National Pain Week 2022

Do you have pain on the right side of your head? Behind your right eye? Throbbing pain in your right temple? If you get right-sided headaches, then this is the blog for you! Firstly, the most important thing to consider when suffering with right sided headaches, is that it’s nothing catastrophic – what we would call a ‘red flag’. Red flags that we look out for include: It’s a brand-new headache that you have never had before It’s the worst headache you have ever had If any neurological symptoms are occurring Numbness or tingling in your hand or limbs Speech impairments Face drooping etc. If any of these things have started happening, that's never ever happened before, you need to get assessed immediately. We highly suggest going to the hospital or to the doctor and make sure that nothing nasty, like a stroke or tumour or a bleed, or anything like that is happening. However, if all of that's clear, your MRIs are clear, you've been to the GP, it's been there for a little while and you are still suffering, then we may just have the answer for you! Generally, what we find is that there's a problem on the right-hand side of your neck. Normally at the OC1 joint or the C23 joint, a little bit lower down. The area of your pain gives us a good idea as to what joint might be the cause of the pain. The first one, if the pain is right at the very top of the head, it can sometimes go up and behind the ear, around the temple and into the temple - it's more likely to be the OC1 joint at the top of the neck that's causing this type of pain. Whereas, the C23 joint, refers the pain up and over the head and into the eye, and behind the eye. This is more likely for a right-sided cluster headache, for example, or a right-sided migraine that's just throbbing and thumping on one side of the head. On occasion, it can be a combination of both joints, OC1 and C23 causing the symptoms to happen. If you have right-sided headaches and your scans are all clear, then you should consider having your neck assessed. Specifically, the right side of your neck, the OC1 joint, the C23 joint, or the inferior oblique muscle that connects the two. Hope this information was helpful – if you have any questions, please reach out to us here .

Triggers… Did you know that they may not be as important as you might think? We get a lot of questions asking why certain things trigger a person’s headache to begin. Most often we hear things like red wine, chocolate, stress or not sleeping enough. In the literature these things are called “triggers”. It’s common for patients to identify what their triggers are - so that they can avoid these triggers with the intent of actually not getting the headaches and migraines anymore. While this might seem simple, surely its easy going without a few things, but there's a problem with this approach… At some points, sometimes there are legitimate things that can cause headache and migraine to happen, like when a person has an allergy. So if you've got something like celiac disease or are allergic to some kind of substance, and genuinely allergic to it, then your inflammatory response may cause the headaches and migraines to happen. However, with triggers like red wine, chocolate, bananas, tomatoes.. it is common that sometimes the migraine happens and sometimes it doesn't. For example; We often hear people say “I can have half a glass of wine and I'm fine, but if I have one glass of wine I'm not” or “I can have half a glass of wine if I'm not tired, but if I'm really tired and have half a glass of wine then I'm wiped out for three days”. It’s really quite mystifying! Triggers that sometimes happen with patients leave them feeling baffled as to what's going on. So lets go back a step… what is the cause of the headaches and migraines in the first place? Headaches and migraines occur when you have a sensitization process happening at the back of your brain at the top of your spinal cord in what's called your ‘brainstem’. There is a lot of different areas that pass in through this special area. Such as the neck, jaw, face, your skin around your face, and a few things from your fight or flight response, your tongue and your ears as well. Also of course, the feeling of the blood vessels inside your brain also have an influence here. All of these things go into the same part of your brain. Then what happens is that part of the brain becomes sensitized. So, if there's anything that's out of the ordinary for any of those things, all of a sudden it starts to become a bit of a problem. If you've already got a sensitized system and then you have something that impacts the serotonin level that's going through your bloodstream or perhaps the blood pressure going up or down, then those are normal changes in serotonin, those normal changes in blood pressure, those normal changes in posture perhaps start to cause a headache and a migraine to happen when generally it shouldn't and normally it doesn't. So… knowing this, instead of looking at what triggers we can avoid… It may be