Headaches happen for lots of reason and can be cause by several sources- both primary and secondary. Once major “red flags” are ruled out, understanding the type of headache is important in order to have it properly addressed.
A cervicogenic headache is a secondary headache arising from a musculoskeletal dysfunction within the cervical spine, and is a disorder that many physiotherapists treat. The main players that are typically involved in generating the pain are the joints, discs, ligaments, nerves and/or muscles found in the upper portion of the neck.
Characteristics of a Cervicogenic Headache:
Pain usually one sided or one side dominant
Pain originates from the back of the neck and radiates along the forehead, orbits around the eye, temple area and ear.
Steady ache or dull, diffuse pain that travels into shoulder region
Limited neck movement especially when turning head
Tenderness to touch at the muscles at the base of the head.
Here are some exercises that would help alleviate your pain:
Cervical side flexion with chin tuck
Sit upright in a chair.
With your shoulders relaxed, relax one arm to your side.
Drop your opposite ear to your shoulder until a stretch is felt.
Using your fingers, tuck your chin in, as to resemble a double chin.
Gently release pressure with your fingers and hold this position.
Relax and repeat
2. Levator stretch Neck stretch – levator scapula
Start in a seated position.
Place the hand of the side you want to stretch down by your side.
Tilt your head forwards and to the opposite side at an angle, as if you are trying to
look at your armpit.
Keeping your back straight and upright, continue to tilt your head down until you
feel a stretch from the base of your skull down into your shoulder blade.
3. Neck stretching (Upper trapezius)
Stand up straight.
Take the hand on the symptomatic side and place it behind your back.
Take your other hand and place it on your head.
Tilt your ear directly down towards your shoulder and hold this position.
You should feel a stretch down the side of your neck.
If you believe you experience Cervicogenic Headaches get in touch with us https://physiofusion.co.nz/ for an in-depth assessment and lets knock out those headaches and decrease you dependence on pain meds
I know how hard it can be when it comes to working out and its really easy to find an excuse to avoid lockdown workouts but it’s not just about staying in shape its also about keeping active to feel mentally strong. We know that exercise does wonders for mental health and at a time where its all uncertainty, anxiety, and a daily dose of doom and gloom, we all need to work out that frustration somewhere!
If you’re struggling with a lack of motivation or negative mindsets there’s only one way to turn it all around: Take ACTION
How much exercise is enough?
You’ve heard the saying something is always better than nothing and that’s the case when it comes to exercise. The current recommendation for adults according to Best Exercises for Health and Weight Loss.org is to aim for 150 minutes of moderate intensity activity every week (or 75 minutes of vigorous intensity) with two sessions of strength building activities per week. That’s about 30 minutes of movement, five times per week.
This is a quick full body routine:
Bodyweight Squats
Stand with your feet shoulder-width apart. Engage your core muscles and gently squat down. As you squat, bend from your hips. Keep your back straight as you push your hips back and counterbalance by leaning your torso forwards. Keep your knees aligned with your toes. Your weight should be evenly on your heels and the balls of your feet, not your toes. It might help to image your are trying to sit down in a chair that is too far away from you. Tense your bottom muscles at the bottom of the squat and keep them tense as you straighten back up to the start position.
Arm dips
Start in a seated position. Place your hands on the seat of the chair and use your arms to move yourself forwards towards the front of the chair. You will need to move your feet further forwards to help your stability. From this position, use the strength of your arms to slowly lower your body directly down towards the floor and then raise yourself back up. Do not actually sit on the floor and keep your hands close in beside you. Relax and repeat.
Lunges
Stand straight with your arms to the side or on your hips. Take a large step forwards on your affected leg, then drop your hips directly down between both feet, bending your hips and knees to a 90 degrees. Push back up to the starting position, and repeat. Make sure you take a large enough step that your front knee does not travel over your foot, and ensure your knee travels directly forwards. Keep your body up straight throughout the movement.
Mountain Climbers
Adopt a plank position insuring your hands are directly beneath your shoulders.
Fully flex one hip and hold.
Extend the bent leg to the rear and repeat the movement pattern on the opposite side
The restrictions and change brought by the outbreak of COVID-19 has resulted in a great deal of control being taken from our hands; this has been anxiety provoking for many of us. Nevertheless, it’s important to re-evaluate, acknowledge and place focus upon the matters that we DO have control over so that we can gain our personal power back!
