Introduction: 

Chronic pain is a debilitating condition that affects millions of people worldwide. Whether it’s back pain, neck pain, headaches, or any other type of chronic pain, it can be frustrating when the pain keeps coming back despite our best efforts to manage it. In this blog post, we will explore why chronic pain persists and what can be done to manage it effectively, with a focus on physical therapy as a viable treatment option.

What is the number one cause of chronic pain? 

Since chronic pain can be brought on by a number of different circumstances, there is no one main element that causes it. An accident, an underlying medical disease like fibromyalgia or arthritis, nerve damage, or other physiological, psychological, or social factors can all contribute to chronic pain. Many times, chronic pain is a multifaceted, complex problem that necessitates an all-encompassing approach to diagnosis and treatment. To identify the underlying cause of chronic pain and create a personalized treatment plan, it's crucial to engage with a healthcare professional like a physical therapist or pain management specialist.

Why Does Pain Come Back? 

There are several reasons why chronic pain persists or keeps coming back, even after treatment. Pain is a complex phenomenon that involves both physical and psychological factors, and often it's a combination of these factors that contributes to the persistence of pain.

Factors Contributing to Chronic Pain

A. Physical Factors

Physical factors that can contribute to chronic pain include underlying medical conditions such as arthritis, fibromyalgia, and nerve damage. Injuries, accidents, and surgeries can also cause physical damage that may result in chronic pain. Poor posture, muscle imbalances, and weak core muscles can also contribute to chronic pain by putting unnecessary stress on the body.

B. Psychological Factors

Psychological factors such as anxiety, depression, and stress can also contribute to the persistence of chronic pain. Chronic pain can lead to feelings of hopelessness, helplessness, and isolation, which can worsen psychological distress. Research suggests that emotional stress can amplify the intensity of pain, making it harder to manage.

C. Social Factors

Social factors such as lack of social support, poverty, and social isolation can also contribute to the persistence of chronic pain. Chronic pain can disrupt our ability to work, socialize, and engage in hobbies, leading to a sense of isolation and loneliness. This, in turn, can exacerbate feelings of stress and anxiety, further worsening the pain.

How Physical Therapy Can Help Manage Chronic Pain

Physical therapy is a non-invasive treatment option that can be effective in managing chronic pain. Physical therapists are experts in diagnosing and treating musculoskeletal conditions that contribute to chronic pain. It can also address psychological and social factors that contribute to pain.

Physical therapy treatment for chronic pain may include manual therapy, therapeutic exercise, and modalities such as cupping and dry needling. Manual therapy techniques such as myofascial release, joint mobilization, and soft tissue mobilization can improve joint range of motion, reduce muscle tension, and improve circulation. Therapeutic exercise can strengthen weak muscles, improve posture, and reduce the risk of further injury. Modalities such as cupping and dry needling can help reduce pain and inflammation.

Physical therapy also addresses psychological and social factors that contribute to pain. Physical therapists can teach relaxation techniques, stress management skills, and coping strategies to help patients manage the emotional distress associated with chronic pain. They can also provide support and guidance to help patients engage in social activities and regain a sense of purpose and meaning in life.

Why does chronic pain come back shortly after discharge from physical therapy?

For several causes, chronic pain might return soon after being released from physical therapy.

First off, it's crucial to realize that physical therapy does not treat chronic pain. Instead, by treating the underlying physical, psychological, and social aspects that contribute to pain, physical therapy is a therapeutic option that can aid in managing chronic pain. It is essential for a patient to carry on using the exercises and skills they learned in physical therapy after being discharged from the facility. The physical variables that contribute to pain can get worse if a patient quits doing these activities or doesn't keep up an active lifestyle, which can cause pain to return.

Second, social and psychological factors may also play a role in the recurrence of pain. Physical therapy-discharged patients who have anxiety or depression may experience increased discomfort that is more difficult to manage. Similar to how social isolation or a lack of social support for the patient once physical therapy is over can intensify stress and anxiety symptoms, making the pain worse.

Last but not least, it's critical to remember that chronic pain can be a complicated and multidimensional condition, and there may be underlying illnesses or injuries that demand continuing care. To effectively manage their chronic pain, a patient may need to keep working with their healthcare professional, which may include a physical therapist.

