Headaches and Neck Pain? Here’s How Your Physical Therapist Can Help!



What Is a Cervicogenic Headache?

A cervicogenic headache is another name for a headache that originates from somewhere in the neck (a.k.a. the cervical spine). This is called “referred pain,” which means that you perceive the pain in a region of your body that is different from where the source of the problem actually exists. This occurs because some of the nerves that supply the neck also supply structures in the head. If you are experiencing a headache along with neck pain, then the issue might actually be with your neck.


The neck is made up of vertebrae that form joints that allow for movement in your neck. During certain movements of your neck, the joints, muscles, ligaments, and nerves could be getting stretched, compressed, or irritated beyond their normal tolerance. This can cause pain that is interpreted as a headache. A head/neck injury in the recent past, such as a whiplash injury or a concussion, could also refer pain that is perceived as a headache.


Common Symptoms.1,2,3

If you are experiencing a cervicogenic headache, you may experience one or more of the following symptoms:

  • Usually one-sided neck pain and a headache that wraps around from the base of the neck, up the back of the head, and into the front of the head
  • Headache that is not constant
  • Headache that is brought on or aggravated by certain neck movements or spending a lot of time in the same position (such as driving or sitting at a computer)
  • Tenderness at the base of the head or upper neck when pressing on it firmly
  • Discomfort in the arm that is on the same side as the head/neck pain
  • May also be associated with light-headedness, dizziness, nausea, ringing in the ears, and decreased ability to concentrate


Possible Causes:2,3

  • Muscle imbalances, weakness, or tightness
  • Poor posture associated with repetitive or prolonged positions at work/home, sleeping, and so on
  • Previous neck or head trauma
  • Stress


What You Can Expect From Your Physical Therapist:1

  • An evaluation that will examine the range of motion, strength, and posture of your neck and other surrounding body regions
  • Hands-on techniques such as stretching, pressing, and positioning to help move your neck to assess mobility
  • Exercises focusing on improving the activation, strength, and endurance of the muscles surrounding and supporting the neck
  • Patient education about your condition, what your PT can do to help, and what you as the patient can do at home to help improve


It is important to remember that every individual’s body is different and that everyone perceives pain differently, so if you think that you might be having cervicogenic headaches but aren’t quite sure, schedule an appointment with your physical therapist to be evaluated!


Please note: If you experience any of the following symptoms, it is important to call 9-1-1 for immediate medical attention, since they may be a RED FLAG for a more serious condition:2


  • Headaches that are progressively getting worse over time
  • Sudden onset of severe headache
  • Headaches associated with high fever, stiff neck, or rash
  • Onset of headache after a head injury
  • Problems with vision or severe dizziness



  1. D. Childs et al., “Neck Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association,” Journal of Orthopaedic & Sports Physical Therapy 9, no. 38 (2008): A1–34.
  2. Page, “Cervicogenic Headaches: An Evidence-Led Approach to Clinical Management,” International Journal of Sports Physical Therapy 6, no. 3 (2011): 254–266.
  3. “Headache (Cervicogenic),” PhysioAdvisor.com, http://www.physioadvisor.com.au/9273650/cervicogenic-headache-neck-headache-physioadvi.htm (accessed March 8, 2016).

Causes Of A Common Sports Injury: Quadricep Tears

By: Alanna Pokorski, PT


Matt Adams of the St. Louis Cardinals tore his quadriceps tendon on May 26 and underwent surgery last Friday. The first basemen tore his quadriceps running between first and second base, and left the game shortly afterwards.


The MRI showed a tear, however surgical intervention showed the extent of the injury was more severe than expected. Matt will be out of baseball for 3-4 months to heal and recover.


The quadriceps tendon works the muscles in the front of the thigh – to straighten and extend the knee. Although anyone can tear the quadriceps tendon, it is most common in middle aged individuals who are in running or jumping sports. Because the quadriceps tendon functions in an “explosive nature” in high level activities, athletes are more prone to this type of tear.


Generally speaking, a tendon is more susceptible to tearing when it is weakened. Often times, it is due to tendonitis or chronic inflammation of the tendon. This is called quadriceps tendonitis and can develop into a chronic condition. With tendonitis, the tendon becomes inflamed and doesn’t function as effectively when strained. It then becomes swollen, and doesn’t have as much tensile strength which is predisposes it to more serious injury.


Physical Therapy can treat tendonitis conditions which can help prevent tears. While it is unknown if Matt Adams had tendonitis prior to his quadriceps tear, many athletes develop tendonitis.


