Story by Jon Hodges

Headaches are one of the oldest (6500 BC) clinical diagnoses known to man, or technically, to women as they are affected twice as often. The answer to this used to be putting a nice golf ball-sized hole in the skull (also known as trephination; you’ll thank me later if you’re ever on Jeopardy). Fortunately, there is a slightly less, uh, cosmetically detrimental option: manual physical therapy. Coupled with corrective exercise, it is possible to have excellent success with non-migraine type headaches in patients of all ages and activity levels. The key is understanding the muscular referral pattern to the head, a system thoroughly researched by Dr. Janet Travell in the mid 1900s.

THE BIG THREE 

There are several muscles involved in keeping your head upright, but three of them stand out as epic headache generators: The upper trapezius, the sternocleidomastoid, and the levator scapulae.

THE UPPER TRAPEZIUS 

This muscle is part of the large diamond-like muscle in the mid-back, which extends from the lower thoracic vertebrae to the base of the skull and laterally to the edge of the scapulae. The portion that we are interested in is the superior region (top). Perhaps a slightly more accessible reference might be the hypertrophied neck masses Tom Hardy was sporting in the movie “Warrior.” I’ll pause for the ladies.

OK where were we? The upper trap has several trigger points, or pain referral “knots,” one of which is depicted in the top illustration. This muscle is stretched by the popular “ear-to-shoulder” stretch most of us are so intuitively familiar with.

This is a good spot for high-lighting neck stretching 101: You should only feel a stretch on the side you are moving away from, no pain on the side you are going towards! Additionally, you shouldn’t wrench on your neck, slow and steady is the key. Finally, any worsening of symptoms or numbness and/or tingling in the upper extremities should be a red flag, and you better pop over to a physical therapist, such as those at Nevada Physical Therapy on campus, and let them take a look–see to rule out anything more serious. Stretches should be held for 30-45 seconds, and if possible, performed three times on both sides. Often times it is only one side of the neck generating your headache, so if you can only stretch in one direction, that’s all right. As your mobility improves, you can revisit trying to stretch both directions.

The sternocleidomastoid (SCM) (indicated by the “x’s”) can help to relieve headaches in several of the red areas marked above.

The sternocleidomastoid (SCM) (indicated by the “x’s”) can help to relieve headaches in several of the red areas marked above.

THE STERNOCLEIDOMASTOID (SCM)

This muscle runs from your sternum, where your collarbone meets, and up to the base of your skull. As shown in the middle photo, this bad boy creates a huge pain pattern in the head and is slightly more challenging to stretch.

The easiest way to stretch this strong anterior neck muscle is to look over the opposite shoulder and then tilt the same-side ear towards the ceiling. A few cues that may help: Imagine trying to catch rainwater in your ear. That should be the end-range position. Additionally, the force should be directed from the ear up, rather than from the muscles on the opposite side. Did I lose you? Often, we fire the muscles on the opposite side and end up “pinching” the neck on the side we are rotating towards — no bueno. Imagine trying to “push your ear to the ceiling” and you’ll likely be in the right ballpark.

THE LEVATOR SCAPULAE

This is the muscle that is usually involved with poor computer posture (more on this in later weeks). In short, when our shoulders are in front of our body or if we are tight in our chest musculature the levators “kick on” — and I’ve been in Lombardi on Mondays, aka “Bench Press Day,” so I know there is no shortage of tight pecs in this group. This constant irritation is a huge cause of tension headaches or, more accurately, neck aches. I think this stretch, out of all of them, gives the most bang for the buck. Here’s what you need to do: Look over the opposite shoulder; if the sternum is 0 degrees and your shoulder is 90 degrees, try a couple positions between 45 and 75 degrees, bringing your chin to your collarbone. You may also know this as the “deodorant check.” Well, you do now. Same rules apply, no pain on the side you are stretching towards. If you do get pain, come out of the stretch (don’t correct mid-stretch) and try a different angle.

Illustrations by Barbara D. Cummings from “Myofascial Pain and Dysfunction” Stretching the levator scapulae (marked in red) can relieve what are commonly referred to as tension headaches or neck aches

Illustrations by Barbara D. Cummings from “Myofascial Pain and Dysfunction”
Stretching the levator scapulae (marked in red) can relieve what are commonly referred to as tension headaches or neck aches

We’re going to cover more body maintenance over the next several weeks, but I figured this would be a good starting point, what with the prolonged computer use from all the studying you must be putting in. Hopefully this will help many of you and knock down some of that persistent pain. While stretching is an excellent starting point, for those of you with more severe and stubborn cases, please don’t tough it out. Seek help from a physical therapist.

Jon Hodges is a physical therapist at Nevada Physical Therapy on campus. He can be reached at sself@sagebrush.unr.edu.