Sunday, February 15, 2009

Myofascial Release for Headaches

Dr. Ajimshaw. M.S, MPT(Neuro), PhD
Headaches are often caused by disorders of the neck or physical and emotional tension. Physiotherapists can successfully treat headaches originating from the neck or soft tissues and show you how to prevent the pain recurring. At one time or another, everyone experiences the dull constricting pressure and pain of a tension headache. For some people, tension headaches occur almost every day.

Is your headache really a neck ache?

For many people, headaches start as pain or tension at the top of the neck. As the pain worsens, it may spread to the back of the head, the temples, forehead or behind the eyes. Moving the neck or bending forward for a long time tends to make it worse. This happens because the nerves in the upper part of your neck are connected to the nerves in your head and face. A disorder of the upper neck joints or muscles can cause referred pain to your head. Any of the following points could suggest that your neck may be causing the headache:

Headache associated with neck pain. Does the pain radiate from the back to the front of your head?
Headache with dizziness or light-headedness or giddiness, Nausea
Headache brought on or worsened by neck movement or staying in the same position for a long time.
Headache which always feels worse on the same side of your head.
Headache eased by pressure to the base of the skull.
Headache which persists after your doctor has checked for other causes.
Pain sweeping up the neck and up behind and over the ear - the 'question mark'
Stabbing pain behind the eye
Pain across the front of the forehead
'Vicelike' pain around the head
Pain under the bony ridge at the back of the skull
Accompanying nerve pain 'neuralgia' into the face, jaw and eye areas
Extreme sensitivity to light and sound
What is Myofascial Release?
The fascia is thin, strong connective tissue that covers muscles and bones and surrounds internal organs such as the heart, lungs, and intestines. Normal, healthy fascia is flexible. It provides a seamless, interconnected web that supports and shapes body structures. When the body becomes injured or inflammation occurs, fascia becomes stiff and range of motion is limited. Myofascial release is a type of bodywork that specifically treats the fascia in the body using sustained dynamic pressure. This pressure helps release the stress in the fascia, restore symmetry in the fascia, and restore balanced muscle tension and body alignment. It increases the elasticity of the fascia so range of motion is improved. Myofascial release is used in the treatment of a range of motion problems and chronic pain.

The neuromuscular and soft tissue causes of Headaches and Migraines
Headaches and Migraines can be due to a tightening and restricting of muscles and fascia in the neck and shoulders, sometimes involving trigger points - areas of muscle fibers which are permanently contracted - which referred pain to other areas of the body. Myofascial release can help with Headaches and Migraines by releasing all the fascia, connective tissue and trigger points in the neck and shoulder area, and rebalancing all the muscles involved.
Headaches from other causes

If cause of migraine is something else, as evident in a careful physical examination; your physiotherapist will recommend that you see a medical practitioner.

Prevention is better than cure!!

Here is some useful advice to help you control and prevent headaches:

Think tall: chest lifted, shoulders relaxed, chin tucked in and head level. Your neck should feel strong, straight and relaxed.

Avoid working with your head down or to one side for long periods. Frequently stretch and change position. Your physiotherapist will show you how.

Awkward sleeping positions will add load and strain to the neck. A down pillow or polyurethane moulded pillow is best for most people. Your physiotherapist will advise you.

Keep your neck joints and muscles flexible and strong with the correct neck exercises. Your physiotherapist will assess for tight or weak muscles and show you specific exercises to restore normal function.

Recognize when you are tense. You may be hunching your shoulders or clenching your teeth without realizing it.

How Physiotherapy Can Help?

