One of our physical therapists once worked with a patient dealing with what looked like a straightforward case of tension headaches. Her suboccipital muscles — which run from the base of the skull to the upper neck — were tight and tender, and tension in that area is a well-known cause of headaches when it starts to compress the nerves running through it.
Treatment focused on deep tissue massage, traction, and joint mobilization to that area, alongside chiropractic care she was already receiving elsewhere. Between the two approaches, she should have started feeling better. But after two to three weeks, there wasn't much improvement, and she was starting to consider injections through a pain management doctor.
The Real Problem Was in the Shoulder
Around that time, she also saw another physical therapist on our team, who uncovered what had been missed: a problem with her shoulder. She worked as a music teacher, which involved a lot of repetitive use of her right arm, and over time that repetition had irritated the rotator cuff muscles in her right shoulder.
The shoulder is a complex joint made up of four separate joints, and the ball-and-socket joint is directly connected to the neck through muscles that run from the shoulder blade to different regions of the neck and upper back. When the rotator cuff gets irritated, the mechanics of the whole shoulder complex start to shift. In this case, the muscles connecting her shoulder blade to her neck began working overtime to compensate, which increased tension around her neck and suboccipital muscles — and that tension was what was causing her headaches.
Treating the Symptom vs. Finding the Root Cause
Continuing to treat only the neck could have gone on for several more weeks without much progress beyond temporary relief. Once treatment shifted to reducing irritation in the rotator cuff, and eventually strengthening it, she improved much more quickly and was able to avoid the injections she'd been considering.
If Neck Pain or Headaches Won't Resolve
If you've been doing what seems like all the right things for neck pain or headaches and still can't get on top of it, the root cause might be somewhere you haven't considered — like the shoulder. A full evaluation with one of our physical therapists can help track down where the problem actually starts, rather than just managing where it shows up.
