370 | What To Do For Cervicogenic Headaches

[00:00:05] [SPEAKER_01]: Welcome to the Optimal Body Podcast. I'm Dr. Jen.

[00:00:08] [SPEAKER_00]: And I'm Dr. Dom and we are Doctors of Physical Therapy, bringing you the body tips and physical

[00:00:13] [SPEAKER_00]: therapy pearls of wisdom to help you begin to understand your body, relieve your pains

[00:00:17] [SPEAKER_00]: and restrictions, and answer your questions.

[00:00:19] [SPEAKER_01]: Along with expert guests, our goal of the Optimal Body Podcast is really to help you

[00:00:24] [SPEAKER_01]: discover what optimal means within your own body. Let's dive in.

[00:00:29] [SPEAKER_02]: I have to read this feedback that I got from a couple people is really incredible. I just

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[00:01:02] [SPEAKER_02]: everything goes apart. Now do it with your foot. Your foot should be able to do the exact

[00:01:07] [SPEAKER_02]: same thing. I'm not kidding you. And if you are spreading your toes and your big toes going way

[00:01:13] [SPEAKER_02]: up or down, but it's not going to the side, this is a crucial muscle that we need in the bottom of

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[00:01:24] [SPEAKER_02]: support what's called our intrinsic foot muscles to help build that stability at the bottom of the

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[00:02:48] [SPEAKER_02]: and then try to spread your toes. You're going to notice a difference, especially if you do that

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[00:02:59] [SPEAKER_02]: reported so much of a difference in how they can use and feel and separate those toes. So it just,

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[00:03:22] [SPEAKER_00]: episode about headaches, specifically cervicogenic headaches. We did a previous episode on tension

[00:03:28] [SPEAKER_00]: headaches, which they have similarities. Some people kind of classify tension headaches as

[00:03:33] [SPEAKER_00]: a type of a cervicogenic headache, but cervicogenic headache, that word is a mouthful in general, but

[00:03:39] [SPEAKER_00]: it really just means a headache that has to do with something originating from the neck or the

[00:03:46] [SPEAKER_00]: cervical region of our spine, which is our neck. I know. And to know that like headaches can cause

[00:03:51] [SPEAKER_02]: considerable disability with 52% of the world population suffering from various types of

[00:03:58] [SPEAKER_02]: headaches. Like that's a large percentage of people that, you know, suffer on a day-to-day

[00:04:03] [SPEAKER_02]: basis, whether it's daily or it comes and goes. I know my mom suffers from headaches. So it's like,

[00:04:09] [SPEAKER_02]: what can we do to start to address this? And I think what you're going to learn from us is that

[00:04:14] [SPEAKER_02]: though there are protocols that can help, you know, there's no one size fits all. So we want

[00:04:19] [SPEAKER_02]: to talk about all the possibilities of what you can really include to start to help your body.

[00:04:24] [SPEAKER_00]: Taking a pause from the conversation about headaches to talk about something that can

[00:04:28] [SPEAKER_00]: actually help headaches or help make sure we're setting up our body to best prevent getting these

[00:04:34] [SPEAKER_00]: random headaches. And that is our hydration, not just hydrating with water, but making sure we're

[00:04:39] [SPEAKER_00]: getting in the electrolytes that we need for proper brain function and function all throughout our

[00:04:45] [SPEAKER_00]: body. That is why Jen and I use Element Electrolyte Mix to make sure we're getting back in the sodium,

[00:04:51] [SPEAKER_00]: potassium, and magnesium that our body needs to function optimally. These electrolytes are so

[00:04:57] [SPEAKER_00]: vital for different processes like headaches, brain fog, fatigue, making sure we're getting

[00:05:02] [SPEAKER_00]: good sleep. And that is why we put it in our water on a daily basis to make sure we're coming back

[00:05:07] [SPEAKER_00]: to the bottle. The other great thing is sometimes regular water can get kind of boring and Element

[00:05:11] [SPEAKER_00]: tastes so great. So with every single order, when you go through the link down in the show notes,

[00:05:16] [SPEAKER_00]: you get a free sample pack so you can try out all their different flavors and make sure you know

[00:05:20] [SPEAKER_00]: which one you like next when you inevitably come back to get more. Go down to the link in the

[00:05:24] [SPEAKER_00]: show notes. It's just drinkelement.com backslash optimal. That's drink element spelt out like

[00:05:30] [SPEAKER_00]: l-m-n-t dot com backslash optimal. Go get an order in, get your free sample pack,

[00:05:36] [SPEAKER_00]: and start leveling up your hydration today. All right, let's get back into the episode.