Lockdown Productivity Tips
Check in with yourself: how is your body and mind feeling. Embrace your emotions and give yourself permission to feel the way toy do.
Stay connected: Social connection is inevitably limited at the moment but catching up with people via text or facetime will help prevent feelings of isolation.
Maintain some form of routine: Maintaining a routine helps provide some structure do days which often all seem to merge into one.
Get fresh air where possible: Daily fresh air can provide an easy change of scenery when we are stuck at home most of the day.
Gentle exercise is a MUST!
Stay Hydrated: Drinking enough water is important to keep your body hydrated and makes sure your body functions properly.
Eat well- You’d be surprised how your diet can affect how you feel. Gut health in particular is linked to mental health.
Get to that “thing” you’ve been delaying for months
Pick up a good book
Learn new habits or rediscover old ones
These may seem like simple strategies but sometimes it’s the simple things that are most effective
“One day this will all be over and we will be grateful for life in ways we never felt possible”
The gratitude we will have for the things we once took for granted will be unmeasurable- getting on a plane, an impromptu visit to the cinema, a shopping spree, going to the gym, even meeting a friend for lunch at a café. Keep going, nothing lasts forever and we have so much to look forward to. In the mean time take each day as it comes, be kind, support those who are struggling and keep going! You are stronger and more resilient than you know!
You may have seen videos or posts online about people talking about a specific area of your shoulder known commonly as the “Rotator Cuff” and wondered what they were on about. Your shoulders do a lot of important things you might take for granted! They help you get something off a high shelf, comb your hair, or play a game of cricket.
It’s a complicated process that your body makes look easy. And your rotator cuff is a big part of that. It protects and stabilizes your shoulder joint and lets you move your arms over your head. It’s importance is widely used in sports like swimming, tennis and netball.
In New Zealand healthcare, shoulder injuries have one of the highest prevalence when it comes to ACC claims and overall cost. Within this, rotator cuff injuries are among the most common pathologies affecting New Zealanders. Other pathologies include acromioclavicular injuries, dislocations, osteoarthritis and frozen shoulder.
So, what exactly is the cuff and how does it influence the shoulder?
The rotator cuff (RC) is a combination of four muscles that run through and attach onto specific areas of the humeral head (top of the arm bone).
Supraspinatus, Infraspinatus, Teres minor and Subscapularis are the four muscles comprising the RC and each one plays an important role however they all contribute to shoulder stability:
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis
A thin triangular muscle that helps perform abduction
A thicker, triangular muscle that performs external rotation.
The smallest muscle of the cuff, helps with rotation as well
The largest muscle of the cuff performs internal rotation (arm behind your back!)
Many people suffer from shoulder pain, so here are the most common injuries that can happen at the rotator cuff:
Rotator Cuff Tear:
A rotator cuff tear is often the result of high levels of load over a short amount of time or a high impact force stressing one or more of the tendons/muscles. Fortunately, majority of tears are partial. Tears are more common in people with jobs that involve heavy loading or lifting or in high impact sports like rugby. It also can happen suddenly if you fall on your arm or try to lift something heavy. Common and easily treatable with conservative management by a physiotherapist, a rotator cuff tear can come right.
Rotator Cuff Tendinopathy:
A rotator cuff tendinopathy is the most common shoulder pain complaint/injury resulting in inflammation and irritation of one or more of the cuff tendons. This pathology is more common in individuals who have an occupation where repetitive use of the shoulder, particularly in an overhead position such as carpenters or painters, or individuals that play highly repetitive, throwing sports like tennis, baseball or volleyball. Once again, this injury is treatable by a physiotherapist, conservative management can be very effective in treating these injuries with a thorough, well planned exercise program to help get patients back to doing what they love.
Majority of people experience pain around the shoulder joint, with some movements being highly provocative. Tenderness on touch at the affected site is also common – this helps your physiotherapist hone in on potentially which tendon is causing those problems!
Medical management vs Physio management
Medical management will be advised by your local GP if you decide to see them first. They might prescribe NSAIDs (anti-inflammatory medications such as ibuprofen) to help with the pain you’re experiencing and recommend you see a physiotherapist. Depending on your injury as well as your ability to function, surgery may be an option if conservative medical and physio treatments don’t help. Most people get by without the need of surgery but some tears can be too large to heal without the use of surgical intervention.
