Welcome to the third lecture and the Headaches and Migraines series. Today we're focusing on cervicogenic, headaches, headaches that have a relationship to the neck. And I'll talk about what that means. But a couple reminders about getting the most out of our time here together. The course suggests that you avoid multitasking, it's easy to split yourself up or slice your attention, or slice your awareness into multiple things. Resist, I ask you to resist that. So just stay with this if you could. And if you can stay muted, including faculty, because they need it, that's always helpful as well. But that'll help you stay focused on this, but do engage your body. Yeah, do please sit like this, not like this, like this girl is kindly demonstrating to us kind of kidding about that. But there is a relationship, it turns out between posture and this type of headache. And as you may know, from spending a bunch of time on zoom, if you do that, like I do that you can definitely feel it in your head, neck and jaw, as well as in your head as a headache. If you sit too long like that. There you go. So or even you could sit like that. There's another option for you to do but the movement seems to be the key. So engage your body today. As you go. Yep. and engage your mind. Engage your body and engage your mind. Put on your thinking cap. And really track your questions, track your comments, share those, just write them in down into your notes. So you can bring them to your discussion groups or chat them into our chat here, the zoom chat or if you're listening to the recorded version, go to the forum and put them into Headaches Principles course there.
Okay, and we have a preview of our quiz sequence. Our quiz for this sequence. What are the typical characteristics of cervicogenic headaches? Watch for those what distinguishes a cervicogenic headache? How would you recognize it and suspect that this is the way you're going to work with it. In the sternocleidomastoid lateral glide technique, which is XD-15, what layer or structure are we feeling for? What's the layer or structure that we're feeling for in that technique? In the flexion-rotation test, E-03, what? Why is the neck flexed? Hmm, why is it the flexion-rotation test and not the extension-rotation test or the anatomical neutral rotation test? Why flexion? What's the deal there? What does flexion do for us in that test. And in that technique in this version of that technique, it'll look familiar to you because we do a very similar technique in the Neck, Jaw & Head workshop. What's our goal here though? What are we after here in this version that might be different from the way it is in the Neck, Jaw & Head workshop. And then for technique, XD-16. What kind of movement does that use, the cervical translation variation 3, atlas occiput. What kind of movement is it we're looking for there? Describe that to us if you could.
The goals for this sequence. This is a collection of techniques or tools or approaches that are particularly good for these goals. They are going to help us assess and normalize any sensitivity, otherwise known as pain, or tendency toward pain, or mobility restrictions, otherwise known as stiffness, of the cervical spine, otherwise known as the neck, related to headache pain. The indications are headaches, especially cervicogenic ones that you'll see have to do with the neck. And these are great techniques too for any kind of upper cervical pain or movement restrictions. Upper is the key there, the key word. And it's actually there's a reason for that. I'll talk about that perhaps as we get through in the lecture. So this is these are, it's a sequence you can use this I'll just remind most of you know this, you can use this as a protocol for somebody that you suspect this has this kind of headache. But since dosing and pacing is everything, you may only do a couple of these with any client in any given session, depending on their response. So this is almost a toolbox or a menu of options from which you can pick your meal that you To serve your client, or participate in with your client.
The neck is related to a lot of kinds of headaches, tension as well. Here's a painting of the back of the head with the axon, say, of the occipital nerves. It's a little metaphorical more than anatomical. But it's it's it has an accurate anatomical analogy, meaning the back of the head has nerve trunks that extend down into the neck and a lot of the sensation from the back of the head is being relayed through nerves that go through the back of the neck, the upper cervicals in particular. There's a class of headaches we're talking about today cervicogenic headaches, I'll give you a little overview and then we'll go down even more detail. There's a few characteristics they have to them. They're often similar to or mixed together with tension headaches, they can be a little hard to tell apart. And maybe that's because the two are going on at once. But the same is true for migraines, you get some of the same kind of phenomenon that you get with migraines with cervicogenic headaches sometimes. And that might be because they're happening at once or might because there's a little overlap in their typology.
That means for that reason, they're controversial. And the controversy is less now than it was a decade ago. But there was quite a bit of debate about is this really a thing are cervicogenic headaches a type or are they just tension headaches sometimes and migraines at other times that have a neck component to them too? The controversy has settled out quite a bit because it's, it's fairly well accepted there's a lot of headaches that respond really well to neck interventions. And that's become one of the defining characteristics. The things that involve movement or normalizing the sensation of the neck seem to help a whole bunch of headaches. And so for that reason, there's probably less debate about what are these. Some of these headaches too will also respond to medications that target migraines. So there's still that uncertainty like how much of that cervicogenic component might be a migraine kind of mechanism? And how much how much might be say musculoskeletal like the tension headache mechanisms likely are.
But the pain from that headache, from cervicogenic headaches, is thought to be related to referral from the upper cervical facet joints. That's one of the key places that let's say, it's interesting to go read the research over the years on these, been some really good studies on cervicogenic headaches, the ones that are conducted by physios or chiropractors or people that work with the joints, not surprisingly, target research into the joints and their theories and their research often shows that, yeah, the upper cervical facet joints can be sensitized and can be a source of nociception. So you can get pain signals from those facet joints. The upper trapezius, or the sternocleidomastoid have also been shown in different studies to be sources of referral pain that manifests as a headache. But essentially what happens is, work with those outer soft tissue structures ends up helping people's headaches. So there's does seem to be some sort of mechanism where that soft tissue is involved.
And then, you know, more coming from a maybe my background or my bias. I think I've had a lot of success with these headaches, working with the superficial and the deeper cervical fascia. Yeah, as well as the viscera, I think there's a role for just calming things down. And maybe maybe some of these headache pains could be a response to an inflammatory reaction in your gut because that vagus nerve feeds right into some of the neurological relationships that manifest as referred pain. Yeah, that's it. So basically, all those things converge in the trigeminal cervical nucleus, there at the base of your brain. And that's where there seems to be some crosstalk between these different nerve branches. It's not quite as clean and clear as dermatomes, where you can map it out and say okay, so if you have this pain in this part of the body, it's probably this peripheral nerve branch, because they all converge there. And there seems to be actually some sharing of signals there are, they have found anatomically interneurons that connect these different branches of the nerve within this nucleus so that you could have say, some nociceptive signal being generated even in your upper back and your spinal nerves that gets relayed, the theory goes into, say, your trigeminal nerve and manifests as a headache in the front of your head. That seems to be plausible as an explanation, and the research seems to support that and then the clinical observations we have as practitioners, there's lots of stories of that someone's headache, not resolving until I worked the neck really thoroughly or the back or the trapezius or the sternocleidomastoid, or one of these structures that I'm naming and it doesn't stop there. Of course, it goes down the body There's probably pretty clear neural pathways from some of these areas into the zones where people will experience these kinds of headaches, as well.
This is in your handout. It's a review of a handout that we did in our first lecture so far, and then I'm going to layer in cervicogenic headaches. So you can see how that compares to what we've covered so far. The review portion of this is that if you haven't found this yet, where is this, it's on page like seven in your handout, in English, and eight in Spanish, cervical sorry tension and neurogenic headaches here each have their own columns. And the typical pain location is different in each, usually it's bilateral for tension, and unilateral in neurogenic. Again, this is review. Usually the associated symptoms are not usually there's not usually a lot of nausea or visual disturbance with a tension headache, but that is a defining feature of a migraine. Often there is nausea or light sound sensitivity, or a visual disturbance or the numbness or tingling that can come with a migraine that is fairly typical those.
The pain description, the words people use to describe their headache to you will be different. It's squeezing with tension headaches typically or words like that are dull, while throbbing or stabbing or piercing or sharp for the migraine pain. Women get treatment for both of these more than men do. Probably because they're more frequent in women there do seem to be hormonal factors in migraines. And then, interestingly, pain sensitivity factors for the tension headaches are different male and female wise. But in both cases, women report in the reporting mechanism, women report more of these than men do. There's also differences in reporting, of course, between the genders.