[00:05:41] [SPEAKER_00]: So again, cervicogenic headaches originating from somewhere in the neck like so what's going on in

[00:05:47] [SPEAKER_00]: the neck that causes causes us or contributes to these headaches and this is where we're generally

[00:05:53] [SPEAKER_00]: talking about some sort of stability or mobility issue. And they tend to go hand in hand when we're

[00:06:01] [SPEAKER_00]: talking about our neck muscles. If we have a mobility issue or if we feel instability,

[00:06:06] [SPEAKER_00]: our neck muscles will kind of tighten down to find some stability to make us feel like we have

[00:06:12] [SPEAKER_00]: safety and stability in our neck which then causes other problems, you know, and some of the muscles

[00:06:17] [SPEAKER_00]: that tend to tighten down or take over are things like our sternocleidomastoid which is this big

[00:06:23] [SPEAKER_00]: ropey muscle that runs down the front of either side of our neck. We've got our upper traps,

[00:06:30] [SPEAKER_00]: you know, that are a big player in cervicogenic or tension headaches. A lot of people will complain

[00:06:37] [SPEAKER_00]: of, oh I just have such tight upper traps. Those upper traps run all the way up to the very tip of,

[00:06:43] [SPEAKER_00]: you know, top of our spine and even into our low occiput or skull area. We have our suboccipital

[00:06:49] [SPEAKER_00]: muscles which are connected right at the top of our neck and into the base of our skull. That's

[00:06:56] [SPEAKER_00]: another place that we can get, you know, very commonly have tightness there if we're having

[00:07:00] [SPEAKER_00]: tension headaches. So, it's generally some combination of we aren't having enough

[00:07:06] [SPEAKER_00]: activation of the muscles we should have so our neck feels unstable and because of that,

[00:07:12] [SPEAKER_00]: other muscles are trying to tighten down to find stability. Another major muscle that you'll hear,

[00:07:19] [SPEAKER_00]: especially if you go into physical therapy, they'll probably, you know, train in you is our deep

[00:07:24] [SPEAKER_00]: cervical neck flexors. Or if you're a GenHealth member, we talk about this a lot. Yeah, we talk

[00:07:29] [SPEAKER_00]: about this a lot in GenHealth and these are muscles that actually lay behind our throat,

[00:07:34] [SPEAKER_00]: essentially, behind our trachea on the front of the spine and what they do is flex the spine forward

[00:07:41] [SPEAKER_00]: or give us stability. They kind of flex our head down and it's the muscles that you're kind of

[00:07:47] [SPEAKER_00]: activating when you do those chin tucks which like Jen said, well, you'll do those in GenHealth. If

[00:07:52] [SPEAKER_00]: you go to physical therapy, they'll probably have you doing some variation of chin tucks or

[00:07:57] [SPEAKER_02]: deep cervical neck flexor training. Yeah, so if we see that not being so great or having some

[00:08:04] [SPEAKER_02]: weakness there, having a loss of endurance because usually that's more like an endurance thing,

[00:08:08] [SPEAKER_02]: right? We're not just like repping it out with chin tucks. We're saying can you lay down on your

[00:08:13] [SPEAKER_02]: back and be in that chin tuck position and barely lift the head or like how like can you hold that

[00:08:19] [SPEAKER_00]: and how long can you hold that? There's endurance tests and we'll kind of try and record an example

[00:08:24] [SPEAKER_00]: of that and they'll time how long can you hold this before we either see other muscles in the

[00:08:29] [SPEAKER_00]: neck taking over or before you feel like you need to put your head down. And some people are shocked

[00:08:33] [SPEAKER_00]: if you get into a true chin tuck and do that endurance test, after five or ten seconds,

[00:08:39] [SPEAKER_00]: you're just feeling like your neck is like, oh my gosh, I'm burning already. I have muscle fatigue

[00:08:44] [SPEAKER_00]: already after five to ten seconds and I don't know the exact numbers but they say you should

[00:08:49] [SPEAKER_00]: be able to do this from like for like 30 seconds to a minute. I feel like for women, from what I