In summary, a number of factors, such as the failure to maintain an active lifestyle, psychological and social issues, and underlying medical disorders, can cause chronic pain to return soon after physical therapy is finished. In order to effectively manage their chronic pain, patients must continue to use the exercises and strategies they learned during physical therapy and closely collaborate with their healthcare professional.

Conclusion

Chronic pain is a complex phenomenon that involves physical, psychological, and social factors. Effective management of chronic pain requires a comprehensive approach that addresses all of these factors. Physical therapy is a non-invasive, safe, and effective treatment option that can help manage chronic pain. If you are struggling with chronic pain, contact a physical therapist to learn more about how physical therapy can help.

External Resources and Links for Managing Chronic Pain:

1. American Physical Therapy Association (APTA) - Chronic Pain Management
2. National Institute of Neurological Disorders and Stroke
3. "Physical Therapy for Pain Management: What You Need to Know" by the Cleveland Clinic: https://health.clevelandclinic.org/physical-therapy-for-pain-management-what-you-need-to-know/
4. "Physical Therapy for Chronic Pain Management: The Benefits, Techniques, and More" by Verywell Health: https://www.verywellhealth.com/physical-therapy-for-chronic-pain-management-4157647

Posture and headaches are often discussed in the same sentence when it comes to improving headache symptoms. I have been treating patients with headaches since 1998, but it wasn't until 2004–05 that I saw headache patients all day. I had just moved to Austin, Texas, and was in the process of opening CORE Therapy & Pilates.

I started working for a headache and pain specialist just down the street while I was building my clinic from scratch. So, I told the doctor that I would move on as soon as my clinic was busy. He agreed, and I saw 16 headache patients a day for him twice per week for 8–9 months.

I worked with occipital neuralgia, migraines, tension headaches, cluster headaches, neck pain, fibromyalgia, and herniated disks in the neck. Headaches are a common diagnosis we treat at CORE Therapy & Pilates in Westlake Hills, Texas. One of the most frequent questions I get is about posture and headaches and how they are related. 

Poor slouched posture is much more common today for all ages due to our unquenchable thirst for technology and having our phone in our hand. Improving your poor posture is one of the most important things you can do to help your headaches.

No amount of medicine, injections, or procedures is going to improve your posture! 

You have to learn what to do to strengthen your posture, do it, and keep putting in repetition in order to make new motor memories.

These are the top six questions we get about posture and headaches.

1. How does poor posture contribute to headaches?

The most common posture that I see that causes headaches is called a "forward head posture." Forward head is a description of the position of the head in relationship to the spine. Imagine the head is a 15-pound bowling ball, and it sits on top of a wooden dowel.

Now imagine that bowling ball sitting 3 inches forward instead of being centered on the dowel. That becomes an immediate problem for the bowling ball and dowel. The same goes for the head and spine.

For every inch the head is displaced forward, there is approximately 10 pounds of force transmitted to the spine at the base of the neck, where the cervical and thoracic spines come together. When the head is sitting forward, it ends up causing imbalances in the muscles of the neck.

The occipital nerve is a cranial nerve that exits below the skull and just above the first cervical vertebra on both sides of the back of the neck. The compression of this nerve due to the forward head causes irritation of the nerve, resulting in a headache known as occipital neuralgia.

Once this nerve is compressed and irritated, the pain can be at the back of the upper neck, behind the eye, or anywhere in between those two spots.

2. What self-test can someone do to tell if their headaches are from poor posture?

If performing a chin tuck relieves your headache, then it is a pretty good indication that forward head posture is causing your symptoms.

1. Sit up tall, squeeze your shoulder blades together in the back, and perform a chin tuck by bringing your head over your spine. 
2. Bring your chin towards your throat as if holding the bowling ball over the dowel.
3. Repeat 2-3 sets of 10 reps and check the response. 

If there is a reduction in your symptoms, then that is a good sign that postural strengthening exercises would help with your headache. Try these advanced chin tuck exercises with a towel.

3. How can people improve their headaches caused by poor posture?

A series of stretches and release exercises, followed by strengthening exercises, is the most effective way to improve your posture. Imagine that the muscles in the front of the neck are locked in a shortened position and pulling your head forward.

We call that "locked short." The muscles in the back of the head are then locked long in response to the fact that the muscles in the front are locked short all the time.