And then manual therapy with the neck like massage or structural work or what you do with your hands mobilizations, etc. definitely can improve symptoms for tension headaches. And then with migraines, it's a it's a, we can also help them it's a it's a it's less of a direct effect, often we're supporting the overall calmness of the nervous system, the overall health of the person, the overall adaptability of the head, to relieve the symptoms. But you can, especially if we're talking about the neck, in particular, it's known to worsen migraines. If you work the neck in someone with migraine, some people get worse at that point. I'm an exception to that. I got a lot of migraines in my youth I get very occasional ones now they usually ocular in nature and neck work actually helps me. In fact, I had an ocular migraine starting this morning. And it was a great opportunity to go back and review some of these techniques. Thank goodness, they come so infrequently now. But I actually used myself as the test and did some of these techniques I'm going to show you now and they helped quite a bit, just a shadow of that going on now.
Okay, so then if we look at that middle column there in your handout, which is about cervicogenic headaches, the space number 13 is the label that column cervicogenic headaches, the location for cervicogenic headaches is ipsilateral to any neck pain, means same side. So if if there's neck pain, together with a headache, and it is a cervicogenic headache, that pain will be on the same side. If you have neck pain on one side and headache on the other side, it's probably not a cervicogenic headache. It may be coincidental or two different things where there's you know, there's pains that come together. But what we're calling a cervicogenic headache. The ones that really respond to these techniques, it'll often be are usually the same side as any neck pain.
The associated symptoms. Often there is decreased or painful neck range of motion, it gets harder to turn the head or it hurts a lot to turn the head. That's a sign of cervicogenic headaches. Occasionally there are migraine-like symptoms people will have some visual disturbances or nausea is not infrequent. Usually in those cases it's less severe than a migraine, per se but not always. It can be a lot of overlap or it can be a lot like a migraine just with a lot of neck involvement. The words people use to describe the pain can be different or again because of this overlap with migraines it can be similar but if someone were to describe that cervicogenic headache, they'd be more likely to say it's aching, or they say the pain started in my neck and moved up into my head.
This is interesting, the male female ratio for cervicogenic mechanics, we don't have as much study on them. But there are some, there are some studies and the ones that have looked at this question find about equal incidence of men and women for this type of headache for cervicogenic, headaches about equal for men and women. And then manual therapy with the neck usually improves cervicogenic headaches, that seems to be again, one of the defining features that because it seems to be related to a movement restriction, and or a sensitivity issue in the neck, then, if we can change that movement restriction or we can normalize the sensitivity, in these cases, usually the headache can be improved or even resolved, you know, or prevented if it's something that's recurring.
So just a visual now that we've gone through the analytical part, just a visual to you, to remind you that the nerves for the back of the head emerge from the neck, these occipital nerves and most of them emerge from the top couple cervical joints. And it feels like your whole world is involved in that when that's hurting. The first technique I want to talk about is on page E-02, on your handout is technique E-02. And you'll excuse the kind of strange page numbering format here this we had to like, get creative to make it match previously published materials. And to make sense now, so bear with me, I'm sorry about the strange numbering here, but you'll find this it's transversospinalis lateral.
Loretta my wife and I had fun with this, it was just over a week ago, we just took a couple hours one afternoon, put my phone on a tripod in my practice room. And I showed six or so of these techniques to the phone. And then that's there waiting for you, it's like a little Christmas present for you all, it's actually a new video. So they're on your course navigator. Now some of you may have already found it. But I gave it to my usual video editor who will remain nameless, because he said, don't ever give me something you shot on your phone again and ask me to put my name on it. It offended his sensibility too concerned about and I hope you'll forgive any amateur quality of that video, we had a lot of fun making that. But you'll see it was made on my phone in the next room in a couple hours in one afternoon. So go enjoy that. It's like a little visit with me and Loretta as we go through some of these techniques. I'm kidding about my video editor, he well, he was actually getting to that he's kind of serious. He's in film school now in Vancouver, and his standards are going up and they're well beyond what I offered to you there. But I think you'll still get some good information from it. Okay, so people are giving me reassuring messages in the chat that it was great for them. I had fun making it. So these pictures are from that we just did screen captures and put them in these techniques.
So this technique I'm working with, like in the transversospinalis technique in the first sequence, there, I'm working with skin and superficial fascia. At first, even though it looks like I'm kind of leaning into a neck, I really just map out the sensitivity in the skin, remembering that that scan of those superficial layers are the terminus of all kinds of nerve endings and mechanoreceptors, the terminus or the ending being the most sensitive part of those. And then those nerve endings are embedded in layers that are hopefully gliding. And if not gliding, then maybe there's an altered sensitivity and maybe the gliding or lack of gliding could be a contributing factor in the headache pain. So I start with really checking sensitivity and checking glide of the skin and the superficial fascia just like we do in the transversospinalis technique in the first sequence with someone supine.
And then you'll see how, with your client being on the side, there are some more options for mobility there, including all of these layers of the deeper cervical fascia. Now this is the fascia that's under the skin in the outer layer, the cervical, sorry, the superficial fascia. Even though it's called deeper fascia, it's still over the muscles. So it's not that deep yet I still haven't gotten down to muscle layer yet. But in this version, in this stage of the technique, I'm actually starting to feel in between the transversospinalis muscles, I'm starting to think about their differentiation, or the ways muscles or myofascial units might be gliding within the neck or not gliding. Keeping in mind as I go, of course, that it's the nerves to the entire back half of the head that are emerging between these myofascial structures. They're following the intermuscular septa out to the back of the head and they're getting more glide there. And getting more mobility between these layers often makes those nerves happier. And I'll work fairly deeply, layer by layer. I don't start deep, but if need be, if it feeling if it's feeling right, and I'm getting the right kind of feedback from my client, I'll work fairly deeply in that neck involving different kinds of movement from the client, you'll see Loretta doing some of those. I may have mentioned that she does get migraines, of a couple different varieties in different times. It's been a great home study project for me over the years. And this is one of the key things that really can help her out of one class of her migraines is this technique of just getting down and helping there be more differentiation between superficial layers and deeper layers in the side of the neck.
The next technique there, the sternocleidomastoid lateral glide technique continues this theme, but now moves around toward the front of the neck. So rather than being focused on the posterior neck, now we're thinking about layers and structures around the front of the neck, as you know, sternocleidomastoid and the fascia around it is very sensitive. Lots of nerve endings, lots of mechanoreceptors, that help us sense how our head is movin,g sense neck position in space, it's one reason say a whiplash or a hyperextension injury hurts so much, because these structures in the front of the neck get aggravated, get alarmed, and trigger off their stabilizing function and try to just clamp down and hold everything still, in a cervicogenic headache, often you'll find places here under the sternocleidomastoid, so it's essentially the layer between the muscle and the deeper fascia under it, where there's quite a bit of sensitivity or quite a bit of place quite a bit of sensation that actually seems to relate to the headache. And if you stay with it, and have someone breathe and move, it will often relieve that headache.
So let me give you another visual of that can you can go see the technique itself on the video, but just so that you get a sense of the layering there. This is the front of the neck. Here's the skin and the platysma. This fluffy cloud like substance is all of the adipose tissue and interstitial fluid that we have just under our skin, then this more linear substance is they're calling the the superficial layer. It's like the we actually in usual English nomenclature call it the deep fascia. So it's around the muscles. And then I'll think I can show you which layer I'm actually feeling for Yeah, I'm going under sternocleidomastoid into the space between the sternocleidomastoid and the even deeper fascia, the cervical the deep cervical fascia under the sternocleidomastoid. And feeling into that space, essentially, I'm not trying to target so much a particular muscle as feeling for the spaces between muscles. If I found some sensitivity, say within the belly of the sternocleidomastoid, that would certainly be fair game for me to attend to or work or stay with, because that's really what I'm doing. I'm looking for things that relieve or provoke that headache pain. Or in the case of this type of headache, things that don't move, because that sensitivity and the headache pain does seem to be related to in this case, movement restrictions really clearly.