[00:08:54] [SPEAKER_02]: remember, okay these are not exact numbers so don't quote me but I think it's above 20 seconds

[00:08:58] [SPEAKER_02]: and then for males I thought it was above 40 seconds but again I could be wrong. Yeah. That's

[00:09:04] [SPEAKER_02]: what I remember from clinic but in general like you're looking around 30 seconds, you know, which

[00:09:08] [SPEAKER_02]: is a quite a bit of time when you especially have not trained this in a while or you work at a desk

[00:09:13] [SPEAKER_02]: a lot where your neck is kind of going forward and so you're getting elongation at the front of that

[00:09:17] [SPEAKER_02]: neck so you're not allowing those neck muscles to really be working more often throughout the day

[00:09:22] [SPEAKER_02]: which is what we need. We need endurance of those muscles. So something that can definitely contribute

[00:09:27] [SPEAKER_02]: and so when we're looking at the first line of defense, when we want to improve this cervicogenic

[00:09:33] [SPEAKER_02]: headache, why do I keep getting headaches? I would say the first line of treatment you should go to

[00:09:37] [SPEAKER_02]: is physical therapy. Of course, we're physical therapists, we're going to say that right?

[00:09:41] [SPEAKER_02]: But before you turn to pain management in terms of drugs or Botox or other treatments that can

[00:09:49] [SPEAKER_02]: be helpful, can we look at what can I do physically in my body because we're not just looking at these

[00:09:56] [SPEAKER_02]: deep neck flexors and chin tucks. We're going to talk about a lot more exercises that can help and

[00:10:00] [SPEAKER_02]: bring awareness to what's happening that could be contributing to this headache but physical therapy,

[00:10:05] [SPEAKER_02]: I think, first line of treatment and when we're looking at the effectiveness of treatments,

[00:10:11] [SPEAKER_02]: what they actually found is that manipulative therapy, so thinking of going to get that neck

[00:10:16] [SPEAKER_02]: manipulation with therapeutic exercise usually tend to be the most effective and that's what

[00:10:22] [SPEAKER_02]: we kind of see from some of the research is that manipulative treatment, so getting that cervical

[00:10:29] [SPEAKER_02]: manipulation mixed or adjustment as many people might know it, mixed with therapeutic exercise

[00:10:36] [SPEAKER_02]: and in combination has been shown to have some benefits.

[00:10:41] [SPEAKER_00]: We have a full episode on manipulations and adjustments.

[00:10:44] [SPEAKER_00]: What that's really doing.

[00:10:45] [SPEAKER_00]: Yeah, talking about what they're doing and a lot of people will think that, oh, physical therapists,

[00:10:51] [SPEAKER_00]: they don't like adjustments. That's what chiropractors do. In most states, physical

[00:10:55] [SPEAKER_00]: therapists are trained in and allowed to do high velocity manipulations, what we call it,

[00:11:02] [SPEAKER_00]: because chiropractors didn't want us to also call it adjustments or something like that.

[00:11:06] [SPEAKER_02]: I don't know.

[00:11:06] [SPEAKER_00]: Probably a legal thing.

[00:11:07] [SPEAKER_02]: Same thing.

[00:11:08] [SPEAKER_00]: But really similar if not the same techniques and we're getting the same result in the body,

[00:11:14] [SPEAKER_00]: which is relaxation, release of endorphins. It helps all those tight muscles just let go a little

[00:11:21] [SPEAKER_00]: bit. And so when we get that release or the relaxation that we're looking for with the

[00:11:28] [SPEAKER_00]: manipulation technique, then it allows us to do more exercise with less pain or with less symptoms.

[00:11:35] [SPEAKER_00]: And that's why they work so well hand in hand. And what we saw with this

[00:11:38] [SPEAKER_00]: technique alone, manipulation plus exercise is that 72% of patients had reduced 50% or more

[00:11:47] [SPEAKER_00]: in their headache frequency at the 12-month follow-up. So, a year later after treatment

[00:11:54] [SPEAKER_00]: started, 72% of people are still saying I had 50% reduction or more and 42% of patients reported

[00:12:01] [SPEAKER_00]: I had 80% or higher relief of some sort based on the metrics that they use.

