Neck pain management

Your spine
is made up of bones (vertebrae that support the body's weight), their joints (facets that guide the direction of the movement of the spine), and the discs (which separate the vertebrae and absorb the shock as you move), the muscles and the ligaments that hold it all together. One or more of these structures can be injured:

• You can strain or sprain the ligaments or muscles from a sudden movement, improper movement, or through over use.
• You can sprain the ligamentus part of your discs.
  Sprains can allows the disc to bulge & press against a nerve.

Any of these injuries can result in a two-or-three day period of acute pain and swelling in the injured tissue, followed by slow healing and gradual reduction of pain. The pain may be felt in the neck, the head (headaches), in the shoulder, or down arm (often the pain is felt primarily in the shoulder, arm or hand with very little actual neck pain). Onset of pain may be immediate or occur some hours after exertion or an injury. There may be a slow onset - pain gradually increases over several days or weeks.

SIGNS & SYMPTOMS

• Pain or deep ache of the neck, shoulder or arm(this needs to be differantiated from true shoulder pain, such as tendonitis\bursitis). There may be burning or tingling of the arm or hand or headaches. It may be continuous, or only occur when you are in a certain position. The pain may be aggravated by turning your head, looking up or looking down ( as with reading).

• limited range of motion (less than normal movement) of the neck.
• Stiffness of the neck and shoulder muscles.

Causes

• postural strain ( improper position when sitting - reading - working at a computer)
• Severe blow or fall.
• Car accident
• Heavy lifting.
• Sleeping without good neck support/sleeping on your stomach
• Turning over while you are asleep. Then waking up with a "stiff neck."
• Degenerated/ ruptured cervical disc.
• Bone spur.
• Nerve dysfunction.
• Osteoporosis, tumors.
• Spondylosis (hardening and stiffening of the spinal column).
• Congenital problem.
• Often there is no obvious cause.

Risk Increases With

• Sitting for long periods and bending your head /neck forward. (desk work, cooking, etc.)
• Participation in sports without warming up ( stretches).
• Sharp increase in athletic activity (weekend athlete)
• Poor posture with sitting - sleeping.
• Frequent travel on planes.
• Falling asleep sitting up.(head hanging down)

How to Prevent

• Exercises to strengthen /stretch neck and shoulder muscles.
• Learn how to sit and work without bending your neck.
• Proper back & neck support for your car/bed/sofa/chair.

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WHAT TO EXPECT WITH IF YOU SEE AN MD:

Diagnostic Measures

• Observe your symptoms.(What makes the pain worse/better)
• Medical history and exam by a doctor & referral to a physical therapist for persistent symptoms.
• Laboratory blood studies to determine if there is an underlying disorder, x-rays of the spine, sometimes a CT or MRI scan.
• Testing (see above) is often not done unless the person is not responding to conservative (rest, medications, physical therapy) treatment.

Appropriate Health Care

• Treatment will depend on severity of the pain and discomfort.
• Acute -sudden onset of pain or severe pain - severe neck and/or arm pain may require use of a collar and/or bed rest for first 24 hours and use of ice for first 72 hours. This usually follows trauma, a car accident, a fall or sharp pain/popping felt in the neck. SELF CARE Additional treatment will be determined by severity of the problem. Recent medical studies indicate that staying more active is better for spinal disorders than prolonged bed rest.
• Chronic- slow onset(over months or years) or low grade pain(constant dull ache). This may respond best to heat. If you are not getting relief with heat, try ice.
• Physical therapy treatment should address risk factors, prevention & a home exercise program in addition to pain reduction treatments.

