TRAPEZIUS AND HEADACHES

Have you a headache and you don´t know the reason?

The trapezius is the muscle more treated in consultant and it can be responsible for neck pain and headaches and I will explain the reason.

Image 1: Trapezius

First of all, it is very important to know where is that muscle, so it extends longitudinally from the occipital bone to the lower thoracic vertebrae of the spine and laterally to the spine of the scapula. It can do movements of rotation, inclination, flexion and extension of our head, furthermore it can do elevation of our shoulders and helps to hold the weight of the upper limbs.

Due to the increment of sedentary, the stress and computer jobs that muscle develops trigger points, that is a small knot in your muscle. These muscle knots can cause pain where it originates or further away, in a spot that seems complete unconnected. It is for that reason trapezius can be responsible for neck pain and headaches. 

Image 2: Different referred pains of trapezius triggers points

So, if you touch that point and the pain is like the image, it can be you have a trapezius trigger point. These are the solutions:

•         The ischemic compression: it consists of applying a pressure on a number of sensitive points previously identified by palpation, until reaching the pain threshold, maintaining the pressure, as the patient's pain decreases, the pressure will increase on the point until reaching a maximum one minute The purpose of ischemic compression is to deliberately increase the blocking of blood to an area so that the affected tissue heals more quickly, improving local blood flow, "washing" the waste products by supplying oxygen to the muscle ^1,2.

•         Ergonomics: you should see if your posture is correctly most of the time. According to my experience as physiotherapist, the forward head posture and protacted shoulders sitting in front of the computer is the reason for having a headache o neck. (You can see my post of FORWARD HEAD POSTURE: EXERCICES AND STRETCHES)

•      Stretching: you should to do a flexion of head, inclination same side and rotation opposite side a minimum of 30 seconds.

•        Of course, consult a health professional

BIBLIOGRAPHY

1. F. Javier Montañez-Aguilera, Noemí Valtueña-Gimenoa, Daniel Pecos-Martín, Rosana Arnau-Masanetc, Carlos Barrios-Pitarqued and Francisco Bosch-Morelle. Changes in a patient with neck pain after application of ischemic compression as a trigger point therapy. Journal of Back and Musculoskeletal Rehabilitation 23 (2010) 101–104. 2010; 23 (2010): 101–104

2. Montañez-Aguilera FJ, Valtueña-Gimeno N, Pecos-Martín D, Arnau-Masanet R, Barrios-Pitarque C, Bosch-Morell F. Changes in a patient with neck pain after application of ischemic compression as a trigger point therapy. J Back Musculoskelet Rehabil. 2010;23(2):101-4. doi: 10.3233/BMR-2010-0255. PubMed PMID: 20555123.

headache location chart and meaning

WHAT I SHOULD PUT ON, HEAT OR COLD?

In the event of injury, is it better to apply cold or, on the contrary, what should we use is heat? It is one of the most asked questions in consultation, so we would like to resolve this question in a generalized way.

Image 1: heat or cold

As a general rule:

- If the injury occurs in the back or we are sure it is a muscle contracture, we will apply heat to the area.

- After physical exercise apply cold.

- In case of traumatic injuries such as blows, sprains or breaks, follow the following advice:

• Acute injuries: (less 3 days from the injury)

We will apply cold until 72 hours after traumatic injuries if we notice that we have red, bulging or reddened area. Maintain the application of cold 20 minutes being able to repeat the operation 3 and 5 times a day allowing at least 2 hours between each one.

• Subacute injuries: (between 3rd day and 1 month since the injury)

We will alternate cold and heat by direct application (bags or gels), containers with cold and hot water or in the shower. The application will be 3'calor + 2'frío + 3'calor + 2'frío + 3'calor. Being able to repeat the operation 3 and 5 times a day allowing at least 2 hours between each of them. Remember that if we do physical exercise and we notice swelling or redness we will apply cold immediately afterwards.

• Chronic injuries: (more than 1 month since the injury)

Apply heat for 20 minutes and can repeat the operation 3 and 5 times a day allowing at least 2 hours between each. Also, remember that if we do physical exercise and we notice swelling or redness we will apply cold immediately afterwards.