[00:12:09] [SPEAKER_00]: So, that's a pretty significant number, pretty positive result saying that 12 months later

[00:12:16] [SPEAKER_00]: after having this treatment protocol, 72% of people having 50% or more and 42% of people

[00:12:22] [SPEAKER_00]: having 80% or more of some sort of relief. Yeah. And again, we're looking at it being

[00:12:29] [SPEAKER_02]: more of a neural stimulation when we're getting that manipulative treatment. It's not realigning

[00:12:36] [SPEAKER_02]: your cervical spine. It's not putting anything back into place. Again, go listen to our episode

[00:12:41] [SPEAKER_02]: to hear and understand more about manipulation and adjustment. But if it's helping you get back

[00:12:46] [SPEAKER_02]: to exercise, that's the key. That's what we really want to look at. And what's most important here is

[00:12:50] [SPEAKER_02]: that because you're having the headache with whatever's coming from the neck, we have to

[00:12:57] [SPEAKER_02]: go about treatment slowly. Because if you're suddenly like give me the most, do all these

[00:13:02] [SPEAKER_02]: things, give me all these exercises, it can actually flare you up a little bit more.

[00:13:06] [SPEAKER_02]: And because you're doing more new exercise, you're going to be putting strain and stress

[00:13:12] [SPEAKER_02]: on those muscles in a way that they may not have felt in a long time. So, you really have to be

[00:13:17] [SPEAKER_02]: careful with the rate at which you move with therapy. And that's kind of been pointed out

[00:13:23] [SPEAKER_02]: in some of the research as well is that just moving slowly through this progressive treatment.

[00:13:29] [SPEAKER_02]: And that's why sometimes working with a physical therapist is best because you get

[00:13:33] [SPEAKER_02]: the treatment based on what you need at the time and how your body progresses because everyone

[00:13:38] [SPEAKER_02]: progresses a little differently. And being able to go at a slower rate, a slower pace really helps

[00:13:44] [SPEAKER_02]: to reduce, just give you better outcomes in reducing that headache.

[00:13:48] [SPEAKER_00]: It's just like working out in any capacity. When you start something new,

[00:13:52] [SPEAKER_00]: you're going to have some degree of soreness, you're going to be feeling new things. And so,

[00:13:56] [SPEAKER_00]: you know, regardless of how slowly you start, if you start doing some deep cervical flexion,

[00:14:02] [SPEAKER_00]: you know, muscle training or muscle endurance training, that might be irritating to some

[00:14:08] [SPEAKER_00]: degree in the neck. And so, again, this is why it's important to be with a physical therapist so

[00:14:13] [SPEAKER_00]: that when you come back and say, oh, I actually like felt worse headaches for a day, you know,

[00:14:19] [SPEAKER_00]: day and a half after we did that, the therapist can put that at ease and say, that's okay.

[00:14:24] [SPEAKER_00]: We're asking your neck to work. We're asking your neck to do different things.

[00:14:28] [SPEAKER_00]: You know, you're in the most irritable state you're probably going to be in,

[00:14:31] [SPEAKER_00]: but we need to keep this training. We need to keep, you know, going down this road,

[00:14:35] [SPEAKER_00]: but we might just adjust based on how your body reacted. And so, I think that's important

[00:14:41] [SPEAKER_00]: to say. I think another important thing that we want to point out is that everyone's a little

[00:14:47] [SPEAKER_00]: bit different and everybody who's having these types of cervicogenic headaches might have a

[00:14:53] [SPEAKER_00]: different root cause. You know, many of them, as we pointed out, might be coming from some sort of

[00:15:00] [SPEAKER_00]: deficiency in mobility or stability or strength in those deep cervical flexors of the neck,

[00:15:08] [SPEAKER_00]: but some may not be coming from that. And this is where, again, getting with a trained set of eyes

[00:15:14] [SPEAKER_00]: and hands to be able to assess you and say, you know what? I'm not really finding many restrictions

[00:15:20] [SPEAKER_00]: in the neck, you know? So, we might need to approach this slightly differently. I think

[00:15:25] [SPEAKER_02]: that's super important. Yeah, and they actually found that like a lot of aerobic type exercise

[00:15:30] [SPEAKER_02]: can help in general with headache relief. So, just getting outside and walking more,

[00:15:36] [SPEAKER_02]: just going on, you know, different machines if that's what you prefer to do some biking or to do

[00:15:42] [SPEAKER_02]: some elliptical work. Like how can I get a little bit more aerobic and just movement throughout my

[00:15:47] [SPEAKER_02]: body, getting the blood flowing a little bit more. Maybe you've had headaches so you haven't

