Headaches and stiff necks
Neck problems are the second most common thing we see as osteopaths. The pain can be restricted to the neck area but I would say that in 70-80% of cases the pain refers down to the top of the back and / or to the backs / tops of the shoulders.
Stiff necks ( wear and tear? )
Many, many people suffer from stiff necks but if it has been a long term problem ( 10/20/30 years ) the person adapts to it and doesn’t realise that their range of movement has decreased SO much. Often the first thing that becomes affected is reversing the car. Even then, most people tend to improve their mirror skills to make up for not being able to comfortably turn their heads.
Stiff necks do not usually respond very well to “forced movement” i.e the exercises given to you at the GPs. What does help is a mixture of
1/ Warmth to the area i.e wheaty bags, hot water bottles.
2/ Passive movement i.e when your neck is mobilised by another person.
3/ Acupuncture – loosening up the deeper tissues.
4/ Postural awareness.
In my view, this is where most GPs give their worst advice. Go to a GP with a stiff, sore neck and the usual path is that you will be told that is down to “wear and tear” and cannot be help. Painkillers and then maybe a visit to the physio if more GP visits are made. The physio usually gives a few exercises which turn out to aggravate the area and so are given up. End point is the person thinks they just have to put up with it for the rest of their lives. THIS IS JUST SO WRONG. The vast majority of people can have their pain, discomfort reduced by a large amount.
HEAVY HEAD SYNDROME
This is something I see regularly. Having a head that just feels “wrong” or “heavy” is usually a sign of long term postural problem. Associated symptoms are
1/ sharp pains to neck on movement – especially on looking upwards.
2/ achey shoulders / tightness to the biceps / elbow.
3/ occasional or constant ( usually worsening ) tingly fingers.
GPs will prescribe painkillers. Most physios will give you stretches to do. These ( usually ) irritate the problem OR more frequently causes the problem to continue. People are often at the end of their wits with the discomfort caused.
The problem is due to having the tissues at the base of the neck compressed. Often the sufferer will have a desk based job and be stressed. The worse someone’s posture is i.e rounded shoulders, head/jaw protruding more than it should, the more likely that this problem occurs. The treatment necessary is to have the base of the neck / top of the back stretched ( some audible “clicks” are often heard when this is done ). In cases where there are no underlying problems ( severe osteo-arthritis, bulging discs ) relief can be very quick. Again, recovery time can be sped up and number of treatments lessened if the person is able to take anti-inflammatories and/ or try some acupuncture.
PINCHING PAIN WHILST TURNING THE HEAD
A very common problem. The cause is usually a strained facet joint. All vertebrae are linked to one another by a disc on the front of the spine and then two small facet joints at the rear. Usually accompanying the strain is a certain amount of inflammation. This is a classic example of where ( usually ) only 2-3 treatments are needed.
The neck would be mobilised – the area be moved by the practitioner not the patient. Often one or two joints would be moved which is when there would be an audible “click” and the treatment would usually finish with some very gentle ( but firm ) stretching. Use of a strong dose of anti-inflammatories for up to a week would also be recommended.
This problem has had a lot of ( negative ) publicity recently due to the amount of people trying to get some money for nothing via Personal Injury Claims from road traffic “accidents”. But when they do occur, they can be a serious problem.
Generally, whiplash can cause a lot of deep, aching, throbbing pain all around the neck, referring to the shoulders and frequently causing headaches. Mobility of the neck can decrease so that hardly any movement is possible. Any movement at all, especially sudden jerks can be very, very painful.
Firstly it should be noted that whiplash can be caused even from a simple fall. Only two weeks ago ( seriously ) I saw a 72 year old gentlemen who had been out walking his dog 6 months previously. He slipped on some wet leaves and pebbles and fell backwards, severely jerking his head and neck as he did so. He had been to the GP and had been sent to a physiotherapist. The physio had given him exercises to do and he had been doing them ever since. His neck pain has become constant and worsening in intensity.
I asked him to stop doing the exercises and to use a wheaty bag 3-4 times a day. After 2 treatments he informed me that he is 60% + better. Treatments consisted of soft tissue techniques to his lower neck, acupuncture and gentle mobilisations.
In a nutshell, his constant exercising of the area had kept the problem going AND eventually was worsening it.
Sometimes, whiplash may not rear it’s ugly head for a matter of weeks AFTER the trauma. It can cause a strain that then needs another smaller strain to start it off.
Generally, the quicker the problem is looked at, the quicker it can be sorted out. I have seen some poor people who have put up with pain and discomfort for a matter of years before they have sought help and these sufferers have needed a lot of treatments ( 10 + ) over a long period of time ( 3-6 months ) before noticeable improvements have been made.
In the worse case scenario, a whiplash may start OR finish off a disc problem in the neck. This can lead to surgery.
The types of headache most easily treated are classic STRESS HEADACHES. These can be mild to debilitating. They may happen 2-3 times a month, 3-4 times a week OR, in the worst case scenario, be constant.
The headache is either at the base of the back of the head ( around the occipital bone ), sometimes come up around the ear but most commonly go over the head to the forehead and around/behind the eyes
The cause ( normally ) being very tight muscles from the top of the shoulder blades which attach to the bottom of the head PLUS very tight muscles attaching from the top of the neck to the bottom of the head.
Poor posture, a desk job, computer usage, ANYTHING STRESSFUL can cause and prolong this problem.
Mobilising the affected areas, manipulating the affected areas ( short, sharp movements causing an audible click ), use of acupuncture plus more very gentle techniques ( where the head will be put into comfortable positions for 2-3 minutes ) mean that the patient stands a very good chance of serious pain reduction over 2-3 treatments. Obviously, it helps if the person also changes working position OR tries to reduce the stressful things which are causing the problem.
True migraines can be a terrible affliction. Specialist advice AND medication are always needed. So how can an osteopath help?
Well, frequently some migraines can be provoked by stress headaches SO by treating these ( as described above ) the frequency of the debilitating true migraine can be lessened. This may sound too good to be true, but it is usually worth a try. I would say that maybe 50% of mild to severe sufferers can be helped.
Treatment of Headaches and Stiff Necks
The treatment itself involves a mixture of massage, mobilisation and manipulation. Massage is to loosen and warm the tissues. Mobilisation is usually done to the areas ( joints, ligaments tendons and muscles ) above and/or below the troubled area. Manipulation is when a joint is stretched ( carefully ) in a short, sharp movement so that a crack may be heard. These techniques are to allow the troubled area to heal more quickly.
Manipulations to the neck must be done very carefully and only when necessary. Often they can be done with some gentle “wiggling” of the neck. These are termed “toggle/shift” manipulations. IF the patient would prefer NOT to have a manipulation done, other techniques are used to get to the same end point.
Frequently, if the patient is ok with needles, some medical acupuncture will be done also. Usually 2-4 needles for approx. 5 minutes. I have found that this can often speed up recovery times and, just as importantly, can reduce pain levels by a matter of 10-40%.
Advice would be given on what movements to avoid, how to rest more comfortably and usually to take anti-inflammatories until pain levels are reduced.