Let me take a minute to talk about that. Because that's a really key concept. In the tension headache, we're looking looking at tension we're looking at layer glide quite a bit and we used face movements, we used active movements to get all those layers gliding. And we worked this transversospinalis technique in back of the neck with the goal being glide. And it was also desensitizing things, but the focus was really on mobility or glide. In the migraine sequence, we looked at sensitivity first and foremost, because you can't always feel something that's not moving in a migraine. Things are moving fine. Now when we find places that do affect the migraine, often they are, you can say they're more sensitive than they are immobile. Sometimes you'll find immobile things that are migraine that when you get them mobile they relieve the migraine that does happen. But more often you find things that are sensitive, and you change their sensitivity, and that affects the migraine. So now that we get to cervicogenic headaches, we got a combination of both. We have sensitized structures, we have brain reactions to that sensitivity. And we have things that aren't moving all the way from the joints out to these superficial skin layers.
So we're combining all the different approaches, but hopefully not like this. Because this is one of my favorite pictures to show because it shows some amazing work being done where you actually have to immobilize your client to get it done. He is differentiating, I think the pectoralis fascia, which could be another source of that cervicogenic pattern. But don't do this. In other words, it's not about getting the tissue mobilized at any cost. In fact, especially with a migraine, as you can imagine, this is probably not going to help. It's not about getting the tissue to respond, it's about getting the nervous system to respond. And that takes a very different approach, a very different approach. And this is our metaphor for that approach, like drop by drop a little bit at a time, adding one little intervention, one technique and then letting the effects settle out and be integrated, before we go to a bunch more. So it's really the pacing, and the dosing. That's so key. Not even so much what you do, but how much you do, and how rapidly you do it, and how much you stay in touch with your client.
So here's just a little video that just shows this. Of course zoom might make it a little bit choppy for you. But imagine it being super smooth and fluid. It's just a slow motion, drop by drop, and you wait till some of these ripples calm down again, before you put in some more, every little thing you do has a big impact on the nervous system, every touch, certainly every glide, all the pressure, every one of these techniques, has ripples that need to spread out throughout the whole body throughout the whole nervous system, and calm down some before you before it makes sense to keep adding in more. The term for that Peter Levine brought it in to talk about it in terms of trauma. It's a term from medicine or chemistry, titration or titrating means to continually measure and adjust the balance of a physiological function or drug dosage. So you're continuously measuring, you're monitoring what happens and you're adjusting, you're giving a little more or a little less, while you're waiting a little bit longer between techniques, taking a breath, pausing, waiting, before you do some more. It's so key. If there's one skill that will really help you with all three types of these headaches and many more, it's really this one, as well as you know, all kinds of life scenarios too titration is really the key there.
Okay, flexion-rotation test on page E-03. I'll talk about this test, and then we'll take a little movement break. Yeah, the flexion-rotation involves flexing the neck, lifting the head up off the table, if your client is supine, or having them drop it forward, if they're sitting and then rotating it. In our Neck, Jaw & Head workshop, we do that to check for even left right motion of the atlas on the occiput. So this is an animation. It is again a little bit jerky today, it's showing the way that C1 moves on top of C2, the big wide one there is the is atlas or C1. And it moves on top of C2 in this rotation test. So when we rotate, that's the main joint where that rotation is happening, especially if we flex the neck. Okay, so here's that, that visual again, when our client is supine, let's say and we lift their head off the table that brings their cervical spine into flexion. What that does is it immobilizes all the joints from C2 down. Because they're in flexion. They don't like to turn as much however, that upper joint stays really mobile. So that C1 actually turns on C2 even when it's in flexion. So by bringing the client's head up and turning it we've isolating that motion right up at the top that allows us like say in the Neck, Jaw & Head workshop to check for evenness of left and right motion in the dial test.
In this application in the Headaches workshop, you can look at left right differences. That's a useful measure. But even more relevant to the headache pain would be does this provoke a headache? So I'll bring someone's neck into a little bit of flexion. I'll rotate left and right and have them report to me about headache provoking or headache relieving. And if often if it's a cervicogenic headache, it can be provoked in that motion. It's actually a great test for cervicogenic headache. There's some really interesting. research that has been published in a number of papers. Tony Hall is often the lead author. He did a PhD in this test the flexion rotation test. And he really looked at how this test is related to cervicogenic headaches. And so that's let me go back to the PowerPoint now and give you that visual again. How we look in there faculty?
Not yet.
Nothing yet.
Here it comes.
Okay. So with the neck in flexion, you get even more of that. You get the atlas rotating on the axis, the one below. That's the reason, we bring it up into flexion. And then we do rotate it, and we check for sensitivity, we get a report, if we find sensitivity there, then we back off a little bit. And we ask someone to breathe and relax. And our goal then becomes normalizing sensation. Yeah. As opposed to just mobilizing, sometimes mobilizing, it will also help if it's if it's a mobility restriction, but if it's not a mobility restriction, but just painful, then more mobility may not help or pushing on the mobility may further sensitize it. What we do then is we pace it and dose it and find the right pressure intensity so someone can relax and calm the brain's reaction down to that position, or that type of sensation that's being provoked.
Okay, we'll get back to this. But I'm thinking, Chris, what do you think this might be a good moment to take a little movement break? What do you think Chris?
Sounds great. I like it. Okay. I'll have you put me on spotlight.
Will do. Got a bronze medal in Zoom share, but a silver in spotlighting.
Thank you, Til. Welcome, everybody. Let's explore a little lack of tension and stand to do this. So let's come out of our chairs for a moment. And start once you're up once you're standing, feel what it's like to have soft feet. So allow your toes to rest. Allow yourself to feel your weight in your feet. And then just shift your weight any way you want to, you can shift left to right, kind of map out your feet as they get soft. You can shift front to back slowly, like a tower moving in the wind. And just map out your feet get really soft. Great, and then try doing a little bouncing. So just bounce. Let your knees soften your ankles soften. Feel your weight transmission, like a spring in your feet. So really establishe where the floor is under you, feel your body weight, and then come back to resting over your soft feet.
And now imagine, bring your attention to your head and allow your head to be floating. So you might imagine if your head were a helium balloon, how could you have a floating free head. And as you discover that feeling of a floating head and soft feet, notice how everything in between, your spine, your hips, begins to have the possibility of being free, of being soft, like your spine is dangling like a chain hanging from a floating balloon or buoy. So feel that in your bodies. We're playing with finding ways to have less tension. So you're feeling the ground, you're sensing the space around you. And come to rest in this place. And just notice what that's like in your body. Take a nice deep breath. Exhale, feel your weight.
And let's play with generating tension in a very gentle way, I want to notice some aspects of how we create that. So from your resting standing place, imagine if you were the Tower of Pisa and you could lean forward from your ankles just a little bit. Notice the weight shift in your feet. And notice at a certain point you're probably going to grip the ground with your toes. So just feel that grip point. And as you do that your toes are responding to keep you from falling. So notice that and then slowly come back to resting in the middle and feel your toes rest again. Do the same thing but this time I'm going to have you bring your attention to the base of your neck or base in your head, top of your neck. As you tilt forward slowly. Feel what happens in the top of your neck, the base of your skull as your toes grip the ground and then feel what happens as you come back to where your toes don't have to grip.
Let's do that one more time just to really feel what happens. Falling forward like a tower. Feel what happens in the top of your neck, feel what your head does over the neck, feel what your toes do, and then drift back into the fullness of your feet. And feel how your neck is now. One way to help us feel what's possible is to move so allow your head to bobble for a moment just to feel what it's like to have a head moving freely on your on your C1, just feel that.