[00:15:52] [SPEAKER_02]: wanted to move a lot. They found that just doing aerobic type exercise can be really beneficial

[00:15:57] [SPEAKER_02]: if it's just headache based and it's not necessarily cervicogenic based. In some of the

[00:16:03] [SPEAKER_00]: studies we looked at, they use the control group either as doing like aerobic exercise like that

[00:16:08] [SPEAKER_00]: or there's this other study where the control group is just doing stretching exercises,

[00:16:13] [SPEAKER_00]: neck stretching exercises. And even in that group where they were just doing neck stretching

[00:16:18] [SPEAKER_00]: exercises, there was 37% degrees in headache reduction and 21% degrees in any upper extremity

[00:16:26] [SPEAKER_00]: pain people may have been having. So, this is also pointing out that activity in general is found to

[00:16:32] [SPEAKER_00]: be beneficial to a decent percentage of people. So, that was the control group in this first study.

[00:16:38] [SPEAKER_00]: There was also a strength group and an endurance group. The strength group was doing more strength

[00:16:44] [SPEAKER_00]: based exercises for both their neck flexors, there's those deep neck flexors we talked about,

[00:16:50] [SPEAKER_00]: as well as shoulders and upper extremities. And then the endurance group was doing that neck

[00:16:56] [SPEAKER_00]: flexor endurance exercise that we had talked about as well as some other upper extremity exercises,

[00:17:02] [SPEAKER_00]: but just adjusted so they were focused more on endurance while the first group was focused

[00:17:06] [SPEAKER_00]: on strength. And both of those groups saw significantly higher decrease in both headache

[00:17:11] [SPEAKER_00]: reduction and upper extremity pain with the strength group actually performing better

[00:17:15] [SPEAKER_00]: than the endurance group. But this is again to point out like, okay, if we get a little bit more

[00:17:20] [SPEAKER_00]: focused on the neck, it catches a much larger percentage of people. Almost, you know, two-thirds

[00:17:25] [SPEAKER_00]: of people were finding benefit in the strength group and 58% of people in the endurance group

[00:17:32] [SPEAKER_02]: found reduction in headaches. So, I think it's really cool to continue to point out how much,

[00:17:37] [SPEAKER_02]: you know, combined treatment, not just like one thing. And this is what another study kind of

[00:17:44] [SPEAKER_02]: looked at. They looked at not only doing manipulation therapy but doing motor control

[00:17:49] [SPEAKER_02]: exercises. So, we're going to work on a little bit more coordination around your, how your shoulder

[00:17:54] [SPEAKER_02]: muscles and your neck kind of work together. Putting all of that together, they found that

[00:17:59] [SPEAKER_02]: there was 10% more participants reported greater than 50% relief or complete relief of headache

[00:18:07] [SPEAKER_02]: when treated with that combined intervention over no physical therapy at all. So, I think it's really

[00:18:14] [SPEAKER_02]: cool to see how effective it is at reducing headache when we're not only just looking at,

[00:18:21] [SPEAKER_02]: you know, deep neck flexors and stretching and not just doing manipulation alone, but

[00:18:27] [SPEAKER_02]: how are we combining that with how the shoulders and the shoulder blades and the neck all work

[00:18:33] [SPEAKER_02]: together in coordination and how can we get that all programming a little bit more so that we can

[00:18:39] [SPEAKER_02]: start to make progress and how we're feeling throughout our entire neck all the way up into

[00:18:45] [SPEAKER_02]: that headache and making that long-term change. So, that was recorded also at 12 months follow-up,

[00:18:51] [SPEAKER_02]: like how long did it last and they were still lasting benefits at 12 months.

[00:18:55] [SPEAKER_00]: And that kind of bridges well because you're talking, we're going more into like neurological

[00:19:00] [SPEAKER_00]: techniques and anytime we're talking about pain, you know, headaches included, this is a neurological

[00:19:06] [SPEAKER_00]: thing, especially headaches. You know, we associate that directly with our head or our brain and there

[00:19:13] [SPEAKER_00]: are a lot more things that can be at play in here or be contributing to this just, you know, over

[00:19:20] [SPEAKER_00]: just our muscles and our, you know, joints and our neck. You know, we have to be more concerned

[00:19:25] [SPEAKER_00]: with what's happening on a neurological level and that, you know, this is where we use more of the