Physiotherapy management is designed around reducing pain and disability, restoring range of motion and helping people return to work or sports to perform how they were prior to the injury. In the early stages of these injuries, rest and ice and/or heat are recommended to allow the inflammation to settle – then your physiotherapist will begin to introduce a detailed exercise program, this may include:
Isometric (static hold) exercises
Resisted movements using bands
Range of motion exercises to restore lost movement
Functional loading – task specific or sport specific
If this is successful, the last step is to build back up the strength that was lost over time – this is done by concentrically (against gravity) loading the affected tendons/muscles in a way that they adapt and lay down more tissue, grow and becoming stronger in hopes that you get to return to what you enjoy!
One common belief about lifting is that rounding your back when lifting an object is considered dangerous while lifting with a straight back is considered safe…
However, there is a lot of misinformation circulating around lifting mechanics and what is deemed “good technique” versus “bad technique.”
Here are some key myths and misinformation that you may have heard:
A ROUNDED BACK WHILE LIFTING OVER STRESSES THE BACK MUSCLES AND LIGAMENTS
Research has shown that regardless of lifting position, whether you’re stooped, squatting or weightlifting, your back has to produce the same amount of force. Statistically speaking, it’s not significantly different.
FLEXING THE SPINE WHILE LIFTING INCREASES THE LOAD ON THE LUMBAR DISCS
Under heavy loads, discs are unlikely to fail unless >95% flexion is achieved (which is near impossible)
With low loads, the disc is unlikely to fail unless you do thousands of repetitions continuously
Your body is an amazing adapter, this includes discs! Your discs can adapt and become more and more able to handle loads when stressed appropriately
THESE COMPOUND TO CAUSE INJURIES AND PAIN TO THE BACK MUSCLES AND DISCS
Resistance training has demonstrated through countless studies the ability to increase bone mineral density (BMD) of the lumbar spine. BMD is actually positively associated with the strength of the spinal discs and ligaments at that level. With appropriate loading and training, disc, ligament, bone and muscles are going to adapt favourably
A NEUTRAL SPINE IS SAFER, STRONGER, MORE EFFICIENT AND BETTER TO LIFT WITH
There is no significant difference between activities that encourage more spinal flexion and one’s that do not in the long term
Lifting with lumbar flexion is not a risk factor for low back pain
Research has shown lifting with a bent back is more metabolically and neuromuscularly efficient
When the spine is in extension during bent over activities, the hip is actually flexed to a greater degree – decreasing the ability for the glutes and hamstrings to create as much internal torque. Flexing the spine reduces this effect and reduces the moment arm for the hip extensors
STOP BACK PAIN & INJURIES BY LIFTING WITH A NEUTRAL SPINE
Your lumbar spine flexes every time your hip flexes! It is impossible to isolate one versus the other. It is also impossible to not flex while doing common movements
Extreme flexion however (>/=100%), may pose an increased risk under heavy loads, but not at light loads
You may still be wondering why you have back pain (stay tuned for our next blog!). Your pain may not be directly related to your lifting strategy.
Could you have pain with forward bending? Absolutely.
Is bending at the lumbar spine an increased risk for pain or injury? In the vast majority of situations, no.
If I have pain with forward bending, is it bad to temporarily limit doing so? Not at all.
Should I fear bending at the spine with or without pain or injury? No. Being fearful of flexing/moving your spine is actually a stronger predictor of disability and back pain.
Work on moving through your spine, after all it’s what it is designed to do! Choose comfortable movements and gain confidence over time, then build up your strength gradually with resistance training – try and not to push too fast, we want nice, healthy adaptation! Give your body time to adapt, back pain is not quick fix sometimes but you are resilient and with healthy, normal movements and some patience, you will be okay.
The Achilles tendon is the largest tendon in the human-body. It is a band of tissue that connects your calf muscles to your heel bone (calcaneus). This tendon primarily facilitates general mobility such as walking, running, climbing stairs, jumping, and standing on your tip toes, by helping to raise the heel off the ground.
