Headache Part One: A Pain in the Neck

Headaches are one of my favorite issues to treat as a physical therapist because they are an everyday nuisance that are often completely fixable. The typical description I hear from patients is an ache at the base of head where it meets the neck that seems to get worse as the day goes on, especially while sitting at a desk.

As much as I’d like to tell everyone to just retire and the headaches will go away, that’s not sustainable for my patients. Their reports of aching and tightness at the base of the head often also includes a dull ache in the upper shoulders and shoulder blade region which improves briefly with massaging the area.

We all know that you can’t recruit someone to rub your neck and shoulders all day at work, so over the next few articles, I will offer tips for decreasing the pain and give techniques to manage it without medication or days off.

When dealing with headaches, it’s important to identify the cause or causes, so they can be treated effectively. Many times, there are a combination of issues which may include seasonal allergies, posture while sitting at your desk, driving or sleeping, stress, neurological problems and trauma. While not all of these causes are suited for physical therapy, there are many that can be improved and solved with physical therapy.

Headaches that are located behind the eyes, at the temples or radiate up the back of the head to the top are often caused by dysfunction in the neck and are called “cervicogenic headaches”. These types of headaches often respond very well to physical therapy. While the pain appears in these areas, it’s not actually caused by dysfunction there specifically.

Limited joint motion, tight muscles or instability at the joint can all cause these symptoms. A skilled physical therapist will utilize a variety of manual hands-on techniques focused on restoring normal joint motion, calming muscles that are overly tight or in a spasm, and re-educating the stabilizing muscles of the neck so that your body can maintain good posture.

Here are some basic ideas to get you started. In the next few blog posts, I will give advice on ergonomics at your desk, while driving and while sleeping as well as exercises to create a strong, stable posture, so stay tuned!

3 Tips

  1. Correcting the forward head posture

The problem: head or neck pain at the computer, while driving or reading.

headache relief

The reasoning: Posture is an important starting point because without restoring the neutral position of the spine, the joints and muscles will be perpetually strained and irritated which creates a pain cycle and forces your body to compensate with unhealthy patterns of movement.

When we sit at a desk or when driving, we all have the tendency to lean toward whatever we’re looking at, typically leading with the chin. This essentially shortens the muscles of at the base of the skull and overstretches the muscles on the front side of the neck. These muscles are deep; they bear the responsibility of stabilizing our spine. If you hold your head in the forward position long enough, those stabilizing muscles in the neck are unable to support the posture and you will begin to feel that ache at the base of your head.

The solution: Postural awarenessstart by sitting tall in a chair with back support, look straight ahead keeping your chin level with the horizon. Squeeze your shoulder blades together gently to support the upper back, then pull your chin directly backwards into your spine (think double chin). The goal is to keep your chin level (not letting it drop toward the floor as you pull it backward) and reverse the curvature that was caused by the forward-head posture that was mentioned earlier. Hold for 10 seconds, while breathing and relaxing. Keep this posture in mind as you drive, work at your computer or read.

headache relief
  1. Pain while sitting at the computer

The problem: working at the computer for hours at a time and ending up with a headache

The solution:

  1. Take frequent mini-breaks – stand up and walk around for a few minutes at least once every hour, or sooner if you begin to notice a headache or neck pain

  2. Good ergonomics – we will go in depth on this topic in the next blog post, but here are a few key points to keep in mind:

    • Sit in a chair with low back support that fills the natural curve of your spine. Using a rolled up sweatshirt or a few thin towels rolled together can accomplish this without needing to buy an expensive new chair.

    • The seat of your chair should be high enough that your hips are higher than your knees, but your feet are still fully on the ground. Try placing a few folded towels under your buttocks to achieve this position.

    • Your screen should be high enough so that you can see the most of the screen by looking straight ahead with your chin parallel with the floor, and without needing to tilt your head up or down.

    • Keep your chin tucked into your neck and avoid that forward-head posture we discussed before.

  3. Balancing flexion and extension – in our society we spend a lot of time bent forward at a computer, driving a car or just staring at our phones. Your body needs to spend time out of that forward bent position (called flexion) with backward bent positions (called extension).

Here is a simple exercise you can do at work to loosen the muscles on the front of your body and give the ones on the back a break:

Doorway Stretch

– Use a narrow doorway, place one forearm flat against each side of the doorframe with your elbows around shoulder height.

– Tighten your abdominal muscles and step into the doorway until you feel a stretch across your chest

– Hold this position for 30 seconds. You should feel the stretch in your chest and upper back. If you feel it in your low back, don’t step into the doorway so far.