Image 2: cold contraindications

Cold contraindications:

- Raynaud's syndroms
- Heart problems
- Alterations of circulation
- Hypersensitivity or allergy to cold
- Acute inflammation of unknown origin or fever

Image 3: heat contraindications

Heat contraindications:

- Heart problems
- Alterations of sensitivity
- Wounds, ulcers, burns
- Fever
- Varicose veins
- Lymphedema
- Diabetes

sciatica pain relief hot or cold

FORWARD HEAD POSTURE: EXERCICES AND STRETCHES

Forward head posture and protacted shoulders are two of the most common postural deviations in people of all ages ¹. This posture constitutes the "upper crossed syndrome" being frequently associated with musculoskeletal pain.

Image 1: upper crossed syndrome

“Upper crossed syndrome" is a decompensation level upper back, shoulder and chest. There are contracted muscles (pectoralis major, trapezius and levator scapulae) and inhibited others (deep neck flexors, rhomboids and serratus major), producing an imbalance and reflected in the position of the upper part of the trunk. This results in a curved posture that intrinsically leads to a weakness in the scapula with the consequent destabilization in the shoulder joint.

Stretching of the upper trapezius, the sternocleidomastoid, the levator scapulae and the strengthening of the deep cervical flexor muscles have been shown to be effective in correcting the forward head position ². While the treatment of the protacted shoulders is based more on the strengthening of the scapular stabilizers and the rotator cuff muscles and pectoralis minor stretch ^2,3.

That is why I propose to you, strength training and stretching for the correction of posture based on the study by Roivo et al. (2016) ⁴. This protocol is intended to restore normal muscle balance between opposing muscle groups (agonists and antagonists) and work the elongation capacity of muscle groups that restrict the range of joint movements to those that oppose, this concept being supported by several studies ^2.5.

How long?

The exercises must be performed 2 non-consecutive days a week for at least 16 weeks. For strength training, we start with light loads (1- 1'5 kg) and 3 sets of 12-15 repetitions, with the rest interval between sets of 30 seconds. In the three stretching exercises, there will be 2 series of 30 seconds of duration ⁶. The total intervention program took an average of 15 minutes to complete, and the order of the exercises can be random.

Strength exercises

Side-lying external rotation

Side lying with arm fully adducted to side and internally rotated with elbow flexed to 90°. Patients then externally rotate the shoulder with the hand moving in an arc away from the body.

Prone horizontal abduction with external rotation

In a prone horizontal abduction position, the patient horizontally abducts the arm with the elbow extended and with external humeral rotation. The participant lifts the hand toward the ceiling keeping head/neck neutral and squeezing both shoulder blades together.

Y-to-I exercise

The patient retracts the scapulae with the arms abducted to 90°. As the patient advances, the shoulders are externally rotated with the elbows flexed to 90°, forming a Y. Then the patient moves into a position of full bilateral elevation with the elbow extension forming an I.

Chin tuck

This exercise targets the deep flexor muscles of the upper cervical region, the longus capitis and longus colli muscles. This is a low-load exercise51 that involves performing and holding inner range positions of craniocervical flexion that specifically activate and train the deep cervical flexor, rather than the superficial flexors muscles. This exercise is done in a supine lying position with the head in contact with the floor.

Video link

Stretches

One-sided unilateral self-stretch exercise Pectorals minor

The participant’s forearm is stabilized by a vertical plane before the trunk is rotated in the opposite direction. Therefore, arm on the involved side is externally rotated and abducted to 90°.

Static sternocleidomastoid stretch

Start in optimal posture and place right arm behind body, depressing the shoulder. Draw abs in. Tuck chin and slowly draw left ear to the left shoulder. Continue by rotating the neck upward toward the ceiling until a slight stretch is felt on the right side. We can use the left hand to apply slight pressure and assist in lateral flexion and rotation. Switch sides and repeat.

Static levator scapulae stretch

Start in optimal posture and place right arm behind body, depressing the shoulder. Draw abs in. Tuck chin and slowly draw left ear to the left shoulder. Continue by rotating the neck downward toward the ceiling until a slight stretch is felt on the right side. We can use the left hand to apply slight pressure and assist in lateral flexion and rotation. Switch sides and repeat.

What results were obtained?

After 16 weeks, significant differences were observed at two postural angles in the intervention group from pretest to posttest, with an increase in the cervical angle (44.4 ° ± 3.5 ° vs 46.8 ° ± 3.9 °) and shoulder angle (45.9 °). ± 4.9 ° vs 49.8 ° ± 6.5 °) after the intervention ⁴. Getting a head position less advanced and a lower shoulder protraction.