more beneficial to look at what is sensitizing your system in the first place. What is the cause of a sensitized system? The most common one is the top of the neck. The top three joints of the neck can sensitize that system really, really nastily in some people (often, it's actually just one joint). When one or all of these joints are not moving nicely, it can cause a myriad of different problems like; headaches, migraines of nausea, vomiting, dizziness. Here’s our way of explaining it…. If, say for example, a parcel was being sent from overseas to arrive here in Australia. The parcel is a box, and in the box was a hat, sunglasses, shorts and a book inside. Now as it is ready to be sent… a person in the warehouse puts a bag of anthrax into the box. The next thing you know… it’s all packaged up in the one box and sent to customs in Australia. Obviously when it gets to customs in Australia, the alarms go off, it goes absolutely bananas. The red light starts to shake, the alarms go off, the dogs start to bark. The right squad comes in to work it out. You can agree that there's nothing wrong with the hat, sunglasses, shorts or the book in the box... But the whole box is being shown as being dangerous because there's anthrax in it, okay? So, on its own, the hat, the sunglasses, the shorts and the book are actually all pretty good, but because the box has anthrax in it, the alarm system says that it's actually really, really dangerous and that box should be treated with absolute caution. This is kind of what happens with headache and migraine. If you've got something that's sensitizing the system. Say for example, the neck is acting as the anthrax in this situation. When you have extra things going into that box, e.g. a bit more tired than usual, a bit more exercise than usual, a bit more hormones or less hormones than usual, a bit more serotonin or less serotonin than usual. Then those changes are being interpreted as a really big alarm signal when it comes to the headache and migraine. So, we need to find out what the anthrax is in your delivery box, I suppose. Majority of the time it's the neck that's causing that to happen. The advice I would give is to get your neck checked by someone who knows what they're doing. Unfortunately, there are a lot of people who claim to know what they're doing. What we have created is an eBook that explains this part of the brain. This part of the brain is called the T rigeminal Cervical Nucleus , but we like to refer to it as ‘The Headache Hub’. If you're interested in getting a copy of that feel free to click the image below, and the PDF version will start to automatically download. Have a read through what it's all about. It's about finding out what's sensitizing the system in the first place so that we can get your headaches and migraines under control. Hope that has been helpful – if you have any questions at all – feel free to reach out to us here ! Cheers and bye for now.

Are you a person living with back pain that's so deep that you can't touch it? Can you feel the pain right at the bottom of the back? Does it hurt when you try to move? If you’ve tried all the massages and products in the world - the massage guns, foam rollers, tennis balls, all the rubbing, and poking just to try reach the pain in the hopes of relieving it… Then today's blog is for you. We are sharing with you two top secrets (that you may not have heard of), about how to get rid of that deep, low back pain. Firstly, before we go any further, it’s important we rule out this: If you have back pain, that is constant, that's there at night, it's worsening and you're also losing weight or there's other health issues that are coming along with it, you need to go to the GP to make sure that there is nothing nasty happening. We're talking cancers, tumors, all those nasties. Especially, if it has come on out of the blue. This is something that we don’t want to be missed! However, if we're assuming that everything is all clear, and there’s no reason to believe anything sinister is occurring, then here are the two secrets to know what's going on with your deep seated, low back pain. Number one, there is a muscle that's very, very deep at the front of your spine. This muscle is called the psoas muscle, and it attaches from T-12 down to L-5 and down into your hip, as you can see in the diagram. It’s covered by organs, nerves, other muscles and skin! We call this muscle the hidden prankster, because a lot of people forget that it's actually there. The pain from this muscle, even though the muscle is at the front of your spine, it’s felt deeply in your back. If this muscle hasn't been assessed or treated before, then this should be your first port of call for consideration. By large, a lot of patients coming through that have been through their transverses of abdominal exercise, have been through their Pilates, tried a lot of different back pain strategies, and it's just not quite getting to where it needs to get to. That psoas muscle is the missing link in a lot of those cases.