– Repeat this stretch one to two times an hour as you go through your day

  1. Pain while sleeping

The problem: Restless sleep because of neck pain

The solution:

Left-sided or right-sided – the key is support

Imagine lying on your favorite side…start with the pillow under your head only (not under your shoulders). Next, tuck one end under your chin, pulling the middle section into the crook of your neck and the end around to the back of your head. Picture a horseshoe shaped pillow wrapping around from your chin to your upper back. A great way to achieve the support of an expensive feather or memory foam pillow is to take a hand towel and roll it into a log, then slide that into the pillowcase at the base of the pillow. This creates support for the neck while also being adjustable to your comfort.

headache relief
headache relief
headache relief

Next, support your top arm. Grab a standard pillow and tuck it all the way up under your armpit and so the length of your arm is comfortably resting on the pillow. Make sure all of it is supported by the pillow – upper arm, elbow, forearm and hand.

headache relief

If you’re a back sleeper:

The goal is to support your head and neck while also keeping your neck in line with the rest of the spine. In the picture below, you see how too many pillows can raise the head so it’s no longer in line with the rest of the spine. Another important point about this picture is that the pillows are there to support your head and neck, and need not be under your shoulders. Pull the pillow under your head so that it fills the curve under your neck.

headache relief
headache relief

Finally, if you have any shoulder issues, you can put a pillow under your arm from your armpit to your belly button to support the weight of the arm. This support will allow the muscles in the neck to turn off at night and rest because they no longer have to hold the weight of the arm.

headache relief

Recovery for True Fitness

I am a physical therapist, a business owner, I am a mother of 2 great busy kids, a wife and I am an athlete. My story is somewhat convoluted and a bit long, but as I work with more people, I hear it repeated over and over again, yet never addressed mainstream medicine.

I was a high-school athlete; I went on to compete in college at the intermural level. I went to grad-school and continued to participate in master’s sports (soccer and swimming).

I became an accomplished swimmer and triathlete along with birthing 2 kids, working and finishing my doctoral degree.

I am what some people may call “type A personality”. Just ok was never good enough for me. Nothing is worth doing if you don’t give it 100%.
In 2009-2010 I was finishing my doctoral degree, my daughters were 4 and 6, my husband traveled, I worked 30 hours a week, I coached one soccer team and assisted with the other. I was damned and determined to maintain my workout schedule. I trained for and completed 3 triathlons, 2 bicycle rides from 60 to 80 miles, and 3 long distance open water swims that year. For fun I swam with the masters team in the mornings and played on a recreational soccer team on Thursday evenings.  I worked out 6 mornings a week at 5:30 am, I did double workouts 3-4 days per week. I had never “needed” much sleep so 5-6 hours 5-6 days week was fine.

I prided myself on this lifestyle. I was a doer, I got it all done, the lady who brought home the bacon and fried it up in a pan from Enjoli commercial of the 80’s https://www.youtube.com/watch?v=_Q0P94wyBYk

I began to get reoccurring sinus infections. I was on a course of antibiotics almost every 8 weeks. I began to gain weight especially around my abdomen (the area I was working so hard to keep tight and flat after the babies). I had bouts of plantar fasciitis, my biceps tendon and my SI joint always bugged me, but I rolled it out and took an Advil. My period stopped, but that just made life less complicated. I began have environmental allergies and soon developed exercise induced asthma, began using a steroid inhaler to get through my runs.

I was always tired, but I still dragged my butt out of bed. Once I got my work out in, I was wired. I didn’t have a lot of patience with my kids, and I didn’t laugh as much with my husband.

Eventually my drive caught up with me. I had exhausted my adrenals. My body finally gave up. The adrenals, the glands on top of your kidneys that regulated my hormones were fried!!! I had to stop. I came crashing down, this has led me on a journey of healing. I hope I can share some of this with you so you or someone you know doesn’t have to fall to the bottom, when she was trying so very hard to be “healthy” and stay on the top.

What I didn’t allow for was RECOVERY. I kept pushing my body to its upper limits and never giving my body the time to regenerate or restore itself. The only way to get stronger is to push, then to rest. In our society we see rest equivalent to being lazy. But that is just not the case. Understanding your body, emotionally and physically is the key to fitness.

Fitness is measured by a combination of few different components:

  • Cardiovascular health: your aerobic capacity (run, swim, walk ie distance and endurance activities)
  • Strength: resistance based activities; pushing weight against gravity ie lifting a barbell or carrying a baby,
  • Flexibility/ mobility: the amount of movement available at the joint and muscles
  • Balance: ability to stay upright against gravity and perturbations. Ie standing on one foot, jumping from rock to rock across a stream

We need to exercise to stimulate the breakdown of the muscles, tendons, and bones. When the body has the right nutrients and the appropriate dosage of resistance our muscles tendons and bones are encouraged to rebuild bigger and stronger; therefor can endure more stress prior to injury.

Stress to the system in manageable doses allows us to grow stronger. This is mediated by our hormones. The endocrine and adrenal systems work together (or occasionally against each other if dysfunctional).

Physical stress produces a spike in the hormone cortisol, the stress hormone. We need this for survival it’s our fight or flight response.  This the action of our sympathetic nervous system which is good for us in small doses. If the system is over stimulated, then Cortisol is over produced.  This stress hormone will be produced in lieu of your sex hormones, growth hormones and thyroid hormones. When this occurs your metabolic function is diminished.
Why does this matter? if we are diverting the body’s resources of hormones just to produce stress hormones, the body cannot function properly.  Muscles cannot grow without testosterone or human growth hormone. When estrogen levels are low our reproductive system doesn’t cycle properly. If we are constantly producing cortisol our neurotransmitters, serotonin and dopamine ratios get thrown off which mess with our state of mind.