So by stretching and releasing the "locked short", tight muscles and following that up with strengthening of the "locked long" muscles, we get postural balance.

Try these stretches and exercises to alleviate your headaches…

4. What exercises and stretches can people try at their desk and as part of their workout routine to prevent headaches caused by poor posture?

The first one is the chin tuck described earlier. This should be done multiple times per day if you are sitting at the desk for long periods.

1. At the desk, I like to teach my patients to sit tall, grasp their hands together behind the base of their skull, open the elbow wide, pull the head to the ceiling slightly, and extend the upper back. 
2. Repeat this 10 times, and you may feel or hear a few gentle cracks in your upper back.
3. For your pre-workout routine, grab a 36-inch foam roller and lay on it from your head to your tailbone.
4. Bend your knees and bring your arms out to the side at about 80–90 degrees. Relax into this and take deep breaths for 3-5 minutes to open your chest.
5. Follow this up with scapula stabilization exercises like rows and lat pulls.

5. Do posture correctors help people maintain proper posture?

I am not a fan of posture correctors for the long term, but I am ok with using them at the beginning of the rehab and postural reeducation process. It's kind of like the back braces you see the guys wearing at Home Depot and big warehouses.

They do not help those suffering with back pain and, in fact, end up causing more harm than good. If you rely on an external stimulus to correct your posture, then your brain will never develop the awareness and strength to do it on its own.

6. When should someone see a physical therapist about their bad posture and headaches?

Go now if you are experiencing headaches! There is no reason to suffer with headaches and hope they get better on their own. Medications and postural correctors will not solve your postural problems, so go see a physical therapist and get a plan.

Get guidance on what muscles are "locked short" and need stretching and what muscles are "locked long" and need strengthening. Posture does not improve overnight and necessitates the formation of new motor memories in the proper posture.

I am a licensed physical therapist and experience occasional neck pain and headaches from poor posture using my cell phone and computer. These tips and tricks that I have shared today are the things that I do on a consistent basis to keep my posture as tall as possible. 

Pilates exercises were the thing that improved my posture the most. It was awareness exercises incorporating core strength with coordination of the abdominals and shoulder blade stabilizers on the Pilates equipment that improved my posture significantly at age 28.

Call 512-215-4227 now to get started on improving your posture and decreasing your headaches and neck pain.

Check out my YouTube videos with demonstrations of these tips and many more at

Learn more about posture and headaches from the American Migraine Foundation.

Try these Headache stretches and Occipital Neuralgia Stretches today. It's Stephen Dunn with CORE Therapy and Pilates and today we're going to go over a couple of towel stretches for your neck. These are typically performed to help with headaches or occipital neuralgia.

Headaches throughout history

Ancient references to headaches, migraine, and neuralgia go back to around 1200 BC. The first headache treatment is evident in a 9000-year-old Neolithic skull. Headaches are one of the most common complaints for those seeking medical care. Headaches cost an estimated $14 billion per year in both direct and indirect socioeconomic costs. Globally, 40% of people suffer from tension-type headaches and 10% suffer from migraines. Females suffer from headaches at a much higher rate than males. Learn more about headaches at this article.

Learn more about Occipital Neuralgia HERE. 

If you're feeling that headache starting to come on, particularly at the base of the skull or just above or behind your eye, try these Occipital Neuralgia exercises Now!  

These towel stretches and exercises will give many people relief at the time they are suffering from a headache. However, if performed consistently when not experiencing a headache can help in many ways. This towel routine can help the mobility of the upper cervical spine and relieve pressure on the occipital nerve caused by tight suboccipital muscles.  

I'm going to show you two ways of doing this routine. One is with a simple hand towel and the second is using a specialized strap called a Mulligan Self Snag Cervical Strap. We're going to start off with a hand towel because everyone has a towel at home.

Occipital Neuralgia Stretches with a Towel

Chin Tuck with the Towel

With the towel placed around the back of the neck, just under the skull, we're going to do a chin tuck. First, hold each end of the towel and pull it away from your head gently. Now perform a chin tuck by bringing your chin back into your throat as you stack your head on top of your spine. Do not look up or down while doing the chin tuck. Maintain your visual field and sight across the horizon.

