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The International Headache Society (IHS 2013) has validated cervicogenic headache as a secondary headache, which means headache caused by a disorder of the cervical spine and its component bony, disc and/or soft tissue elements, usually but not invariably accompanied by neck pain.
A. Any headache fulfilling criterion C
B. Clinical, laboratory and/or imaging evidence of a disorder or lesion within the cervical spine or soft tissues of the neck, known to be able to cause headache
C. Evidence of causation demonstrated by at least two of the following:
1. headache has developed in temporal relation to the onset of the cervical disorder or appearance of the lesion
2. headache has significantly improved or resolved in parallel with improvement in or resolution of the cervical disorder or lesion
3. cervical range of motion is reduced and headache is made significantly worse by provocative manœuvres
4. headache is abolished following diagnostic blockade of a cervical structure or its nerve supply
D. Not better accounted for by another ICHD-3 diagnosis.
It is a chronic headache that arises from the atlanto-occipital and upper cervical joints and perceived in one or more regions of the head and/or face. These occur due to a neck disorder or lesion and feature the converging of trigeminal and cervical afferents in the trigeminocervical nucleus within the upper cervical spinal cord. By definition the headache should be abolished following a diagnostic blockade of a cervical structure or its nerve supply.
Figure 1: Cervicogenic Headache Figure 2: Upper Cervical Spine
Challenging to diagnose clinically, but often includes:
· Unilateral “ram’s horn” or unilateral dominant headache (Excluding those with bilateral headache or symptoms that typify migrane headaches).
· Exacerbated by neck movement or posture
· Tenderness of the upper 3 cervical spine joints
· Association with neck pain or dysfunction
· Definitive diagnosis made through selective nerve blocking through injection of specific sites
· Compared to migraine headache and control groups, cervicogenic headache group patients tend to have increased tightness and trigger points in upper trapezius, levator scapulae, scales and suboccipital extensors, splenius capitis and sternocleidomastoideus
· Weakness in the deep neck flexors
· Increased activity in the superficial flexors
· Atrophy in the suboccipital extensors and so the deep muscle sleeve which is important for active support of the cervical segments becomes impaired
· upper trapezius, sternocleidomastoid, scalenes, levator scapulae, pectoralis major and minor, and short sub-occipital extensors have been implicated
– Trigger points have been reported to be present in patients with tension type headache, migraine, and cluster headache. In addition, active TrPs have been also related to neck pain, a common symptom experienced by individuals with cervicogenic headaches.
It is also important to differentiate from other types of headache:
|Cluster||Unilateral: (orbital, supraorbital, temporal)||Severe||1x every other day -> 8x day||15-180 minutes||Associated with ipsilateral: conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, miosis, ptosis, eyelid edema.
Restlessness or agitation.
|Tension||Bilateral||Mild-Moderate||>15day/mo, >3 mo||Hours-continuous||Pressing, tightening
<1 of photophobia, phonophobia or mild nausea
|Migraine without aura||Unilateral: Frontotemporal in adults, Occipital in children||Moderate-Severe||>14 days/month||4-72 hours||Flickering lights/spots in vision, pulsating quality, nausea, photophobia, phonophobia|
The preferred practice pattern for cervicogenic headache is 5D: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System-Acquired in Adolescence or Adulthood. Goodman states that “Although this type of headache is responsive to therapy oriented at treating the soft tissue restrictions, the method of examination, assessment, and treatment needs to be specific to the neck and occiput.”
Jull et al reported that a six week physiotherapy program including manual therapy and exercise interventions was an effective treatment option for reduction of cervicogenic headache symptoms and decreasing medication intake in both the short term and at one-year follow-up.
|Seated CT Manipulation||Seated Mid Thoracic Manipulation|
The physiotherapist examines or assesses the condition and confirms the diagnosis. He/she also identifies the cause of your sciatica and provides valuable advice to assist you to manage the condition.
An individual with sciatica needs to undergo physiotherapy management in order to restore his/ her
• Muscle strength
• Range of motion of lower limbs
• Posture and flexibility
• Function in activities of daily life
• Muscle tension
When the physiotherapist makes a diagnosis of sciatica he/she puts together a useful programme to deal with it.
