Neck and Shoulders alignment
Lower back pain
Work-related pain and injury: RSI, overuse injuries
Headaches: Yoga’s Healing Options by Chanthalah Webster-Tight – Published in Australian Yoga Life June 2014
Slowly Changing Posture
The marriage of yoga with physiotherapy and other allied health practices is a complementary one. Literature and clinical experience suggests that a multimodal approach creates an environment in which we can address head pain with supportive therapies.
When you observe your everyday life, how often does your posture feature? Think how often you press that spot at the base of your skull or rub your shoulders, or take a pain killer so you can get through the rest of your day. Our work demands increasingly longer hours in stationary postures. We may get to our regular yoga class on the way home; however, once home, we become comfortable on the lounge or spend hours on the laptop. Our acceptable non-work activities tend to include the constant rehearsal of a new ‘efficient’ posture—one that allows us to spend lengthy time slowly accommodating to the diminishing natural curves of our spine, with our neck and head suspended forward. Then we wonder why we are less adaptable and more prone to injury and pain when we decide to become active again.
This is an example of gradual structural adaptation and change, much like the poor old frog in a pot. Thomas Meyers, an American anatomist, passionate body-worker, and author Anatomy Trains on his recent tour of Australia explains, “Experimentation in movement [to avoid discomfort] becomes a gesture, repeated gesture forms a habit, reinforced habit becomes a pattern, and ingrained patterns become structural compensation.” In his insightful workshops he explains that at a quick glance, we are able to recognize these patterns, but changing our habitual postures is extremely difficult, particularly when our new ‘normal’ changes our experience and perception of movement.
Headaches are a health concern
Neck pain and headache are common complaints. Headache affects approximately 70% of people at some time in their lives, being among the most common disorders of the nervous system. Not only is headache painful, it is also disabling, with causes ranging from eye-strain to hyperventilation, and serious organic problems such as spinal infections or tumor. Primary nervous system disorders include migraine and tension-type headache. One suggestion as to how these headache complexes occur is that blood vessels to the brain narrow temporarily as a result of various factors--stress and muscular tension being the most common two. For the migraine sufferer, blood flow increases to the head abruptly as arterioles dilate. Secondary disorders include symptoms arising from another recognisable cause—one example being cervicogenic headache arising primarily from neck structures.
Headaches are a global problem
The recently published Global Burden of Disease Study 2010 (GBD 2010) indicates that headache is among the many causes of disability worldwide.
Tension-type headache (TTH) and migraine are the second and third most prevalent disorders in the world, with migraine being the seventh highest cause of disability in the world. No age group or occupation appears immune, and related neck pain is second only to lower back pain in annual worker compensation costs.
There is a growing body of research that also describes headache attributed to disorders of the neck (cervical spine), with more studies investigating theories around optimal postures in our ‘sitting’ society. Recent international epidemiological data suggests that an estimated 47% of the population have had headache symptoms in the past year. Persistent headache disorders are underestimated, under-recognised, and under-treated throughout the world, despite racial, economical, and geographical variations. There is limited Australian research on the financial cost of headache to society.
In 2012, the European Journal of Neurology published estimates for the total cost of disorders of the brain from 2010 data across 30 European (EU) countries. Of the total estimated cost of €798 billion, the cost for headache was estimated at €43.5 billion. These results were lower than comparable estimates from the US. Headache Australia, the International Headache Society and the World Health Organization (WHO), agree that we need to take steps to remedy the past neglect of headache disorders and the inadequacies of responses to them.
Muscle overuse, breathing and psychosomatic contributions
When we become fatigued in a sitting position, the initial change often occurs in the lumbar spine, with the extension curve flattening out. The pull of gravity increases upper back flexion, producing the familiar forward head and neck position ‘slump.’ The superficial muscles of the neck and upper back include spinalis, longissimus and iliocostalis capitus and cervicis divisions, with the muscles of the trapezius affecting the head, scapula and thoracic contributions to poor posture. Deep to these, the semispinalis divisions interconnect, stabilise and refine movement of the vertebrae for postural adjustments. With repeated slumping, the receptors in the muscles undergo hundreds of contract/relax repetitions. Receptors detect a quick increase in muscle length and tension, causing a reflexive contraction to protect the muscles from overstretching. This leads to chronic tightness and a state of reduced oxygen in the muscle, so that by the time we want to use them for our yoga practice or another exercise, they are already pre-fatigued. A result of this overuse, fatigue, and altered neuromuscular patterns can predispose individuals to injury and be a causative factor in recurrent TTH symptoms.
Dysfunctional breathing patterns can also contribute to headaches. Any alterations to spinal position can impact the function of the diaphragm. Paradoxical breathing patterns occur when you are suddenly startled, and, with your gasp, you pull your abdomen in and breathe high in the upper chest. This can also occur when there is a constant contraction of the abdomen (as in trying to flatten your belly when holding your core or when you are stressed), and this both increases respiration rate and prevents the diaphragm fully descending on inhalation. Upper chest breathers tend to overuse the accessory breathing muscles (scalenes) for ‘normal’ breathing, resulting in tension, fatigue, altered diaphragmatic movement and headache.
Some headache sufferers may also have a psychosomatic (emotional) element existing alongside stress, posture, and breathing issues. Chronic muscular hypertonicity can result from another condition, genetic contribution or learned childhood habit, and can make a person more vulnerable to tension and headache.
Headache prevention and management
The marriage of yoga with physiotherapy and other allied health practices is a complementary one. Literature and clinical experience suggests that a multimodal approach creates an environment in which we can address head pain with supportive therapies. Yoga, mindfulness, changing behavior and neuromuscular patterns, manual therapy and soft tissue work for emotional release can all help improve posture and lead the sufferer to understand the complex underpinning biopsychosocial issues associated with persistent headache. From clinical experience, almost 75% of all secondary headaches arise from muscle tension, fatigue, weakness and fascial change in the neck, back and shoulders, caused by maladaptive postural patterns. Changing habits, however, is a significant hurdle.
The Gift of Yoga
Yoga provides a comprehensive and holistic approach to facilitate lasting change. With the support of an experienced teacher and authentic practice, asana, pranayama and meditation can offer many solutions to better manage some types of headache, reducing their frequency and severity. Restorative asana, using supporting props, can specifically and sensitively address the tight front structures that need to be stretched first, before the weak back muscles can be reawakened and strengthened. Pranayama (breath control) can also be effective in reducing the intensity of headache; however, these practices need to be adapted to each individual. Influencing the breath can produce a variety of experiences, some not always positive in the beginning, especially for those new to the practice. The deep respiratory centres in the brainstem are highly sensitive to oxygen and carbon dioxide concentration and pressure alterations. When lengthening the exhalation, a yoga therapist may be more discerning in pranayama and dharana (concentration) choice, and can reassure the individual when the first instinct can be to panic and gasp for breath.
Jull, G. et.al. Whiplash, Headache, and Neck Pain. Elsevier Limited, 2008.
Meyers, T. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists, 2nd edition. Elsevier Limited, 2009.
The International Classification of Headache Disorders, 3rd edition. http://www.ihs-headache.org/ichd-guidelines
The Global Burden of Disease survey 2010, Lifting The Burden and thinking outside-the-box on headache disorders, J Headache Pain. 14(1), 2013.