When performing this exercise with the towel, make sure to hold the towel by the edge of the towel and not by bunching it all up. Pull away with your hands gently as you perform the chin tuck...

Hold for five seconds and relax.

Hold for five seconds and relax.

Repeat 10 times.

Chin Tuck with the Strap

Let's practice with the strap if you have one. You'll see the actual chin tuck motion a little better as I show you the strap versus the towel. Place the strap right at the base of the skull. Find the knob on the back of the skull and drop it down about an inch. Using the ergonomic handles of the strap pull straight away with your hands as you do the chin tuck. I want you to hold 5 seconds and perform 10 reps.

That's the first one.

Rotation Stretch with the Towel

The next thing we're going to do is called a rotation stretch. We're going to take that same towel and put it around your neck and let it fall on your chest. Cross your hands in front of you with your right hand under (closer to the chest) your left hand. You are going to grab onto the left side of the towel with your right hand. Grab the right side of the towel with the left hand on top.

Right hand under, left hand on the top while holding the ends of the towel. The right hand is going to pull straight down on the towel like an anchor and the left hand is going to pull the towel under your right ear, between your nose and mouth, and pull straight across to the left, causing your neck to rotate to the left.

Hold that for 10 seconds and repeat it three times.

Now switch the hands and have the left hand on the bottom, pulling straight down on the towel. Do not pull across and choke yourself, pull straight down with the bottom left hand. With the top right hand, pull the towel to the right and hold for 10 seconds. Repeat three times on that side, 10 seconds each time. You should feel this stretching just under the left ear and left side of the base of the skull. This is where the first cervical vertebra attaches to the skull. One side will typically feel more restricted than the other. See if you can tell the difference in your right rotation versus your left rotation. 

This hand placement can get confusing so please watch the video a few times to see the entire routine.

Rotation Stretch with the Strap

What's the difference between the towel and strap? The strap is longer and has ergonomic handles making it easier on the hands. The towel is more challenging to hold and negotiate.

Place the strap around your neck and let the handles hang. Cross the hands with the right hand on the bottom and the left hand on top. The anchor is the right hand and pulling straight down. The left hand is pulling across to the left with the strap under the ear and between the nose and mouth. You will feel a more specific stretch in the suboccipital muscles with the strap compared to the towel.

Hold 10 seconds and repeat three times on this side.

Now switch the hands and stretch in the opposite direction.

And that's it. That's your towel and Mulligan Self Snag Strap stretches to help with headaches and occipital neuralgia. Do these headache stretches and occipital neuralgia exercises daily and see how things change.  

Local to the Austin area, call 512-215-4227 to learn more about how we can help you with your headaches... We have helped hundreds of patients improve their headache symptoms with our physical therapy program at CORE Therapy & Pilates in Westlake Hills, Texas.

Thanks a lot, guys. Y'all take care. We'll see you soon.

輕鬆緩解枕神經痛(occipital neuralgia) | 物理治療簡單兩招 Andy C. Tseng, DPT, MOT, MTC, NCPT || Physical Therapist, Occupational Therapist and Pilates Instructor at CORE Therapy & Pilates, Austin, TX

你有過頭痛痛到額頭、眉毛甚至眼睛的經驗嗎？這很可能是枕神經痛作祟！本片將介紹枕神經痛的成因，以及兩個簡單的緩解運動。 請在下方留言，告訴我們你或者身邊的人是否受到枕神經痛困擾...？ 建議觀眾朋友到我們網站下載免費的緩解偏頭痛電子書--

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0:31 枕神經痛的成因

1:27 枕神經痛的緩解運動

Do these occipital neuralgia exercises if occipital neuralgia bothers the base of your skull and behind your eye. 

Occipital Neuralgia exercises are the best natural solution to Occipital Headaches. Why is occipital neuralgia causing so much pain and frustration in my life? By the end of this video, you’ll have the essential stretch that no one is talking about and the number one occipital pain exercise to improve occipital neuralgia and the symptoms that it’s causing. I’ve helped hundreds of people over the past two decades suffering from occipital nerve pain, occipital migraines, and occipital headaches by teaching them the essential occipital neuralgia exercises. I look forward to helping you as well.

Occipital Neuralgia: What it is?

