinched nerves, can cause pain. Other medical conditions, such as muscular dystrophy, cause muscle dystonia.
  • Illness. Muscle pain can occur as a symptom in colds, flu, Rocky Mountain Spotted Fever, and other viral or bacterial infections.
  • Disease. Many diseases, such as Polio, Lupus, and Lyme’s Disease, cause muscle pain.
  • Medications. Certain medications, such as statin drugs for cholesterol, have been strongly associated with muscle pain.
  • Fibromyalgia. This condition causes muscle pain, joint pain, and extreme fatigue.
  • Rhabdomyolysis. A serious condition, due to either direct or indirect muscle trauma, which causes pain. It can be life threating due to the potential for kidney failure. Common causes include extreme exercise, statin medication, severe injury or illicit drug use.
  • Compartment Syndrome. A serious condition in which excessive swelling and pressure build up in a confined space. It leads to extreme muscle pain and eventually, numbness and tissue death.

This list highlights some of the many potential causes of muscle pain.  Many are benign while others are true medical emergencies.  The most common reasons include: delayed onset muscle soreness (DOMS); muscle strains; myofascial related issues due to posture and/or repetitive motion injuries; and fibromyalgia.

In order to properly treat muscle pain, first identify the cause of your muscle pain.  Can you correlate the symptoms with a certain activity or exercise?  Are you suffering from a cold or flu like symptoms?  If you are unable to correlate a reason for the pain, then you may consider consulting with your medical physician to rule out other possible causes for muscle pain.

Young man experiencing neck pain against a white background

The following tips and strategies to treat muscle soreness specifically address mechanical causes related to DOMS, minor muscle strains, and myofascial issues.  Many of these strategies are also appropriate in helping to manage fibromyalgia symptoms.

14 Tips and Strategies to Self-Treat Muscle Pain: 

  1. Fix Your Posture. Poor posture is one of the most common causes of muscle spasming and pain. This is particularly true if you spend a good portion of your day sitting. Sign up to receive my weekly blog posts via e-mail, and I will share with you My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain. These simple exercises, with complete instructions and photos, will help you to improve poor posture and can be performed at home.
  2. Massage. Contact a masseuse, physical therapist, athletic trainer or friend who is skillful in body work and massage to relieve the area in spasm. The specific massage technique to use will vary according to your preference. Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.
  3. Foam Roller. The foam roller allows you to perform self-massage and tissue mobilization. The foam roller is a wonderful tool to prevent muscle cramping and spasms. Please refer to the following posts for more information: Foam Rolling For Rehabilitation and 5 Ways to Improve Range-Of-Motion. I highly recommend a High Density Foam Roller to help aid in your recovery.
  4. Other Self-Mobilization Tools. Many times, a friend or masseuse isn’t available to assist when you need the help the most. A foam roller cannot effective reach places in the upper back or arms, so other self-mobilization tools may be necessary. You can get creative and use a tennis ball or golf ball, but I like a specific tool called a Thera Cane Massager. This tool allows you to apply direct pressure to a spasming muscle. When held for a long enough period of time, the Thera Cane Massager will usually cause the muscle spasms to release and provide much needed pain relief! I am also a big fan of the Thera-Band Standard Roller Massager. I particularly like that its firmness allows for a deep amount of pressure. If you prefer something similar, but more flexible for the boney regions of the thigh or lower leg, I recommend The Stick Self Roller Massager.
  5. Topical Agents. Many topical agents can help to decrease and eliminate muscle spasms. The method of action varies greatly according to the product used. You may find that one product works better than another. Some of my favorite products in my medicine cabinet include: Biofreeze Pain Relieving Gel; Arnica Rub (Arnica Montana, an herbal rub); and topical magnesium.
  6. Magnesium Bath. The combination of warm water with magnesium is very soothing and relaxing. Magnesium is known to help decrease muscle pain and soreness. Options include: Epsoak Epson Salt or Ancient Minerals Magnesium Bath Flakes. I find that the magnesium flakes work better, but they are significantly more expensive than Epson salt.
  7. Oral Magnesium. You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates. Taking additional magnesium (particularly at night) can help to reduce muscle cramps and spasming. It is also very helpful in reducing overall muscle soreness and aiding in a better night’s rest. Most people are deficient in the amount of magnesium they consume on a regular basis. I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose as needed. I would caution you that taking too much magnesium can lead to diarrhea. Mag Glycinate in its oral form is the most highly absorbable. Although not as absorbable, Thorne Research Magnesium Citrate and magnesium oxide can also be beneficial.
  8. Stay Hydrated. The human body is primarily made of water, which is critical for all body functions. Your muscles are approximately 80% water. Dehydrated tissues are prone to injury and pain as they struggle to gain needed nutrients to heal and repair. Dehydrated tissues are less flexible and tend to accumulate waste products. Stay hydrated by drinking water. Try to avoid beverages that contain artificial sweeteners or chemicals with names you can’t spell or pronounce.
  9. Eat Healthy. A healthy diet is critical to avoid injury, illness, and pain. Your body tissue needs nutrients to be able to perform at a high level. Avoid processed food as much as possible. Limit sugary food and add more protein and healthy fat in your diet. Maintaining a diet with adequate healthy fats is essential in providing the nutrients to support all hormone function in the body as well as support the brain and nervous system. Adequate protein intake is necessary to support muscle health and development. Give your body the needed nutrients to combat illness and function at a high level.
  10. Move More! Not only has research proven that sitting for more than two hours at a time decreases your expected life span, but extended sitting also leads to increased muscle tension, cramping, and pain. If you sit most of the day, get up and walk. If you stand most of the day, frequently change your standing posture. To optimize health and joint function, you should take each joint in your body through a least one full range of motion (ROM) every day. If you are experiencing pain, I recommend performing more frequent ROM (every 1-2 hours).
  11. Stretch. Stretching is a wonderful way to help eliminate a muscle spasm. We instinctively stretch when we feel a spasm begin. Try gently stretching (lengthening) the muscle affected by the spasm. I recommend beginning with a short 30-60 seconds stretch, then repeating as needed. If the spasm or cramp is severe, you will likely need to continue stretching several times in a row, multiple times throughout the day. Stretching should always be part of a general fitness and lifestyle program. As we age, muscle and tendons tend to lose elasticity so stretching becomes even more important. I highly recommend a daily stretching routine or participation in a group class, such as yoga, which incorporates full body stretching.
  12. Acupuncture. I am personally a big fan of acupuncture. It is very useful in treating all kinds of medical conditions. It can be particularly effective in treating muscle cramps, spasms, and pain as it addresses the issues on multiple layers. Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  13. Sleep and Rest More. Most people are not sleeping long enough or often enough to optimize health. Take a nap or go to bed earlier. Your body requires time to repair and heal as you sleep. Your body must rest in order to grow and develop. Training every day is not the best way to improve. It can lead to injury and burn out. Take a rest day and have fun. Participate in a Tai Chi or yoga class, take a leisurely bike ride or take a walk in the park.
  14. Speak with your Physical Therapist (PT) or Physician (MD). If your muscle pain cannot be correlated to a specific mechanical cause, please speak to your medical provider to determine if other causes are contributing to the problem. The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Most muscle pain and soreness can be self-managed and self-treated if you are proactive.  These tips and strategies are highly effective in managing muscle pain.  A healthy lifestyle is a lifelong pursuit.  If you are injured or not enjoying an activity, you will not stay engaged or motivated in the long term.  Seeking advice specifically from a running coach, physical therapist or physician can be beneficial.

How do you manage your aches and pains?  Which tip or strategy will you incorporate into your treatment?  Please leave your comments below.

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Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.