A: Cervical angle; B: Shoulder angle

In summary

This study indicates that a specific exercise program, performed twice a week and integrated into physical education classes over a period of 16 weeks, may result in improved posture, with increases in cervical and shoulder angles.

Bibliography

1. Grimmer-Somers K. An investigation of poor cervical resting posturer. Aust Physiother. 1997;43(1):7-16.2. Lynch S, Thigpen C, Mihalik JP, Prentice W, Padua D. The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers. Br J Sports Med. 2010;44(5):376-381.3. McDonnell MK, Sahrmann SA, Van Dillen L. A specific exercise program and modification of postural alignment for treatment of cervicogenic headache: a case report. J Orthop Sports Phys Ther. 2005;35(1):3-15.
4. Ruivo RM, Pezarat-Correia P, Carita AI. Effects of a Resistance and Stretching Training Program on Forward Head and Protracted Shoulder Posture in Adolescents. J Manipulative Physiol Ther. 2017 Jan; 40:1-10.5. Lee M-H, Park S-J, Kim J-S. Effects of neck exercise on highschool students’ neck-shoulder posture. J Phys Ther Sci. 2013;25(5):571-574.
6. Page P. Current concepts in muscle stretching for exercise and rehabilitation. Int J Sports Phys Ther. 2012;7(1):109-119.

forward head posture fix 

flex posture corrector

BEFORE DOING PHYSICAL EXERCISE ... TO STRETCH OR NOT TO STRETCH? ... THAT IS THE QUESTION

The static stretching is held in a stretch of the muscle at rest until a certain position and maintaining the position for 15 - 30 seconds. It is commonly practiced by athletes as part of a routine prior to exercise and as part of a continuous exercise program.

Every weekend I can see that, before a race, a lot of athletes do this type of stretching, which makes me think if I should imitate them or not. With this article I want to scientifically verify if static stretches before physical exercise fulfill the benefits that most people believe they have:

· Improve flexibility,
· Improve physical performance and / or,
· Prevent injuries in the musculotendinous unit.

FLEXIBILITY

There is consistent evidence that static stretching increases flexibility in the short term, although gains in flexibility decrease relatively quickly, so that they are lost in 30 minutes 1-5. But there is also consistent evidence that stretches performed regularly over several weeks produce significant improvements in the range of motion ^6-11.

The mechanism of how this increase in range of motion occurs is subject to debate, which may be changes in neurophysiological factors (for example, changes in the tolerance to stretching) or mechanical factors (for example, viscoelastic changes).

Several studies have shown that static stretching does not change the mechanical properties of the musculotendinous unit ^10,12-18. This would suggest that the increase in range of motion is due to a greater tolerance to stretching, rather than to any mechanical alteration in the tissues.

In summary:
· Static stretching increases flexibility in both the short and long term.
· The mechanism through which static stretching achieves greater flexibility is still debatable. While a greater tolerance to stretching is likely and mechanical changes are very unlikely.

PHYSICAL PERFORMANCE

Effect on explosive strength, power and muscular performance.

Several recent reviews and meta-analyzes ^19-22 have agreed that, static stretching maintained for more than 45 seconds immediately before exercise:

· Influences negatively on maximum strength, power, explosive muscular performance (for example, jumping and running), balance and agility or,

· It has no effect on performance.

In other words, none of the reviews showed a beneficial effect of static stretching on explosive muscle performance.

Effect on endurance performance

The influence of stretching on activities such as running and cycling is less clear. A recent review 23 described how several studies ^24-27 show a negative influence, while others ^23,28-30 show no change in performance. Very few studies 60 report improvements in endurance performance after stretching.

In summary

· Stretching should be avoided for more than 45 seconds immediately prior to participation in activities where strength or power are important, since performance is likely to be reduced without any clear benefit to justify continued use.
· In endurance activities, stretching is difficult to justify immediately before participation, since performance can be reduced without clear benefits that justify continued use.

INJURY PREVENTION

It seems intuitively to make sense that stretching should help prevent injuries or help speed up the return to activity. However, the relationship between the reference flexibility and the future risk of injury is complex, and many studies ^31,32 show that there is no relationship between the two.

