Superior Scapula and Cervicogenic Headaches
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.
