​What are the symptoms?
 
The pain of a cervicogenic headache is usually unilateral (on one side), and often described as a dull or aching pain that can be felt in the neck, head, face or even behind the eyes. It can also be accompanied by other symptoms such as neck stiffness, limited range of motion in the neck, and tenderness in the neck or scalp.
 
How does it happen?
 
Cervicogenic headache is an example of referred pain, where dysfunction of the structures in the neck cause pain to be felt in a different location. The most common reason for this pain to be felt are joint and muscle stiffness around the cervical spine. 
 
Tight muscles can develop trigger points that refer pain into the cranial region in a typical pattern. Headaches can also be caused by irritated nerves that originate in the spine and travel into the head. Whiplash following a trauma such as a car accident is known to be a cause of ongoing neck-related headaches.
 
How is it diagnosed?
 
Diagnosis of a cervicogenic headache can be difficult as it needs to be differentiated from other forms of headache such as migraine, tension headaches and sinus headaches. Your physiotherapist will perform a thorough assessment to determine the origins of your headaches. Some signs that headaches are caused by cervical dysfunction include muscle tightness, joint limitations, concurrent neck pain and poor posture.
 
What is the treatment?
 
Treatment for neck-related headaches is aimed at correcting any dysfunction, restoring movement and flexibility to stiff joints and muscles and addressing any postural issues.

What is Carpal Tunnel Syndrome?
 
The carpal tunnel is a small space where the wrist meets the base of the hand. This space is covered by a thick ligament and creates a small tunnel where various nerves, arteries and tendons pass through from the forearm into the hand. If anything causes this space to be reduced, these structures can become compressed or damaged, particularly the median nerve. This condition is referred to as Carpal Tunnel Syndrome. 

What are the symptoms?
 
The hallmark symptoms of carpal tunnel syndrome are pain, tingling or numbness in the hand, usually following a typical pattern over the thumb, index and middle finger. There can also be a reduction in grip strength and wasting of the thumb muscles. Symptoms are usually worse on waking or with repetitive hand movements. Patients might also report difficulty holding items, writing or doing up their buttons.
 
How does it happen?
 
Carpal tunnel syndrome can be caused by anything that reduces the space in the carpal tunnel, including arthritis, the growth of a cyst or compression from everyday activities. The median nerve is particularly vulnerable to compression and is of the most concern as prolonged compression can cause nerve damage and permanent weakness of the hand. 
 
How is it treated?
 
There are a few different treatment options for carpal tunnel syndrome. Non-surgical treatment is recommended first, which could include physiotherapy, wearing a splint, cortisone or plasma rich platelet injections to promote nerve healing. The effectiveness of physiotherapy will depend on the cause of your syndrome. If the space of the tunnel has been reduced permanently, such as with arthritis, then surgery is likely to be the most effective treatment. Carpal tunnel surgery is an operation to widen and release the carpal tunnel allowing decompression. This is a common procedure but is not without risks or complications and requires a period of time off work for recovery.
 
For non-surgical cases, altered biomechanics of the arm, the mobility of the median nerve and muscle tightness may all be contributing to symptoms. In this case, physiotherapy can be highly effective, along with a period of rest, possibly splinting and a change in your daily activities.

Have you ever woken up with a stiff and painful neck that will only turn to one side? You might have been suffering from acute wry neck, a painful condition following a typical pattern of symptoms. Most wry necks are classified as one of two different types – facet (joint) or discogenic wry neck. 

Facetogenic Wry Neck:
 
Facet joints are found on either side of the spine and allow controlled rotation and side bending of the neck. An awkward or sudden movement of the neck can cause a part of the joint capsule to strain, tear or get caught in the joint, making it feel locked. The muscles around the area can also become tight and spasm, which amplifies the pain. The pain is usually sharp and can be pinpointed quite accurately to the part of the neck causing the problem, and the pain rarely travels down into the arm. It is usually possible to find a resting position where the pain goes away completely, only having pain when turning in specific directions. The good news about facetogenic wry neck is that your physiotherapist is usually able to help you ‘unlock’ the neck quite quickly with gentle mobilisations. Most of the time, a full recovery can be expected within a week. 
 
Discogenic Wry Neck: 
 
The vertebrae of the neck are separated from each other by fibrous discs, filled with a gelatinous centre. These discs provide support, flexibility and shock absorption. When placed under pressure, these discs may bulge or tear, and the resulting swelling can cause pain and muscle spasm in the surrounding area. It is important to note that in an area as sensitive as the neck, a small amount of damage can result in a large amount of pain. 
 
The development of discogenic wry neck is usually due to a combination of factors, including neck stiffness, poor posture and biomechanics than can contribute to the disc being vulnerable prior to the injury. In these cases, it can be challenging to find a comfortable position, and it is more likely for pain or tingling to travel into the arm.
 
Treatment of discogenic wry neck is focused on reducing pain and muscle spasm with massage, taping, heat and postural education. Further treatment aims to reduce any stress that is being placed on the disc, mobilise any stiff spinal segments and correct any muscle imbalances. While the initial symptoms may settle down quite quickly, it can take up to six weeks to fully recover from discogenic wry neck. In this condition, it is also essential to address all the factors that may cause a recurrence of the issue.

What Are They?
 
Trigger points are what are often thought of as muscle "knots" and can feel like painful, hard lumps located in your muscles. These points can both be painful to touch and refer pain to surrounding areas. It is thought that trigger points form when a portion of muscle contracts abnormally, compressing the blood supply to this area, which in turn causes this part of the muscle to become extra sensitive.  Trigger points are a common source of pain around the neck, shoulders, hips and lower back. 

What Causes Trigger Points?
 
