Headaches from Neck with Heather Camenzind
Mark: Hi, it's Mark from TLR. I'm here with Heather Camenzind in from Insync Physio in Vancouver. We're going to talk about headaches from your neck.
Mark: How're you doing Heather?
Heather: I'm good. Thank you. So yeah, we're going to talk about headaches that can be driven from the next. So talk briefly, I guess, about a case study. I've been seeing a client they're mid twenties and they've been cycling a lot this summer.
And so you can imagine, especially with road cycling, so they're over quite a bit. And then just to be able to see you're looking up. So you're in that, kind of chin poke position quite a bit. And over the summer she just started to notice that she started to develop more headaches in general. And the headaches for her sat kind of right at the back of the neck, but they also kind of wrapped up around her head and a little bit into her eyes.
What brought her in is that she started to notice headaches. First thing in the morning, she'd wake up with a headache. So it wasn't necessarily driven from just cycling anymore, which is how it started. It started to get a headache after she go for her ride and then had gone long enough that then she starting to wake up and have these headaches very consistently on a daily basis. And that's what brought this client in.
Mark: Sure. So maybe to, and I'll just kind of guess here a little bit, having your head out like that all the time, I used to race bikes, is like having a 10 pound weight on the end of your arm and you're trying to hold it. For who knows, if you're training a lot, it could be a hundred miles. That's a lot of weight hanging out there all the time. So that's a lot of tension.
Heather: Exactly, yeah. Once you have the helmet on, and then you just, the position that you're in for so long that it's a long time to hold your head in that position. And the longer you ride yet, the more time, exactly you're holding that weight in that position. So things can start to get a bit tight and sometimes the joints can get a bit stiff or stuck.
Mark: And you're not noticing it when you're riding because you're working on your cardio, you're working on your legs. That's what you're focused on is hammering as hard as you can or keeping a cadence. You're not paying attention to your neck at all.
Heather: No, often you're not you're. You're focusing on other things. You're not necessarily focusing on the position of your head. Or even just worried about the strength or the mobility of your neck. You're probably more concerned about the strength and mobility of your legs, which is common for a lot of cyclists. But sometimes we have to work on the upper body a little bit too, to help just to strengthen position-wise into the shoulders as well.
Mark: So when you see this come in and, I've got a headache. Okay. Well, there's probably, like you mentioned earlier, when we were talking about this, maybe a hundred different kinds of headaches, possible causes. How do you start to diagnose or determine what's the cause of this?
Heather: Yeah, so it comes down to history. So we have to ask a lot of questions. How do the headaches feel? Where do they sit? Are they changing? Sometimes they have a pattern that can change throughout the day and just general questions. Overall health screening is important with that. Vision testing too. Sometimes if you're having vision problems that can precipitate some headaches as well.
So you have to kind of just ask all these generalized questions to kind of start to narrow in on that you think this is more treatable by a physiotherapist. That it is within our scope, that it's appropriate. And then the second thing that we do is our assessment. So that would be more looking at range of motion. We test things, we're getting in and feeling the joints, feeling the muscles and testing.
So those two things combined, that can help us narrow in on that, yes, we do think that this is appropriate for a physiotherapist to treat. And the second is that that we can do something about it for them and that we don't need to then refer on or go get something else checked first that may be contributing.
Mark: Right. So once you've determined that it's a problem with the actual tension, too much tension in the neck and not enough mobility kind of progressing, what's the typical course of treatment?
Heather: So the first couple of treatments will be, well, one education. Is that we're kind of teaching them what's going on in their body. Then how are we going to fix it? And then there'll also be a lot of manual therapy. So working with our hands, the therapists, working with their hands to maybe release a tight muscle or get a joint that might be a little bit stiff moving again, help the person move. Often they're stuck in this kind of chin poke position. So how do we teach them and get them to promote, to tuck their chin in a little bit.
So it's a lot of manual therapy to work on that. Sometimes you can do some IMS to release the muscle tension. And then it will be followed up with like an exercise program. So lots of stretching. And then also strengthening in through the neck and teaching the person, how do we get your chin tucked down, to get the joints and the muscles at the top of the neck moving, if, and that was what this client had presented with. Was that they were stiff into the top of their neck. That was our focus.
Mark: So does strengthening, like any particular exercises, like against resistance. Is that part of it? Did I miss that?
Heather: No, it can be. A lot of it is actually strengthening the deep neck flexor. So those are the muscles at the front of the neck. And so we're doing more like a chin tuck, almost like you're giving yourself a double chin and learning to strengthen there.
A lot of the time we actually are quite strong, especially cyclist into the extension because that's where you are a lot of the time and we actually need to strengthen the front of the neck. Analogy is the core muscles of the neck. So with low back pain, we're often strengthening the core. With this, we are again, strengthening the core muscles of the neck and that's to give our head that support in that position.
And sometimes it's just education too, but where to hold their head is to not allow themselves to fall into that kind of poking position, is be strong through the shoulders and have that chin in. And then to try to look up with the eyes rather than always falling into that hyper extended position.
Mark: And how long till somebody usually because it's always individual, but how long till they usually are going to see a reduction in symptom?
Heather: Often people can notice a difference quite quickly. So probably within a few weeks, they'll start to notice the headache won't be gone completely, but they'll start to notice a decrease in the frequency of the headaches.
So this client in particular, we've worked with her for two weeks. So she came in for two sessions and then with some home exercises and some manual therapy, she noticed a decrease that she wasn't waking up daily with headaches.
So she noticed it quite quickly, and then we just continue to work on the strengthening piece and getting rid of the headaches that she was getting towards the end of the site, like her sessions. And that was more a strength piece for her. And that just takes a little bit more time.
So some people like her, she was very, it was very nice. You responded very, very quickly. Other people that can take up to maybe four to six weeks to start to notice a bigger change for them.
Mark: If you're having headaches from your cycling or from any kind of physical activity. Or just headaches period, and you need somebody and you can't get into the doctor, but you want somebody to maybe help. Maybe diagnose it a little bit before you get to the level, you might still need to see the doctor and get x-rays and go through all that. Go see Insync Physio. You can reach them at insyncphysio.com to book. They have two locations, one in Vancouver, one in Burnaby. You can call them in Vancouver, (604) 566-9716. Go see Heather. She'll help you out. Thanks Heather.
Heather: Thank you, bye.