In view of the fact that the pain experienced is as a result of pressure on the nerve, the management involves the reduction of the pressure and hence a decrease in the pain.
Exercise is significant in the management of Sciatica. Stretching exercises will facilitate the reduction of tightness in the lower back, and thigh muscles.
Strengthening your core (trunk) muscles will aid in promoting an enhanced lower back support.
She/he will also provide education on attaining a good posture and how to identify and avoid the bad postural habits during the day.
The adoption of a good posture whilst bending to pick objects from the floor or lifting and carrying objects is essential. These exercises also need to be performed at home to assist in the management of your condition.
This exercise provides flexibility to your back. Lie on your back and place a small cushion beneath your head.
Bend one knee and bring it towards your chest with both hands. Hold position for 30 seconds. Gently lower and straighten your leg and place it on the bed.
Perform the same for your other knee and maintain the stretch. Remember to take in deep breaths and repeat the exercise throughout the day.
You can also bend both knees and draw them towards your chest. Hold position for 20 seconds. You should feel a slight stretch and not pain.
This exercise stretches and maintains the thigh muscles. Begin the exercise by standing upright with one leg raised onto a stable surface. Gently lean forwards, whilst you keep your back straight. Hold position for 30 seconds.
You should feel a stretch in your thigh muscles. Alternate stance with your other leg and hold stretch for 30 seconds.
Stretch to the positioning where you are comfortable not in pain. Remember to keep your back straight as you perform this exercise.
The strengthening programme
The Core Strengthening Programme is an exercise protocol that seeks to improve the stability and maintenance of to the spine. This is attained by exercising specific trunk muscles, which may not be frequently utilised.
When those muscles are strengthened, you’d realise that the movement of your hands and legs have more control than they had before.
An individual diagnosed with cSciatica would also be cautious about his/her sleeping posture. It’s advisable to sleep on a firm bed which would provide enough support for the back.
Whenever you sleep on your back, place a large pillow beneath both knees and ensure to also place a pillow between your knees when you lie on your side. This ensures that your back gets the needed support.
You also need to adopt a posture that will relax the muscles and provide pain relief.
Posture plays a significant role in the prevention of sciatica. Individuals who usually have prolonged sitting and bending routines in which the lower back is constantly placed under a lot of stress should break the routine.
To avert the occurrence or recurrence of sciatica you need to take good care of your back by adopting new postures which maintain the natural curves of your backbone at all times.
The various curves sustain the load-carrying capacity of the backbone, which would be quite difficult if the back bone was straighter.
Have you ever wondered about how many calories you burn lifting weights? It takes a great deal of energy to strength train like this, specifically when you’re pushing your body above and beyond its normal abilities. However, there are too many assumptions related to the expenditure of calories when you’re lifting weights, which can lead to problems with regard to fat loss–specifically for women.
Anaerobic activity, like lifting weights provides some great benefits, not only for the hope of fat loss, but for toning the body and building muscle as you do burn fat. Most people are beginning to realize that anaerobic activity simply has to be a part of a healthy weight loss plan if one is going to reach long-term goals.
You can believe this: “Strength training can burn fat in ways other exercise simply can not.” It’s a fact. You gain longer benefits following lifting weights than you do just walking or running on the treadmill. The benefits of lifting weights goes on for hours after a workout, even if this is only a 30 minute session.
So, how many calories do you burn lifting weight?
We want you to realize that while you need a calorie deficit, this isn’t all about your calories–there is much more. How many calories you burn depends upon your own individual weight, the intensity you’re putting in and where your body stands in general. Everyone is different! Remember, muscle helps boost your metabolism, but running on the treadmill doesn’t do this. In other words, muscle provides continuing fat burn capabilities. This is why it is so important. That, and it simply makes you look leaner and healthier!
Some experts will tell you that the calories burned is dependent more on your weight. Most see a 185 pound person burning about 240 calories for an hour workout, but if they really push out their routine in 30 to 45 minutes, they might burn more than what that hour projects, so it varies. We can’t stress this enough. There simply is no way to be 100% certain exactly how many calories one individual is going to burn lifting weights.
Now, here is something for you to digest. The more muscles you have to put into play for lifting weights, the more calories you’re going to expend and the more health benefits you’re going to acquire. Body weight exercise like squats, lunges, pull-ups and push ups (possibly even bench dips and deadlifts) provide the more serious calorie burn. Lunges in and of themselves can burn a hefty amount of calories, especially if these are long lunges with weights.