[00:19:30] [SPEAKER_00]: bio-psycho-social model. You know, we just talked more about the bio, the biomechanic, the biological

[00:19:36] [SPEAKER_00]: with the muscles, but the psychological and the social components like what types of stress are

[00:19:43] [SPEAKER_00]: happening in our life? Are we getting good enough sleep? I had a couple tough nights sleep because

[00:19:48] [SPEAKER_00]: our son got me up really early, just like the last couple days and I had a headache all day long

[00:19:54] [SPEAKER_00]: yesterday. And I associated that with like not getting enough sleep and I got a decent night

[00:20:00] [SPEAKER_00]: sleep tonight and headaches are gone, you know? And so, it's like trying to focus in on some of

[00:20:06] [SPEAKER_00]: the other things in life that you think might be out of balance. Am I drinking enough water? You

[00:20:10] [SPEAKER_00]: know, I mentioned stress, but it's like, are there relationships in your life that seem like

[00:20:14] [SPEAKER_00]: they're adding a lot more onto your plate? Is work really overwhelming you? And this is where we

[00:20:20] [SPEAKER_00]: saw other, you know, studies or research talking about the importance of breath work.

[00:20:26] [SPEAKER_02]: Yes, diaphragmatic breathing.

[00:20:28] [SPEAKER_00]: Diaphragmatic breathing. That's something that we always go to and diaphragmatically breathing and

[00:20:32] [SPEAKER_00]: properly using your breath to downregulate your nervous system can be an absolute game changer

[00:20:38] [SPEAKER_00]: in the amount of stress or perception of stress. Like the stress, of course, externally doesn't

[00:20:46] [SPEAKER_00]: disappear, but it can really calm down that sympathetic drive, that fight or flight drive

[00:20:52] [SPEAKER_00]: in our body and also help our muscles relax a little bit more. So, breath can be so valuable

[00:20:58] [SPEAKER_00]: as a tool in helping with these headaches.

[00:21:01] [SPEAKER_02]: And what's really cool, I got to do a one-on-one session with someone who had won something,

[00:21:07] [SPEAKER_02]: within GenHealth, and she had a great reduction within her headaches doing the neck and upper

[00:21:14] [SPEAKER_02]: back plan on GenHealth, but she still had some remaining symptoms. And she was going to a physical

[00:21:19] [SPEAKER_02]: therapist as well, but some of those strengthening exercises would actually flare her up even more,

[00:21:24] [SPEAKER_02]: which is kind of what we talked about, how slow it needs to go. But what I really looked at with her

[00:21:30] [SPEAKER_02]: was starting from the basics. Like, okay, just come in front of, we were on Zoom, come in front

[00:21:36] [SPEAKER_02]: of the screen, take a couple deep breaths, let me know what you see. And her taking a couple deep

[00:21:41] [SPEAKER_02]: breaths, she was using her neck muscles to breathe because as she took those deep breaths, her

[00:21:47] [SPEAKER_02]: shoulders were immediately going up and it was almost impossible for her to keep her shoulders

[00:21:52] [SPEAKER_02]: relaxed the entire time and only expand from the rib cage. So this only highlights even more,

[00:21:57] [SPEAKER_02]: not only is it a down regulatory effect that we're looking at with breathing, but we're trying to

[00:22:03] [SPEAKER_02]: make sure that we're not turning on unnecessary muscles that shouldn't be turned on throughout

[00:22:08] [SPEAKER_02]: the day. The only time we want to use our neck muscles when we're breathing is if we're doing

[00:22:12] [SPEAKER_02]: high level activity and really going for a sport type of play. Otherwise, throughout the day,

[00:22:22] [SPEAKER_02]: we should, when we're breathing, our shoulders should be relaxed. If someone tells you to take

[00:22:25] [SPEAKER_02]: a deep breath, your shoulders should not raise. And that is the misconception when people say,

[00:22:31] [SPEAKER_02]: take a deep breath and relax, your shoulders go up to your ears. We're using accessory muscles

[00:22:36] [SPEAKER_02]: that shouldn't necessarily be in play. So I think that is usually a missing link that people don't

[00:22:42] [SPEAKER_02]: think about. But I liked some of the other stuff that we looked at in research as well,

[00:22:47] [SPEAKER_02]: not only looking at diaphragmatic breathing playing a role, but also postural awareness.

