Headaches are a problem that affects at least 90% of us during our lifetime. There are multiple types of headaches that vary in symptoms and severity, with some of the more common types including tension-type, migraine and cervicogenic headaches. A number of headache types share common contributing factors to their source of pain, including that they often originate or are linked to the neck region. Some of the following signs may indicate that your headache may be neck related:
Pain and tension through the neck
Pain is initiated or increased with neck movement or prolonged neck posture
Neck range of motion is reduced
The pain may be more prominent or localised to one side, or may exist on both sides of the head
Pain may be experienced from the base of the skull and often refer around the skull or behind the eyes
There may be a feeling of dizziness or light headedness
History of acute trauma or repetitive trauma to the neck region
Diagnosis of headache type is critical for effective management and is an area where physiotherapists can utilise their assessment skills to help differentiate which type of headache is present. Physiotherapy invention can be very effective in managing headaches with a cervical spine (neck) related origin. A physiotherapist will assess the joints of your neck, associated muscles and neural structures to identify any abnormalities. Your posture and work ergonomics may also have a significant impact on headache development and persistence, which are areas that physiotherapists have expertise.
Physiotherapy management may include any of the following depending of your specific presentation and symptoms:
Soft tissue mobilisation/massage
Stretching of tight structures
Postural advice and correction
Strengthening of important neck stabilising muscles
Ergonomic assessment/advice for your work place set-up
Stress and tension management
If any of the above physical symptoms are sounding familiar you may find that your pain in the neck was the cause of your headache all along.
Dry needling involves the application of very fine sterilised acupuncture needles into muscle and surrounding tissues to assist in the release of myofascial trigger points, reduce tightness and spasm, improve muscle function and relieve pain. It is commonly used as an adjunct to physiotherapy and myotherapy techniques to improve treatment outcomes.
There are two types of Dry Needling, the first called Superficial Dry Needling (SDN) works by inserting the needle only 5-10mm under the skin. Secondarily is Deep Dry Needling (DDN) where the needle is inserted to the depth required to penetrate the targeted myofascial trigger point.
How does it work?
Myofascial trigger points are hyper-irritable, taut bands within muscles, which are painful to touch and can contribute to muscle shortening, weakness and pain (both locally and referred). They often develop following muscle, joint or nerve injury and sometimes persist well after the initial tissue injured has healed. This leads to persistent pain and discomfort.
Dry needling releases these trigger points by encouraging local blood flow to the trigger point and by modulating nerve pathways that erroneously cause them to persist. The needling also stimulates your body’s own endorphin system to provide pain relief and help allow the muscle to relax.
Dry needling can be extremely effective in the treatment of:
Needles used in dry needling are much thinner than those you receive when you see your GP for an injection and so usually cause much less discomfort. This does vary depending on what techniques your therapist uses. You may also experience the very satisfying response of the muscle twanging and releasing quickly. A sure sign of a successful trigger point release.
The initial treatment is conservative to determine the patient’s response. This varies from person to person. It is expected that there will be some post treatment soreness during the first 24-48hrs and sometimes minor bruising is experienced.
What sorts of conditions can Dry Needling be beneficial for?
Dry needling can produce excellent results as an adjunct to standard physiotherapy and manual therapy treatment. It can be used in both acute and chronic painful conditions.
Dry needling can be extremely effective in the treatment of:
Back, neck and shoulder pain
Hand and wrist pain
Tendinopathy pathologies i.e. Tennis elbow, Achilles pain
Many other musculoskeletal injuries (You can discuss dry needling with your therapist to see if it may be useful for your condition)
What is the difference between Dry Needling and Acupuncture?
Dry needling revolves around Western Medicine philosophy and involves inserting needles into muscular trigger points palpated by your therapist and consistent with your area of pain.
Acupuncture is based on ancient Eastern Medicine, with needle placement over specific points along meridian lines or ‘energy’ lines which are thought to associate with particular illness and disease.
To understand why back pain recurs, we need to first look at why pain occurs to begin with and then how back pain physiotherapy can help. Back pain generally stems from some form of trauma or loading placed on your back, which may occur as a one off incident or be repetitive loading over time. Normally your core muscles will control your spine and allow an even distribution of load in the appropriate tissues. However, in an acute incident or with poor biomechanical control these muscles will not be able to withstand the load placed on them and trauma will occur. This trauma may cause damage to the tissues within your spine including the disc, joints and muscles.
It is essential to determine how and why the injury occurred
Once your back has been subjected to trauma the damage sustained may alter thestructure of your spine, including arthritis within the joints, disc disruption or bone alignment. Whilst physiotherapy will aim to alleviate your pain, regain full spinal movement and prevent further spinal damage it is important to determine why the injury occurred to understand the underlying cause and surrounding factors so that the same incident is not replicated and your back can be appropriately managed in the long term. The most important aspects of this management include altering your biomechanics to optimise your back function, modifying any activities which may aggravate your back, having optimal sleep postures and implementing an exercise routine including stretches and strengthening to maintain appropriate muscular stability and flexibility.