To be a well-rounded healthy athlete you must address all areas of fitness but the true gold standard of the perfect model human athlete is “how fast does your body recover?”

Vo2 max, lactate threshold, muscle soreness, return to base line heart rate; all of these measurements of fitness boil down to one thing, how good is your metabolism? Metabolism is usually associated with “how fast do I burn calories”. But that is only one aspect. It is also how your body converts and processes energy and clears out waste. The body converts nutrients in to energy. The byproducts of that conversion is metabolic waste that the body can’t use and needs to get rid of. The chemicals produced are toxic to us. Hence why we need detoxification.

The stars have to align for detox and recovery to happen. Two of the most important things are

  1. Provide the body with the proper nutrients for metabolism. Good balance of Macro-nutrients: protein, carbohydrates, and fats. Micronutrients: vitamins, minerals and amino acids.
  2. It also must occur when the body is not doing anything else. Detox and recovery can’t happen when there is a stress response occurring. We have two sides to the nervous system. Fight or fight (stress run from tiger) and Rest and digest (climb up the tree safely away from said tiger, relax while sipping on a coconut, let the body return to steady state.

Indicators of overtraining or Adrenal fatigue:

  • Weight gain (especially around the abdomen) or weight loss resistance, no matter how clean you eat.
  • Food sensitivities or new allergies to foods and/or the environment
  • Tendon and joint pains that don’t heal 100%, or keep reoccurring despite rest
  • Feeling wired yet tired, roller-coaster energy levels.
  • Cravings for high-sugar foods and caffeine
  • Increased incidence of colds, respiratory infections, asthma.
  • Anxiety or depression that may temporarily alleviate with intense cardio/ aerobic exercise.

Tips to support your body’s recovery process

  • Muscular recovery: working the whole body is important. We use more muscle fibers with big movements such as a deadlift or a squat. The energy used increases the metabolic breakdown as well. When doing strength training acknowledge this fact and let the body recover at least 24-48 hours before doing the same activity again
  • Smaller muscles and Postural muscle are small the energy requirements are less these can be worked more frequently.
  • Active recovery, Epsom salt baths, massage, essential oils all can help the body metabolize the end products for quicker recovery
  • NO Pain No gain must be qualified. Muscle belly burn is great. Burn baby burn. But a sharp pain or a tweak where the muscle meets the bone is bad. When you feel this type of pain you must adjust the movement or resistance. Your body cannot will not strengthen itself if there is pain. The body is more concerned with cleaning up the inflammation occurring than it is about trying to rebuild the healthy muscle or tendon fibers.
  • Muscular soreness for 24-48 hours is normal. It is a good sign that you have challenged yourself and pushed your body to where it will grow and be more ready for what life has to throw at it. If you are sore and stiff every morning that is a sign that you have overdone it. Your body needs more time, and or nutrients to recover. Accept and respect it, pushing more will not make you stronger.
  • Exercise… mix it up with cardio, strength, Pilates, power or hot yoga. 2-3 days consecutively at intense levels then you must give the body proper rest. 1-2 days of gentle fun movement. Don’t focus on heart-rate, focus on feeling good, energized by being in the sun, walking with your dog or favorite person, focus on the trees or the river play on a paddle board feel the sun, float on a tube.
  • Stabilize your blood sugar levels. Eat a wide variety of clean whole foods… balance portions of fat, protein, and low glycemic carbohydrates in your diet for essential nutrients.
  • Pay attention to your activity: increased protein with weight lifting to build healthy muscles and tendons.
  • Starchy veggies and fruits are the best source of carbohydrates when pushing aerobic activity.
  • Eat up to 30% of your daily calories with heathy saturated and monounsaturated fats. Fats are absolutely for detoxification processes. Without fat the body will not burn fat the because that is where the toxins are stored.
  • Sleep 8-10 hours/night this is absolutely imperative…non-negotiable, we are only able to detox and rebuild when the body is rested…. Studies show weight gain is greater when sleep is not adequate. Hormonal imbalances occur. Waking up at 5 am to work out can actually make you fatter than if you slept well and missed the workout.
  • Avoid commercial cleaners look in to non-toxic labels. Hormone disruptors will make your liver and adrenals have to work harder at ridding the body of toxins vs building the body back up. This can add strain to a decreased immune response and increased inflammation (tendonitis, asthma, allergies)
  • Avoid make-up and body products with parabens, SLS, rancid oils, bleaches.
  • Active recovery with Restorative yoga, meditation, self-care days to restore the mind and recover the body is essential.

Engage in activities you enjoy… strolling at the farmer’s market, listening to a live band outside, dinner with friends, walks on the beach, lying on a hammock with a great book, cuddling with your spouse or kids. These activities can be way more important and beneficial to your overall health and fitness than that work out. Listen to your body and your brain, sometimes being still is more important than the 10,000 steps a day.



Daniel Kalish Kalish Mentorship program adrenal module www.kalishinstitute.com

Sarah Balyentine auto-immune protocol