If you've been living with long term neck pain, neck stiffness, neck weakness or have difficulty turning your neck– then this blog is going to rock your world. Our patients with neck pain often report: Stiffness, soreness and aching pain Difficulty turning their head in different directions Feeling like it constantly needs to be stretched Feeling like their head is 'too heavy' for their neck Referred pain from the neck into their shoulder/s and/or arm/s Referred pain from the neck into their head causing headaches Generally, when you have pain in your neck, the muscles adjacent to where the pain is, start to not work as well. It's like your brain cheats by moving in a different way so it doesn't hurt. However, the muscles that it doesn't use anymore become inhibited, and rarely used. When those muscles are inhibited, they become less strong. The joints adjacent to those muscles become stiff and tight, and you may not be able to move and rotate your neck freely, easily or without pain. We want to do two things when we're solving a neck issue. 1. We're wanting to get the neck moving first, and 2. We're wanting to get it as strong as it possibly can be. There are two sections of the neck that we need to focus on. The first is the top of the neck and the second is the bottom of the neck. Now the top of the neck is responsible for most of the turning and nodding. Then the lower neck, there’s a bit of movement in tilting, a bit of turning, a bit of looking up as well. It basically just comes along for the ride. When people are stiff through their neck, there's some kind of imbalance between the top of the neck moving and the bottom of the neck moving. For example, those suffering with neck pain, will often only use the top of their neck to look upwards, rather than using the entirety of their neck. So firstly, we need to ensure the patient has a nice even movement between the top of the neck and the bottom of the neck. We can do that by number of different ways and means. Once we get the movement, we need to make sure that the muscles are strong enough to be able to perform the movement over and over again, without the muscles becoming fatigued and becoming sore. We want them to become really strong and less inhibited. How do we strengthen the Neck muscles? The most efficient way is by using our wonderful piece of equipment, the Multi-Cervical unit . Now it's called the Multi-Cervical unit because you're able to move and lift weight in all different directions. Up, down and sideways, plus you can combine movements – for example, having the angle positioned sideways whilst moving upwards, or you could be positioned forward but move your head towards your shoulder… and so forth. So, this bit of equipment is able to strengthen the muscles in whichever direction where you have the most restriction in terms of your strength. Think of it like this, a whiplash accident for example, people aren't typically hit square on from behind - where their head completely straight. Often, their head is turned a bit, or they might have been thrown around a little bit in one direction or another. Another example, is those people that have wry neck pain – it’s likely to be more rotational rather than extension movements. This is how we tailor the treatment program to each individual – the most important thing is getting the muscles strong in the direction that needs it the most, as well as gaining a bit of global strength. In addition to using the machine, we teach you exercises at home to maintain the strength in between sessions and of course, to self-manage over time. When it comes to neck pain, we can make things more complicated than what it needs to be. We can do little exercises that are tiny little nods, we can do all sorts of joint positional things, closing eyes and using all sorts of different manoeuvres. For some people that works really well, but I'm talking to vast majority of people here with persistent pain (the most common cases of neck pain and neck stiffness) , these are the top 2 things you need to do. 1. Get the neck moving well with reduced pain. 2. Get the neck strong. If you do those two things and keep it simple and have a strategy over a period of time, you are more than likely going to get the results that you want. You'll be able to do the things that you want to do, much more often, without the burden of needing to change your schedule, change work, change work setups, worry about seats in your car or be scared about checking blind spots. The strategies and techniques that we do here at the clinic can help you and guide you to get the result that you need. Not sure if we can help you out? That's totally ok! Feel free to fill in our Neck Pain Questionnaire, which you can do so by clicking here . We will have a look over the form and contact you via your preference. We will ask a few questions that will give us a good idea if we are able to help, and then recommend if it is worth coming in for an assessment. I hope this information is helpful. We would love to help you and your neck pain, like we have thousands of others. To start the process, simply fill in our questionnaire here . Or for answers asap, book in our one-hour consultation and we can tell you exactly what is going on and what you can do about it! Click here .

