Myofascial Pain Syndromes of the Neck & Chronic Headaches
By Dr. Greg Fors
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We have become a society that constantly traumatizes the cervical spine, more and more individuals are suffering with chronic myofascial pain of their neck. This trauma to our neck muscles comes in two forms. First, as a society many of us sit reading or working at desks and/or computer terminals all day. This position causes individuals to sit for long periods of time with their neck in a slightly bent forward or flexed position.
To realize the stress this places on your neck muscles, imagine holding a six pound bowling ball upright in your hand in a slightly bent forward or flexed position. It would not be long before you dropped the ball from pain and fatigue. As we sit at our desks working, our muscles along the back of our neck are constantly straining to keep our head in a slightly bent forward position. These muscles under this stress overtime develop myofascial trigger points or muscle knots which can cause us neck pain, stiffness and headaches.
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The second form of trauma that is common to neck muscles in this society is acute whiplash injury from automobile accidents or slip/fall injuries. This tremendous force into neck muscles will cause myofascial trigger points or muscle knots to form, causing myofascial pain syndromes of the neck and/or chronic headaches. To realize the small amount of force needed to injure the neck, again imagine holding onto a six pound bowling ball upright in your hand but this time in a car traveling only 30 miles an hour. Then think of just coming to an immediate stop, imagine how much force would be placed on your muscles trying to keep the bowling ball from flying forward. This is why even small accidents can produce severe and chronic injuries to the neck.
There are a wide variety of physical, physiological, and environmental factors involved in the cause of chronic neck pain and/or headaches. However, very rarely headaches and even neck pain can be caused by dangerous pathological processes or diseases (e.g. tumors, infections, etc.) Because of this anyone with headaches and/or neck pain must have a proper diagnostic work-up by a competent health-care professional before beginning any home care program!
The Stiff Neck Muscle - Levator Scapula:
One of the most commonly involved shoulder-neck muscles that are injured by acute or chronic stress is the levator scapula muscle. This muscle starts at the upper inside corner of your shoulder blade and runs up the side of your neck to connect to the upper four bones (vertebra) of your spine. One study by Sola et al. found that 1/5 of healthy individuals had trigger points in levator scapula without even being conscious of it. It is also one of the most common trigger points found in the research studies. In the picture of the model you will find the trigger point of the levator scapula at the upper end of line E about a hands width below line G, near the X.
This is the trigger point that can give you that deep burning ache at the top corner of your shoulder blade and runs up your neck. You can see people at their desk reaching over their shoulder grabbing this area all the time. This myofascial trigger point is also the most common cause of neck stiffness. When someone has a hard time turning their neck to the right generally there is a trigger point on the same side in their right levator scapula muscle, located right at the top inside corner of their shoulder blade. If someone has a hard time turning to their left then it's just the opposite with the myofascial trigger point on the left top inside shoulder blade corner, just like the pain drawing demonstrates. Examine the pain drawing for trigger point location and trigger point therapy position in the picture of the model. Don't forget to stretch the levator scapula after performing myofascial trigger point therapy, see picture of the model and follow the instructions. Do the stretch slow and easy without causing yourself any pain for about 60 seconds.
The Fenix Rehab System can and should be shared with your doctor or therapist. They can help you pin-point the myofascial trigger points needing trigger point treatment. The Fenix Rehab System is an ideal home-care active therapy program to assist you and your healthcare provider in keeping you as pain-free as possible.
Levator Scapula myofascial trigger point and referral pain
X=Levator Scapula Myofascial Trigger Point
Trigger point therapy position for deactivation of the levator scapula muscle
Posterior and lateral neck and upper back muscles (pull nose to armpit)-Levator Scapula stretch
The "Coat Hanger" Muscle - upper trapezius:
The major trigger points of the upper trapezius muscle can be found by probing and pinching along the entire length of line G as shown on the model. The upper trapezius attaches to the upper boney ridge of your shoulder blade and runs up the side of your neck to connect to the back of your head. Some describe both sides of the upper trapezius forming the "coat hanger muscle," which is appropriate because you basically hang your shoulders by this muscle from the back of your head. The upper trapezius is the muscle that keeps your shoulders elevated. This is the muscle that gets involved when you find your shoulders elevated "up around your ears" because of stress and tension. This is the muscle you relax when someone tells you to "relax, drop your shoulders!" In other words this is a major muscle when it comes to neck pain and headaches from being tense and stressed-out.
If you take your left hand and reach across the front of your face to your opposite shoulder and pinch with your thumb and fore finger along that muscle ridge, you may find you have a trigger point somewhere along this muscle. Squeeze multiple areas along this muscle to see if you have any myofascial trigger points. This myofascial trigger point will refer pain up the side and/or back of your neck to the back of your head. If any of these myofascial trigger points are severe you may feel pain running around the side of your head to your temple on the same side (see pain drawing). Occasionally the pain will be felt above the eye and into the side of you face. Don't forget to switch sides and check the left upper trapezius by reaching across with your right hand.
You can now see why chronic neck pain and headaches are often caused by this muscle, leading to millions of Americans constantly taking pain meds because of stress and tension. These pain meds over time can have serious side-effects on your liver, kidney, and even heart function. Recently, the anti-inflammatory pain med Vioxx was taken off the market because of its cardiovascular side-effects.
