I often see clients who come to massage therapy in need of treatment to address neck pain and headaches. During the consultation I'll ask them what position they sleep in and often the answer is "on my stomach". When sleeping in this position the head has to be turned to one side which causes overstretching of some muscles and shortening of others. The result can be limited rotation of the head to the side opposite to that which they turn their head when sleeping, combined with head and neck pain that doesn't seem to shift. Some of the muscles involved, such as oblique capitis inferior - a small muscle at the back of the neck that attaches from the C2 vertebrae spinous process (axis) onto the C1 vertebrae transverse process (atlas) - end up pulling on the axis and causing muscle spasm. Nerves become overstretched and compressed and there is dragging on the the dura mater, the outer membrane that surrounds the brain and spinal cord. Blood flow is also reduced from the neck being rotated into this position for an extended period of time. Sometimes there may also be numbness and tingling down the arm and into the hands.
Massage therapy can assist with releasing the habitually shortened muscles, freeing up movement in the neck and creating more space for nerves and blood flow. A range of techniques including myofascial release and triggerpoint therapy can be effective. I generally treat the sub occipital muscles together with the upper cervical erectors, upper trapezius, levator scapula, plus the sternocleidomastoid and scalenes on the front of the neck.
Educating clients about the causes of the pain and steps that can be taken to help prevent these headaches and neck pain is also important. There are a few stretches that can assist but often postural awareness is a critical aspect. While it can take time to establish a new sleeping position habit, persevering with sleeping on the back or side can make a big difference. Using a pillow between the knees to prevent rolling over onto the stomach can help. Also, choosing a contoured pillow that offers support into the curve of the neck while being flatter under the head will prevent the neck being too flexed. Becoming aware of other postural patterns, such as always turning to one particular side to look at a computer screen or cradling a phone between the ear and neck on one side can also help the client to make changes that make a difference.
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References:
Bogduk, N. (1995). Anatomy and physiology of headache. Biomedicine & pharmacotherapy, 49(10), 435-445.
Dalton. E. (n.d.) Stomach sleepers headache. Retrieved from http://erikdalton.com/stomach-sleepers-headache/
Harvard Medical School. (2015). Say good night to neck pain. Retrieved from: http://www.health.harvard.edu/pain/say-good-night-to-neck-pain
Vincent, M. B. (2000). Cervicogenic headache: clinical aspects. Clinical and experimental rheumatology, 18(2; SUPP/19), S-7.
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