[00:22:52] [SPEAKER_02]: So just being aware of our posture throughout the day. We're not going to have perfect posture

[00:22:57] [SPEAKER_02]: throughout the day. We've also done an episode on posture. Yes, it changes, it moves.

[00:23:01] [SPEAKER_00]: What we think about how that should look throughout the day.

[00:23:04] [SPEAKER_02]: With that said, having a general sense of awareness of how to hold your head over your body

[00:23:12] [SPEAKER_02]: more so throughout the day and how we kind of find that balance within ourselves rather than

[00:23:17] [SPEAKER_02]: forcing it. But what exercises do I need to do? Do I need to open up my upper back more?

[00:23:21] [SPEAKER_02]: Do I need to open up my chest and my pecs? Maybe they're so tight and rigid that it's pulling my

[00:23:27] [SPEAKER_02]: head. And so me trying to force a good posture isn't going to happen. So what do I need to do

[00:23:32] [SPEAKER_02]: to help move that forward? You know, I think that's really important.

[00:23:36] [SPEAKER_00]: This reminds me just recently, I got home from this dinner I went to

[00:23:40] [SPEAKER_00]: with a couple of friends and a couple of their friends that I had never met before.

[00:23:46] [SPEAKER_00]: And the woman that was with us, she knew I was a physical therapist and just kind of asked me,

[00:23:51] [SPEAKER_00]: I just, when I work, I have this really bad pain in my back. And she kind of like reaches around

[00:23:57] [SPEAKER_00]: her upper traps, like classic upper trap pain that people would be feeling for a long day at work.

[00:24:03] [SPEAKER_00]: And she's just like, what exercises should I do? And I kind of had to make a decision in my head

[00:24:08] [SPEAKER_00]: because as you who listen to the podcast, you all know it's not a simple answer. Like, oh,

[00:24:13] [SPEAKER_00]: do this one exercise that'll clear right up. Yeah, you might be able to have one or two exercises

[00:24:19] [SPEAKER_00]: that could give you relief or make you feel relief, but we are looking for the long-term solution.

[00:24:24] [SPEAKER_00]: And I'm just like, okay, I'm going to try doing this in like 60 seconds in the best way possible.

[00:24:30] [SPEAKER_00]: And it kind of reflects what our posture episode said. I just said, you sit and work at a computer.

[00:24:34] [SPEAKER_00]: She was an actuary. So she'd worked in finance and doing actuarial reviews for these big companies.

[00:24:40] [SPEAKER_00]: And she's like, yep, I sit for long periods of time. So I'm just like, and what position are

[00:24:44] [SPEAKER_00]: you in? And she like does the classic rolls her arms in, gets kind of looking forward into her

[00:24:49] [SPEAKER_00]: computer. And I'm like, this is the main problem. I could give you a couple exercises that you can do

[00:24:54] [SPEAKER_00]: once or twice throughout the day and you might feel a little bit better, but

[00:24:58] [SPEAKER_00]: you're sitting in this position for a long time. And it's kind of said, coming back to the

[00:25:02] [SPEAKER_00]: postural awareness that Jen just brought up, how can we every 30 minutes, 30 or 40 minutes when

[00:25:08] [SPEAKER_00]: we are working throughout the day have like a reminder, whether it's a physical reminder on

[00:25:13] [SPEAKER_00]: our phone saying, hey, get up and do a little movement. And I just said, do the opposite of

[00:25:18] [SPEAKER_00]: what you're doing. Open up your back, rotate through your back, open your chest, and then

[00:25:23] [SPEAKER_00]: get back to work. And if you do that every 30 minutes, you're doing it 12 to 16 to 20 times

[00:25:29] [SPEAKER_00]: throughout the day. And that's going to start having a much larger impact on our nervous system

[00:25:34] [SPEAKER_00]: than doing a couple exercises once a day. And she's like, huh, that actually makes a lot of

[00:25:40] [SPEAKER_00]: sense because, you know, hopefully I explained it well enough and she seemed like a smart cookie.

[00:25:45] [SPEAKER_00]: So she's just like, okay, I'll try doing that. And then I gave her some more specifics like

[00:25:50] [SPEAKER_00]: get to a wall and open up your chest and do a pec stretch.

[00:25:54] [SPEAKER_02]: Things we do in the neck and upper back plan.