• WHEN TO SEE A PHYSICAL THERAPIST

• Physical therapy should be prescribed when you have been treated by your M.D. but pain persists beyond 1-2 weeks or if you have had multiple episodes of pain over the past year.
• In most states you can go directly to a physical therapist. Depending on the nature of the condition, the therapist may refer you to a physician . The physician can prescribe medications, order tests and check to be sure you do not have a more serious medical condition that may be causing your symptoms.
• Physical therapy treatments should address risk factors, prevention & a home exercise program in addition to pain reduction treatments. SELF CARE.
• A physical therapy evaluation should include:
  1. History( The therapists will ask: How did you hurt yourself, When did the pain first appear? What makes the pain worse/better? Have you had this type of pain before? What were you doing just before you felt pain? What does your daily routine involve? etc.)
  2. Physical exam: ( You will be asked to do certain movements to determine what movements increase your pain, Your posture - how you sit & stand - will be evaluated, Your muscles will be palpated(massaged) to look for painful "knots" or spasm (increased tension), The mobility and quality of the motion of your joints will be checked, Your may have your reflexes tested, etc.
• Physical therapy treatments will vary depending on the condition. A through treatment will include a few basic elements:
  1. Pain reduction may include use of heat, ice, massage, relaxation, stretches, joint mobilization and other modalities including ultrasound & electric stimulation.
  2. *A home program may start out as simple as a list of things to avoid. This should increase gradually as you progress to include exercises, stretches and some type of simple first aid. The goal is for you to gain control over the symptoms as you gradually eliminate the cause of the problem. * This is where physical therapy differs from traditional chiropractic care.
  3. Prevention includes:
     • discussing risk factors for your specific condition.
     • exercises to increase strength and flexibility.
     • training in how to sit, stand, bend, move, return to sports, etc. without re-injuring yourself.
     • Suggestions for basic equipment including chairs, lumbar supports, wrist rests, etc. Depending on the person and the condition this may require purchasing a few items. Many "lumbar supports" can be made from simple items in the home such as pillows, towels, blankets. ( Your jacket can work as a lumbar support if you are out and you run into an unfriendly chair.)
• Options are available such as physical therapy, acupuncture, orthopedic care, treatment by a chiropractor, physiatrist or neurologist and others including surgery for damaged disk, or a local injection(epidural).
• Massage may help. Be sure the person is well trained or the massage may cause more harm than help.
• HOME TREATMENT The goals of self-care are to relieve pain, promote healing and avoid re-injury. For the first two or three days: Immediately after an injury and for the next few days, the most important home treatments include:

• Ice pack or cold massage applied to the low back for ACUTE strains Get in a comfortable position and apply cold packs or ice for 15-20 minutes three or four times a day or up to once an hour for at least the first three days. Cold decreases inflammation, swelling and pain.
• Heat applied for 15 -20 minutes while resting in a comfortable position with heating pad or hot water bottle for CHRONIC strains . Use caution with heat as this can increase swelling. If you are not getting relief with heat you may respond better to ice. SEE DEFINITION OF ACUTE VS CHRONIC.
• Use a cervical pillow. If you don't have a cervical pillow use a feather pillow with a small towel roll tucked in to support your neck. Everyone is different if you have a "good" pillow you will feel better after resting. If you have a "bad" pillow you will feel worse after resting.
• Use of a collar.
• Learn stress reduction techniques, if needed.
• Take breaks if you have to stand or sit for long periods.

• Sit or lie in positions that are most comfortable and reduce your pain, especially positions that reduce arm or hand pain.

• Do not sit up in bed, and avoid soft couches and twisting positions. Avoid positions that worsen your symptoms, such as sitting for long periods of time.

• Bed rest can help relieve neck pain but may not speed healing. Stick with what makes you feel better. Unless you have severe arm pain, one to three days of rest should relieve pain. More than three days is not recommended and could actually delay healing. Try one of the following:

POSTURES FOR ACUTE PAIN RELIEF

• Lie on your back with a soft(feather) pillow and a small towel roll under your neck with your knees bent and supported by large pillows.

• Lie on your side with a soft (feather) pillow and a small towel roll under your neck.
• When you sit add pillows so you can rest your head back comfortably and place a pillow under your arms.
• How big should the pillow be? Exactly where do I put the pillow? Use what gives you the best pain relief. ( We are all a little different.)
• Good posture means ear, shoulder & hip are in a straight line - this is the same for standing, sitting & lying down.