Remember to bring in variation to your exercises in hopes of burning even more calories! Now, you don’t want your strength training session to turn into a cardio session, but do focus on the muscle burn to hit fat loss! Don’t waste time and stay focused to get the most from your workout.
Common sense, right? Ultimately, it is always going to depend on you as to how much weight you lose, how much muscle you build and how hefty an impact you have on your body. Include aerobic activity with anerobic activity and you’ll always have a winning mix!
Eighty percent (80%) of people will experience lower back pain at some stage of their life. It is one of the most common reasons for people missing work and seeing a doctor or physiotherapist. But lower back pain is something you can avoid with some inside knowledge, back care strategies and some back exercises.
However, if you choose to neglect your back care, you can be rendered vulnerable to lower back pain, sciatica (leg pain) or other nerve pain from a pinched nerve. Long-term lower back pain can result in permanent conditions such as spinal stenosis or degenerative disc disease.
Significant acute lower back pain can result from a herniated disc (slipped disc), back muscle pain, back ligament strain or a non-specific lower back pain.
You can also suffer lower back pain associated with systemic conditions such as fibromyalgia, rheumatoid arthritis or ankylosing spondylitis.
As you can see while lower back pain is common, the diagnosis is specific to you and is best care for with the assistance of a spinal health care such as a musculoskeletal physiotherapist.
Not only can they assist you with acute back pain relief, they can also help you on your way to long-term self management and prevention. This usually includes a thorough back assessment to determine risk factors such and muscle weakness, inflexibility, stiff or unstable joints. They can also advise you when a back brace is suitable or if you are better advised to perform some specific back exercises.
Real-time ultrasound has been used by back pain research in recent years to assist the diagnosis and successful treatment of lower back pain. Real-time ultrasound is now available at leading physiotherapy clinics to assist you and your back pain relief and prevention.
For more information please contact us, your trusted spinal health care practitioner. You’ve only got one back – isn’t it about time you cared for it correctly?
Lower back pain has many causes. Most lower back pain causes are musculoskeletal in origin and known as non-specific low back pain. Most commonly, these back injuries are caused by muscular strains, ligament sprains and joint dysfunction, particularly when pain arises suddenly during or following physical loading of the spine.
The good news is that you can take measures to prevent or lessen most back pain episodes. Your physiotherapist is an expert who treats and can help you to prevent low back pain.
Early diagnosis and treatment is the easiest way to recover quickly from lower back pain and to prevent a recurrence.
The causes of lower back pain are numerous but roughly fall into either a sudden (traumatic) or sustained overstress injuries.
Most people can relate to traumatic injury such as bending awkwardly to lift a heavy load that tears or damages structures. However, sustained overstress injuries are probably more common but also easier to prevent.
In these cases, normally positional stress or postural fatigue creates an accumulated microtrauma that overloads your lower back structures over an extended period of time to cause injury and back pain.
Back muscle injuries are the most common form of back injury. Muscle fatigue, excessive loads or poor lifting postures are the most common problems. Inefficient back muscles can lead to poor joint stabilisation and subsequent injury
Ligaments are the strong fibrous bands that limit the amount of movement at available at each spinal level. Stretching ligaments too far or too quickly will tear them with subsequent bleeding into the surrounding tissues, causing swelling and pain. Awkward lifting, sports injuries and motor vehicle accidents are very common causes. Just as in other regions of the body, physiotherapy hastens ligament healing and relieves pain so that you can enjoy life again as soon as possible.
A bulging disc injury is a common spine injury sustained to your spine’s intervertebral disc. Spinal discs are the shock-absorbing rings of fibrocartilage and glycoprotein that separate your bony vertebral bodies, while allowing movement at each spinal level, and enough room for the major spinal nerves to exit from the spinal canal and travel to your limbs.
The annulus is the outer section of the spinal disc, consisting of several layers of multi-directional fibrocartilaginous fibres all densely packed to create a wall around the glycoprotein filled jelly-like disc nucleus. A disc bulge (commonly referred to as slipped disc), can potentially press against or irritate the nerve where it exits from the spine. This nerve pinch can cause back pain, spasms, cramping, numbness, pins and needles, or pain into your legs.
