Whiplash: Eliminate Headaches and Neck Pain Quick

Whiplash {The Medical Definition}: an acceleration-deceleration mechanism of energy transfer to the neck.

Whiplash {Translation}: Your head got whipped forward and backward really quick dude!

The amount of people I see in clinic following rear end collisions continues to increase. In many cases, primary care providers do not recommend patients for rehabilitation right off the bat. We avoid over management of this condition because whiplash often resolves on its own. However, I believe that many complaints of headaches and neck pain can be resolved quicker if managed earlier. Guidelines for Acute Whiplash recommend rehabilitation as early as 7 days following the initial assessment by a physician if symptoms are not improving.

Today we will discuss how trigger points can impact neck pain and headaches. We will also leave you with some techniques for identifying and treating these trigger points.  The goal is not to give you a physiology lecture on trigger points, but to give you a visual of how certain muscles can cause radiating pain in different regions of the body.

Trigger points are hyperirritable nodules in muscle that cause pain. Sometimes this pain may radiate to a different region of the body. Treating muscles around the neck can help reduce many of the headaches that are experienced on a daily basis. This is usually the missing piece of the puzzle following a whiplash injury. This is not to say that the headache is secondary to muscle dysfunction alone. I usually tell people to look at headaches like a nice big pizza pie.

Treating headaches and most pain for that matter requires good habits. This includes sleep, nutrition, physical activity and proper rest following a whiplash or concussion injury. Your physician will typically help guide you in the right direction when it comes to those pieces of the pizza pie.

Take a look at the muscles below. Trigger points in these muscles will radiate pain to the areas highlighted in red. Darker areas of red are regions where pain is more commonly reported when trigger points in these muscle groups are palpated.

 

Back Side of the Neck

Trapezius Muscle

Upper Trapezius, trigger point, referral, pain

Middle and Lower Trapezius Muscle + Levator Scapula

mid trapezius, lower trapezius, referral, trigger points, pain

Levator Scapula, trigger point, referral, pain

Cervical Paraspinals

cervical paraspinals, trigger points, referral, pain sub occipitals, referral, trigger point, paincervical paraspinal, referral, trigger point, pain

Front Side of the Neck 

Sternocleidomastoid

sternocleidomastoid, pain, referral, trigger point

Scalenes

scalene, trigger point, referral, pain

 

Steps for Identifying and Treating Trigger Points

 

 

Step 1: Scan

 

Identify areas of tenderness, hopefully areas that mimic the pain you experience. This includes headaches. Roll your selected soft tissue tool over the muscles listed above. You are basically targeting the back of the neck, front of the neck and upper back to keep things simple.

 

Tools: Lacrosse ball, tennis ball, double tennis ball, roller stick, thera-cane.

 

Step 2: Treat

 

Once you identify painful sites you will use your treatment techniques to help resolve pain and headaches. A general rule is to treat the area that reproduces the pain or headache you typically experience. If an area is too sensitive to treat move on to the next area that reproduces your similar pain pattern.

 

Be sure to focus on relaxed breathing strategies when performing soft tissue techniques.

 

Self-Massage: Place your ball of choice over the tender area, and roll the ball along the musculature at your highest level of pain tolerance. Ok, I know what your thinking. I have really high pain tolerance, Rehab Renegade Guys. Yes, yes I know. Everyone tells me that. The idea is to make the pressure intense enough that we can feel the muscle begin to “release” or relax. If pain increases reduce the amount of force used.

Prescription: At least 1 minute.

 

Trigger Point Release: Place ball over trigger point, increase pressure to the highest level of pain tolerance.

Prescription: Hold pressure for 5 seconds and then relax for 2-3 seconds by taking pressure off of the site being treated. Continue to repeat this cycle for 2 minutes. Pain should not increase during this technique. Reduce pressure if necessary.

 

Trigger Point Release with Active Movement: Place ball over trigger point, increase pressure to the highest level of pain tolerance. Actively stretch body part being targeted while applying pressure.

Prescription: Perform 5x, with 2-3 seconds of rest. Continue to repeat this cycle for 2 minutes. Pain should not increase during this technique. Reduce pressure if necessary.

 

Trigger Point Release with Contraction/Relaxation (of targeted muscle): Place ball over trigger point, increase pressure to the highest level of pain tolerance.

Prescription: Contract the muscles being treated for 5 seconds followed by 10 seconds of rest. Attempt to let the ball “sink” deeper into your tissues during each 10 second rest. Repeat cycle for 2 minutes.

 

 

Early motion and resolution of tender and tight muscles will help you to reduce pain and headaches following a whiplash injury. This is one strategy for reducing muscle tension. Do not neglect the importance of a healthy lifestyle, relaxed breathing strategies and use of modalities such as heat to gain similar effects as stretching and soft tissue work. In order to see the best results you need to consider every piece of the pizza pie.

 

Michael Infantino, DPT

 

Guidelines for the management of acute whiplash associated disorders for health professionals 2014.

Chaitow, L., Fritz, S., King, R. K., & Chambers, G. (2006). A massage therapist’s guide to understanding, locating and treating myofascial trigger points. Edinburgh: Churchill Livingstone/Elsevier.

Bron, C., & Dommerholt, J. D. (2012). Etiology of Myofascial Trigger Points. Current Pain and Headache Reports16(5), 439–444. http://doi.org/10.1007/s11916-012-0289-4

Trigger point referral pictures are from Myopain Seminars Course Material.

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3 Replies to “Whiplash: Eliminate Headaches and Neck Pain Quick”
  • Annie
    April 23, 2017 at 4:27 am

    did one of your sources come up with the prescription or is that your own recommendation? Say the MD didn’t educated the patient- any specific tips on nutrition?

    Reply
    • rehabrenegades2012 • Post Author •
      April 23, 2017 at 7:17 am

      Hi Annie, thanks for asking! The prescription for trigger point release is from:
      Chaitow, L., Fritz, S., King, R. K., & Chambers, G. (2006). A massage therapist’s guide to understanding, locating and treating myofascial trigger points. Edinburgh: Churchill Livingstone/Elsevier.

      Research on recommended duration for manual trigger point release is spotty. Based on my clinical experience it seems like patient preference is a better guide.

      I tend to leave the nutrition recommendations for the physicians and nutritionists. However, as a general rule I will recommend that patients avoid processed sugars and high carbohydrate diets. More emphasis on healthy fats, a well balanced diet and adequate hydration.

      Reply
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