If you're a lady who lives with migraines once a month and can set the calendar to when your next headache or migraine will come, then this blog is for you... We may just unlock the hidden secret as to why your headaches and migraines continue to be a burden, no matter what it is that you've tried before! If you live with hormonal headaches, you will often have to plan your diary and events around this time of the month, because when your cycle hits - you may feel knocked out, end up in bed, and have to take plenty of medication. Within the last 5-10 years, a new understanding of how headaches and migraines occur has come into focus. They are caused by a sensitization process. It’s a process that occurs at the bottom of your brain... an area which takes in all of the nerves from pretty much the top lip, all the way up and over to the back of your neck. In essence, your eyes, your ears, your teeth, your tongue, your lips, the back of your neck and the blood vessels inside your head all pass through the same area. What's less recognized is that this nerve centre is modulated by a chemical called serotonin. Serotonin is your happy chemical - the one that causes you to feel deep love and affection. It's the hormone that makes you feel good! When we're talking about hormonal headaches and hormonal migraines, it's important to understand what happens in the menstrual cycle through the month. In mid cycle what happens is that the serotonin increases, then decreases at the end of the cycle, and will then return back to the normal amount during other times of the cycle. So, what has this got to do with your headaches and migraines? Well, there used to be a really strong thought that it's all about the changes in the hormones that cause these headaches and migraines to happen. But, there's a study that came out a number of years ago that showed that it didn't matter if you got headaches or migraines or not, those hormones did the same thing. So some people were getting the headaches and migraines, others weren't, but the hormones were acting the same way. What does that tell us about how the hormonal headaches and migraines work? Well, it might not be the hormones to blame in the first place. What this sensitization means is that if the levels of serotonin is too much or too little, your brain perceives that normal change as a threat. It sees it as something that it needs to have a reaction to, even when there is no need. The problem is, this menstrual cycle is a normal process, and it happens to all females, so what's causing this whole sensitization process to happen? It's not the hormones because that is just a normal process. So, what could it be? Let's go back to talking about that Nerve Centre at the bottom of the brain. There's something that's sensitizing this nerve centre... and can cause the hormonal headaches and migraines to occur. What we've found over a long period of time here treating at The Headache and Pain Management Centre, through many courses we've done, through many thousands of patients that we've seen over the years is that quite often it's the neck that's sensitizing this whole process to occur. Even though the neck has nothing to do with your hormones, it is the "hidden prankster" that's sensitizing this area. It's almost like a ticking time bomb going off! So when your serotonin drops, your brain perceives that change in the hormones as the threat (even when it isn't), because it's already sensitized from what's going on with the nerve signals coming from your neck. What this means in practical terms, there is usually a joint or a muscle or sometimes a combination of both, that's sending a signal into that nerve centre. We like to explain this like a dripping pipette into the water, which over time fills a glass up to 85, 90%. Then at the mensural cycle, the hormones push that water causing it to overflow the glass and causing the headache to happen, so to speak. The hormones themselves are only a little bit of the problem, but the real problem is lying dormant for the rest of the month. It's a bit of an interesting concept if you've never heard that before, but we've seen it way too often to know that this is something that really does need to be considered. How do we know if it's your neck? Here’s a few hints to know if your hormonal headaches might be coming from your neck… 1. If your headache is on one side and can swap across to the other side. So, one month it might be on the right, the other month it might be on the left. If it's moving around, the neck is a prime suspect. About the only thing that can cause a headache to move like this, is your neck joints and the neck muscles. It can be stiffer on one side one month, stiffer on the other side another month, which causes the headache to be on the right or the left. 2. If your headache is locked to one side. If you have a think about it - if it's a genuine hormonal issue, the hormones will have an impact on both sides of the body. You can't just have hormones impact the right side of your brain or the left side of your brain. It impacts your whole system! In the few cases where it is genuinely hormonal, it's generally a really explosive headache that is on both sides and nothing is able to touch it, and the neck will often assess clear in these cases. But if it's on one side or the other side and it's locked there, then it's really worth having your neck assessed to see if the neck is driving this pattern to happen and the hormones are more an innocent bystander. 