Let's do something different. Let's gently carefully topple backwards like a tower, such that your toes at a certain point will instinctively lift, you might feel your knees engage. But also notice as your toes lifts, what happens in your throat and the base of your skull. So just notice that and then feel what happens as you come back into the fullness of your feet. as a as a comparison. Let's do the bobble head again, get soft, gently topple backwards, wait till your toes begin to lift, feel what happens here in your neck. Now while you're here, try bobbling your head and notice any challenges in that movement. And then slowly topple back into the center and see if that bobble is available again. Right. So we're just playing with ideas of how we might create tension in the real world in the way we stand and support ourselves at our feet. Let's try going to one side, if I topple like a tower to the right, notice at what point you begin to feel tension in your neck. And then as you come back, feel if that changes and softens, we do the same thing going left. If you toggle left, at a certain point, you may notice that the bobble ability is challenged. And then drift back to center.
I'm noticing by the way, Chris, that with this little shadow of my morning migraine, I can provoke it in certain directions, I can still feel a little hint of that. This is fantastic.
But let's as a finishing piece, let's experiment with options for movement that involve the same thing we just done. But we're going to look for ways to adapt our bodies in these different planes of movement so the neck gets to rest. And most importantly, we're going to feel what happens to the feet. And the goal of this exercise is to do what we just did. But to not ever have to lift the toes to catch yourself from falling backwards, or have to grip the toes to prevent yourself from falling forward. And my advice is as you play with this, release your knees and your hips. So let's just try that while we're standing. Feel your hips be free, you can do some circular movements, feel your knees be really soft. So you become a springing springy mechanism again. And then I'm going to have you all gently find a way to let your head fall forward. But adjust your hips and knees in such a way that you never have to scrunch your toes. So in other words, your feet remain nice and soft and neutral as your head topples forward. And notice that one of the ways you get to do that is to send your hips back and bend at the hip joint. And probably to soften the knees as well. So you get to experiment with how would you fall forward without losing a soft foot where your toes don't have to grip.
And then from here, let's float our way back up again, keeping the toes soft. And then this time attempt to bring your head back like you're about to look up. And see if you could allow your hips to very naturally move in a direction such that your toes never have to lift off the ground to stop you from falling backwards. And you get to experiment you get to find out how does the rest of your body adjust between the head and the feet so that you never have to lift the toes or grip the toes. So that's sort of a little experiment you can use for yourself and with your clients to discover that in fact, the rest of your body is a balancing mechanism, including the arms and the shoulders. As we lean forward in some way our hips go back. If the arms are resting and hanging your scapulas get wider as you tip forward, they broaden across your back and your arms hang as counterweights such that your toes get to rest. And hopefully, you can try this, your head and neck is also free at the same time. So it's just a little way of discovering proprioceptively ways that we find support in our feet, and how we use our body as a mechanism as a segmental mechanism, to not have to grip the neck as a way of holding ourselves up. So just a little tour of the ways in which we can get tension and then maybe discover ways we can find out what we're doing in our regular lives that might be evoking more neck tension than we'd like. So that's that's the experiment. Til how are we in time? Do we have time for a little neck release? Or do you want to jump into
Yeah, let's, neck release, let's do that.
Wonderful. I'm gonna put the camera down. Yeah, so watch Til we're going to wrap our hand around the back of the neck while we're standing. And just gently squeeze the neck tissue, you might imagine gently drawing it back. Most importantly, we're finding a way to hold the surface layers of our neck. And then from here, allow your head to fall to one side, you can practice your shift where your toes rest, your heels rest. And then from here, tuck your tail, just tuck your tail go into a slump, let your head fall forward while you're holding your neck. And then roll around to the front, you got your tail tucked your head resting forward, and then roll to the left. Great, and then flow back up again. So you're really creating a barrel roll with your body, letting your hips be free. So we'll do it again, tip to one side, let your head fall forward, tuck your tail, fall to the left. And this time, you can even look up as your hips go forward and start to create a large circle. Feeling how your body adapts while you hold on to your neck tissue as a way of feeling how that tension might change, but also just to explore sensation there. And then let's go the opposite direction, you might just simply reverse that fall the other way, tip forward, let your hips be the counterbalance for your neck and your head movements. So it's a large body movement while you're holding onto the back of your neck. And when you're finished, float your head back up, you know how you can push into the floor to press your head back up. And you can release your hand shake your shoulders out. And then just experience the sensation in your neck having done that simple exercise, exploring any movements you want to, but mostly just noticing what's new about the relationship of your head on your neck, and how you feel in your body. Thank you.
Awesome. Thank you, Chris. We managed that Oh, that's great, holding the skin and then adding the movement and, of course, the standing piece. So key too. I stayed in the camera zone sitting down. But yeah, if you can stand up and do that or guide your client through it while they're standing, that'll keep the whole body involved. Let's go ahead and get your strap too while we're on the movement subject, get your strap or your belt, get that handy. And we're going to continue this now. But we're going to take it down maybe one level a little deeper, the mother cat really does hold the skin and the superficial fascia, Chris was combining that with whole body movement. Now we're going to use the strap right under the occiput, yeah, to move the bones. So with one hand, I'm going to pull forward and the other hand I'm going to pull down. Yeah. So what this does right under my occiput is it allows me to use the strap to assist my C1 in turning to the side. Take a deep breath, and then let that go.
Let's compare that to the other way. So I'm going to pull the other hand straight forward toward your camera, the other hand pulls down. And that strap right up under your occiput helps you focus that movement out at the bony level and move C1. You might notice a difference in mobility, you might notice a difference in sensitivity to the side, take a breath and then back to the center. From here, you can follow yourself, I definitely felt a difference in one direction which makes me think there's there's a cervical component to this headache that started to appear for me earlier today. And so I'm going to go back to the sensitive direction for me. And I'm going to play with that a little bit. Not to try to rub out or erase or obliterate the pain, but more like to try to find the edge of it and relax into it. So I'm using enough of a pull where I can just feel that stiffness and in my case, a little bit of that headache referral and wait there and soften and I'm going to use my eyes even to look farther to the left, look farther to the right and breathe and mobilize in that in that difficult way.
Okay, so you don't want to overdose, you know, it's maybe a couple of breaths in each direction. And then the other way as well, using your own pace and your own directions, really focusing that movement of the strap right up to the top of the neck by pulling down and pulling forward. Now, the down and the forward's the easy part, the part that really counts is what you do once you're there, that breathing and relaxing, working with the eyes, maybe looking up looking down a little bit. That's the normalizing of sensation phase, where you get to hang out there. And you'll feel yourself how more isn't necessarily better. In fact, Toby Hall's work that I mentioned, he studied this one, and found that three, three reps of this, I think it was twice a day, for 12 weeks, that's not much, it's like do this three times, twice a day for 12 weeks, people have significant reduction in their cervicogenic headaches, quite a bit less frequent and less intense headaches, when they just did this with themselves as a prevention. But then it could also be a treatment.
I'll show you one other variation with the strap while we got it. Imagine now that you're going to help your neck extend and go very gently, you're just getting long in the front of your body as you pull forward on a vertebra. Yeah, so it's kind of like I'm bending around with the strap, or maybe even the top of the strap. In my case, since it's kind of big. So I'm helping my neck extend gently, not to so much increase the range of motion. But to desensitize that motion. Now, I move the strap down a vertebra. And I'm gonna pull forward and down a little bit, and I'm going to extend right there. So I'm using this strap as a kind of fulcrum, like we did in our cervical wedge technique in the neck class, to isolate the movement, and to get the facets to join the glide, if some of those were sensitive, and I could do the gentle relaxing into that. The complement, which is probably the one to finish with for most of us is to pull the vertebra forward on the one below it. So I'm going to pull straight forward and look down, breathe and relax. In this case, I'm using the strap as an assistant toward very specific cervical flexion. And gently mobilizing various vertebrae in my neck in the flexion direction as I breathe and relax, sliding that strap up and down. And you'll feel how the upper cervicals are much more mobile, respond better. And in many, many of us, much more sensitive. It's it's about finding that edge, relaxing into it. Not trying to get any new records of mobility. But make a new record for your ability to relax. Let's put it that way.