X=upper trapezius myofascial trigger point and referral pain pattern
X=upper trapezius Myofascial TriggerPoint
Treating upper trapezius
Lateral neck muscles/upper trapezius (pull ear to shoulder)
To apply trigger point therapy to these upper trapezius trigger points you would take the longest therapeutic digit and place it in one of the most angled holes, as seen in the picture of the model. Next lie down on the platform and slide headward into the digit, as if someone was pushing down with their thumb on your trigger point. If the digit is too long and misses the trigger point then try the digit that is slightly shorter. Just take your time searching along line G for all the upper trapezius myofascial trigger points that may be causing you neck pain and/or headaches. Go slow and easy, don't over do it. If the trigger point is hypersensitive try Variable Compression Technique. You can also stroke through the myofascial trigger point by turning your head away from the digit while applying pressure, applying a Myofascial Release Technique. It's important to stretch the upper trapezius muscle after applying trigger point therapy. Follow the instructions in the picture, go slow and easy without causing any pain, gently stretching the muscle for about 60 seconds.
The "Pain in the Neck" Muscle - posterior cervical Muscles:
An important group of muscles involved in chronic neck pain and headaches are the deep posterior cervical (neck) muscles on each side of the spine. These muscles develop myofascial trigger points when we sit with our head slightly bent forward for long periods of time, as previously discussed. This means that our desk work and/or computer work can place a great burden on these muscles. Then if we work under stress we add insult to injury. These muscles can also develop severe chronic myofascial trigger points secondary to whiplash injury, as previously discussed.
These posterior cervical muscles are the deep third and fourth muscle layers of the neck and start all the way down in the middle back about half way down line D on the model and run up all the way to attach to the back of our head above line H on the model. Their myofascial trigger points run one to three finger widths lateral or away from the tips of the boney ridge (spinous processes) of upper back and neck, as indicated by line D and line H on the model. (Never place a therapeutic digit on a spinous process). These common trigger points are found along the top half of line D and continue up line H to the back of the skull (occiput).
The first trigger points located in these muscles are located on our upper back on each side of the spine. These will refer pain up the neck on each side. These trigger points are found at the upper end of line D on each side of the spine. The second myofascial trigger points are located in the middle of the neck lateral to spinous processes by 2 finger widths, (located above the base of the neck at C5-6). It is very common to have these myofascial trigger points send pain up the neck to back of the skull, on each side of the spine. These trigger points are found right above the junction where line D and line H meet on the model.
posterior cervical muscle myofascial trigger point 1 through 4
Second posterior cervical Muscle TPs around C5-C6
#3-posterior cervical muscle trigger point
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The "Headache Muscles":
Moving headward, the third muscle knots or trigger points found in these muscles are located about 2 finger widths below the back of your skull (occiput) around the hair-line towards the top of line H. These trigger points are common and are a source for headaches that start at the back of the head and run to the top of the skull. See pain drawing for location of myofascial trigger point and referral patterns. Also examine the picture of the model for position for trigger point therapy for this muscle knot.
Above the end of line H inside the hair-line on the model we find the fourth myofascial trigger points. These deep posterior cervical muscles located in the soft tissue just below the hard boney ridge the back of the skull (occiput). These myofascial trigger points on each side of the spine do not cause neck pain. These myofascial trigger points are famous for causing severe and chronic headaches that come over the side of the head to the temple and forehead to over the eye. Individuals with this headache pattern should test these muscles by reaching back and probing under their skull in this muscle to see if they can duplicate this pain pattern. Also do not forget about the myofascial trigger point in the muscle ridge of the shoulder, the upper trapezius, which also tends to send pain up the neck over the side of the head to the temple. Examine the pictures of the models for the position for trigger points therapy for these muscles.
Reminder, if you have headaches, you must have them properly diagnosed to rule out any possibility of pathology or disease (brain tumors, infections etc.) Once these have been ruled out then talk to your doctor or therapist about the role, diet, stress, and myofascial trigger points may play in your headaches. One study by Lin et al. (1995) found 100% of their subjects with cervicogenic headaches (non pathological headaches) had myofascial trigger points that triggered headaches.
The FENIX Rehab System can and should be shared with your doctor or therapist. He or she can help you pin-point the trigger points needing treatment. The FENIX Rehab System is an ideal home-care active therapy program to assist you and your healthcare provider in keeping you as pain-free and drug-free as possible.
|Third posterior cervical Muscle Myofascial Trigger Points This technique for cervicogenic headaches applies a single digit into the fourth trigger point at the top of the neck. This trigger point therapy would cause refer pain up over the side of the head to the temple and/or forehead. Go easy and slow with this take time to remove this trigger point over many treatments.|
|Fourth posterior cervical TPs treated on both sides at the same time Many times when the muscles at the back of the head develop trigger points and tighten-up, they can pinch delicate nerves causing severe headaches. The subocciptial lift utilizes two paired angle digits that gently push against the back of the skull. This causes a light traction or stretch on these muscles at the back of the head.|
|Stretch the upper posterior cervical muscles after trigger point therapy|