3. If other medical interventions haven’t worked Lastly, if you've had your hormones looked at and they're normal, if you've had other medications that you've tried, if there's been birth control that you've tried, there's been other interventions that have been tried and nothing seems to work, then it's really important to have the neck assessed because it might just be the missing link in the puzzle. It might well be the thing, the hidden prankster if you like, that's causing all of these issues to occur. If you are in one of those three groups then it's really, really important to get your neck assessed, to see if there is an issue with the neck causing these hormonal headaches and migraines to occur. How do we assess the neck? That's a really good question. It may be a genuine hormonal issue, or it could be your neck. What we do here at The Headache and Pain Management Centre that allows us to determine whether or not it’s your neck that’s the cause, is a very skilled and comprehensive assessment of the top of the neck and all of the other factors that might be driving your headache and migraine to occur. Our process: First step - If you’re unsure whether it’s worthwhile having the assessment, we happily offer free 15 minute phone calls to listen to your story. Which, based on our judgement will be able to recommend if an initial consultation is suitable for you. Everyone is an individual. Everyone has different stories, and we want to make sure that you're not wasting your time or money trying something new. Second step - Is to have an assessment with us, with one of our physiotherapists. This goes for one hour where we look at the history, we see what's been happening, what the impacts are, what you're hoping to get out of treatment. We will then do a full physical assessment to decipher if your headaches and migraines are coming from your neck. We know what we're looking for here. We're looking for stiffness in the joints, we're looking at the way that your neck moves, we're looking at the way that the muscles are behaving at the top of your neck as well, to see if it's something worth considering. If it is something worth considering, what we'll do is we'll tell you how we can help you out. We will tell you exactly how long it might take, how many sessions it might take, what we'll be doing in the room, what you'll need to do at home. We may recommend other interventions or scans or other things and will work alongside your GP to get the results that you need. We've been doing this now for a decade! We have many, many people that we've helped with these hormonal headaches and migraines. We want you to be the next person that we can help out. If this is something that interests you, if you are at your wits' end and wanting some help with this - the best thing you can do is to book a phone call with one of our team, using the link below. https://calendly.com/hpmcentre/10-minute-phone-call-with-hpmcentre

The MedX Medical Lumbar Extension Machine is a very effective way to isolate and strengthen the muscles of the lower back. The machine will force the back to do all of the work, and to do it in a way that is safe, objectively measured, and tailored to your age, weight, height and ability to move. In order to fo rce the back to do the work, it's crucial to make sure that your legs and hips can't "cheat" and to do this, it's necessary to restrict leg and hip movement. Yes, the machine looks a bit intense, but the reality is that this equipment can be adapted to a person of any shape or size, and tailored to how far you feel safe moving, and should be PAIN-FREE to use. The pictures below show the key features:

When it comes to pain, and when it comes to the way that pain is processed, one thing that you might not know is that pain is 100% produced by your brain. So, even though you feel it in a particular body part, it's your brain that produces the feeling of pain. Pain is like another sense. There's a lot of information that comes in through our senses, through our eyes, our ears, our skin, and so forth. It's the brain's job to process all of those signals, before you then experience what you might see as a colour, what you might hear as a sound, what you might feel as a sensation. The experience of pain can be different for everybody. This is why some people feel pain more than others; why some people can have a very minor feeling, as opposed to others that have a major feeling, to the same input. Let me explain briefly what goes on when you have pain... You have a whole stack of nerves that go into your spinal cord. All of these nerves, for example the ones that run from your hand, your feet, are what we call the peripheral nerves. They all filter in and meet in the spinal cord. The signal goes up the nerves, up the spinal cord, and then sent up to your brain for processing those signals. So remember, when signals are sent from your body to your spinal cord it's not pain yet, it's not even a feeling yet. It's basically electricity that your body is taking in, through special channels called nociceptors. Your brain then needs to process these signals, along with all of the information that's going on around it at the same time, in order for the "electricity" to become a sensation of any type, like pain. Let's talk about a really easy example. Let's say I am in the kitchen, and I'm cooking, and my finger touches the frying pan... This is what happens in your brain, in real time. My brain goes, "Oh, okay. There's something happening, but I'm not sure what. Let's go through the process." When the finger touches the fry pan, my thermal receptors in my finger start to activate, and sends signals up my nerve, into my spinal cord, and then shoots up through my spinal cord and up to my brain. My brain then asks the question, "What does this mean? What happens here?" Then, my brain starts to take in some more information about what's going on around the place, to form a decision: Visual Cortex: "What am I looking at right now?" "Well, My finger is touching a black shiny surface, next to some bacon, I'm in the kitchen, there's fire underneath this shiny glass surface." Auditory Cortex: "What am I hearing?" "I'm hearing the crackling of the bacon underneath it, hearing a couple of birds outside in the kitchen, but it's mostly the crackling that I'm hearing." Planning Cortex: "What am I doing tomorrow?" "I need to have these fingers for tomorrow for work, it's actually really important for my fingers to be working" Past Memory Cortex: "What do we remember about situations like this?" "My mum burnt her finger like this years ago, and she would not stop complaining about it, there was a blister on her finger, it must have really hurt." My brain takes in all of the information! From the nociceptors coming from my finger, all of these other inputs, pretty much everything that can possibly be causing a physical issue, and everything that's going on in, and around you. The brain then asks a very important question: Do I need pain now? Or do I not need pain now? My brain will go, "Hey, this