Okay, play Yes, if your arm's going numb back off a little bit, it means you found something interesting. You're just going too much. Perhaps you're not, you know, probably damaging things. You're going easy on yourself. But yeah, it means that you found something that relates to that peripheral nerve of your arm. Is it possible to show the back of the neck Julie says with the strap motions? Yeah, sure. So let me do it this way. That's a good idea. You show the profile there. So here's extension. I'm just finding that top edge of the strap. Let me do it this way. So I'm facing the mic a little better. Finding the top edge of the strap and extending right there. So it's just a little bit. Yeah. And breathing and relaxing. And then for the flexion pulling the vertebra forward with the strap in order to assist that vertebra in flexion. And so check its sensitivity, see if I provoke or relieve any of that. That sensation there.
Okay, so let's go back to our slideshow. Here's some of Toby Hall's research. And we showed this in the neck workshop too, how this is this is called a SNAG. For right cervical rotation here she is pulling forward and pulling down a special strap for this purpose, but you can use any strap self-sustained natural apophyseal glide or SNAG. So she's rotating her bones and this simple exercise repeated a couple times a day. For in this case four weeks made a significant difference in people's headache index headache pain index compared to people that were doing a different kind of movement exercise the placebo group and that persisted over time. If I remember right, they recommended, they didn't rec they didn't keep people doing the regimen. They just had a four week maybe, for some reason I thought it was a three month regimen. And then they let it persist over time without further intervention and people's headache stayed better. So good for them. But if it got worse, we could do this, again, as a ongoing maintenance. I know there was another one year study that they had people doing this for a year, and they showed even more results. So that's, you could say, in some ways, what we're doing in our neck workshop, we're mobilizing, and what we're doing here in the headache workshop is we're finding sensitivity, and helping people renegotiate that.
Turning the page, now, for the isolated cervical circumduction technique, you can see me demonstrating this in the video, it's also got a similar technique in our neck workshop. In this case, though, again, I'm mapping sensitivity, I'm finding the places the directions, I can get very specific about each joint about each pair of facets, and get it to tilt and side bend and rotate in a way that will discover some little pockets of sensitivity throughout that neck. And I can actually just rest my hand on the table there and get really specific with the head. And kind of undial someone's sensitivity there. And what that's doing is it's working with way the facets slide, this is what we're doing with the strap as well, I was pulling a facet, sorry, pulling a vertebra forward and bending back over it to slide the facets closed. And then I tilt my chin forward and would pull vertebra forward to get it to slide there.
You can do this in that isolated cervical circumduction technique as well just get those facets to glide in both directions, one by one as you go up the neck. Because often it seems to be it's the facet joint and the joint capsules that are sensitized. That seems to be a structure that does contribute quite a bit of nociceptive signal to the whole headache story. And because of the way those nerves combine in the trigeminal cervical nucleus, it could just be experienced as a headache. But when you find that sensitivity with the movement or with palpation, there's actually some interesting research about finding those sensitive places with palpation and just helping them diminish their sensitivity, people's headaches getting better.
Or another way it's done is through injections. Corticosteroid often is injected into that facet joint, it's thought to stop its inflammatory cycle, but it's also helping with its sensitivity. And sometimes people's headaches will get better often their movement or headaches will get better if it was the cervicogenic headache. Now continuing to do injections of a steroid isn't so great an idea over a long term situation. But any of those structures could be sensitized. So the kind of movement we can teach people to do or the mobility we can give them with their hands can be more general, you know, we're not getting right down into that one joint, we're actually moving everything all around that when we do this more global movement, including the joint capsules, but also including all of the deeper ligaments, and then all of the myofascia around that.
In this technique, cervical translation variation three, cervical translation is one we do in our Neck, Jaw & Head workshop too in the C sequence. But here in our final sequence in the headache workshop, we are instead of translating each vertebrae, like we do in the neck workshops, if I can get this guy to translate, there's translation. I'm translating the head on the vertebrae below it so you could say I'm moving the cup from side to side. It isn't tilting the head from side to side. It's shifting the head straight left and straight, right. Yep. And his soft tissues are pretty tight on this model. So he's got some limited motion, but he does have some motion left and right. So I would feel for both mobility, but especially I would check with sensitivity and while we were filming this Loretta had some that got provoked. And in the lower picture that she's saying yes, it's referring up into my head up into my temple when you move that way. So I get excited at that point. I think we found something we found something that relates to the headache and we could wait there we can relax there we can do gentle movement but often static waiting and breathing and relaxing is the most effective way to kind of renegotiate that sensitivity there.
Yeah, Mulligan is the SNAG guy. Mulligan's manual therapy approach NAGS, SNAGS, MWNS, he's got a bunch of different techniques that he uses straps for, in a really creative way, the Mulligan method pretty common in the physical therapy world.
So this is the egg we're moving in the ring, the ring being C1, the egg being the occiput or C0, we're actually just gliding that side to side now as opposed to flexion extension like we did in the earlier versions, and checking for the direction of sensitivity. So someone's asking, so you hold the head to right for reaction. So move left and hold. I don't quite understand the syntax there. But I think you're asking me to clarify the procedure, check out the video, that'll explain it better than I can in the abstract here, because that's the same thing that happens is when you're trying to type fast into the chat, the words get a bit jumbled, and it gets hard to understand. But basically, I find the direction that's sensitive, hang out and relax. And it's not a tilting. It's a translating, left and right.
The final technique in this sequence, the dial test technique, here it's on XD-17 is essentially the same thing as we did earlier in the dial test except it's seated, get someone seated sitting up so that we can begin to bridge what we did on the table out into everyday life. And I can start here in this case, in this case, it's really great to do something like Chris was doing with the mother cat idea where I can start with just skin and superficial fascia, dialing the head checking left and right. And then I can get a little bigger grip into say myofascia or then I can go way down into bones, and actually feel how the bones rotate. Not only do I feel how they rotate as I passively turn his head, but he's going to report to me about how they might relate to headache, pain, or sensitivity. And you'll find you discover another layer of that when someone's sitting up as opposed to lying down. But you can also you can do the same technique lying down of course.
Some of what we're sensing there, it goes even deeper than the joints. So we've talked about all the different layers from skin down to joints. even deeper than the joints we get into say the meninges or neural tissue itself. nerve roots, the person that had the numb feeling in their arm was probably getting into a bit of nerve root kind of a lack of mobility, you could say or lack of space, gently that's against not necessarily harmful, but it's not something you want to push. But you will find sensitivity that's probably related to neural tissue itself, not having the mobility, it needs to be happy. The meninges like the dura here in blue is very sensitive, it's highly innervated, so that your body can monitor and protect the central nervous system, which is what it surrounds. It glides through those foramen as you turn and tilt, there's a little bit of glide right there at this opening where that nerve root is mobile, hopefully through that space. If it's not, there could be some sensitivity, or even numbness when you turn say and things don't glide, that adverse neural tension could actually cause a little bit of numbness. so gentle mobilizing here can be really therapeutic, the gentle being key, because it's not just about stretching it free or, or, you know, releasing the tissue adhesion as much as it is restoring a little bit of mobility and glide so that the nerve can be happy enough to have its normal motion there.
You can also have your, your client slump further or gently back bend here while you're doing the dial test number three, I think I did something like that with Loretta, on the video. So that you that's what that essentially is doing is now it's gliding the spinal cord up and down the spinal canal by slumping and extending. And you're essentially pulling on the other end of the central nervous system to see if that provokes a headache as well. Which is a fascinating way to do I think we've actually found some and I can find some in myself sometimes if I take a hold of a vertebra get it to a place of sensitivity and actually play with slumping and straightening, that'll change the headache sensitivity too and one thing that might be happening is I'm actually pulling my spinal cord down my spinal canal and revealing a lack of glide or an excess of sensitivity than then I can breathe into gently noodle around with play with soften around. It will often help it diminish or resolve.
