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Studies Show Specific Exercise and Manual Therapy Help With Neck Pain and Headache

Neck pain and headaches affect a significant number of people. Physical therapy can help these issues in a variety of ways.  Two recent studies have found that manual therapy techniques and specific exercises performed by PT's can help chronic neck pain and headaches.   

 The first study by Espi-Lopez et al looked at the use of specific manual techniques applied to the suboccipital area (just below your hairline on the back of your neck) for treatment of headaches.  They were specifically used on people who had chronic tenstion-type headaches.  This type of headache is characterized by a pressure-type pain felt on both sides of the head starting at the base of the skull and may also be felt in the temples or forehead. 

They treated headache sufferers with hands-on techniques (individually or in combination) designed to decrease the muscle spasm or to increase movement in the joints of the neck .  They then asked questions to see if the treatment provided improved the patient's quality of life.  This included areas such as performing physical activity, work, social functions, and general health, energy, and pain interference with activities. Patients were only seen for 4 weeks but they still experienced a significant improvement in quality of life after treatment with both treatments separately and in combination.  

 Two recent studies have found that manual therapy techniques and specific exercises performed by PT's can help chronic neck pain and headaches.  

The second study by Izquierdo et al compared two types of exercises used by physical therapists  for treating neck pain and headaches. Often, people with neck pain have impaired muscle activation.  This means that the body gets confused about what muscles to contract when for daily movement.  This muscle confusion can lead to continued pain for a long period of time after an injury.  

The first exercise used addresses the coordination of the deep muscles of the neck.  The second type of exercise addressed the coordination of neck muscle activity with eye and head movements.  This type of exercise improves proprioception or the awareness of one's own body position.   The researchers found that both types of exercise improved pain and function in people with chronic neck pain. Subjects had better neck muscle endurance, proprioception, and decreased pain.  

These findings are good news for people with chronic neck pain or headaches.  Your physical therapist can help you recover faster using the appropriate treatments and home exercise program.


The material on this site is for informational purposes only and is not intended to diagnose of suggest treatment for individuals.  Consult your health care provider regarding your specific needs.


~What I Have Learned-Experience of a PT Intern

Here are some final thoughts from Missy on what she has learned during her time in our clinic.  We see a variety of specialty conditions that can be eye-opening to interns when experiencing them for the first time.  Marnie

I am an intern doing a rotation in women's health and chronic pain with Marnie Clemens, DPT.  During my rotation, I have learned that not only is physical therapy useful for the typical shoulders, knees, can be very helpful in chronic pain and pelvic floor dysfunction.  Many things have surprised me during this rotation.  Among them, the lack of awareness of physical therapy's effectiveness for pelvic floor dysfunction, how chronic pain can be decreased with skilled manual techniques, and the effectiveness of biofeedback for relaxation and pain reduction.

Many patients and even healthcare professionals aren't aware that pelvic pain can be caused by things other than pelvic organs.  Also, many men can have pelvic pain too.  Many cases of pelvic pain can be remedied or controlled by internal myofascial / trigger point release, and therapeutic exercise prescribed by a physical therapist.  I used to think that urinary incontinence was caused by childbirth and that it was a normal process of aging.  It turns out, that is a misconception.  It is NEVER normal to have leakage during a cough, laugh or sneeze.  Sometimes it can be caused by weak muscles but it can also be caused by the muscles not kicking in when they should.  The problems can be determined by a simple internal pelvic floor examination and exercises prescribed for the particular problem. 

Chronic pain problems can be an issue for many.  Surprisingly, it can start with pain in a localized region and then seem to "spread."  This is because the brain gets confused where the pain actually is located, then causes the pain to become more spread out and not easy to locate.  Calming the nervous system down with specialized physical therapy techniques improves the body's relaxation response and ability to control pain. 

Biofeedback has so many uses in physical therapy.  For instance, with chronic pain symptoms, patients can learn to perform deep breathing / belly breathing exercises to calm the heart rate, nervous system, and subsequently the entire body.  Patients can see their body's natural rhythm and make real-time changes to improve.  Most generally, after deep breathing exercises, within a short time, the body calms itself and they spend more percentage of their time in the more relaxed state.  Patients then can use this technique every day in either stressful events or painful episodes.  Biofeedback also has a great utility in managing painful headaches. 

In physical therapy school we learn how to treat patients in a more acute state and we have minimal classes in women's health.  Dr. Clemens is a great PT that really connects with and educates her patients, not only about their current condition but also how they can manage their chronic pain on a daily basis in any situation. 

Melissa Hickman SPT 


The material on this site is for informational purposes only and is not intended to diagnose of suggest treatment for individuals.  Consult your health care provider regarding your specific needs.


~Benefits of Tai Chi

Tai Chi is a great form of relaxing movement that is great for people with pain.  Marnie

Just like judo, karate, and kung fu, Tai -chi is considered a martial art.  It does not involve high energy movements like kicking, punching, and fighting.  It uses slow, steady movements that enhance relaxation, stress reduction, and inner peace while also being physically challenging the body. There are different types of tai chi that can be accommodative to almost anyone.  The most popular types are yang, wu, and tai chi chih.  Yang is physically challenging because the knees are kept bent with a wide stance at the feet during the movements.  Wu is like yang, except the knees are just slightly bent with the feet closer together.  Wu is best for beginners and people with balance problems.  Tai chi chih style focuses on keeping weight distributed evenly between both feet, so it tends to be easier on the body.