Some initial signs of quadriceps tendonitis are:

  • Swelling and tenderness over the tendon ( located just above the kneecap)
  • Increased discomfort of the quadriceps and knee during sporting activities, especially running and jumping
  • Relief with rest
  • Dull achiness and clicking in the joint


Physical Therapy looks to effectively reduce inflammation of the tendon and joint with specific stretching and strengthening activities. Physical therapists also evaluate the entire lower leg which can sometimes offer clues on how the body maybe contributing to abnormal mechanics during sport, therefore creating tendonitis symptoms.


Since surgery, Matt Adams will continue to be in a brace for a period of time to allow the tendon to heal, and then will begin rehabilitation to increase his knee motion and restore strength. The expected timeframe for this would be about 3-4 months.


For more information on a quadriceps tendon tear or tendonitis, please contact us at info@sptny.com







Avoiding Low Back Injuries With Squatting And Deadlifting

By: Raphael Fabrizi, SPT


Low back pain is very common among weight lifters, however can be prevented or improved by some simple technique modifications to help take stress off the low back. I’m sure if you’ve been to a gym, you’ve seen some awful technique. Now let’s talk about some steps we can take to not become “that guy” at the gym.


1. Avoid rounding your back. Rounding your back puts a great deal of stress on the structures of the low back and is a common scenario for low back disc issues.

2. Stay tight. Keeping your upper back muscles and core tight will help better transfer the weight from the bar to your feet, helping you to lift more weight safely.

3. Bend the bar. When squatting attempt to bend the bar across your back, and when deadlifting attempt to bend the bar by turning your hands out and pulling your shoulder blades back.  This will help to engage your lats and help to stabilize the back from top to bottom.

4. Spread the Floor. “Spreading the floor” will help to activate your hip muscles which will help to take stress away from the low back and place it in the hips to help you generate more power.

5. Save the belt for the max lifts. Doing your warm-up and lighter sets without a belt can help develop crucial muscles in your low back.  No doubt a belt can help you lift more by increasing stability, but save if for the heavier sets.

6. Lift with a partner. You may not notice your technique flaws, but having someone else there to let you know where your lacking can be a very valuable tool to help your lifting. If this isn’t an option, try videotaping yourself and watch the video to see if your low back rounds or form breaks down in any way.


Good luck, and happy, safe lifting!



1) Raske, Åse, and Rolf Norlin. “Injury incidence and prevalence among elite weight and power lifters.” The American journal of sports medicine 30.2 (2002): 248-256.

2) McGill, Stuart. Low back disorders: evidence-based prevention and rehabilitation. Human Kinetics, 2007.

3) McGill, Stuart. Ultimate Back Fitness and Performance. 2006. 

Identifying And Treating Pain From Nerve Tension

By: Kelly Mottolese, SPT


What is nerve tension? Nerve tension is pain that occurs because a nerve is being compressed or stuck in its surrounding tissue which prevents it from moving within its tract like it normally does. This can happen for a variety of reasons. If a joint has been immobile for a period of time it increases the risk that a nerve can get a little stuck due to the prolonged lack of motion. The movement patterns that a person typically uses can also increase the chance of nerve tension. Sometimes there is no known reason at all.


How does this cause pain? This can occur for several reasons. The first is because of inflammation in the tissue surrounding the nerve causing compression. This compression on the nerve can send signals to your brain indicating pain at the site of inflammation. It could also be due to hypersensitivity of a nerve. This is when the nerve sends signals to your brain indicating pain with movement that is not usually painful. Finally, it can also occur if the nerve is getting stuck in the tract that it normally glides in. This prevents the nerve from moving freely and can limit that amount of motion allowed at a joint.


What are the symptoms? Some common symptoms can be a burning or tingling sensation in positions that elongate the nerve. A feeling of heaviness or weakness can also be caused by a problem with nerve tension. Even a decrease in the range of motion of a joint can sometimes stem from a nerve tension issue.


How is this treated? This can be treated by gliding the nerve through its tract.  Nerves cannot be stretched in the same way muscles can be. They instead just slide through a tract all throughout your body. So to help them move better you can moving body parts on both ends of the nerve to help “floss” it back and forth through its tract. This helps it to move more freely along its normal path.


Talk to your physical therapist about nerve tension if you feel like this might relate to you.



Coppieters, M., Hough, A., & Dilley, A. (2009). Different Nerve-Gliding Exercises Induce Different Magnitudes of Median Nerve Longitudinal Excursion: An In Vivo Study Using Dynamic Ultrasound Imaging. Journal of Orthopaedic & Sports Physical Therapy, 39(3), 164-171.