is potentially dangerous. So therefore pain is the outcome." That is the decision, and that’s what is going to happen. What's important to note – is that this whole process from the signals going up your nerves and into your brain, happens EXTREMELY fast. So, the response after all of that is ‘ouch!’ and my brain has decided to change my behaviour and take the finger out of the frying pan. That’s normal pain. That's how normal pain generally works to protect us, so that we're not stepping on roads and burning our feet, we're not chopping our fingers off, we're not getting frostbite at the end of our nose, and we're not doing things that are actually, inherently dangerous to us, because pain protects us from danger. Now, I know what you're thinking, what's happening with people that have pain all the time, or what's happening when you have pain that's there when it's inconvenient, and it's not useful anymore? You might've hurt yourself 5 - 10 years ago, and now you're getting pain all the time - it might be after a car accident, it might be after hurting your back a long time ago, and yet the pain is still there. What we now know is that persistent pain is less about tissue damage, and more about the sensitivity of your system. When we've got a bit of sensitivity in the system, what can happen is that the spinal cord can crank up the signal by up to 100 times. It's like you get a normal signal coming in, and then this other signal comes up that’s much stronger than what it should be. With all things being equal, your brain is going to look at that signal and go, "Wow, that's a really big signal." It's then going to go, "Wow, this is dangerous." Therefore, we're going to get some pain as a result of that. What can also happen, is your brain may decide the signal is dangerous for an illogical, or an irrational reason. It’s important to know, that it's not your doing. For example, this might be why you're able to do some gardening, but the moment you vacuum, your back is really sore. This is caused by the context under which you're doing it. The vacuuming, for whatever reason, is causing your brain to say "Yeah, I don't like that" and give you pain as the output, but gardening may be more "Yeah, I enjoy this!" When everything should be normal - there's normal movement, the past injury has healed and scans are clear, but this awful pain is still there - means the signals coming in are being cranked up in the spinal cord, and causing a sensitization process to occur. The third thing that can happen is, a relatively normal signal comes in, but there are other contexts that are coming into your system which are tricking your brain into giving pain when it doesn't really need it. It’s very important to understand the pain that you're experiencing is very real, however the reason why your pain is there, may be different to what you think that it might be. Most of the people we treat here at The Headache and Pain Management Centre have one of two things, when it comes to their long-term, undiagnosed, pain condition. The first thing is: most people have been to see everyone and have tried everything. They’ve been to a physio, chiro, doctor, and tried all of these different treatment methods, so much so that they start to believe their pain will never go away. A lot of the time, when it comes to Headache and Migraine, it might be a stiff joint in the neck that hasn't been moved in the right way, or in a neck or low back, it could be a muscle that hasn't had the treatment that it has needed. It's unfortunately, somewhat common for these things to be missed. This is why we always do a full assessment on all the things that might be causing the issue. Often by removing the issue, things are much better. However, more commonly, when people that have fibromyalgia, chronic regional pain syndrome, post whiplash or persistent low back pain, it's more this sensitization process that's happening which we explained above. Instead of being able to remove the issue, we have to focus on doing things to wind th e system down, so that those signals aren't being amplified quite as much. Therefore, by the time the signals get to the brain, it's not as bad and the brain doesn’t send pain inappropriately. Secondly, we need to consider all of the other inputs that are coming in that’s causing your brain to produce pain unnecessarily. Common things that could be causing this, are things like anxiety, or fear. However, the biggest one is probably a lack of knowledge about why their pain is there in the first place. Our brain really likes to have an explanation for why things are happening. A lot of the time, our brains take a shortcut, or they take the information that best suits them, or it could be the repetition of incorrect information that has been given over time. What I can tell you categorically is, this is actually how pain works. To simplify, there's three levels. There's the peripheral, where it's all the nerves going into your spinal cord. So through your arms, your legs and your feet, the skin, things of that nature. There’s the spinal cord, which takes the signals in, and those signals can be amplified. Then there’s the brain, which receives the signals and needs to make a decision - if something is dangerous or if it's not dangerous. If your brain concludes that, based on all the things around it, that it is dangerous, then it will give you pain. Even if the reality is that it's not dangerous… The education around how pain works is really interesting, and for people who do have a long-term chronic pain condition, it's really important to get to know the principles which we have outlined, and really understand it. The more awareness you have about how pain is prescribed and why it has presented in a certain way, the more comfort and control you will have in managing the pain. Whether, that might mean, engaging in movement, a stretch, or perhaps changing your mind set or knowledge base, it’s important that you know what is happening and what can be done to rectify the issue. Which of course, is what we do every single day. We assess, we diagnose, and we organize a treatment plan tailored to you and your needs – to ensure your pain management is on the right pathway to long-term relief. Click here to see if we can help you too.

