Superior Scapula and Cervicogenic Headaches: Difference between revisions
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== Introduction == | == Introduction == | ||
Cervicogenic headache (CGH) is a form of headache that originates in the neck and refers to the head. Dysfunction in the upper cervical spine is recognised as the source of CGH.<ref name=":0">Biondi DM. Cervicogenic headache: mechanisms, evaluation, and treatment strategies. J Am Osteopath Assoc. 2000;100(9 Suppl): S7-14.</ref> However, the upper trapezius has a clear pain referral pattern to the head, so it too should be considered when assessing and treating CGH.<ref>Kaplan A. Superior Scapula - Cervigenic Headaches Course. Physioplus, 2020.</ref> | Cervicogenic headache (CGH) is a form of headache that originates in the neck and refers to the head. Dysfunction in the upper cervical spine is recognised as the source of CGH.<ref name=":0">Biondi DM. Cervicogenic headache: mechanisms, evaluation, and treatment strategies. J Am Osteopath Assoc. 2000;100(9 Suppl): S7-14.</ref> However, the upper trapezius has a clear pain referral pattern to the head, so it too should be considered when assessing and treating CGH.<ref name=":1">Kaplan A. Superior Scapula - Cervigenic Headaches Course. Physioplus, 2020.</ref> | ||
As discussed [[Introduction to Cervicogenic Headaches|here]], pain is able to refer from the neck to the head (and vice versa) because of the convergence of trigeminal afferents and afferents from the upper three cervical spinal nerves.<ref name=":0" /><ref>Fernandez M, Moore C, Tan J, Lian D, Nguyen J, Bacon A et al. Spinal manipulation for the management of cervicogenic headache: A systematic review and meta‐analysis. Eur J Pain. 2020; 24(9): 1687-702.</ref><ref>Castien R, De Hertogh W. A Neuroscience Perspective of Physical Treatment of Headache and Neck Pain. Front Neurol. 2019;10: 276.</ref> This enables somatosensory, proprioceptive and nociceptive information from the trapezius, sternocleidomastoid and other cervical muscles to be exchanged at the trigeminocervical nucleus and ultimately be referred to the trigeminal sensory areas of the head and face.<ref>Biondi DM. Cervicogenic headache: diagnostic evaluation and treatment strategies. Curr Pain Headache Rep. 2001; 5(4): 361-8.</ref> | As discussed [[Introduction to Cervicogenic Headaches|here]], pain is able to refer from the neck to the head (and vice versa) because of the convergence of trigeminal afferents and afferents from the upper three cervical spinal nerves.<ref name=":0" /><ref>Fernandez M, Moore C, Tan J, Lian D, Nguyen J, Bacon A et al. Spinal manipulation for the management of cervicogenic headache: A systematic review and meta‐analysis. Eur J Pain. 2020; 24(9): 1687-702.</ref><ref>Castien R, De Hertogh W. A Neuroscience Perspective of Physical Treatment of Headache and Neck Pain. Front Neurol. 2019;10: 276.</ref> This enables somatosensory, proprioceptive and nociceptive information from the trapezius, sternocleidomastoid and other cervical muscles to be exchanged at the trigeminocervical nucleus and ultimately be referred to the trigeminal sensory areas of the head and face.<ref>Biondi DM. Cervicogenic headache: diagnostic evaluation and treatment strategies. Curr Pain Headache Rep. 2001; 5(4): 361-8.</ref> | ||
The trapezius referral patterns are | The trapezius referral patterns are shown in the video below. | ||
{{#ev:youtube|uNB6B9SjORI}}<ref>NAT Education. Trapezius - How To Find Trigger Points. Available from https://www.youtube.com/watch?v=uNB6B9SjORI [last accessed 11/12/2020]</ref> | {{#ev:youtube|uNB6B9SjORI}}<ref>NAT Education. Trapezius - How To Find Trigger Points. Available from https://www.youtube.com/watch?v=uNB6B9SjORI [last accessed 11/12/2020]</ref> | ||
== Upper Trapezius == | |||
The trapezius plays a significant role in scapula movement.<ref name=":2">Camargo PR, Neumann DA. Kinesiologic considerations for targeting activation of scapulothoracic muscles - part 2: trapezius. Braz J Phys Ther. 2019; 23(6): 467-475. </ref> The serratus anterior and trapezius muscles are the main force couple that acts on the scapula. When these stabilisers are weak, or do not activate properly, scapula positioning and mechanics can be affected.<ref name=":2" /> | |||
The upper trapezius attaches distally to the clavicle, so the majority of its influence of scapulothoracic mobility occurs here. Contraction of the upper trapezius pulls the clavicle into elevation and retraction.<ref name=":2" /> | |||
Patients who have shoulder pain during arm elevation, often present with abnormal shoulder movements, as well as:<ref name=":1" /><ref name=":2" /> | |||
* Excessive activation of the upper trapezius | |||
* Decreased and / or delayed activation of the lower and middle trapezius and serratus anterior | |||
This excessive activation of upper trapezius is likely associated with:<ref name=":2" /> | |||
* Increased elevation of the clavicle | |||
* Anterior tilt of the scapula | |||
Decreased activation of the lower trapezius is probably accompanied with reduced scapula upward rotation.<ref name=":2" /> | |||