You can also fracture your spine if the force involved is highly traumatic or you have low bone density (eg osteoporosis).
Poor posture when sitting, standing and lifting at work can place unnecessary stress upon your spine. Muscles fatigue, ligaments overstretch, discs stretch and this places spinal joints and nerves under pain-causing pressure.
With accurate assessment and early treatment, most lower back pain injuries will respond extremely quickly to physiotherapy allowing you to quickly resume pain-free and normal activities of daily living.
Please ask you physiotherapist for their professional treatment advice.
While lower back pain treatment will vary depending on your specific diagnosis, your physiotherapist will have the following aims.
With the correct lower back pain exercises and specific treatment guided by your physiotherapist, back pain relief is very achievable. Most severe lower back pain sufferers will recover within 4 to 6 weeks. However, this time can vary greatly as it depends on the nature of your back injury, the treatment plan that you develop with your physiotherapist, and how compliant you are with your treatment and lower back pain exercises.
Please ask your physiotherapist for their advice in what will help you most.
While there are no guarantees, it is well known that active individuals who regularly exercise to maintain normal flexibility and muscle strength to support their spine have the best chance of avoiding lower back pain.
Healthy spine postures and safe lifting techniques at home and at work also reduce your risk of developing lower back pain. Feel free to discuss with your physiotherapist the specific postures and activities that you perform on a daily basis. They will aim to help you to understand how to position yourself and move with the lowest risk of injury
While performing an advanced, therapeutic back massage requires plenty of professional training, you can still give someone a relaxing, tissue stimulating massage even without training. By learning some of the basic massage techniques and how to apply them, you can begin giving quality massages at home. One of the most important parts to note is that without professional training, you should apply only light pressure with all of your techniques.
Get a massage table. Using a massage table will give you the best access to somebody’s back, and it’s built for comfort, complete with a face cradle for alignment of the spine. However, if that’s not available, there are a few alternatives.
Prepare the room. Make sure the room is warm without being hot. This is the ideal atmosphere for the person to relax the muscles you’re trying to massage.
Have the person undress to his or her comfort level. Massage is best given and received without clothing on the area being massaged, especially if you are using oil or lotion. Request that the person undress as much as he or she is comfortable with.
Have the person lie face down. If you have a proper massage table, this means the person’s face will rest in the face cradle.
CP may be diagnosed very early in an infant known to be at risk for developing the condition because of premature birth or other health problems. Doctors, such as pediatricians and developmental and neurological specialists, usually follow these kids closely from birth so that they can identify and address any developmental delays or problems with muscle function that might indicate CP.
In a baby carried to term with no other obvious risk factors for CP, it may be difficult to diagnose the disorder in the first year of life. Often doctors aren’t able to diagnose CP until they see a delay in normal developmental milestones (such as reaching for toys by 4 months or sitting up by 7 months), which can be a sign of CP.
Abnormal muscle tone, poorly coordinated movements, and the persistence of infant reflexes beyond the age at which they are expected to disappear also can be signs. If these developmental milestones are only mildly delayed, the diagnosis of CP may not be made until the child is a toddler.
In many cases the causes of CP are unknown, so there’s no way to prevent it. But if you’re having a baby, you can take steps to ensure a healthy pregnancy and carry the baby to term, thus lowering the risk that your baby will have CP.
Before becoming pregnant, it’s important to maintain a healthy diet and make sure that any medical problems are managed properly. As soon as you know you’re pregnant, proper prenatal medical care (including prenatal vitamins and avoiding alcohol and illegal drugs) is vital. If you are taking any medications, review these with your doctor and clarify if there are any side effects that can cause birth defects.
Controlling diabetes, anemia, hypertension, seizures, and nutritional deficiencies during pregnancy can help prevent some premature births and, as a result, some cases of cerebral palsy.
Once your baby is born there are actions you can take to lower the risk of brain damage, which could lead to CP. Never shake an infant, as this can lead to shaken baby syndrome and brain damage. If you’re riding in a car, make sure your baby is properly strapped into an infant car seat that’s correctly installed — if an accident occurs, the baby will be as protected as possible.