Which excercises are for you?

• If you have injured your neck within the last two weeks, or you have more pain in you arm/hand than in your neck, see First aid for back pain.
• Discontinue any exercises that increase pain or that causes pain to move towards the hand (i.e.: pain moves form shoulder to arm or arm to hand).

• Gradually increase any exercise that helps you feel better. STRETCHES

EXERCISES TO AVOID Many common exercises actually increase the risk of low neck pain. Avoid the following:

• neck circles.

• bending neck forward or looking up.

FIRST AID FOR NECK PAIN stop any exercise or treatment that increases your pain. When you first feel a catch or strain in you neck, try these steps to avoid or reduce expected pain. These are the most important home treatments for the first few days of neck pain.

First aid # 1 ICE As soon as possible, apply an ice pack to the injured area. (10-15 minutes every hour). Cold limits swelling, reduces pain and speeds healing.

First aid # 2 MEDICATION Some medications are available without a prescription. If the non-prescription dose does not relieve your pain CALL YOUR DOCTOR. Take aspirin or ibuprofen reglularly as directed on the bottle(call your doctor if you've been told to avoid anti inflammatory medication). Acetaminophen (tylenol) may also be used. Take these medications sensibly; never exceed the dosage suggested on the bottle, the maximum recommended dose will reduce the pain. Masking the pain completely might allow movement that could lead to re-injury.

First aid # 3 CHANGE POSITION FREQUENTLY Take the time to add a small pillow or towel roll to support your head/neck when you are sitting or lying down. DON'T STAY IN ANY POSITION THAT INCREASES YOUR PAIN.

First aid # 4 RELAX YOUR MUSCLES Listen to soft music - Practice deep breathing - try one of the commercially available relaxation tapes.

First aid # 5 USE A COLLAR USE A COLLAR A soft collar can help to rest your neck. This should be used for short periods .(Not more than an hour at a time. - take it off after the first fifteen minutes to be sure it does not increase your pain - Not more than a few days.)

First aid # 6 STRETCHES When to see M.D.

DO NOT CONTINUE WITH ANY EXERCISE THAT INCREASES YOUR PAIN. YOUR SHOULD FEEL A GENTLE STRETCH TRY TO RELAX.

1. SIDE STRETCHES
   • Sit or stand in a comfortable position
   • Move your head slightly to one side, bringing your ear closer to your shoulder
   • Keep your shoulders down
   • Relax and hold for 5-10 seconds
   • Stop if pain is increased or has moved into the arm or toward the hand.

   
   

2. CHIN TUCK
   • Sit or stand in a comfortable position
   • Pinch your shoulder blades together
   • Bring your chin back so it is in line with your shoulder and hip(see picture)
   • Keep eyes level - do not look up or down
   • This is a very small movement of your head, do not push back too hard.
   • Keep your shoulders down
   • Relax and hold for 5-20 seconds
   • Stop if pain is increased or has moved into the arm or toward the hand.

   
   

3. TURNING
   • Sit or stand in a comfortable position
   • Turns your head slowly to one side.
   • Keep your shoulders down.
   • Relax and hold for 5-10 seconds.
   • Stop if pain is increased or has moved into the arm or toward the hand.
   
   
4. Do the first aid exercises three to four times a day .

After two or three days of home treatment:

• Slowly increase the frequency of the first aid exercises.

• When your pain is gone slowly resume normal activities. Continue to use caution with lifting, bending, sitting & sports for 6 - 8 weeks, after the pain is gone, to allow the neck to heal. If you have a regular exercise program begin easy exercises that do not increase your pain. Start with 2-5 repetitions twice a day and increase to 10 as you are able.