Ellis, R., Hing, W., & Mcnair, P. (2009). Comparison of Longitudinal Sciatic Nerve Movement With Different Mobilization Exercises: An In Vivo Study Utilizing Ultrasound Imaging. Journal of Orthopaedic & Sports Physical Therapy, 39(3), 667-675.

Nagrale, A., Patil, S., Gandhi, R., & Learman, K. (2012). Effect of slump stretching versus lumbar mobilization with exercise in subjects with non-radicular low back pain: A randomized clinical trial. Journal of Manual & Manipulative Therapy, 35-42.

Nee, R., Jull, G., Vicenzino, B., & Coppieters, M. (2112). The Validity of Upper-Limb Neurodynamic Tests for Detecting Peripheral Neuropathic Pain. Journal of Orthopaedic & Sports Physical Therapy, 42(5), 413-424.

Van Ryssegem, G. (n.d.). Neurodynamic Techniques. Retrieved April 1, 2015, from https://www.medbridgeeducation.com/


The Greatest Contributor To Obesity? Bulk Foods.

By: Sports PT Staff


According to the National Bureau of Economic Research, the economic factor that has the greatest impact on overweight and obesity today is the availability of family-size and bulk packages from “big box” grocery stores and warehouse clubs. Many people opt to purchase larger quantities to save money, and it actually creates an excessive amount of food in their household.


Almost 50% of people have predisposed (genetic) factors that lead them to overeating during the day. So, if they have extra food in their home or workplace, they tend to eat it and gain weight. There has been a lot of advice in the past decade on portion size at meals, and now the research is looking to portion size for what’s in the pantry as well.


The 3 most common traits associated with overeating are:

  • Low satiety
  • Emotional eating
  • Self-control


While physical therapists cannot offer nutritional advice, we have a network of professionals that can help with weight management. We CAN, however, help with proper movement, fitness, and injury reduction. Contact us here.



HealthWatch 360 April 27, 2015.



5 Tips To Avoid Injury At CrossFit

 By: Elizabeth A Dungan, PT, DPT


Below are five essential tips from a PT’s perspective to remember when performing your basic CrossFit movements:


1.)  CORE: From an air squat, to a heavy back squat, a power clean, to a shoulder overhead press; one’s core should always be engaged. Many CrossFit athletes feel like they activate their core, but in reality many are activating their core incorrectly or not at all. Engaging your core does not mean “sucking in.” It is about abdominal bracing. This involves activating transverse abdominus muscle, keeping the spine in neutral, and making sure the pelvic floor is strong. To active transverse abdominus one needs to draw their spine into neutral and pop their abdominal muscles outward. By palpating the top of your iliac crest or pelvis, you can feel if this muscle is harder and “turned on.” This core activation should be used with every heavy lift. This is the container that provides stability and strength to your entire body and prevents low back pain, disc problems, and lower extremity injuries.


2.)  THE SQUAT: The air squat is one of the most common movements in CrossFit. It’s important to make sure one has a proper form and doesn’t push their limits just so they can reach a new 1 rep max. When completing a squat with or without weight make sure the back is flat and low back and shoulders are not rounded at all (this is key). Keep feet are a little wider than shoulder width, feet facing forward, back and shoulders flat, hip hinge backwards (like you’re about to sit in a chair), and then bend knees (knees never over the toes). As soon as the sacrum or tailbone area starts to dip down and tuck under you, you’ve gone too far. As the sacrum tucks under you, it’s gapping your lower lumbar spinal segments and allowing those discs to be pushed outward, causing potential injury. Have a partner or coach make sure you’re performing the squat properly.


3.)  THE DEADLIFT: Similar to a squat, it’s essential to engage your CORE first. Secondly, while you’re keeping feet at shoulder width, facing forward, slightly bend knees and keep the back flat the entire time. As you lower down to grab the bar, do not round the low back or upper shoulders. Both of these could cause disc injuries to your spine or disengagement of your core due to poor posture. Once you are about to grab the bar, look down and make sure that shins are perpendicular to the floor (knees not over toes), back is straight, hinging at the hips first, squeezing glute muscles and standing up to neutral. The low back and shoulders should remain straight as a board through the movement, especially when lifting a weight that’s causing you to round your back to get the weight up. If you’re feeling soreness in your low back during the movement or a day or two after, you are not doing them properly. Hamstrings should be sore but no low back pain should be felt with a deadlift!