In fact, several systematic reviews have evaluated the effect of stretching on the risk of injury ^33-35, concluding that:

- "There is insufficient evidence to support or interrupt routine stretching before or after exercise to avoid injury among competitive or recreational athletes" ³³ and

- "In light of these findings, routine stretching exercises before the start of sports activities are not a proven and effective method to reduce injury rates" ³⁶.

In summary:

· Static stretching does not seem to reduce the risk of injury.

CLINICAL IMPLICATIONS

It is difficult to justify the use of stretching for any of the objectives examined in this article:

· Flexibility: stretching is very effective both in the short and long term. However, flexibility is not as important a factor in performance and injury prevention as was previously thought.

· Short term performance: stretching can decrease performance, especially when performed immediately before explosive activities.

· Injury prevention: there is very little evidence that stretching is effective.

Therefore, the only area in which static stretching seems to offer a specific advantage is in the one with the greatest flexibility. There may be times when the most important goal is to improve flexibility (for example, ballet) by being only in these isolated circumstances in which static stretching may be justifiable.

BIBLIOGRAPHY

1.            de Weijer VC, Gorniak GC, Shamus E. The effect of static stretch and warm-up exercise on hamstring length over the course of 24 hours. J Orthop Sports Phys Ther 2003; 33:727-733.

2.            DePino G, Webright W, Arnold B, Duration of maintained hamstring flexibility after cessation of an acute static stretching protocol. J Athl Train 2 2000; 35:56-59.

3.            Spernoga SG, Uhl TL, Arnold BL, Gansneder BM. Duration of maintained hamstring flexibility after a one-time, modified hold-relax stretching protocol. J Athl Train 2001; 36:44-48.

4.            Ford P, McChesney J. Duration of maintained hamstring ROM following termination of three stretching protocols. J Sport Rehabil 2007; 16:18-27.

5.            O'Sullivan K, Murray E, Sainsbury D. The effect of warm-up, static stretching and dynamic stretching on hamstring flexibility in previously injured subjects. BMC Musculoskelet Disord 2009; 10:37.

6.            Harvey L, Herbert R, Crosbie J. Does stretching induce lasting increases in joint ROM? A systematic review. Physiother Res Int2002; 7:1-13.

7.            Radford JA, Burns J, Buchbinder R, Landorf KB, Cook C. Does stretching increase ankle dorsiflexion range of motion? A systematic review. Br J Sports Med 2006; 40:870-875.

8.            Bandy WD, Irion JM, Briggler M. The effect of static stretch and dynamic range of motion training on the flexibility of the hamstring muscles. J Orthop Sports Phys Ther 1998; 27:295-300.

9.          Chan SP, Hong Y, Robinson PD. Flexibility and passive resistance of the hamstrings of young adults using two different static stretching protocols. Scand J Med Sci Sports 2001; 11:81-86.

10.          Reid DA, McNair PJ. Passive force, angle, and stiffness changes after stretching of hamstring muscles. Med Sci Sports Exerc 2004; 36:1944-1948.

11.          Decoster LC, Cleland J, Altieri C, Russell P. The effects of hamstring stretching on range of motion: a systematic literature review. J Orthop Sports Phys Ther 2005; 35:377-387.

12.          Halbertsma JP, Goeken LN. Stretching exercises: effect on passive extensibility and stiffness in short hamstrings of healthy subjects. Arch Phys Med Rehabil 1994; 75:976-981.

13.          Klinge K, Magnusson SP, Simonsen EB, Aagaard P, Klausen K, Kjaer M. The effect of strength and flexibility training on skeletal muscle electromyographic activity, stiffness, and viscoelastic stress relaxation response. Am J Sports Med 1997; 25:710-716.

14.          Magnusson SP, Simonsen EB, Aagaard P, Boesen J, Johannsen F, Kjaer M. Determinants of musculoskeletal flexibility: viscoelastic properties, cross‐sectional area, EMG and stretch tolerance. Scand J Med Sci Sports 1997; 7:195-202.

15.          Gajdosik RL, Allred JD, Gabbert HL, Sonsteng BA. A stretching program increases the dynamic passive length and passive resistive properties of the calf muscle-tendon unit of unconditioned younger women. Eur J Appl Physiol 2007; 99:449-454.

16.          Weppler CH, Magnusson SP. Increasing muscle extensibility: a matter of increasing length or modifying sensation? Phys Ther 2010; 90:438-449.