If you have pain in the back of your head with a headache or migraine then this blog is for you. A lot of the time all the scans are clear and you've been to your doctors and they can't find anything else that's wrong. There's three things that be causing this pain, here it is... The first and most common cause is a referred pain from the joints, the top three joints at the back of your neck. Most commonly it's a joint right below your skull, just at the top of the neck that can cause some deep tension-like pain that goes right into the back of your head. Sometimes it can refer pain around to the front, into the temples as well. It's really common when you have a very stiff top joint. They often call it the atlas or the atlanto-occipital joint. We’re talking about the joint between the skull and C1. What needs to be careful when you are having that assessed, is that it's moving in the correct direction. If you’re seeing a chiropractor who is manipulating it, doing a really big crack or a click or something with it – it may not be the best thing for it. It actually might just need a bit of a glide on the joint to desensitize it. The second thing. There's a lot of muscles that attach into the top of the neck - they attach from the skull down to C1 and into C2. So into the top bone, which I said is the atlas. The second one called C2 or the axis is what it's called. There's a lot of muscles that attach into the head and a lot of muscles that go down, attach into the neck. Those muscles themselves can refer pain into your head. So even though it feels like your head is the issue, it's the muscles themselves, which are referring the pain. Some of the muscles are called the suboccipitals. The occipital muscles. Rectus capitis. There's a whole swathe of little ones that can refer pain into the back of the head and they're really important. Muscles can often be forgotten when it comes to headaches. Although, it’s so important for them to be assessed to decide the best course of treatment. Do we need to stretch them? Do we need to do something with a bit of massage. Is dry needling an option? Perhaps it's strengthening that's the issue. Reality is, one thing that works for one person might not work for the other person. The third one that can refer pain into the back of the head, is a nerve issue. It's not really that common, but when it is this condition, it is really painful. It’s called occipital neuralgia. There's a nerve called the greater occipital nerve that comes up and supplies the skin predominantly. It feels really compressive when you've got an issue there and sometimes it can sting and it can stab at the back of the head. It's really, really nasty when you do get it and it's really, really painful. So that nerve itself can be a driver of pain. There can be inflammation around and it can be compressed or it could just be sensitized. So there's nothing wrong with the nerve, but the signals coming from the nerve, is actually tricking your brain into thinking that there's something really nasty going on there. We do see a lot of people that are diagnosed with occipital neuralgia, although the reality is it's actually not the nerve itself that's the issue. It's referred pain, from the joint or from the muscle on its own. It's really important to get an assessment if you have got pain at the back of the head. It can be just diagnosed as a tension type headache where it's a lot of paracetamol or other things that are being prescribed to try to wind them down. Perhaps some stretching or some movement might do a little bit of a trick, but not the whole thing. Which is why it’s so important to look at the entire picture. What's sensitizing the whole system? Is it a nerve, muscle, or joint. Is it a combination? Because when we're talking about pain of any type, it's all about the sensitivity of the nervous system, that is the issue. All of those other things are driving that sensitivity to happen. So if it's your muscle, if it's a joint, if it's your nerve, it does need to be assessed. I hope this helps and gives you some understanding of what may be happening. Please feel free to click here to get in touch if you have any questions. Have a great day!