Common Achilles Pathology
Achilles tendinitis and tendinosis are two common disorders and are typically classified as overuse injuries.
Achilles tendonitis involves inflammation of the Achilles tendon. Inflammation is the body’s natural response to injury or disease, and often causes swelling, pain, or irritation. This inflammation is typically short-lived. Over time, if this is left resolved, the condition may progress to degeneration of the tendon- Achilles tendinosis, in which case, the tendon loses its organized structure and is likely to develop microscopic tears.
There are two types of Achilles tendonitis and it is based on which part of the tendon is inflamed:
Insertional Achilles tendonitis affects the lower portion of your tendon where it attaches to your heel bone.
Non-insertional Achilles tendonitis involves fibres in the middle portion of the tendon and tends to affect younger people who are active.
In both non-insertional and insertional Achilles tendinitis, damaged tendon fibres may also calcify (harden) and often bone spurs (extra bone growth) develop with insertional Achilles tendinitis. Achilles tendonitis may also increase your risk of sustaining an Achilles tendon rupture (tear).
Causes
Typically referred to as “overuse” conditions, Achilles tendonitis and tendinosis are often caused by the sudden increase in repetitive activity involving the Achilles tendon. This can put too much stress on the tendon too quickly, that can then lead to micro-injury of the tendon fibres. Because of this ongoing stress on the Achilles, the body is not able to repair the injured tissue. The structure of this tendon is then modified, resulting in continued pain and other symptoms. The Achilles tendon also has poor blood supply that makes it more susceptible to injury and may make recovery from injury slow.
Common factors that may lead to the development of disorders of the Achilles tendon include:
Weak and/or tight calf muscles
Rapidly increasing the amount or intensity of exercise within a short span of time
Hill climbing or stair climbing exercises
Presence of bony spurs in the back of your heel
Changes in footwear – especially changing from wearing high-heeled shoes to flat shoes
Wearing poor fitting, inappropriate, or worn out shoes during sporting activities
Exercising without adequate warm-ups and stretching
A sudden sharp movement which causes the calf muscles to contract and the stress on the Achilles tendon to be increased. This can cause the tendon fibres to tear.
Excessive mobility
Poor feet positioning and biomechanics (excessive pronation and flattening of the arches of the foot)
Symptoms
Common symptoms include:
Pain and stiffness along the Achilles tendon especially first thing in the morning
Pain along the tendon or back of the heel that worsens with activity
Severe pain the day after exercising
Visible thickening of the tendon
Tenderness to touch
Bone spur
Swelling that is present all the time and gets worse throughout the day with activity
If you have experienced a sudden “pop” in the back of your calf or heel, you may have torn your Achilles tendon. Please seek urgent medical attention if you think you may have torn your tendon.
Diagnosis
If Achilles tendonitis or tendinosis is suspected, please deter from any activity or exercise which causes the pain. It is advisable to see your doctor or physiotherapist as soon as possible so that an accurate diagnosis may be made and appropriate treatment recommended.
You will be asked about the nature and duration of your symptoms and the medical professional assessing you will have a look at your foot and ankle. Ultrasound scanning may be used to evaluate the damage to the tendon and/or surrounding structures.
An MRI may be recommended if symptoms persist. X-rays may also be taken to rule out other disorders which may cause symptoms like Achilles tendonitis and tendinosis.
Treatment
Treatment will depend on the nature, severity, and length of the injury. Generally speaking, the longer the symptoms are present before treatment commences, the longer the timeframe until full recovery is attained. Full recovery may take between three and nine months.
Initial treatment options in the early stages may include:
Rest – to avoid further injury to the area
Ice – to reduce inflammation
Elevation – to reduce swelling
Non-steroidal anti-inflammatory drugs to reduce pain and inflammation.
How physiotherapy can help:
Physiotherapy typically focuses on two main areas: treatment and rehabilitation. Treatment may entail massage, shockwave therapy, acupuncture, gait re-education, and gentle stretching, whereas, rehabilitation predominantly entails strengthening of the Achilles and surrounding musculature.
Strengthening of the muscles surrounding the Achilles tendon facilitates healing in the tendon itself. Strengthening is attained through the utilization of specific exercises, that will be taught by your physiotherapist. It is common for the rehabilitation programme to take up to three months.
Pain usually one sided or one side dominant