4.)  THE KETTLEBELL: Here, it’s important to make sure that your back remains neutral and flat and that you limit the amount of shoulder involvement during the movement. This should be a movement that the hips perform, not the shoulders or arms. To start, make sure feet are in squatting stance and the back is flat. Hips sink backwards like a mini squat, momentum is created by swinging the bell using your hips, and when the bell continues to move upward snap your hips open, squeezing the glutes and standing tall. Be careful not to round the shoulders when bringing the kettlebell above your head. Keep the neck stable when the bell is overhead and don’t shift it forward. If your back is not flat when starting, just like with the squat and deadlift, you are at risk for disc injuries. If your neck and shoulders round when weight is overhead, you’re more prone to a shoulder injury or cervical issues and pain.


Lastly, it’s important to recognize the difference between soreness and pain. Delayed onset of muscle soreness is real and natural. Recover, stretch, mobilize, and take a rest day. Form is everything, not just because it looks good, but because it is what keeps you injury free and able to stay active for years ahead.


A Lesson In Patience On Marathon Monday

By: Megan James, PT, DPT


One year ago today, I was running the most sought-after 26.2 miles through the streets of Boston with at least one million cheerleaders – including some of my family – alongside me all the way to the infamous “right on Hereford, left of Boylston.” It was absolutely the most incredible experience in my running career.


About one month later, I was still living on the “high” of completing the Boston Marathon and had resumed my normal training schedule after only a few days of rest. I woke up one morning to go for a run and realized I could not walk due to severe pain in my left foot. Between my own knowledge and consulting with other physical therapists, we had a pretty good idea about what was going on. After seeing a podiatrist and having X-rays and an MRI, I was diagnosed with a stress fracture on my 4th metatarsal with deep bone bruising on my 5th metatarsal. My summer would be spent on crutches and in a walking boot – no running and no biking.


It wasn’t until the end of September that I was able to return to running, and that was only for a few minutes at a time to start. By the end of October, I was up to running 3-4 miles at a time and was feeling optimistic about being able to resume my training, but my eagerness to return overcame my patience, leading me to push it too hard. I had a recurrence of foot pain in early November that sidelined me for an additional week. From that point on, I made a promise to myself to be more patient and cognizant with my training to ensure my body was fully recovered.


After almost a year off of racing, I found myself back on the starting line at the Syracuse Half in March. I bested my half marathon time by six minutes and broke the 1:30 barrier for the first time. The past 10 months were a true test of my patience – if not for recognizing the importance of taking a step back in the fall, I would likely be back at square one right now. As a physical therapist and a competitive distance runner, I cannot stress enough to myself, my friends and my patients that patience is a virtue, and a very important one at that. Next up on my race schedule? Bennington Marathon, followed by a week of REST.


Pelvic Floor Dysfunction: How Does PT Help?

By: Ashley Zaroogian, SPT


Are you currently experiencing low back pain, hip pain, or stomach pains? Have you experienced urinary leakage after coughing, sneezing or laughing? If you answered yes to either one of these, you are not alone. There are many people who are noticing signs of dysfunction in their pelvic floor muscles and convince themselves this is normal. Many people will even find ways to self-treat in order to prevent this awkward conversation with healthcare providers. It’s easy to convince yourself you drank too much water or just didn’t make it to the bathroom in time. What you may not know is that there are physical therapists who specialize in treating patients with pelvic floor involvement.


Approximately 1 out of every 5 American experiences some type of pelvic floor dysfunction? Additionally, 1 out of every 4 women aged 18 years or older experiences urinary leakage. Research shows two thirds of men and women between 30 and 70 years old have never talked about their bladder health with their physicians. Many people are concerned signs of pelvic floor dysfunction can mean it’s something more than the muscles not working properly. In reality, there are a lot of muscles involved in the pelvic floor which help us all to walk around, sneeze, cough, run and jump without having to run to the bathroom. Stress, diets, pregnancies, and/or prior surgeries can contribute to dysfunction in these muscles. This is where physical therapists specialized in this area can help.


You may be wondering why physical therapists are trained to treat an area which is is so intimate. Aren’t physical therapists trained to treat problems with muscles? Treating symptoms such as urinary leakage can likely be due to problems with the muscles, in which physical therapists are most certainly trained to treat. Many people who have been diagnosed with IBS, constipation, endometriosis, or frequent UTIs have shown positive responses to pelvic floor physical therapy. These physical therapists will talk to you to find out what symptoms you have been experiencing, and do as much of an assessment you are comfortable with. They will also assist with training your muscles to work properly, begin strengthening them and then teach you how to continue to work these muscles properly at home in order to prevent you from continuing to have these symptoms.