So that's all that's on the video on that extra video that Loretta and I made for you guys. There's a couple things on the supplemental techniques video that I thought I'd mention too. I think that's in the different chapter in your course navigator that's going to be in the X sequence. It's still in this handout, but the standing masseter release technique, there's Larry, with Loretta, many moons ago, showing a technique, you know, Larry, where you actually get a hold of the masseters, you could say, or the side of the face, the jaw, which is often involved in a lot of headaches is this clenching or holding, and you have your client, soften her knees, and then stand back up through the layers that you have a hold of. Great way to feel the whole body and connect into that. It is demonstrated there in that technique. But Larry, is there anything you want to say about that, at this point in the description?
The biggest thing is, this technique is used for integration. A lot of times people will soften their jaw on the table and everything else. But when they stand vertically, they clamp everything back up. And this helps them understand the postural habits that they have when they're standing in locking their jaw. So it definitely shows them that.
That's great. That's right. And you got this from Hubert Godard, did you?
Yes.
Inspired by some of his work? Yeah, he's a dancer and a Rolfing teacher and a movement teacher. And he's got some really creative ways to bridge what happens on the table on into everyday movement like this one here, the Larry's showing us. Here's a picture from Fritz Kahn, an illustration of Fritz Kahn. He was a illustrator in Germany before World War Two, who did all these amazing kind of functional illustrations of the body, he was showing that when we're in upright position, there's a whole bunch of work going on is a bunch of muscle contraction, that helps us stay upright, and muscle contraction to help us keep our mouth shut. And in this case to keep our eyes open. And then let's say someone goes on too long with their lecture or something like that, as people start to go to sleep, and there's a bit more of a letting go. So on the table, Larry's saying we help someone find a different level of letting go. Now let's come back up to upright and, and integrate that with being able to do what we need to do to stand but not have more of this work intention going on thqn we need to do all that as well.
In that supplemental video, too, there's a picture just this bizarre outtake from some other workshop we're doing many years ago, I think this was actually a pelvis workshop. And Larry, I think you were there for that one, too. Where Sue Reinhardt was a Rolfer that was there assisting, we did some work with her headache and her eye movement. And it ended up on video so we just threw it on to the supplemental techniques in the headache course. But it's it shows some just some experimenting with eye movement and working with the suboccipitals too. So eyes are so key in any of these techniques, you could add that in as an active movement on almost every one of these techniques as a way to experiment with both provoking any sensation like this morning when I was playing with my own migraine that was emerging, it was really getting my eyes involved and finding the direction that was most connected to that headache sensation and then I actually used a strap there too to have to breathe and relax and soften into that reactivity that my brain was going into that was causing that to hurt. And that in my case that helped me quite a bit.
So in summary, as we as we begin to wrap up here, our protocol our general protocol for headaches, cervicogenic headaches, you could say it's similar and yet different to some of our others. We're gonna assess we're going to begin by assessing for movements positions and places of headache sensitivity. We want to find out what movements hurt which positions are uncomfortable and which places we push or coax bring about that sensitivity we assess for that. And then we look for the direction a layer or a pressure that relieves or gently, what do you think I'm gonna put in there? Chat it in if you think I know what I'm gonna put in number 2. I want to see, this has been repeated so many times I want to see if it's actually getting through someone says it's a great show thank you for the compliment but tell me what you think I'm going to put in number 2. You can chat that in. What would you put in number two? someone says yet normalizes worsens provokes. That's it. That's you got you got the idea. Okay, so good. Someone's listening. At least I'm saying the right stuff. Gently provokes the headache pain, which is counterintuitive. Usually we're looking to try to make it feel better. As I've been saying all three lectures here, sometimes we provoke it. And that gives us even more information about what to do to help. really.
We also want to encourage the client to breathe. And to relax. This is key, it there's a lot you can do with a passive client who's just relaxing on the table, there's even more you can do with an actively engaged client who you're guiding into actively relaxing there. Yeah. So that you actually you are guiding someone into that act of softening and opening and easing those protective responses around their headache pain. And you could say that pain if we if we accept the idea that pain is a protective response, you can say, headaches are a protective reaction to something the brain thinks is a problem. Now, maybe there's a problem there that we have to address, like a mobility restriction, or certainly a medical condition. But meanwhile, we can reassure the brain, we can reassure the brain so it says you don't have to protect quite so much. In other words, you don't have to hurt so much. Because that's what pain is doing. It's protecting us from what it thinks is a problem.
So before we get into more of that idea, what am I, you know, things that might be going on, I just want to say, and this my own headache this morning was a reminder of this. Just because we can relieve headaches, doesn't mean we should, I don't know, maybe the headache is important. Maybe the headache is an important sign of something going on. And it may be a serious medical concern, like these are the concerns for, but maybe it's a sign that maybe it's time for us to go a little slower, or do something differently. Maybe it's feedback from the body going, hey, we got to actually re evaluate the pace. And this one came up in our, our study group, those of you who are there, remember the questions that led to this discussion about how it's, it's not always about just relieving the pain, sometimes it's about someone learning to do things differently, so they don't keep provoking that pain. Now we can we can help people to get over that pain. And that's helpful. But often, it's understand having people understand or push less, or take time for themselves and take a break. That ends up being the biggest headache prevention, whether it's primary or secondary, whether it's migraine or tension, etc.
So just because we can relieve the symptom, doesn't mean that's the end of the story. And that's certainly the case with these medical red flags, that I want to go over here at the, you know, final, final section of the lecture here. Last but not least, because some of you have heard me say this, one of my earliest office managers here at Advanced Trainings, had pretty severe headaches, and I would work on her and I could usually almost always relieve them to some extent. And then at some point I couldn't. They were, they were not getting better no matter what she or I did. And she went in for an evaluation and she had a tumor. She had a brain tumor. And that was a quite a, you know, it was a, it was a hard wake up call for me and broke my heart because who knows? Sometimes you can delay someone getting treatment by making them better. And I don't know if that was the case for her or not. But certainly I wouldn't want to even put you in a place of wondering that did you cause someone to delay getting some treatment that they should have gotten earlier. And so I just want to really emphasize that just because you can relieve it doesn't mean they shouldn't get checked out.
Here are some of the classic signs that you'll use when someone does get checked out. Acronym. The S stands for systemic symptoms, fever or weight loss, things that implicate or suggest a systemic issue going on, a systemic infection or systemic disease like HIV or cancer. Neurologic symptoms, the N is for neurologic that could be a sign such as confusion, impaired alertness, asymmetry of perception or asymmetry of balance, eye dilation, motor weakness, and stiff neck. These nuchal rigidity means really stiff neck stiff and painful. That's not necessarily a you know, I don't think you need to go to my brain tumor story for all these but you want to have someone ruled out visual disturbances other than aura, meaning like a completely blind eye, for example, have them checked out. Dysphasia not able to swallow or speak there. The onset being sudden, abrupt split second minutes. That's it. That's a red flag sign. In the older person, this one says over 50 years of age, so a few of us are in that category, a new headache and an older patient, or a progressively worsening headache in a middle aged patient that's a sign to get checked out. If it's progressively worsening, something doesn't make it better. Go have it checked out. And then the P stands for the progression pattern of a previous headache history. Let's say I've had headaches for a long time. If that changes if it gets more frequent or more severe, or shows different clinical features, like all of a sudden I'm getting some blind spots and I wasn't before, or it's a different kind of headache that I've had before. Even if I had a history of other kinds of headaches, get them checked out. If in doubt, check out there's there's some things to rule out the headaches are a sign of for sure.