Activity

• Try to continue with daily work or school schedules to the extent possible. Use care in resuming normal activities. Stop activities that cause increased pain.
• A gradual stretching/strenghtening program can help reduce pain. (Use caution - sometimes you don't feel pain until the day after you exercise.)
• Physical therapy is indicated for Acute ( severe ) pain that does not respond to bed rest or for Chronic ( less severe, but lingers over several weeks/months years) pain. Physical therapy can be prescribed by your doctor and is generally covered by insurance. A physical therapist is licensed to treat you without a doctor's prescription but in many cases he/she may advise you to see a M.D. to rule out a more serious problem. Generally, physical therapists and M.D.'s work together to provide you with the best care.
• Avoid strenuous activity for 6-8 weeks.
• After healing, continued use of good body mechanics (good posture with sitting, standing, bending, driving and resting) can prevent future problems. A physical therapist can instruct you in a basic program of back care including maintenance exercises and a first aid program to prevent a minor injury from becoming a major injury.

POSITIONS TO AVOID Many common activities actually increase the risk of neck pain. Avoid the following:

• Sleeping/resting on the couch with your head on the arm rest.

• Falling asleep in your chair or in your car without support for your head.
• Aviod looking down (working at a desk) or looking up (painting a ceiling, looking at something on a high shelf.) for prolonged periods.

Possible Complications

Chronic neck pain and restricted lifestyle.

DONT LIVE WITH PAIN - THERE ARE SIMPLE TREATMENTS INCLUDING SLOWLY PROGRESSIVE EXERCISE PROGRAMS THAT CAN HELP MOST EVERYONE WITH CHRONIC NECK PAIN. THIS IS USUALLY COVERED BY INSURANCE. IF YOU NEED HELP A PHYSICAL THERAPIST CAN ASSIST WITH REDUCING PAIN AND SETTING UP A HOME PROGRAM.

CALL YOUR DOCTOR IF:

You have mild, neck pain that persists for 3 or 4 days after self-treatment .

• Neck pain or arm pain is severe.
• Neck pain or neck and arm pain that goes away for short periods but keeps coming back.
• New or unexplained symptoms appear.
• Physical therapy should be prescribed when you have been treated by your M.D. but pain persists beyond 1-2 weeks or if you have had multiple episodes of pain over the past year.

Probable Outcome

Gradual recovery, but back troubles tend to recur. A home program can prevent continued neck problems.

Physical therapy can help you prevent long term problems.

Pain in Head & Neck

Neck and Head Pain is the most common expression of myofascial dysfunction yet chronic headache sufferers respond badly to diagnoses of muscle tension headache. The labels of "vascular" headache or "neurological disease" seem more respectable, more likely to be taken seriously. But "vascular" doesn't stop at the head; "neurological" isn't restricted to the brain or spine. Tight muscles and fascia press, shear, block, and strangle both blood vessels and nerves throughout the body. “Muscle tension headache” can mean very simply “headache due to tight muscles” but from there it has been a short trip to “You’re just tense” and . . . “Have you considered psychiatric counseling?” with the clear implication that...

The pain is not real. YOU are just crazy.

Many pains do indeed have psychiatric components, but the psychogenic diagnosis is woefully overdone. Strangely, it is rarely applied to knee pain, big toe pain, or shoulder pain, but is used all too often by the physician, who, when asked for the underlying cause of head pain, cannot bring himself to say “I don’t know.” And there's a lot to know. Over 20 muscles (primarily of the neck) refer pain to the head. Several refer pain specifically to the eye. At least three refer pain directly to the teeth for reasons that will never be relieved by fillings or repeated root canals.

Of particular concern is strain or compression of the trigeminal nerve and its branches which mediate tissue inflammation, vasodilation and vascular permeability -- all issues in migraine. Over the last few years, plastic surgeons have verified the muscle-migraine connection beginning with the odd observation that Botox injections in the frontalis and corrugator muscles of the brow also eliminated migraines.

If irritated muscles and nerves fire off an inflammatory response and vasodilation, is the resulting headache "muscular," "neurological," or "vascular"? Perhaps the only real answer is "all of the above" because amazingly enough, it all functions together -- or dysfunctions together.

For patient or physician, the following pain patterns may look surprisingly familiar and will, we hope, point the user in the direction of truly effective treatment.