Delayed activation of the middle trapezius may be related to increased internal rotation of the scapula and reduced stabilisation of the scapula on the thorax.<ref name=":2" /> | |||
While the upper trapezius is implicated in shoulder pain, it can also be involved in or affected by cervical dysfunction and CGH.<ref name=":1" /><ref>Kocur P, Wilski M, Lewandowski J, Łochyński D. Female Office Workers With Moderate Neck Pain Have Increased Anterior Positioning of the Cervical Spine and Stiffness of Upper Trapezius Myofascial Tissue in Sitting Posture. PM R. 2019; 11(5): 476-482. </ref><ref name=":3">Park SK, Yang DJ, Kim JH, Heo JW, Uhm YH, Yoon JH. Analysis of mechanical properties of cervical muscles in patients with cervicogenic headache. J Phys Ther Sci. 2017; 29(2): 332-335. </ref> A recent study by Park and colleagues found that there was a statistically significant difference in the tone and stiffness of both the upper trapezius and suboccipital muscles in patients with cervicogenic headache when compared to healthy controls.<ref name=":3" /> | |||
== References == | |||
[[Category:Course Pages]] | [[Category:Course Pages]] | ||
[[Category:Cervical Spine]] | [[Category:Cervical Spine]] | ||
<references /> | |||
Revision as of 23:45, 10 December 2020
Introduction[edit | edit source]
Cervicogenic headache (CGH) is a form of headache that originates in the neck and refers to the head. Dysfunction in the upper cervical spine is recognised as the source of CGH.[1] However, the upper trapezius has a clear pain referral pattern to the head, so it too should be considered when assessing and treating CGH.[2]
As discussed here, pain is able to refer from the neck to the head (and vice versa) because of the convergence of trigeminal afferents and afferents from the upper three cervical spinal nerves.[1][3][4] This enables somatosensory, proprioceptive and nociceptive information from the trapezius, sternocleidomastoid and other cervical muscles to be exchanged at the trigeminocervical nucleus and ultimately be referred to the trigeminal sensory areas of the head and face.[5]
The trapezius referral patterns are shown in the video below.
Upper Trapezius[edit | edit source]
The trapezius plays a significant role in scapula movement.[7] The serratus anterior and trapezius muscles are the main force couple that acts on the scapula. When these stabilisers are weak, or do not activate properly, scapula positioning and mechanics can be affected.[7]
The upper trapezius attaches distally to the clavicle, so the majority of its influence of scapulothoracic mobility occurs here. Contraction of the upper trapezius pulls the clavicle into elevation and retraction.[7]
Patients who have shoulder pain during arm elevation, often present with abnormal shoulder movements, as well as:[2][7]
- Excessive activation of the upper trapezius
- Decreased and / or delayed activation of the lower and middle trapezius and serratus anterior
This excessive activation of upper trapezius is likely associated with:[7]
- Increased elevation of the clavicle
- Anterior tilt of the scapula
Decreased activation of the lower trapezius is probably accompanied with reduced scapula upward rotation.[7]
Delayed activation of the middle trapezius may be related to increased internal rotation of the scapula and reduced stabilisation of the scapula on the thorax.[7]
While the upper trapezius is implicated in shoulder pain, it can also be involved in or affected by cervical dysfunction and CGH.[2][8][9] A recent study by Park and colleagues found that there was a statistically significant difference in the tone and stiffness of both the upper trapezius and suboccipital muscles in patients with cervicogenic headache when compared to healthy controls.[9]
References[edit | edit source]
- ↑ 1.0 1.1 Biondi DM. Cervicogenic headache: mechanisms, evaluation, and treatment strategies. J Am Osteopath Assoc. 2000;100(9 Suppl): S7-14.
- ↑ 2.0 2.1 2.2 Kaplan A. Superior Scapula - Cervigenic Headaches Course. Physioplus, 2020.
- ↑ Fernandez M, Moore C, Tan J, Lian D, Nguyen J, Bacon A et al. Spinal manipulation for the management of cervicogenic headache: A systematic review and meta‐analysis. Eur J Pain. 2020; 24(9): 1687-702.
- ↑ Castien R, De Hertogh W. A Neuroscience Perspective of Physical Treatment of Headache and Neck Pain. Front Neurol. 2019;10: 276.
- ↑ Biondi DM. Cervicogenic headache: diagnostic evaluation and treatment strategies. Curr Pain Headache Rep. 2001; 5(4): 361-8.
- ↑ NAT Education. Trapezius - How To Find Trigger Points. Available from https://www.youtube.com/watch?v=uNB6B9SjORI [last accessed 11/12/2020]
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 Camargo PR, Neumann DA. Kinesiologic considerations for targeting activation of scapulothoracic muscles - part 2: trapezius. Braz J Phys Ther. 2019; 23(6): 467-475.
- ↑ Kocur P, Wilski M, Lewandowski J, Łochyński D. Female Office Workers With Moderate Neck Pain Have Increased Anterior Positioning of the Cervical Spine and Stiffness of Upper Trapezius Myofascial Tissue in Sitting Posture. PM R. 2019; 11(5): 476-482.
- ↑ 9.0 9.1 Park SK, Yang DJ, Kim JH, Heo JW, Uhm YH, Yoon JH. Analysis of mechanical properties of cervical muscles in patients with cervicogenic headache. J Phys Ther Sci. 2017; 29(2): 332-335.