Okay, so now we'll go back to the rest of the program. Feel free to type in your questions and thoughts as I do my reshare.
We had a question from Audrey about the nuchal rigidity. Does that refer to the nuchal ligament?
Yeah. Nuchal means neck, neck, nuchal means neck, the nuchal ligament is the ligament in the neck. Nuchal rigidity just means neck rigidity. Yeah. And we're dealing with stiff necks a lot. But that could be a neurological sign of a clonus, or kind of a severe guarding reaction that can be assigned to have a checked out too if it seems really rigid beyond that point there. Anything else, Bethany, that we should catch up on there?
A little further back was a question about the uh, Pippa had about variations for some of the strap movements for more of a military or hyperextension neck. I mean, maybe it's something we want to talk about at the end, but
No, we can take a section for that. Military neck or hyperextension is a positional description of a neck that seems to be very straight. And I'm less concerned about that, as you may know, from my bias, as I am about the inability to flex. So I'm not trying to look at the necessarily the shape of the neck and get it to shape be a certain different shape. I'm having someone feel each place in their own neck where it moves or doesn't, or is sensitive or is not, and increase the options there. So let's say this one, you know, could be helping the neck extend. This one's helping the neck flex. We would expect that someone, you know, that has a classic military neck yeah, doesn't extend much, but I wouldn't assume that. I wouldn't assume that's the case. Really check the mobility before you just look at their static position and say, You need to do this neck motion. could say. That's the way that these assessments keep us really relevant. We're really going to have someone feel what moves or what hurts and work precisely with that.
We have another question about contraindications.
Yes.
For fused cervicals or bulged discs?
Mm hmm. That would be a caution. I would say, well, fused cervicals. Not necessarily This is going to be great for someone with fused fusion surgery that's happened in the neck. Yeah, of course, after they've had a chance to recover from the surgery. Keeping it mobile with this kind of motion with the strap, I assume that's what it's about or these techniques can be really helpful. Because I'm not trying to say break anything free, or move anything that doesn't want to move, I'm finding where it's sensitive or guarded, and helping it be a little less sensitive, or a little less guarded. And the same applies for bulging discs. Now, if there's a lot of symptoms, or a lot of pain, that's a caution. I'm not going to push into that. And so just this, staying in touch carefully as you work is what keeps you safe. That's what helps you really keep this relevant and useful for your client. Of course, if someone tells me they have that history, I'm gonna start even more, you know, finer gradations of experiments than I am if they didn't tell me that, but I would still play with very gentle movements and see what, if there was a headache going on, if that triggered a headache. I'm not gonna push into anything that doesn't feel right. Anything else? Bethany,
We are getting a couple more. Yes. Claire asks, she says I've had many reports of these types of headaches being worse at night, waking the person. They have to get up and get upright. Get upright. Do you think that the position of lying with the neck into the sensitized areas provokes the pain.
Certainly. Yeah, yeah, it's I mean, the first variable, if it's worse at night is your bed or your pillow. Yeah. So that just experiments with that can often help that kind of night pain. But then there are certain types of pain too, that emerge more when we're still. But that's, you know, I would ask questions like, does it, does it happen when you sleep in another bed? If you just happen to go on vacation? You know, have you done experiments with positioning or different pillows. And that's often trial and error.
Now, I'm going to go back to the slideshow. So I'm looking at our time here, just so we can finish something close to time. And then if there's more questions, we can stay afterwards as usual and answer those. So these are just a couple pictures here at the end, again, to review the experience of the headache, how extreme it can be. How graphic it can be, can be like your head's breaking open, your brain is dripping out like an egg yolk. The good news from all this, you know, is it a hands on work really can help. It's such a powerful tool for helping people live with headaches and, and diminish their severity that's rooted in our basic instincts of touching our own head when our head hurts, there's a way that we're participating in that instinctual response our body has, but some of the ways just to wrap it up to leave you with a familiarity and clarity about the ways that hands on work can help. It helps through the local tissue and mechanoreceptor effects that's often mobility. It helps layers glide say, it helps joints move where they might not. Yeah, it can help with calming sympathetic arousal, and stress levels. It helps people chill out, hands on work just helps calm down that nervous system. And often it's that nervous system that kicks us into the headache pain that's like essentially like a threshold over the threshold kind of response. So if we can keep the level of water in the stress bucket lower, people will have far fewer or less intense headaches by just doing rituals, including hands on bodywork that keep that nervous system calmed. And that's true in the case of an episode too, that a lot of the effects come from calming the nervous system.
And then hands on work also helps by refining recontextualizing and desensitizing. Your body sense, your interception your proprioception, just the power of touch, just being touched, can either ramp up your sensitivity, touch has the ability to do that to make you more sensitive or more on guard, or it has the power to ramp down your reactivity to down modulate your pain responses. And often that's related to our deep mammalian comforting and social responses and deeply evolved mechanisms, our brain and our nervous system go through to use each other, and use touch and use sensation as a way to deal with challenge stress and pain. So in situations where there's those things, challenge, stress and pain, it really is you can really just trust the basic power of your touch to be helpful. Even without three lectures about the specifics of headaches, just your touch itself is going to be incredibly powerful.
Faculty, I think we are ready for your pearls. We are ready for your brief pearls. Who would like to go first? Larry, you are unmuted. Do you want to start?
Yeah, I can start. One of the things I want to stress with all of this sensitivity is the titration factor. And the titration doesn't mean you just poke slowly a bunch of times, sometimes it means just one slow poke going down through the layers and checking sensitivity at each layer. It doesn't mean you're bouncing in and out of the tissue all the time. So make sure that you're really listening and working with the client on their sensitivity and exploring it and listening to them and help have them help you find a way out of their pain. so titration is key. Thank you.
Thank you, Larry. That's great. Who's next?
I'll go Til, um, I'm just I'm interested in the similarities between the cervoenic headaches and the neurogenic headaches and having those subtle differences and being able to parse out the subtle differences when you're working with a client and, and choosing the correct path to go to is very important and the chart with the similarities between all three types of headaches is a great reference for that. Another another point that I really hit home for me today is um working with sensitivity is not only working with that sensitivity, but it might also change the options for movement without directly doing manual options for movement working with the cervical vertebrae, for instance. So just working with sensitivity may shift that potential that proprioceptive sense and those options for movement. So
That's so true. Yeah, so too often we mobilize around something that's sensitive. So even when we're doing sensitivity work, we're often affecting mobility. Thank you, Bruce, go for it.
I just wanted to piggyback actually on what you were saying, Bruce, about the sensitivity, I do suffer from cervicogenic headaches. And I had an interesting chat with Til actually, this morning about my understanding of the source of those headaches. And, you know, I have tended to think of them as positional, but I'm really rewriting my story to realize that it is lack of options for movement in my neck that leads to the sensitivity. Or perhaps it's the sensitivity that leads to the lack of options for movement. But at any rate, working with my own neck, and following those subtle pieces of sensitivity helps me find the way through locating new, subtle awareness of movement and out of the pain.
So you when you say, positional, when you say your story about your headaches was that it was positional, that's like the idea that your neck would be out or that your vertebrae would be rotated or something. Is that what you mean by that?
That is what I mean by that. Mm hmm. And, you know, there certainly could be some validity to that model. But I really, I'm preferring the context that you're offering that perhaps what I'm really sensing in my body is a lack of ability to move into positions that would be beneficial. And that's been my most helpful route. So thank you for that.
Well, no, thank you for sharing that. And that's a big discussion right there that we are going to resist getting into here at the end of the course. But that's essentially what I'm saying here. So you can think of these things either way, but try thinking about them as mobility restrictions or sensitivity issues. And see if that doesn't give you a whole lot of great results. Thank you, Laureen, who's next.