4 Tips To Improve Your Seated Posture

By: Allison Pulvino, MSPT, CMP


Research shows that the seated professional is at much higher risk for low back injuries, since sitting places 2.5 times your body weight on your spine. Below are easy tips for improved seated posture:


  1. When sitting during the work day, make sure your computer screen is at eye level and directly in front of you to prevent any unnecessary forward leaning or rotational stresses.
  1. When sitting at a computer desk, the arms should be relaxed at one’s side during typing and operating a mouse, and not reaching forward, to prevent forward slouching and possible upper and lower back pain.
  1. When sitting in any type of chair, the shoulder blades should be back against the chair to prevent any increased stresses to the lumbar spine or to the neck and shoulders.
  1. If there is any uncomfortable pressure in the lower back from prolonged sitting, use of a lumbar roll can help to maintain the spine’s natural curve and decrease the unwanted stress.

If you experience pain from poor posture, contact us here.


Tendonitis vs. Tendinosis: What’s the Difference?

By: Cory Hall, SPT


Tendonitis and Tendinosis


Tendonitis is the inflammation of the tendon resulting from micro-tears that happen when the tendon is overloaded with too much weight or loaded too quickly. Tendonitis shows very evident signs of inflammation with cells invading the area to carry out the healing of the tendon and may be red, swollen or hot.


On the other hand, tendinosis is represented by degeneration of the tendon’s collagen in response to chronic overuse (even at benign levels of force) without allowing the tendon time to heal. The chronic nature of this injury means inflammatory cells and active inflammation do not respond to the tissue’s demands.


This pathology is noted by the following findings:


  • Immature type III collagen vs. type I – The tougher type I collagen is replaced in a non-effective pattern by type III collagen that weakens the tendon and exposes it to further damage.
  • In order to help the repair process the body starts to lay down new blood vessels and nerves to the area. However, the added vessels typically do not end up carrying any blood just congesting the area further and the nerves just cause pain.
  • The changes above result in an increase in the bulk of the tendon and represents a significant loss of tendon strength.




It is important to differentiate the pathology because it changes the treatments and the timelines for prognosis. Tendonitis care consists mostly of anti-inflammatory medication, rest and deep tendon massage to reduce adhesions during the inflammatory and healing process. The timeline for this injury varies from several days to 6 weeks depending on chronicity.


The treatment of tendinosis mostly utilizes physical therapies to combat the pain and weakness. Research suggests that, “tendons require over 100 days to make new collagen,” so the prognosis for tendinosis should be longer than tendinitis, ranging from 6-10 weeks for acute to 3-6 months for chronic.


Suggested physical therapies include:


  • Exercises emphasizing eccentric muscle contractions – These contractions are thought of as “negatives,” during which the muscle is contracted as it is lengthened. For example, slowly lowering a weight or your body to the ground.
  • Deep friction massage – Rubbing across or around the area of the tendon stimulates cells called fibroblast to increase activity for collagen production to repair the tendon.
  • Blood platelet replacement or Platelet rich plasma (PRP) – Since there’s no inflammatory process present in the tendon, the body doesn’t know to repair itself.  Here, physicians take blood and separate the cells and growth factors located in blood plasma. Once they have “platelet rich plasma,” they inject it back into the tendon to stimulate healing.
  • Sclerosant agents or high tendon injections – This therapy is aimed at decreasing the excessive neural growth that accompanies the formation of new incompetent blood vessels in order to decrease pain.
  • Extracorporeal shock wave therapy – This is the method of using high frequency sound waves to decrease the excessive neural and vascular growth in to the tendon.
  • Nutrient supplementation – Adding vitamin C, manganese or zinc to your diet have all been shown to be integral to the synthesis of collagen and may be beneficial.


It may be as important to note that the use of non-steroidal anti-inflammatory drugs (ex: ibuprofen) or corticosteroids should be avoided since they can inhibit collagen growth, even though they can provide short term relief from pain.


In conclusion, tendinosis is incredibly more common than true tendonitis and may respond better to therapies that do not focus on the reduction of inflammation. Tendinosis is more challenging to recover from, but there are numerous options being researched to clarify the best interventions to return individuals to activities.




Bass, Lmt Evelyn. “Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters.” International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice 5.1 (2012)

Kardouni, Joseph. “Neovascularization Prevalence in the Supraspinatus of Patients With Rotator Cuff Tendinopathy.” Clinical Journal of Sport Medicine 23.6 (2013)

Khan, JM. “Overuse Tendinosis, Not Tendinitis Part 1: A New Paradigm for a Difficult Clinical Problem.” Physical Sports Medicine 25.5 (2000)

Rees, J. D., M. Stride, and A. Scott. “Tendons – Time to Revisit Inflammation.” British Journal of Sports Medicine 48 (2014)