The Chinese believe that practicing tai chi can slow the aging process, increase flexibility, strengthen muscles and tendons, and also help treat high blood pressure, heart disease, arthritis, digestive issues, skin diseases, depression and even cancer! However, these claims need to be studied scientifically.  Scientists do know that practicing tai chi improves balance, fear of falling, strength and endurance, aerobic capacity, walking, fibromyalgia, and stress. 

  • Balance:  Tai chi helps with balance by shifting weight in legs while the upper body is steadily moving also.  Researchers found that balance improved significantly after only performing tai chi for 8 weeks.
  • Fear of falling:  Tai chi aids in increasing self-confidence when it comes to falling with the elderly.  This self-confidence also gives them the added benefit of motivation to continue exercising.  Win win!
  • Strength and endurance:  Muscle strength, endurance, and flexibility were all improved in the upper and lower body after practicing tai chi for only 12 weeks.
  • Aerobic capacity:  Those who do tai chi have greater aerobic capacity when compared to sedentary people of the same age, even though the movements are slow and steady.
  • Walking:  As we age, walking speed seems to slow down.  With tai chi, research showed people actually take more steps!
  • Fibromyalgia:  Fibromyalgia can be debilitating, depending on severity.  However, tai chi decreased symptoms of fibromyalgia and therefore, enhances quality of life.
  • Stress:  Practicing deep breathing during tai chi exercises helps with finding inner peace and calmness because of the mental concentration with physical movements.

Other reasons to practice tai chi include: low impact movements, less risk of injury, can be done anywhere at your own pace, non-competitive, and can be done alone or with friends.  So, find some videos to do it at home, or go to your local gym and ask about tai chi classes offered, and grab a friend and get moving!  


Melissa Hickman SPT 


The material on this site is for informational purposes only and is not intended to diagnose of suggest treatment for individuals.  Consult your health care provider regarding your specific needs.


~Deep Breathing for Pain

Here is a post on breathing from our intern. This is a great technique to control pain and stress.   Marnie

We all experience stress at some time in our lives, some of more than others.  There is no avoiding stress, but learning to manage it can help with our health and control of pain.  We've all heard of the fight or flight response... it's our body's way of protecting us from harm and letting us know when danger is ahead.  Health problems can occur when we have too much stress every single day. Constant, day-to-day stress is bad for our heart and also our immune systems.  Unfortunately, it can also lead to anxiety and depression.  The best thing to do is to learn ways to relax, especially in stressful moments.  Ways to do this are progressive muscle relaxation, meditation, yoga, and deep breathing. 

Deep breathing is also known as diaphragmatic breathing, abdominal breathing, belly breathing, and paced respiration. With deep breathing, the belly should rise when you inhale.  A lot of us breathe with our chests, instead of our bellies, which increases tension and anxiety.  When we breathe with our upper chest only, the lower part of our lungs don't get fully inflated and the diaphragm doesn't fully go down all the way.  This lack of oxygen to the lower part of the lungs alone can make us feel anxious and short of breath. On the other hand, deep breathing  is where the lungs get fully inflated, the diaphragm goes down far enough and lets the belly rise.  This allows oxygen to reach the lungs and actually slows the heart rate and lowers the blood pressure.

Slow breathing helps you focus on your breathing instead of everyday stressful thoughts. First, learn to breathe:  lie in a quiet place, place a hand on your belly and take in slow deep breath and you should feel your hand rise, then breathe out as slowly as you inhaled.  It can help to listen to the sound of your breath.  Try to disconnect yourself from distracting thoughts.  Once you've mastered this part, then you're ready for the next step:  belly breathing while focusing on images or words that relax you. 

Breath focus helps with other relaxation methods like progressive muscle relaxation, meditation, yoga, prayer, and pleasant images.  It's best to have a daily routine of deep breathing, especially right before a stressful event.  Find a quiet place, don't let the breathing be stressful, practice the same time everyday 1-2 times per day, and perform 10-20 minutes each day. 

Melissa Hickman SPT


The material on this site is for informational purposes only and is not intended to diagnose of suggest treatment for individuals.  Consult your health care provider regarding your specific needs.


~TMJ (Jaw Pain) Basics

Here is another post from our intern.  She is learning more about some of the special problems we see.  Marnie

The TMJ (temporomandibular joint) is the joint where the jaw and skull bones meet.  TMJ syndrome occurs when that joint is impaired.  Causes range from teeth alignment to poor posture or even stress. Just like any joint in the body, arthritis (breakdown of the joint and/or bony surfaces) can occur there as well. TMJ syndrome occurs when there is nerve, muscle, or joint damage.  Women are more at risk to develop this issue.  Some of the more common causes are poor posture, grinding teeth, increased stress/anxiety, or even too much gum chewing. 
Symptoms can be severe and may include:
  • jaw, neck, tongue, face and/or shoulder pain
  • jaw clicking or popping
  • ear pain or cracking sounds in the ears / fullness in ears / tinnitus
  • headaches
  • blurry vision, dizziness
  • soreness in neck/face muscles
  • locking of jaw
Many do not know that physical therapy can be very helpful for this condition.  Physical therapy is useful by correcting posture, strengthening jaw/neck muscles, increasing flexibility and jaw/neck motion.  PT can help you learn things to do at home such as using ice packs, eating softer foods, and even reducing stress. 
Melissa Hickman SPT