Hi, I’m Dr. Fergus with Cornerstone Health. Today I’d like to show you two tests you can do at home to see if your shoulder is causing your chronic headaches. I’m also gonna show you one exercise strategy that you can try today to see if you can get that under control and reduce your headache pain.
Hi, I’m Dr. Benjamin Fergus, here with Cornerstone Health in downtown Evanston. Our practice really sets out to help eradicate the chronic pain crisis here in Evanston, but also through Chicago, and the other areas that we help other practitioners with our style of practice.
One thing that comes up a lot in our practice is patients that have headaches that will not go away without the use of medication, and sometimes even with the use of medication, they suffer from chronic recurring headaches. Today we’re gonna dive into one or two things that we look at in our office when a patient suffers from chronic headaches.
The first thing we need to be aware of with headaches is that the muscles in your shoulders and your back, and in your chest, can all create a referral symptom, or send symptoms to the head, that create your headaches. The area that we’re gonna inspect together today are the muscles that run from the neck to the shoulder. These are called suprascapular muscles. And a good way to evaluate how these muscles function is by bringing the shoulder through a range of motion. Now typically, when we have to do things overhead, we wanna see most of that shoulder rotation happen around an axis towards the tip of the shoulder. And what we find very often in our chronic headache pain sufferers is, when they elevate the arms above head, all of the muscles between the shoulder and the neck fire in a very intense way. And this way of functioning can happen normally a few times, but when it’s used every single time you move the shoulder, this leads to the chronic problem. So let’s take a look at a few motions to highlight that.
First I’m gonna bring the arms out to the side, and this is a test you can do at home. We’re gonna take the angle of the shoulder and place the arm just inline with that angle. So if you have slightly rounded shoulders, your arm will be further forward. Keeping the arms straight, I want you to slowly elevate the arms like you’re gonna dive into a pool. Now we have a few criteria for this test as we watch him complete the motion. One, by keeping the arms straight, you should be able to touch the backs of your wrists together above your head. So he can get there, but there’s a pretty good bend in the elbow. Let’s bring that back and see if he can accomplish that with the arms straight. Go ahead and bring those together. So with some guidance and effort, he can keep his arms mostly straight and touch his wrists together. Bring that back down. So the first criteria is a bit of a pass for him, but it took some coaching. Next we’re gonna look at the space between the ear and the tip of the shoulder. When you elevate your arms up to touch them overhead, I should still see a lot of space, or an opening between the neck and the shoulder. I don’t wanna see that opening close with muscle activity and shoulder-hiking. Go through that motion once more. Arms completely straight. Elevate, and I want this to be the axis. So I don’t want crowding of the shoulder towards the neck. Great. Now, if you do this and you have a family member observing you, and the shoulder elevates up towards the ear on one or both sides, this is a high indicator to be a cause of your chronic headaches. You can let that lower down, all the way down.
In our office we’ll then evaluate the muscles that create that motion, primarily the upper trapezius muscle and the levator scapula muscle, and when I can press into those particular muscles, it may reproduce or recreate your headaches. When we can do that, I can guarantee you, with a high level of success, that we can help you stop suffering from your chronic headaches.
An additional test that we use for patients who suffer from headaches is to observe the way they rotate their head to each side. One criteria is you need to be able to rotate your head purely, in one plane of motion, until your nose can cross the line of the front of the shoulder on each side. So we’re gonna watch that. But we’re also gonna watch what muscles might be used to compensate for a loss in that normal rotation. So I’m gonna have our patient keep the neck as one unit. That means no segmental movement, one axis of movement. And I want you to slowly look all the way to the left. And I’m gonna watch what the neck does and it should be in a nice, straight line. He does a very good job of that. His nose matches the front line of the shoulder. So he has full functional rotation to the left. Come back to center. Keeping the head as one unit, let’s rotate to the right. As we rotate to the right here, there’s a limit in the motion of his spine on the right side that creates side-bending of the head when his attempt was pure rotation. We see the muscle activity kick up, and this is a spot that will be evaluated as a potential cause for his chronic recurring headaches. When we have identified this rotational element as a contributing factor to the headaches, there’s a few great exercises that you can try out at home to reduce that tension. Let’s show you one now.
I’m gonna have you stand up and come over to the wall. If you’ve done these two tests and identified that your shoulder might be a contributor to your neck or headache pain, we’re gonna show you one exercise you can try today at home.
This is called the wall-lean diamond elbow support with head rotation. In our office we also call it extra-column, the movement of external rotation for the neck. I’m gonna have you stand about a foot and a half away from the wall and place your elbows and hand in a diamond position. The diamond for your hands should be at about forehead height, and then you’re gonna lean your elbows into the wall. The elbows need to be a little bit higher than the shoulders in the initial setup. In this position I want your back muscles to push along through the arms, like you’re lengthening the elbows up and out, and I want to avoid the movement of the shoulder up towards the neck. To do that you have to think about being wide in the shoulders while pushing long. This is gonna create an initial stability in the shoulder that allows the neck to move without cramping or clenching those muscles. Then we’re gonna add some neck rotation. So keeping the back of the neck long, I’m gonna have you rotate to look past your left elbow. And again, this rotation’s quite good. Come back to center. And let’s rotate to the opposite side. And we see that little limitation when he rotates to the right. So we’re gonna ask him to remove that. Come back to center. And I want you to keep the neck as one unit and very slowly rotate until you just start to feel that barrier, right there. To counteract this muscle activity, you’re gonna think about turning the shoulder wide and pushing long. Now pick something that’s in your vision, and we’re gonna come back to that spot. Rotate back to the start, and each time you rotate, I want you to get to that same spot that you looked at, or maybe just a quarter of an inch further, without letting the shoulder travel up towards the ear, and back. After 10 repetitions, we should see the neck being able to rotate progressively further without clenching the muscles that cause headaches. You can try this exercise at home.
It’s not the only exercise we use, but it’s one that might help you today, before you can get in for your appointment.
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1030 Davis St. Suite 100
Evanston, IL 60201
(Intersection of Davis & Oak)