Many factors can cause trigger points to develop. Repetitive stress, injuries, overuse and excessive loads are common examples. Inflammation, stress, nutritional deficiencies and prolonged unhealthy postures may also contribute to the formation of these painful areas. Generally speaking, muscular overload, where the demands placed on the muscle mean that the fibres are unable to function optimally, is thought to be the primary cause of trigger points. This is why you might notice trigger points in weaker muscles or after starting a new training program.

Signs and Symptoms

Pain caused by trigger points can often be mistaken for joint or nerve-related pain as it can be felt in a different location to the site of the trigger point. Trigger points feel like hard lumps in the muscles and may cause tightness, heaviness, aching pain and general discomfort. They can cause the length of the affected tissues to shorten, which may be why trigger points can increase the symptoms of arthritis, tennis elbow, tendonitis and bursitis.

How Can Physiotherapy Help?

Your physiotherapist will first assess and diagnose whether trigger points are contributing to your pain. If they feel that treatment will be beneficial, there are a variety of techniques that can help, including dry needling, manual therapy, electrical stimulation, mechanical vibration, stretching and strengthening exercises. While these techniques may be effective in treating trigger points, it is important to address any biomechanical faults that contribute to their development so they don't keep recurring.
 
Your physiotherapist is able to identify causative factors such as poor training technique, posture and biomechanics and will prescribe an exercise program to address any muscle weaknesses and imbalances.  If you have any questions about how trigger points might be affecting you, don’t hesitate to ask your physiotherapist. 

Referred pain is one of the most complicated processes in the human body. You may have experienced this if you ever saw a physiotherapist for pain in one part of your body, and they started to treat an entirely different area.  The complexity of pain is one of the reason's why physiotherapists conduct such a thorough interview with you and physical examination before being able to determine the exact source of your pain.

Why is pain so complicated?
 
Unfortunately, we still don't understand everything about the way pain is processed.  Usually, when an injury or damage occurs to body tissues, a signal is sent to the brain, which begins to interpret this signal and creates the sensation of pain. Pain is thought to be a warning signal to let you know to avoid danger and pay attention to the injured body part. Occasionally this system goes a little haywire, and pain signals are sent when there is no damage or the location of the pain is misdirected.
 
Referred pain is the term used when pain is felt at a different location to the source of the problem that is sending the pain signal. There are many kinds of referred pain, and some are easier to explain than others.
 
What are the different types of referred pain?
 
In some cases, if it is a nerve that is sending the pain signal, then pain can be felt all along the length of the nerve. This may be described as a sharp burning pain along the skin. One of the most common examples of this is "sciatica", where the large nerve that runs down the back of the leg is irritated around the lower back or buttock. The source of the pain signal is near the spine. However, that pain follows a distinctive pattern down the leg. In other cases, it is the muscles and not the nerves that are referring pain elsewhere. Muscular trigger points are taut bands that develop within muscle tissue that is undergoing abnormal stress. Poor posture, lack of movement, and overuse can cause muscles to develop areas of dysfunction. These trigger points can cause pain that radiates out in distinctive patterns. Trigger points are diagnosed as the source of pain if symptoms are reproduced when a therapist presses on a specific point.
 
If that wasn't confusing enough, we know that our internal organs can also refer pain.  Pain referred by internal organs may be described as a deep ache, and usually not influenced by movements of the limbs or back. Organs often distribute pain in patterns that are very obscure and sometimes don't even create any pain at their own  location. For example, kidney pain can feel like lower back pain. 
 
There are many other fascinating aspects to pain and understanding how it works is an important part of managing your symptoms. To understand how referred pain may be affecting you, talk to your physiotherapist who can help with any questions. None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your individual injury. 

What is spinal stenosis?
 
The spinal cord, nerves and arteries are housed by the spine, which acts as a hard casing to support and protect these vulnerable structures. The spine has a hollow column that allows the spinal cord to run from the brain to the rest of the body. At each spinal segment, nerves exit the spine and supply the tissues of the body. There is also an intricate network of small veins and arteries that provide blood to the spinal cord and vertebrae, providing them with the nutrients needed to operate.
 
Spinal stenosis is characterized by a narrowing of the spaces that house the spinal cord, nerves and blood supply. A variety of factors can cause spinal stenosis, however overwhelmingly it is caused by degenerative changes to the spine as we age. Many people over the age of 60 will have a degree of spinal stenosis, however not all will have pain. Clinically, spinal stenosis is often used to describe the painful symptoms of this condition rather than just the narrowing itself.

What are the symptoms?

Pain with walking or standing that radiates into the hips, thighs and even as far as the feet is the hallmark of spinal stenosis. Usually, this pain will be reduced with rest and forward movements of the spine. Spinal stenosis is a progressive condition and symptoms will gradually increase over time. The pain is often described as a deep ache and can be associated with fatigue, heaviness, weakness and numbness. It can affect just one leg, but often will be felt in both legs.  There will often be associated back pain, however leg pain is usually the most severe complaint.

How can physiotherapy help?

There are many conditions that need to be excluded before a diagnosis can be made. Your physiotherapist is able to conduct a thorough examination and accurately diagnose this condition. In some cases, imaging may be requested. As mentioned earlier, many people have stenotic spinal changes without symptoms. Surgery to decompress the restricted nerves and stabilize the spine can be used in very severe cases. 

For mild to moderate cases of spinal stenosis, physiotherapy can be extremely beneficial.  Your physiotherapist can help you manage your pain through hands-on techniques and by providing a targeted exercise program based on biomechanical assessment. They are also able to help you to understand and manage your day in a way that helps to reduce flare-ups and maintain muscle strength.

Occasionally surgery is the right choice for you, then your physiotherapist is able to guide you through this treatment pathway, helping you to prepare and recover from surgery to get the best overall outcome possible.