Wonder why your head feels heavy? Many years ago, one of our physical therapists and I were looking at some neck MRIs. The fact that the low back multifidus muscle atrophies in many patients with chronic low back pain had just been discovered and we wondered if the same thing happened in necks. The therapist ultimately went onto get his PhD. researching whether this was real and is now a professor at Northwestern. The ultimate answer appears to be that the upper neck muscles do atrophy in patients with head and neck trauma like whiplash or when something hits the head causing upper neck injury.
The research that supports this concept was developed by Jim Elliott, PhD. Some of his excellent work is here, here, and here. Basically, the upper neck muscles help to stabilize the head on the neck. When the upper neck is injured (often the facet joints and ligaments get damaged), the muscles shut down and begin to atrophy. As they shrink they can no longer support the head and keep it stable (hence the “heavy head” feeling). This instability of the head on the neck causes the spinal discs, joints, nerves, and muscles to get beat up over time-leading to headaches. The injury of the upper neck joints and ligaments that began the atrophy can also cause headaches.
One of my favorite ways to test this effect in the office is in our practice’s e-book, Orthopedics 2.0 under the Stability Test. When I see a traumatic neck injury patient with headaches, I ask the patient to lift their hands above their head. They often can’t do this, or it’s difficult. I then hold their head still with my hands, acting like their upper neck stabilizer muscles. When they try again, it’s often easier for them to lift their arms when someone stabilizes the head. Why? The stabilization of the head gives the upper trapezius a solid base of support to pull from as the arms are lifted. Without that support in a patient with atrophied and weak upper neck muscles, the upper trapezius works harder to both stabilize the head and lift the arms.
The video above explains the mechanics of what’s going on, as pictures are worth a thousand words. What can be done? First, you have to get rid of the pain in the damaged joints-we use biologic injections like platelets and stem cells to help the joints. Sometimes the ligaments have to be injected as well. A slow and gentle strengthening program is a good place to start (we start the patient using an adapted ipod game where their head movements have to guide a ball through a maze). The patient can then transition into a program where there’s more force used. We like the BTE Multi-cervical unit for this part.