I'll be happy to jump in. Something comes up for me just another way of thinking about our work and, and ways of taking it further is make an effort to notice the successes during a session, it might have been something along the lines in the context of headaches that your client notices when their eyes soften, they feel better, or they notice they breathe in a new way that they're not used to breathing. And, and they associate that with some kind of relief or a shift in the nervous system, or their discomfort. So take that information and just remember it and when they come back to sitting and standing or the end of your session, have them recheck in with those things, those awarenesses and especially in the context of the real world, either standing, walking, sitting down and getting up. Ask them to see if they can find that again, as a way of having a self help tool, or an awareness, a new awareness they can take with them. Thank you.
Thank you, Chris. Thanks a lot there. Bethany.
Yeah, um, all of these, especially when you're looking for and trying to assess small changes in sensitivity, it comes back to the communication with your client. And I think just this idea, often I let them in on the fact that we are looking for times when the sensitivity changes, becomes less sensitive, or as we said before, or provokes it, and just bringing that into part of your curiosity as a practitioner and a client. It gives permission. Because a lot of times what we're doing is giving people permission to trust something again, or to trust being able to explore an area. So often mentioning that, you know, there's not a there's not a bad outcome. We're learning to kind of explore the edges around these places, can help add that conversation and kind of create a little bit more openness to to feeling what really is.
So important, so important. Well, you know, we're about at time. Chat monitors, anything else you think we should make sure we address before we formally adjourn, we can stay after informally. But before we formally adjourn, any other chat that we want to make sure we mention?
I think questions that want to ask once we close the, once we finish our meeting, I will stay around, but I think that we've gotten to everything for the video.
Okay, fantastic. Well, thank you for that. At that we'll go ahead and call it a wrap. There'll be some little polishes, it will go back and fix I can do on the recording. But thanks for your patience with that. And thanks for all of you, the faculty who did this, thanks to the office crew, thanks to everybody who was patient enough to help us give this to you, present this to you in turn. And I hope you'll come join us again, I'll put the rest of those links up again too, about where you would go do that. But in the meantime, go finish up your paperwork, if you want the credit. Keep asking your questions in the forum. Go do your final small group, etc. and we hope to see you around. Thanks on your way out. And the gratefulness from all of you guys great. Brian, you had a question? Let's, what do you got? What are you thinking?
Uh, you know, I understand the sources of cervicogenic. headaches. But what about migraines? Like, what, what initially affects where the trigeminal nerve comes out? Is it, is it sensory input? Is it our dreams? Is it. is it what we're thinking about? When, what, what, what part of the brain? What's affecting that physical tissue where the trigeminal nerve originates?
What's your bias toward physical tissue?
(laughter)
If you knew that, how would that help you?
Um,
What if migraines are not physical? What if they're neurological?
Well, what I'm saying is what's affecting that tissue?
What tissue
That where the trigeminal nerve originates?
The nerve tissue.
Yeah.
Okay. so nerves have activity. Sometimes it's related to a physical, a neurophysiological event like compression. But sometimes it's just neural activity that you can almost say is not physical.
No, I don't mean it's the physical tissue. I'm just wondering what's what's. Is it the homunculus? What's what's, what's stimulating that to project to our body? Or like, the greater occipital nerve? What's, what's initiating that neural activity? Do we know?
What mechanical factors might be stimulating?
emotional, anything?
I love it. Okay, you're ahead of me, man.
Yeah,
emotional.
I always know, I know.
I know, I was giving you a little bit of a hard time because that's that's where we tend to go even tend to think what's mechanical. Turns out migraines are probably only have a minor mechanical contributor, and a whole lot of other contributors. And that is the mystery it's exactly what you're asking. What is what are the things that seem to generate that experience? And it turns out that it's, you know, we know some things, there's triggers for people, you know, we get like those triggers that listed on that trigger side. But a lot of times, we don't even know, we don't even know what is triggering it, it seems to be like a genetic propensity for people. It seems to be like a seizure kind of phenomenon, akin to seizure. Sometimes people know why their seizures happened, other times the seizures happen. Sometimes migraines just seem to happen. Okay, and there's things we can do to decrease the severity or decrease the frequency. But some This is bad luck and bad timing. And who knows, sunspots are going to say because go through,
Yeah. Okay. My other question was, and I learned this from Whitney's class is when doing assessment he said to me, you know, well, if you if you do it in the standing or sitting position, remember there's an eccentric contraction going on. It's It's so you know, when you lay down and do assessments, the antagonist muscle isn't as effective as affected. So but when you're standing up if I rotate, I've got one muscle working against the other. Isn't that more of a true sense of what's going on when assessing versus laying down?
Yeah. Thank you.
I only brought up Whitney because I know you two work together I just
You'e just name dropping. You're just name dropping. I'm not gonna argue with Whitney no Whitney's got it going on. And what you what you said is absolutely accurate. That we'll get more complete, get a more complete sense and a sense that's more like everyday life when we do things in loaded positions or upright positions than we do just in passive open chain positions for sure. Yeah. Thank you, Brian.
I love you too.
Mutual my friend. Audrey, you got a question? What do you got?
Got it?
Got it?
All right. Um, I actually asked this question in the first class, and you said, Oh, this would be perfect for this class. So I'll re ask the question. Oftentimes, when I'm feeling around someone's neck area, they will have a bulge. And it seems like it's I, based on Laureen's own experience of positional, let's say, in chiropractic term, subluxations of the cervicals. Sometimes I'll feel about a lot of times on the right side, where the, it seems like it's the TPs are rotating, I'm feeling something bulging on the right, and then it's completely smooth on the left. And then there's a buildup of, of tissue behind and sometimes in front of it. And I would try that flexion rotation test that we learned in the spine neck, and found that that was useful. Moreso when they were doing it, we were doing it in a active fashion, or passive fashion, moving the neck versus an active. When they were doing the active and I would hold my finger at that stuck point. And it'll rotate back into a more straighter, less protruding. That was
Tell me your question, Aubrey, you have a you have a question there?
So my question is the flexion rotation test, are we actually helping the circles kind of rotate back into alignment? Is that, is that what I'm feeling? I'm just trying to figure out what I'm feeling here, and how to help it, it happens to be on the same side as their headache.
No, I totally, I'm totally with you in terms of feeling a prominence on one side. Yeah, feeling like one side is more prominence prominent in terms of both bony and soft tissue, and then finding ways to help that prominence be less prominent or be more mobile, I'm totally with you there. That's not my goal, in this in this particular application, or that's not my map. That's, that's certainly maps and goals that people find useful and base their work on in other situations. But that's not really what I'm after. Here, I'm not trying to make the left side of the neck feel like the right side of the neck to my hands. Now I am trying to help it feel similar or feel balanced to the client. I'm helping them feel from the inside out a kind of alignment in terms of being even throughout their, their proprioceptive body. And sometimes I can feel things like you're describing a lump or a prominence, and I can get it to move. And they feel differently from the inside to and then bingo, we got it. But sometimes they're independent. And for headaches in particular, they seem to be often different things.
Well, yeah, I found the same results. Some people their headaches went decreased.
Yeah.
And others it didn't change.
Yep. Okay.
All right. Thank you.
Hey, good. That's gonna be a perfect question to ask in the next class, too. Could you bring that back? And I'm kidding you. It's good. No, that's a great question. It is, in some ways, the fundamental question about understanding this different approach. Yeah. Thank you very well, Jodi's asking, wondering about research on childhood physical traumas to the upper body and head that become more than physical and some sensory memory. Yeah, absolutely. You could say that all of our protective impulses, including the pain, pain is a manifestation of that is a you could say a response to try to prevent trauma or respond to trauma or to deal with trauma of some sort, whether it's physical, emotional, imagined, actual, etc. So there would be for sure a trauma map or narrative we could understand all this from that probably correlates really well. Alright, my friends I think we got it. If you guys are good, I'm good. Appreciate it again everybody. See you later. Gonna say goodnight for now. Goodbye for now. Good morning for now, wherever you are. See you next time.