Biomechanical corrections are vital
Biomechanical corrections are vital to allow appropriate load distribution throughout the spinal column. The spinal column is very long, thin and has attachments to the other major structural components within your body. There are many different muscles which attach to it which can pull each individual spinal segment in a different direction. Those with back pain will often be overactive in particular muscle groups and under active in others, particularly their ‘core’ muscles. Your physiotherapist is likely to discuss these with you and may make alterations depending on your particular posture. It is important that following your treatment you continue to maintain these alterations. This may mean the need to continue stretches and specific strengthening exercises longer term to prevent reverting back to previous postures.
Activity modification is often required
Activity modification is often required to prevent re-injuring your back after your injury. Most people will have specific movements or activities which will cause them pain during the recovery from a back injury. It is important to take note of these activities and understand why they are painful so that once your pain is gone you are still aware of activities which are most likely to cause you pain in the future. You may need to modify these activities to prevent ongoing loading of your spine in a particular way, such as changing your work setup so you don’t have to lift from the ground repetitively or altering your desk setup so you can sit or stand during the day to prevent stiffness and slumped spinal postures. And it is important to remember, that whilst you don’t have pain currently, factors that contributed to a back injury in the first place are likely to be the contributing factors in recurrence of an injury.
Sleep postures are vital in the care of your back as such a large proportion of your life is spent in bed. It is important to maintain a neutral spinal position, where your spinal is relatively flat and straight, to prevent unnecessary stress being placed on particular spinal segments. You should make sure that your back has appropriate support from your mattress and pillow and that these are replaced and turned regularly to maintain their optimal shape.
Exercise is a necessary long term part of treatment
Exercise is likely to be given to you as part of your treatment for your back injury and should become part of your long term management. This may include a combination of stretches and strengthening exercises which are required to maintain your spinal alignment and prevent you from reverting back to your previous posture and biomechanics. Clinical Pilates or specific gym exercises are a great medium for this, particularly in a supervised environment where your physiotherapist is able to monitor your posture and positioning at all times to gain the most benefit. Hydrotherapy is also a fantastic way to complete your rehabilitation due to the reduced weight bearing placing less impact on the affected areas and allowing greater flexibity in the warm water. By completing these structured programs the resistance, intensity and difficulty can be regularly monitored and adjusted for people at all stages of rehabilitation.
Seek early intervention if pain recurs
If you feel like your back pain is recurring it is important to seek early intervention. Your physiotherapist will be able to analyse your symptoms and resolve your pain much more quickly if you return earlier and have less associated tissue involvement.
Health economists from Johns Hopkins University writing in The Journal of Pain reported the annual cost of chronic pain is as high as $635 billion a year, which is more than the yearly costs for cancer, heart disease and diabetes.
Previous studies have not shown a comprehensive analysis of the impact on health care and labor markets associated with people with chronic pain. The Johns Hopkins researchers estimated the annual economic costs of chronic pain in the U.S. by assessing incremental costs of health care due to pain and the indirect costs of pain from lower productivity. They compared the costs of health care for persons with chronic pain with those who do not report chronic pain.
Data from the 2008 Medical Expenditure Panel Survey was used to gauge the economic burden of pain in the United States. The sample included 20,214 individuals 18 and older to represent 210.7 million U.S. adults.
The authors defined persons with pain as those who have pain that limits their ability to work, are diagnosed with joint pain or arthritis, or have a disability that limits capacity for work. To measure indirect costs, they used a model to predict health care costs if someone has any type of pain and subtracted predicted health care costs of persons who do not have pain. The impact of incremental costs of selected pain conditions were calculated for various payers of health care services.
Results showed that mean health care expenditures for adults were $4,475. Prevalence estimates for pain conditions were 10 percent for moderate pain, 11 percent for severe pain, 33 percent for joint pain, 25 percent for arthritis, and 12 percent for functional disability. Persons with moderate pain had health care expenditures $4,516 higher than someone with no pain, and individuals with severe pain had costs $3,210 higher than those with moderate pain. Similar differences were found for other pain conditions: $4,048 higher for joint pain, $5,838 for arthritis, and $9,680 for functional disabilities.
Also, adults with pain reported missing more days from work than people without pain. Pain negatively impacted three components of productivity: work days missed, number of annual hours worked and hourly wages.
Based on their analysis of the data, the authors determined that that the total cost for pain in the United States ranged from $560 to $635 billion. Total incremental costs of health care due to pain ranged from $261 to $300 billion, and the value of lost productivity ranged from $299 to $334 billion. Compared with other major disease conditions, the per-person cost of pain is lower but the total cost is higher.
The authors noted their conclusions are conservative because the analysis did not consider the costs of pain for institutionalized and non-civilian populations, for persons under 18 and for caregivers.
The Journal of Pain is published by the American Pain Society.
Darrell J. Gaskin, Patrick Richard. The Economic Costs of Pain in the United States. The Journal of Pain, 2012; 13 (8): 715 DOI: 10.1016/j.jpain.2012.03.009