[00:25:55] [SPEAKER_00]: Yeah. Do some upper back rotation because when we're sitting and working,

[00:26:00] [SPEAKER_00]: we're not rotating through our spine. But yeah, postural awareness. It's not just about

[00:26:04] [SPEAKER_00]: posture. I need to sit in one specific position. It's I need to find more movement throughout my

[00:26:09] [SPEAKER_02]: day. And then, you know, going into what we've already talked about is strengthening those deep

[00:26:14] [SPEAKER_02]: neck flexors. And there's different ways that you can progress this in clinic specifically looking

[00:26:18] [SPEAKER_02]: at using like a blood pressure cuff to kind of measure how much pressure you're putting in and

[00:26:25] [SPEAKER_02]: how hard you're, you know, how strong those muscles are. We have different kinds of progressions on

[00:26:30] [SPEAKER_02]: GenHealth where we start in sitting where it's not a lot of ton of pressure. And then we go to laying

[00:26:35] [SPEAKER_02]: on your back. And then we have different progressions from there where you don't have to

[00:26:38] [SPEAKER_02]: use something, but you're going to feel the progression as you continue working on it.

[00:26:44] [SPEAKER_02]: But there's different ways that you can progress to really continue to strengthen so that again,

[00:26:49] [SPEAKER_02]: it's not something that you have to be throughout the day thinking, oh, let me chin tuck. But it's

[00:26:53] [SPEAKER_02]: like if I make those muscles strong in general, my head and my brain is going to have more awareness

[00:26:59] [SPEAKER_02]: of how to hold my head there naturally. And that's really what we're looking at.

[00:27:04] [SPEAKER_02]: And then looking at, you know, dynamic exercises, isometric exercises, exercises that strengthen

[00:27:09] [SPEAKER_02]: all along the upper body again. And I think it's really important to note, and this is something

[00:27:16] [SPEAKER_02]: we do in GenHealth and the neck and upper back plan as well. When we're talking about strengthening

[00:27:22] [SPEAKER_02]: around our shoulder blades or around our shoulders, we're looking at the core as well.

[00:27:26] [SPEAKER_02]: Your core, it plays a role all the way up into our shoulder blades. Our entire trunk,

[00:27:33] [SPEAKER_02]: our entire pillar should really play a role in how that's breathing, moving and functioning together.

[00:27:39] [SPEAKER_02]: So we can't look at just the neck and shoulders and say, let me just strengthen here. But I get

[00:27:44] [SPEAKER_02]: to look at the entire picture, that entire pillar and how that's moving, breathing and functioning

[00:27:49] [SPEAKER_02]: and coordinating together in order to know that I'm making progress. And so this is where it's just

[00:27:55] [SPEAKER_02]: continuing to be important on how we're training it all together, how we're really strengthening

[00:28:01] [SPEAKER_02]: the entire complex. And then the biopsychosocial, what am I doing in my life that's really

[00:28:09] [SPEAKER_02]: kind of be impacting what I'm feeling in my head.

[00:28:12] [SPEAKER_00]: And as with everything, it's a continual journey. Like we might go to a physical therapist,

[00:28:17] [SPEAKER_00]: they'll find these specific things that they want us to work on because we have restrictions there.

[00:28:21] [SPEAKER_00]: But like we mentioned, there are benefits shown for headaches in almost every type of exercise,

[00:28:26] [SPEAKER_00]: whether it's aerobic, whether it's strength training. And that makes a lot of sense because

[00:28:30] [SPEAKER_00]: when we do exercise, we improve the physiologic systems of our body and we can progressively

[00:28:35] [SPEAKER_00]: continue to improve those through life. And Jen mentioned it a couple times,

[00:28:40] [SPEAKER_00]: we have a great place to start. We've had a lot of people give us feedback that it has improved or

[00:28:46] [SPEAKER_00]: completely eliminated the headaches that they experience. It's our neck and upper back plan on

[00:28:51] [SPEAKER_00]: Jen Health. You can get a free week trial if you've never joined a membership before. So you

[00:28:56] [SPEAKER_00]: can get the link down in the show notes or it's just Jen.health.com backslash free trial. It'll

[00:29:02] [SPEAKER_00]: give you seven days for free to explore the neck and upper back plan. And as a podcast listener,

[00:29:07] [SPEAKER_00]: you can always use code optimal to get an extra bonus discount on either your first month or your

[00:29:12] [SPEAKER_00]: year of membership.