Pudendal Neuralgia... This particular condition is relatively uncommon. Unfortunately, patients can feel embarrassed to have this condition, as it affects your pudendal nerve, which comes out of your sacrum and then pretty much supplies everything in your jocks effectively. The inside of your thigh, the external genitalia, and also a branch of the nerve that goes down the back of your leg. The symptoms you can get from this really nasty condition can differ for males and females. With females, it can feel like a really strong period pain, a lower abdominal pain, and with men, it can feel like they've been 'kicked in the balls' effectively. One thing that men in particular tell us, is it feels like their jocks are too tight - that they feel like they constantly have to adjust their underpants, and it's not helping. It just feels like this really deep abdominal pain, typically on the one side where it's affected. On both sexes, there’s symptoms such as burning and painful urination and pain with defecation as well. Other symptoms may include pins and needles and numbness on the inside of the thigh and the external genitalia. Typically we find with these patients, they can get tailbone pain and what's called coccyx pain as well, where it's really painful to sit and lean back because it feels like there's a sharp pain on your tailbone. As you can see this condition is really quite awful. It can be very uncomfortable, certainly going to the toilet is affected and just other activities of daily living like sitting is not pleasant. Most people with this condition often go to the doctor first due to the pain in their lower abdominal, or pain when they're going to the toilet. Quite often they're misdiagnosed as having some kind of infection. They're diagnosed as having period pain. They're diagnosed with effectively anything else. They’re sent for all sorts of scans and sent to different specialists around the place to try to work out what the cause of this pain is. In some really bad cases, they can get some false positives where you can get an ultrasound done, and it looks like surgery needs to be done. Although, the reality is the pain could be coming from something else, and that something else is the pudendal nerve. What causes the pudendal nerve to get irritated and have pain? Where it can get irritated is in the SIJ - your sacroiliac joint. It’s the big sort of bone right at the bottom of your spine that matches and joins in with both pelvic bones. If it's not moving well it can cause the nerve to get irritated. It typically happens to those who sit a lot and is more common in cyclists than any other population, more because they're bending right forward over the handle bar. So it's putting pressure and strain through that pudendal nerve. After they stop cycling, they feel like they've got tailbone pain or pain on the inside of the groin. How can Pudendal Neuralgia be treated? Firstly, to have a look and see what the range through the pelvis is like. See how the sacrum and pelvis are moving in relation to each other. If there's one pudendal nerve, like one side that's affected, then basically the movement of that pelvis on the sacrum is going to be affected on that side as well. The treatment can be relatively simple. There was a really good protocol that was designed by another Brisbane physiotherapist about 10-15 years ago... His name's Peter Dornan. His protocol was showing enormous results, more so than any other treatment for this condition had ever seen before. So much so that the research knocked it back because the results were unbelievably good. The good news is that it's now been published, and it showed that 90% of people when you follow this protocol can actually get some really good effects and results from following this protocol. It involves getting the sacrum moving, doing some strength work around the sacrum and pelvis and doing some strength work with the abdomen as well. Other things that can affect the treatment of this condition is the tightness in the muscle called ‘Psoas’, which runs down the front of your spine. There's a couple of nerves that run through psoas, one that's called the iliohypogastric nerve and the other one that's called the ilioinguinal nerve. Also the genitofemoral nerve. They all flow through that psoas muscle and sort of talk to one another to cause us to have a functional deficit to happen. It’s necessary to have a look at the movement of the sacrum. Look at where the nerve comes out. Get it moving in any way possible. Typically, exercise is the best way to do that and you'll find that the symptoms start really decreasing a lot in terms of being able to feel things again, in order to have less pain when you're going to the toilet and things of that nature. It's not uncommon to see it in people with chronic low back pain either, where you have a lot of low back pain sort of on one side. They find that there's these other unrelated, well, what they think are unrelated symptoms that are happening either on the inside of their groin or in that area. If you find this is you, it's really important to talk to your doctor or physio about the potential of them being linked to see if there's actually a relationship there. A lot of the time you can just ask the question and sure enough, there actually is an issue there and it can crack the case, not just for the pudendal nerve, but also for low back pain as well. Is surgery needed for Pudendal Neuralgia? Surgery generally isn't needed for this. It used to be the routine thing to treat this, but it's found that it's only a 50% success rate and a 50% chance of making it worse. We now have a protocol which can be followed to get this right 90% of the time. I hope this was helpful, please feel free to get in touch with us via private message or contact us here if you have any questions, or if you are suffering with this condition yourself – let us know and we can assist you in the best way we can.