Be aware of lead exposure in your house, as lead poisoning can lead to brain damage. Remember to have your child get his or herimmunizations on time — these shots protect against serious infections, some of which can cause brain damage resulting in CP.
Cerebral palsy (CP) is a disorder that affects muscle tone, movement, and motor skills (the ability to move in a coordinated and purposeful way). CP is usually caused by brain damage that occurs before or during a child’s birth, or during the first 3 to 5 years of a child’s life.
The brain damage that leads to cerebral palsy can also lead to other health issues, including vision, hearing, and speech problems, and learning disabilities.
There is no cure for CP, but treatment, physiotherapy, special equipment, and, in some cases, surgery can help a child who is living with the condition.
Cerebral palsy is one of the most common congenital (existing before birth or at birth) disorders of childhood. About 500,000 children and adults of all ages in the United States have the condition.
The three types of CP are:
Cerebral palsy affects muscle control and coordination, so even simple movements — like standing still — are difficult. Other vital functions that also involve motor skills and muscles — such as breathing, bladder and bowel control, eating, and learning — may also be affected when a child has CP. Cerebral palsy does not get worse over time.
The exact causes of most cases of CP are unknown, but many are the result of problems during pregnancy in which the brain is either damaged or doesn’t develop normally. This can be due to infections, maternal health problems, a genetic disorder, or something else that interferes with normal brain development. Problems during labour and delivery can cause CP in some cases. but this is the exception.
Premature babies — particularly those who weigh less than 3.3 pounds (1,510 grams) — have a higher risk of CP than babies that are carried full-term, as are other low birth weight babies and multiple births, such as twins and triplets.
Brain damage in infancy or early childhood can also lead to CP. A baby or toddler might suffer this damage because of lead poisoning, bacterial meningitis, malnutrition, being shaken as an infant (shaken baby syndrome), or being in a car accident while not properly restrained.
To be continued…
We all know that massage therapy feels good and is a healthy reward for our overworked bodies. But, how do you know when you need a massage? I have provided a little cheat sheet for you below.
To summarize: Massage therapy = less pain, more function, better sleep, and less stress. It’s a no-brainer.
Call physiooncall today for your comprehensive massage session as well as your FREE musculoskeletal assessment today!
Ever wondered about the magic of exercise? Ever wondered why you feeeeel soooo good after a nice session? EUREKA! You have found the solution to the problem right here on Physiooncall.net. We present to you the different factors that are responsible for exercise induced euphoria…
Endorphins are released in the brain whenever you engage in moderate to vigourous exercise. When endorphins lock to special receptors they block transmission of pain signals and also produce a euphoric feeling. They are released in response to pain and stress and help to alleviate anxiety and depression.
Ever heard of the euphoric runners high? It is as a result of endorphins after a VIGOROUS run. Similar to morphine endorphins act as a analgesic and sedative, diminishing our perception of pain.
Exercise leads to increased production of antibodies which are a special type of protein produced by the immune system. Increased antibodies help your body fight off viruses and keep you healthy in the long run.
INCREASED OVERALL MOOD
If you ever go for a run after a stressful day, chances are you felt better afterward. The link between exercise and mood is pretty strong, usually within five minutes after moderate exercise you get a mood enhancement effect.
A study with over 190 students showed that not only does exercise give students more “pleasure – activated” feelings but they also felt less “unpleasant – deactivated” feelings. Students who did 15 minutes or more of vigourous exercise were in overall better moods than students that did not.
BOOSTED SELF – ESTEEM
Self esteem plays an important role in your day to day feelings. Thats why something as simple as setting fitness goals for yourself and acheiving them can help you boost self-esteem. Ever wondered whya stallion / horse is so gracious and strong…?The answer is because they run. Maybe one of these days we will highlight why you have never seen a fat horse.
HELP CONTROL ADDICTION
The brain releases dopamine,the reward chemical in response to any form of pleasure, be it exercise, sex, drugs, alcohol or food. Unfortunately some people become addicted to dapamine and dependent on the substance that produce it, like drug or alcohol (and more rarely, food and sex ). On the bright side exercise can help in addiction recovery. Vigorous exercise can also effectively distract drug or alcohol addicts making them de-priortize cravings (at – least in the short term.)
So get in that sweat pant and top, kick in some exercise and be happy….!!!