Occipital neuralgia is a diagnosis that one gets when their occipital nerve is compressed and causing pain or headaches. Compression of this nerve is typically beneath your skull and above your first cervical vertebra. There is seven cervical vertebrae with the first cervical just under the skull. And where that nerve comes out, it basically gets compressed. The nerve goes up and over your head to the back of your eye. So, you get pain and symptoms at the base of your skull that can go up and over to behind your eye. It is more common to be on one side but can affect both sides.

What causes Occipital Neuralgia?

Why is this compression of my occipital nerve taking place? More commonly than not, it’s a positional fault by your head being forward. Basically bad posture from looking down at your phone, slouching while driving, or whatever. By the head being forward, it’s causing compression on that nerve. And what that’s doing is its causing tightness… Or let me rephrase that, there’s tightness here in the front of the neck causing the head to come forward. So, let’s work on that.

What Occipital Neuralgia exercises should I do?

Platysma / Scalene Stretch

First, we’re going to do is two stretches for the front of the neck. Most people focus on the back of the neck, which is important but I like to focus on the front of the neck where the head is getting pulled forward.

So, there is a muscle here called the platysma. Ah, it’s a funny word, platysma. It’s from just below the collarbones up to the jaw and underneath it, the scalenes. The scalenes are attached from the ribs up to the vertebra and your cervical spine.

We’re going to use our hands. You’re going to put one right underneath your collarbone. As you put your hand underneath your collarbone, use the other hand on top of the first hand and give a little force into the body and then down towards the floor. As you do that move your neck in the opposite direction of your hands and look up and over your shoulder.  You should feel the stretch all through the front of the chest and neck. 

Take 4-5 deep breaths in this position allowing your gaze and head to go a little further with each exhale. Inhale and exhale. 

Repeat on the opposite side, and put the hand right under the collarbone. Hold in and down with the other hand and look up and over that shoulder. My right one is a little tighter. Take four or five deep breaths into that position. So that’s the stretch for the front and side of the neck. The scalene and the platysma.

Chin Tuck Occipital Neuralgia Exercise

One of the best neck pain exercises available. The chin tuck will help bring your head back and tall to help avoid compressing that nerve. 

Bring your chin back towards your throat. 

Also, think about lengthening your spine. This length of the back of your neck helps relieve the pressure off that inflamed nerve. 

Go back and up. Chin tuck. Back with the head going up.

I like to put my hand here on top of my head and think about pushing my hand towards the ceiling. Pushing my hand towards the ceiling with my chin tuck.

And that’s the chin tuck, to open that space where the occipital neuralgia is bothering you.

Do these Occipital Neuralgia exercises a couple of times a day for a few days to see if you get any relief. 

Try these products from Amazon to help with your occipital Neuralgia symptoms.

Download our Free Report

Click on my website and download the free report on headaches and neck pain. You can find that at: https://therapyandpilates.com/headaches.

Thank you for watching my video today and reading my blog today. I hope you got some value… And these occipital neuralgia exercises help improve your occipital neuralgia.

If you need more information and you like to reach out and schedule an appointment with us at CORE Therapy & Pilates, give us a call at 512-215-4227.

What is Occipital Neuralgia? 

Occipital neuralgia is a distinct type of headache that can cause a throbbing, piercing, or electric shock pain, usually on one side of the head, that can travel from the upper neck to the scalp, behind the ears, and possibly behind the eyes and forehead. Some patients may also experience increased sensitivity to light and their scalp can be tender to the touch.

These symptoms are caused by the greater and lesser occipital nerves when they are compressed as they exit the spine where it meets the skull, or by tight muscles in this area. Typically, this is caused when the head is in a forward position leading to closing of the joint between the skull and spine and tightening of the muscles located in the upper neck and at the base of the head. 

Most of the treatment strategies we will discuss include improving the space where these nerves exit by moving the head into a better position over the spine which increases the length of the spine. This also includes making sure the low back and the shoulder blades are in the correct position as well, typically, because when people first try to bring their head backward; they arch their back to compensate. 

Included is a 10-minute exercise routine to address the issues mentioned previously. It involves improving the posture, use of a towel to stretch the neck where the nerves are compressed, and several basic neck and spinal stretches. 