In the following illustrations, black dots indicate common trigger point locations; red areas indicate the pain referred by the trigger point. You can evaluate these muscles with the Cervical and Masticatory Tests excerpted and adapted from our Range-of-Motion Testing Charts.

1. Upper Trapezius > Tension headache and "bursitis". The trapezius muscle of the back and neck is the single muscle most likely to have trigger points in both adults and children.

   The upper trapezius refers a "fish-hook" pain pattern up the back side of the neck to the head, and around the temple to the eye. There may be goosebumps to upper arm and thigh possibly with nausea and visual disturbances. Problems often begin with heavy bags or purses, balancing phones between head and shoulder, or imbalances and strain by tight SCM or scalene muscles.

   The nauseating pain of a one-sided trapezius headache is commonly diagnosed as "migraine" although migraine medications often fail to relieve the pain. ("Bursitis" and backpain may arise from the upper and lower fibers of the same muscle; see Introduction to Shoulder Pain.)

   
   
   

2. Sternocleidomastoid (SCM) > Dizziness, nausea, "migraine" and "sinus". Because of its intimate involvement with brain stem and the vagus nerve, the SCM muscle of the neck produces a long list of neurological and pain symptoms which appear primarily in the head and face but which may also appear as nausea, motion sickness, and balance problems.

   These are commonly mistaken for migraine, sinus headache, inner-ear problems, trigeminal neuralgia -- and so on. SCM has one of the most extensive patterns of pain and dysfunction, yet is one of the easiest muscles to self-treat. Click the link to see an info page on this muscle.
   
   
   

3. Scalenes > "Thoracic outlet" and "carpal tunnel" syndromes; chest, arm, and upper back pain. Scalenes contribute to severe tension headache and are one of the leading causes of "carpal tunnel syndrome." On the list of a half-dozen possible causes, the carpal tunnel itself is dead last. This is one of the reasons why carpal tunnel surgery is so ineffective. Check before you cut!

   Notice also the fingerlike projections of pain extending down the chest. This is easily confused with angina. If you think you are having heart problems, get to a doctor immediately!

   If, however, no cardiac problems are found, consider other muscles, especially if the chest pain was accompanied by a tingly thumb or index finger. Scalene pain typically extends down the upper arm, skipping the elbow. There may also be severe pain at the vertebral border of the scapula.

   All of these patterns may be painfully familiar to wrestlers and Aikidoists who have suffered too many "neck-a-nage's." In Aikido, students who don't understand kokyu-nage techniques (based on balance and timing) tend to interpret what they think they see as: "Swing your partner around by the neck then drop him on his head," a painful variation on the game of “Hangman.”

   In professional football, doing the same thing to a large, padded, extremely fit refrigerator-sized opponent by grabbing his face-guard will get you an instant 15-yard penalty, for very good reason.

   The consequences of “neck-a-nage” can be extremely painful or disabling. The the electrical supply for arm and fingers comes from the brachial plexus, the “wiring harness” originating in the neck. If the source of finger pain is diagnosed as entrapment of the median nerve, the patient may be referred for carpal tunnel surgery. If the problem is identified as scalene entrapment of the brachial plexus, the current treatment is surgical removal ("scalenectomy") of the anterior scalene and the first rib to which the muscle is attached. Unfortunately, this barbaric surgery usually causes more problems than it cures. Where care, consideration, and technical skill on the mat have failed, know this pain pattern and how to treat it -- by treating the muscle and its trigger points.
   
   

4. Masseter > TMJ, tinnitus, "sinus", and toothache. For its size and weight, the masseter is the strongest muscle in the body and its effects are not trivial. It refers pain to both upper and lower molar teeth, causes TMJ dysfunction, earache and a "sinus" pain over the eyebrow.

   Prozac and related anti-depressants such as Paxil specifically cause tightness in this muscle. If you're grinding your teeth at night and waking with a headache, ask your doctor about taking the medication during the daytime when you can be more aware of clenching and tooth-grinding which tense the masseter but also strain the temporalis . . .