17.          Konrad A, Gad M, Tilp M. Effect of PNF stretching training on the properties of human muscle and tendon structures. Scand J Med Sci Sports 2014.

18.          Ben M, Harvey L. Regular stretch does not increase muscle extensibility: a randomized controlled trial. Scand J Med Sci Sports 2010; 20:136-144.

19.          Behm D, Bambury A, Farrel C, Power K. Effect of acute static stretching on force, balance, reaction time, and movement time. Med Sci Sports Exerc 2004; 36:1397-1402.

20.          Kay AD, Blazevich AJ. Effect of acute static stretch on maximal muscle performance: a systematic review. Med Sci Sports Exerc 2012; 44:154-164.

21.          Simic L, Sarabon N, Markovic G. Does pre‐exercise static stretching inhibit maximal muscular performance? A meta‐analytical review. Scand J Med Sci Sports 2013; 23:131-148.

22.          Winchester JB, Nelson AG, Landin D, Young MA, Schexnayder IC. Static stretching impairs sprint performance in collegiate track and field athletes. J Strength Cond Res 2008; 22:13-18.

23.          Peck E, Chomko G, Gaz DV, Farrell AM. The effects of stretching on performance. Curr Sports Med Rep 2014; 13:179-185.

24.          Wilson JM, Hornbuckle LM, Kim JS, Ugrinowitsch C, Lee S-R, Zourdos MC, et al. Effects of static stretching on energy cost and running endurance performance. J Strength Cond Res 2010; 24:2274-2279.

25.          Lowery RP, Joy JM, Brown LE, Oliveira de Souza E, Wistocki DR, Davis GS, et al. Effects of static stretching on 1-mile uphill run performance. J Strength Cond Res 2014; 28:161-167.

26.          Wolfe AE, Brown LE, Coburn JW, Kersey RD, Bottaro M. Time course of the effects of static stretching on cycling economy. J Strength Cond Res 2011; 25:2980-2984.

27.          Esposito F, Cè E, Limonta E. Cycling efficiency and time to exhaustion are reduced after acute passive stretching administration. Scand J Med Sci Sports 2012; 22:737-745.

28.          Mojock CD, Kim JS, Eccles DW, Panton LB. The effects of static stretching on running economy and endurance performance in female distance runners during treadmill running. J Strength Cond Res 2011; 25:2170-2176.

29.          Hayes PR, Walker A. Pre-exercise stretching does not impact upon running economy. J Strength Cond Res 2007; 21:1227-1232.

30.          Allison SJ, Bailey DM, Folland JP. Prolonged static stretching does not influence running economy despite changes in neuromuscular function. J Sports Sci 2008; 26:1489-1495.

31.          Bennell K, Tully E, Harvey N. Does the toe-touch test predict hamstring injury in Australian Rules footballers? Aust J Physiother 1999; 45:103-109.

32.          Wang HK, Chen CH, Shiang TY, Jan MH, Lin KH. Risk-factor analysis of high school basketball–player ankle injuries: a prospective controlled cohort study evaluating postural sway, ankle strength, and flexibility. Arch Phys Med Rehabil 2006; 87:821-825.

33.          Thacker SB, Gilchrist J, Stroup DF, Kimsey CJ. The impact of stretching on sports injury risk: a systematic review of the literature. Med Sci Sports Exerc 2004; 36:371-378.

34.          Herbert RD, Gabriel M. Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review. BMJ 2002; 325:468.

35.          Shrier I. Does stretching improve performance? A systematic and critical review of the literature. Clin J Sport Med 2004; 14:267-273.

36.          Schiff MA, Caine DJ, O'Halloran R. Injury prevention in sports. Am J Lifestyle Med 2010; 4:42-64.

stretch

stretch before or after exercise

ABOUT ME

I am Carlos, creator of the blog “Click Physiotherapy”.

I am a physiotherapist and I love my job. I have worked in clinics of rehabilitations and clinics of physiotherapy in Spain. I have experience in all areas of musculoskeletal physiotherapy specially in manual therapy, Pilates, dry needling and infant colic.

Last 2 years I have treated more than 800 patients and taught about 1000 Pilates´ classes. I like to help people in their physical rehabilitation, so this is the reason about my blog!

Please, contact me about any question: clickphysiotherapy@gmail.com