Occipital Neuralgia Exercises

Lumbar and Scapula Stabilization

The first exercise we will work on is to place the low back, or lumbar spine, in a neutral position. Start out in sitting, with your feet slightly ahead of your knees. You will then gently push into your heels engaging by engaging your hamstrings and glutes which will assist you in gently tilting your back and pelvis posteriorly. At the same time, you will also gently squeeze your shoulder blades toward each. This causes what I term the slinky effect, which helps to improve your posture and lengthen your spine. You can then repeat this for five breaths. 

Towel Chin Tuck

Next is an exercise to help stretch your neck. You will take a towel and place the edge underneath your neck while in a seated position. The edge of the towel will not be on your head, but on the second cervical vertebrae underneath where your neck meets the base of the skull.

You will then take hold of the edge of the towel and pull gently forward while tucking your chin in. Simultaneously, you will gently press your heels into the ground and flatten your low back to further lengthen the spine.

Make sure when doing the chin tuck that you are not extending your neck by looking upward, but you are engaging the muscles in the front of the neck and getting into a “double chin” position. What this will do is to improve the space where the occipital nerves exit the spine at the levels of the first and second cervical vertebrae and the skull. You can repeat this for five breaths as well. 

Towel Rotation Stretch

This next exercise is called a Cervical Snag. It is effective in improving the motion of her upper neck. You will begin in a seated position with your feet slightly past your knees. You will have a towel and place it again on the second cervical vertebrae below the skull.

Now, cross your left arm over your right arm on your chest and take the edge of the towel. Performing this simultaneously, you will gently pull down on the edge of the towel with the right hand while you pull the other end of the towel with your left arm at the level of the neck while rotating your head to the left.

Hold this position as you take in two deep breaths while lengthening your low back. Come back to the neutral position. You will now do the other side by crossing the right arm over the left arm. Taking each side of the towel, now pull down with the left arm while pulling forward with the right arm and rotate the head to the right. Hold for two breaths, and then relax back to a neutral position. 

Rotator cuff exercise

Next, we will perform an exercise to help retrain the shoulder blades and rotator cuff muscles that are in the shoulder. In the same seated position, take the ends of a towel or Theraband while bending your elbows next to your side at a perpendicular angle to your shoulders.

Then, pull the ends away from each other while squeezing your shoulder blades together and engage the muscles below the notch in your shoulder blade called the Infraspinatus and Teres Minor. This is accomplished by rotating your arms backward. While doing this, make sure to flatten your low back and perform a chin tuck to bring the head over your shoulders instead of forward. 

Upper Trapezius Stretch

The next exercise is a stretch for the Upper Trapezius. In the same seating position, and without arching your back, you with placing your left arm behind your back and take your right hand to the top of your head.

You will then gently bring your head to the right and hold until you feel a stretch in your upper shoulder. Then, repeat for the other side by placing your right arm behind your back and using the left hand to pull the head to the left.

Hold each side for two breaths. You can modify this stretch by placing by holding the side of a chair instead of placing your arm behind your back. 

Levator Scapulae Stretch

Next, is a stretch for your Levator Scapulae. It is the same sequence as the Upper Trapezius stretch performed before, but now you bring your head down and nose pointing into the armpit opposite of the side you are stretching. You can hold each stretch for 2 breaths and then repeat on the other side. 

Spinal Twist

These next exercises are to increase mobility in your thoracic spine, which is the middle and upper section of your back. The first is for rotation. Again, in the same seated position, take an inhale and on the exhale rotate to the right while pressing the left hand into the left thigh.

Then switch positions by rotating to the left and pressing the right hand into the right thigh while looking over your left shoulder. Come back to the neutral starting position. 

Side Stretch

Now, while maintaining the elongated spine, reach down to your left side and side bend your back toward the left. Hold for two breaths and then return to the starting position. Then repeat on the right. Next, lift your right arm up and then bend to the left side to assist in stretching the right side of the body. Repeat for the right side. 

Shoulder Rolls

Now, finish up by performing some shoulder rolls. In the same seated position, length your spine and gently roll your shoulders back by taking deep breaths. This concludes the regime for the Occipital Neuralgia exercise! 

Check out what Hopkins Medicine has to say about Occipital Neuralgia.  Please try physical therapy with an experienced clinician before trying the surgery they discuss as I have seen very little relief from it.