   
   
   
   
   
   

5. Temporalis > "Tension / sinus" headache, TMJ and toothache in upper teeth. Combine a head-forward position with a pipe and long hours of playing the violin (see the scalene pain pattern, above) and what do you get?

   "Elementary!" cries Dr. Watson. "Head pain, tooth pain, and extreme tooth sensitivity to heat/cold and vibration."

   You may wisely eschew "The Seven Percent Solution" in favor of directions to massage the temples to relieve tension headaches. But to make it more effective, notice the location of the trigger points and their specific areas of pain. Temporalis is remarkable for spoke-like lines of pain up into the temple and down into the upper teeth. Follow these lines and you will feel distinct taut bands. Massaging them may provide temporary relief. But the best approach is to follow the taut bands down to their trigger points located as shown near the cheekbones and adjacent to the ears.

6. Pterygoids > TMJ and "sinus" pain. The lateral pterygoids (at right) help to open and protrude the jaw. These relatively weak muscles are easily strained in opposing the powerful masseter and temporalis muscles that close the jaw.
   The pterygoids commonly develop trigger points which in turn cause pain and/or clicking in the TMJ joint. They may block drainage from the maxillary sinus causing more still more pain. They are also linked to tinnitis, and cause lateral deviation on opening the jaw. There may be entrapment of the buccal nerve causing numbness / tingling in the cheek (see buccinator, below). The masseter muscle and medial pterygoid support the jaw like a sling. Masseter is on the outside, medial pterygoid inside; together they close the jaw.

   Medial pterygoids produce diffuse pain in the mouth involving the floor of the nose, tongue, throat and hard palate; pain below and behind the TMJ joint, pain and/or stuffiness of the ear, difficulty swallowing, lateral deviation and possibly pain on opening the jaw. They can also entrap the lingual nerve producing the odd symptom of a bitter, metallic taste in the mouth (which the patient may not connect with other symptoms and may not report for fear of being thought "crazy.")

7. Buccinator > Cheek pain. This muscle forms the wall of cheek and mouth. It's the part of the cheek that puffs out when playing the trumpet (for which it is named), blowing up balloons or stuffing one's mouth too full. Buccinator pain may appear suddenly following dental/orthotic work.

   There are no entrapments by the buccinator itself, but the lateral pterygoid can entrap the buccal nerve which supplies the skin and mucous membrane in this area. The muscle itself can cause local pain deep in the cheek while chewing, commonly misdiagnosed as TMJ dysfunction.
   
   
   

   
   
   

8. Digastric > Neck pain and and toothache in the lower incisors. The digastric assists the lateral pterygoid in opening the jaw against the counterforce of the far more powerful temporalis and masseter muscles. The upper portion can entrap the external carotid artery and auricular artery decreasing blood flow to the brain. Strained by retrusion of the jaw (as in playing the clarinet or similar wind instruments) or by holding a violin in place with the chin. Commonly damaged in whiplash injuries in concert with other neck muscles such as trapezius and splenius.

   Trigger points in the anterior belly send pain to the four lower incisor teeth and the alveolar ridge. There may also be pain in the throat and tongue and difficulty swallowing because of the relationship to the hyoid bone.

   Trigger points in the posterior belly refer pain to the upper sternocleidomastoid muscle, pain to the throat possibly as far back as the occiput. There may also be difficulty swallowing and a bothersome feeling of a persistant "lump" in the throat. That "lump" may be the hyoid bone which, again, is not moving properly.

9. Orbicularis > Nose and cheek pain (shown with zygomaticus, below). A trigger point in orbicularis refers pain along the eybrow, alongside the nose to the upper lip. There may be visual disturbances and problems with "jumpy print" in reading, along with droopy eyelid (ptosis).
10. Zygomaticus > Nose, cheek, and forehead pain (shown with orbicularis, below).

    Orbicularis and zygomaticus are the only two muscles that refer pain to the nose. Both patterns are commonly mistaken for "sinus" pain but may be due to a blow to the eye or simply smiling too long at the reception.