Physiotherapists are experts in posture and human movement. They will be able to determine if your neck is causing or contributing to the headaches and plan a treatment program accordingly.
How Myofascial Release can Help Headaches
When the body experiences physical insults such as sprains, strains, scarring from surgery or injury, inflammation, disease, trauma from falls, repetitive stress, and poor posture, it responds by assuming unnatural positions. This unnatural positioning puts abnormal stress on the various areas of the fascia. The fascia then shortens and loses elasticity. This in turn creates tension in the muscles so that they pull the body out of alignment. Poor posture, a non-ergonomic office environment, stress, and injury to the arm, shoulder, neck, or jaw are common causes of muscle tension that cause headaches. These causes can be modified by myofascial release to relieve headaches.
In order to restore flexibility to the fascia and to release muscle tension, the myofascial release practitioner performs movements that alternately stretch and compress the fascia. The goal of this is to restore the natural alignment of the body. Fascia is connected through the entire body, so myofascial release performed on parts of the fascia will release tension in the entire body. As abnormal stresses on the head and neck disappear, so do the headaches. Although myofascial release therapy works best on tension headaches, it can also help prevent or reduce the frequency of migraine and cluster headaches as well.
Headaches also can have a psychological or emotional component. People who experience emotional trauma may assume protective body positions that strain the muscles of the head, neck, and shoulders. This stress deforms the fascia and can cause tension headaches. Myofascial release is not intended to directly address the emotional causes of headache pain. However, some clients discover that during their myofascial release sessions emotions are liberated in a way that has a positive effect on both physical and emotional healing.
What Happens During a Myofascial Release Session?
Treatment of headaches can take several myofascial release sessions. On the first visit, the practitioner will discuss the nature of the patient’s headaches—what brings them on, how long they last, what activities the patient is engaged in at the onset, what kind of pain is experienced—as well as the patient’s lifestyle, stressors, and the goal of the treatment. The practitioner will explain how a myofascial release treatment plan can achieve the patient’s treatment goals and reduce frequency and severity of headaches.
During this initial visit, the practitioner will also evaluate the patient’s posture and movement to determine whether this could be a cause of tension that leads to headaches. The practitioner will develop a plan of treatment based on the individual patient’s needs, the type of headaches they experience, and the feedback the practitioner gets while working with the patient’s body.
Each myofascial release session generally lasts about an hour. Depending on the plan of treatment and the patient’s goals, sessions can occur from three to six times per week. The patient will wear minimal, non-baggy clothing to allow the practitioner access to the body. The practitioner uses light pressure, compression and traction to stretch the fascia that is tense and rigid. The patient may feel pain during this therapy; pressure is applied slowly, increasing blood flow to the site of the pressure and allowing the fascia to relax and regain its natural, correct structure.
Many times, only one or two parts of the body are worked in one myofascial release session. Trigger points on the patient’s body will tell the practitioner where work needs to be done. Trigger points are areas on the body where pain or tension resides. The practitioner will use gentle pressure to find these points based on the feedback he or she gets from touch. Even though only one or two areas may be worked, the entire body will benefit because fascia is interconnected like a web.
Temporary soreness might occasionally result after a myofascial release session, but most people do not feel any discomfort after a session. When soreness is felt, it is usually because deeper, more intense pressure was used to unwind very tense fascia. This soreness is normally quite brief.
Relief can be felt after a single myofascial release session, but three or more sessions will yield more lasting relief from headache symptoms.Usually between 2 to 6, 45 minute treatments at the Myofascial Release Clinic bring about substantial decrease in headaches and migraines.
Physiotherapists may use other techniques in combination with MFR such as :-

Craniosacral therapy
Functional and rehabilitative exercises.
Encouraging normal activity.
Postural assessment, correction and advice.
Relaxation therapy.
Laser, ultrasound, electrotherapy and heat treatment.

Your physiotherapist can also offer you self-help advice on ways to correct the cause of headaches, such as practical ergonomic tips for work and in the home; adjusting furniture, relaxation and exercise. Manipulation can be an effective treatment for headache caused by neck problems, but may not be the best option in every situation. After a thorough examination your physiotherapist will discuss treatment options with you to ensure that your headaches are managed safely and effectively.
Finding a Myofascial Release Practitioner
In India, numbers of therapists who are practicing Myofascial release techniques are very few since there is scarcity in the number of authorized institutions. Myofascial Therapy and Research Foundation, India® is the one and only center in India which conducts diploma courses on Myofascial Release. The course ADMFT© (Advanced Diploma in Myofascial Therapy) is a three months duration course conducted at its main centre in Kottayam, Kerala. All type of MFR and other “Hands-On” treatments for various osteomyofascial dysfunction can be available at MFTRF®’s clinical Wing “SCeB CAPT®” (Specialized Centre for Back Care And Advanced Physical Therapy), Kottayam, Kerala( Here practitioners of myofascial release also have training in bodywork techniques such as Rolfing, Cranio Sacral Therapy, Critz Technique, Neil Ascher Technique, Muscle energy Technique, Maitland manipulation and Mobilization and Ergonomics .