Any headache sufferer knows that headaches can be among the most frustrating and debilitating health problems. When headaches develop they often interfere with prevent many of our most basic daily activities such as using the computer, reading, carrying on a conversation, and even thinking. To make matters worse, studies show that treatment for headaches tops list for conditions in which patients are most dissatisfied with their care.
There is a common perception that the cause of all headaches is in the head itself, which seems like a logical assumption since that is where the symptoms are. However, there is now a firm base of scientific evidence that suggests many of the most common types of headaches may actually be generated in the muscles, joints, and nerves of the neck.
When talking about the neck, we are actually talking about the upper portion of the spinal column – the cervical spine. The cervical spine consists of 7 small bones called “vertebrae” stacked on top of each other. By themselves the joints of the cervical spine are not very stable, so to protect the region, a complex system of muscles surrounds the spinal column to control movement and protect the area from injury.
Not only do these muscles need to move and protect the cervical spine, but they also must control the weight of the head. The head and neck have a unique anatomical relationship in that the larger, heavier head – which weighs about 10 pounds – sits atop the thinner neck. This essentially represents an inverted pendulum where the natural tendency is for the heavier head, which represents the top of the inverted pendulum, to topple over. This places a high demand on the neck muscles to both support and control the weight of the head, while at the same time ensuring adequate movement and stability of the joints of the cervical spine. This complex process requires each muscle to be adequately strong, flexible, and coordinated, and as long as this is the case the neck remains protected and healthy, and will not generate headache symptoms.
The interesting fact is that muscles and joint dysfunction in the cervical spine has actually been shown to cause headaches through a process called ”Referred Pain. The referred pain phenomenon is a complicated neurological process, but simply stated, referred pain is a process that causes pain to be felt at a location other than where the problem is occurring. Other examples of referred pain can be seen during a heart attack, when pain is felt in the left arm, or with a disc herniation in the low back, which causes pain to felt down the leg.
Scientific studies have shown that when problems in the muscles and joints of the neck occur, they often refer pain to the head, causing symptoms such as ache, throbbing, pressure, burning, even stabbing pain. In many cases there can be some ache or tension in the neck that occur along with the headache symptoms, but in many cases there are no noticeable symptoms in the neck at all.
There are many situations that can develop which will affect the health and function on the muscles and joints of the neck. For example, poor or prolonged postural strain that occurs with computer use and many desk jobs, repetitive use with certain sports, muscle imbalance, lack of stretching or strengthening, or previous injury such as car accidents (even minor accidents with little or no injuries that occurred at the time) can all lead to muscle tightness, weakness, and a lack of coordination of the cervical spine muscles – muscles that are critical to maintaining the health and function of the head and neck region.
Over time this strain can develop into what is known as micro-trauma. Simply stated, micro-trauma is very small scale damage that occurs in the muscles, tendons, joint capsules, and ligaments in response to small levels of strain. In many cases this micro-trauma is not painful, but the damage still needs to be repaired. The body responds to micro-trauma in a predictable way – by laying down small amounts of scar tissue to repair the area. Unfortunately, over time this scar tissue will build-up and accumulate into what we call adhesions. As adhesions form they start to affect the normal health and function of the muscles and related joints. In fact, they will often lead to pain, tightness, stiffness, restricted joint motion, and diminished blood flow. This places even further strain on the neck muscles, which in turn leads to even more micro-trauma. Essentially a repetitive strain injury cycle is set-up causing continued adhesion formation and progressive spinal column dysfunction.
Although strain of the muscles, tendons, and ligaments themselves can be responsible for tension-type headaches through the referred pain phenomenon, they may also cause headaches if they compress or entrap the nerves that supply the head. As the nerves exit the spinal cord they travel through small opening in the spinal column, then pass through and between the muscles that surround the cervical spine, and continue on to supply distant structures such as muscles, joints, skin, and blood vessels.
Many of these nerves travel down the arm (which is why neck problems often cause arm pain) but some of these nerves actually travel up to supply the back, side, and top of the head. Under normal circumstances these nerves should be able to move and slide between the surrounding muscles. However, when the neck muscles become tight and there is an accumulation of scar tissue adhesions in and around the musces it is common for these adhesions to affect the nerves. In many cases the adhesions can cause nerves to become “stuck” to the surrounding muscles and other structure. Instead of the nerves easily gliding between the muscles they become stretched and irritated. When nerves become irritated symptoms are usually generated in the area that the nerve travels to – in this case, the head.
The most common approach to treating headaches is medication to reduce inflammation, block pain, or relax muscles that may be causing headache symptoms. In the case of chronic or recurrent headaches, sometimes doctors will prescribe stronger prescription medications to help fight the headache symptoms. In some cases, even more invasive measures such as joint blocks are used, whereby an agent is injected into the joint to block the referred pain and other symptoms.
The main reason that medications fail to provide long-term resolution for headaches is that they fail to address any underlying problems of the muscles, nerves or joints of the neck that are causing recurrent headaches. Instead, they address the symptoms of the headache and simply cover up the underlying issues in the neck – issues that if not addressed will continue to cause problems.
Unfortunately, muscle tightness, scar tissue adhesions, nerve entrapment, and normal joint movement cannot be seen on x-rays or advances imaging. This is because the water density of the scar tissue tends to be quite similar to the surrounding tissues. These problems in the muscles, joints, nerves and ligaments can, however, be felt or tested with the hands of a properly skilled practitioner, as scar tissue has a very unique texture. A thorough history and clinical examination is usually sufficient to give the clinician enough information to diagnose the problem.
A.R.T. stands for Active Release Techniques. It is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves. A.R.T. treatment is highly successful in dealing with many types of headaches because it is specifically designed to locate and treat scar tissue adhesions that accumulate in the muscles and surrounding soft tissues. By locating and treating the soft-tissue adhesions with A.R.T it allows the practitioner to, 1) break-up restrictive adhesions, 2) free entrapped nerves, 3) reinstate normal tissue flexibility and movement, and 4) more completely restore flexibility, balance, and stability to the injured area and to the entire kinetic chain.
You can think of an A.R.T. treatment as a type of active massage. The practitioner will first shorten the muscle, tendon, or ligament, and then apply a very specific pressure with their hands as you actively stretch and lengthen the tissue. As the tissue lengthens the practitioner is able to assess the texture and tension of the muscle to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar tissue adhesions are felt the amount and direction of tension can be modified to treat the problematic area. In this sense, each treatment is also an assessment of the health of the area as we are able to feel specifically where the problem is occurring.
An additional benefit of A.R.T. is that it allows us to further assess and correct problems not only at the site of pain itself, but also in other areas of the kinetic chain, which are associated with movement compensations and are often contributing factors to the problem. This ensures that all the soft tissues that have become dysfunctional and are contributing to the specific injury are addressed, even if they have not yet all developed pain.
One of the best things about A.R.T. is how fast it can get results. In our experience, many patients respond very well to A.R.T. treatment, especially when combined with the appropriate self-directed neck stretching exercises. Although each case is unique and there are several factors that will determine the length of time required to improve or resolve each condition, we usually find a significant improvement can be gained in just 4 – 6 treatments. These results are the main reason that many elite athletes and professional sports teams have A.R.T. practitioners on staff, and why Art is an integral part of the Ironman triathlon series.