    Zygomaticus can entrap blood vessels that travel from cheek to nose and up to the forehead. The resulting pain is not "sinus," it's a muscle cramp due to reduced blood and oxygen supply -- but no less painful.
    
    
    
    
    
    

11. Occipitofrontalis > Temporal and eye pain.
    Trauma to the scalp fascia or the occipitalis at the back of the skull can transmit pain through the head and into the eye. Trauma may include a blow to the back of the head, strain from a tight ponytail or bun, or the weight of long, heavy hair.

    In one case I know of, a man struck the top of his head on the corner of a cabinet. Result: a slight puncture wound in the scalp, a brutal pain in the eye.

    Frontalis helps open the eyes, raises the eyebrows, and wrinkles the forehead into "worry lines." It is commonly used by biofeedback practitioners to monitor muscle tension. Trauma to frontalis (whether a blow to the forehead or habitual frowning) can cause severe frontal headache often diagnosed as "migraine." Frontalis is one of the muscles that definitively proved the muscle-migraine connection.

    Botox injections paralyzed the frontalis, eliminating "worry lines" but they also had the surprising side effect of halting chronic "migraines". Or maybe not so surprising, as frontalis entraps the supraorbital nerve. The related corrugator supercilii (at the top of the nose between the eyebrows) compresses branches of the supraorbital nerve along with the supratrochlear nerve and branches of the supraorbital nerve. All of these are branches of the trigeminal nerve which is heavily involved in migraine. You can treat trigger points with great results -- or, avoid compressing those muscles. Your frown may be giving you a headache!

12. Splenius Capitis > Occipital neuralgia and "word processor headache". Splenius capitis and splenius cervicis (below) are almost always injured in auto accidents, regardless of the direction of the blow. They are commonly injured in "head rolling" movements in exercise classes, always strained by head forward position and by computer use or other reasons for sitting with head held forward and turned to the side. Splenius capitis (shown below, right) typically causes a pain at the top lateral side of head.

    

13. Splenius Cervicis > Neck pain, eye pain, and blurred vision. Splenius cervicis (above, left) is strained in all the ways as splenius capitis (above, right) but the results are even more brutal. A trigger point high in the neck portion of the muscle sends pain through the head from the occiput and into the eye. Even without the pain, there may be blurred vision. The lower trigger point refers pain to the angle of the neck. Reading under a drafty air conditioner or riding a motorcycle with head forward with a cold wind whipping around the edge of the helmet is damaging to these muscles.
14. Semispinalis Capitis > Head pain and occipital neuralgia. Injured in whiplash and involved in "tension" and "cervicogenic" headache.
    
    
    

    Semispinalis capitis is commonly injured in auto accidents. You can injure it more slowly but just as effectively with a chronic head-forward position.

    When tight, semispinalis may entrap the greater occipital nerve which in turn causes numbness, tingling and/or burning pain extending over the back of the head to the top (vertex) of the head. It may be difficult to touch chin to chest, and sufferers may be unable to bear the pain of laying the back of the head on a pillow.

    Relieve nerve pain with cold.
    Relieve muscle pain with moist heat.
    In either case, look for the origin of the pain, rarely the spot where it hurts.

15. Semispinalis Cervicis > Even more head pain.
    This muscle typically produces a vague band of pain from occiput along side of head to just behind orbit (similar to suboccipital pain pattern).
16. Longus Capitis, Longus Colli > Neck, ear, and eye pain. A pain in the neck, and surprisingly, pain in the eye and ear and possibly the forehead (more "sinus" pain!) as well. Almost always injured in whiplash.
17. Multifidi and Rotatores > Basal skull pain, neck pain and scapular pain.
    This pain arises from the tiny muscles that run between the individual vertebrae of the spine.
18. Levator scapula > The "wry" or "stiff neck" muscle.
    This muscle is the Number One cause of "stiff" or "wry" neck and the second most common shoulder girdle muscle (trapezius is Number One) to have trigger points. Working with trapezius, levator shrugs the shoulders and helps prevent forward flexion of the neck, hence it is also damaged in whiplash injuries. In daily life, it is commonly strained when shoulder (or shoulders) are chronically hunched, either in stress, or by attempting to keep a strap from sliding off the shoulder, especially when the muscle is cold or fatigued. Pain in the angle of the neck and along the vertebral border of the scapula may be so severe that patient cannot move the neck at all.
19. Suboccipitals > Temporal and eye pain. The four pairs of suboccipital muscles cause deep aching pain running in a band from the back of the head to the orbit of the eye, possibly with balance problems and dizziness.

    One of these (the rectus capitis superior minor) attaches directly to the dura mater of the spinal cord. When traumatized it can produce odd visual and neurological symptoms to the point of seizures.

    Suboccipitals are commonly strained or hypertrophied in persons who wear bifocals, children who watch TV lying with chin propped on hands, and anyone who habitually holds the head in position with chin up and neck flexed backward.

20. Omohyoid > Head, neck, shoulder, and back pain. This small muscle (actually missing from many anatomy books)can cause disabling pain and dysfunction. It's just one of the several muscles that attaches to the hyoid bone. The other end attaches to the scapula at the back of the shoulder. Aside from the severe pain in shoulder, neck, and jaw (which often appears after a bout of coughing or vomiting) there may also be weakness and tingling down arm and fingers and symptoms of thoracic outlet syndrome. Pain patterns may be confused with that of the scalenes or levator scapula. An excellent article on The Omohyoideus Syndrome is available online.
21. Soleus > Heel and calf pain, sacral pain and cheek (facial) pain. One of the outstanding examples of long-distance pain referral from muscles. This muscle of the calf sends pain to the calf and heel (commonly known "jogger's heel") -- but there's more. Pain from this muscle also appears in the sacrum at the sacro-iliac joint and then reappears in the face and jaw where it may fire off symptoms of TMJ and toothache.

    "But," you say, "migraine is vascular!"

    Indeed it is -- and the soleus is the other end of the cardio-vascular system. It is known as "The Second Heart" because its pumping action returns blood from the lower extremities to the heart. I have stopped many full-blown migraines by working adductor and calf muscles.

    "But," you say, "migraine is neurological!"

    Indeed it is -- and tightness and restriction in soleus and the adductor magnus can cause serious impingement of neurovascular structures including the femoral nerve, femoral artery, and femoral vein (at the adductor hiatus of the adductor magnus) and the posterior tibial nerve, vein, and artery by the soleus. (The plantaris, a slip of the soleus muscle, can also entrap the popliteal artery at the back of the knee.) Entrapment by these muscles can be so severe that the patient may lose deep tendon reflexes. Short of that, it's no surprise that a sufferer might have cold feet.

    Upstream, entrapment by the adductors can be brought on by failing to stretch out after using the thigh machines at the gym and very commonly, by footwear. It may be difficult to believe that shoes (whether you call them "cowboy boots" or "high heels") may be causing your jaw and head pain, but it is often true. Knee-high stockings with tight, constricting bands will do the job and I have also seen a man who never had headaches in his life until he caught some shrapnel in the calf. Even worse can happen, however.

    When the soleus can no longer work as "the second heart" due to inactivity or constriction, there can be side effects far worse than migraine. Pooling and subsequent clotting of blood in the lower extremities is involved in deep vein thrombosis, also known as "airline thrombosis" due to the consequences of a cramped seat and long periods of inactivity. The condition is very real, but sadly mis-named. The condition arises far more commonly from long hours of sitting at a desk than from (relatively rare) airline travel.

Introduction

Head and neck is one of the most important part of human body and the diseases of this region is not uncommon. Some of the diseases of this area are sometimes unrecognized to a normal person but they are very harmful and deadly. So my target is mainly to aware the normal people so that they can recognize the diseases and know how to treat and contact immediately to a doctor for treatment .This is also helpful for professional, students.