Elena Suarez

Referred pain is pain felt somewhere other than where the cause is situated. In muscles pain is referred through trigger points.

A trigger point is a sensitive area or hyperirritable spot in the muscle or connective tissue (fascia) that becomes painful when compressed. Pressing on a trigger point can produce a local twitch response and reproduce specific referred pain.

Many of my clients’ experience headaches due to trigger points which can be caused by muscle injury or repetitive strain. The following images show examples of triggers points (x) that can cause headaches.


Poor posture causes your stabilizing muscles to switch off, and other muscles to work in excess causing muscle tension. Poor upper body and head postures can cause increased tension in muscles around the neck occasionally referring pain to arms, upper back and/or the head.

For example, in the picture below we can observe someone with a forward head and shoulders posture. This posture causes your upper trapezius and your pectorals to be short/tight and your deep neck flexors and postural shoulder muscles, Rhomboids and Serratus Anterior, to switch off.  The deep neck flexors are the stabilising and ‘core’ muscles of your neck, that hold your head upright and along with your postural shoulder muscles need to be strong and in an optimal position.


Cervicogenic headaches can mimic migraines. The primary difference is that a migraine headache is rooted in the brain, and a cervicogenic headache is rooted in the cervical spine. These problems in your neck can be caused by disc degeneration or prolapse, facet joint arthritis or sustained poor postures. Prolonged poor postures and positions at work are huge contributing factors to triggering this type of headache i.e. office jobs, dentists, drivers.

If you have this type of headache, physiotherapy could help you significantly. At Four Sides London we will assess your movement patterns and muscle control whilst asking questions to understand better where the dysfunction is, and how we can restore normal movement and regain strength.


We will work on 2 main areas to relieve your symptoms and prevent them from coming back.

  • Manual therapy
    - Trigger point release with techniques such as myofascial trigger pointing, acupuncture or dry needling
    - Joint mobilisations to improve and restore and segmental movement in your spine
    - Myofascial (muscle) release through massage, acupuncture or dry needling
    - Taping to offload muscles and facilitate muscle activation.
  •  Rehab

It is key to gain active movement in your thoracic spine and strength in your deep neck flexors and posterior postural shoulder muscles. This will help you hold your head more upright and shoulders open. Within rehab we will discuss optimising your postures at work and in daily life to relieve your symptoms and prevent them reoccurring.


Here are two exercises to get you started:

Deep neck flexors

Lie on your back with your knees bent and feet flat on the mat. Place a rolled towel below your neck filling the space but not lifting your head or neck up. Activate your deep neck flexors by gently taking your chin in (as if making a double chin but not quite) and growing out from the crown of your head. This is a small movement activating the deep core muscles in your neck so avoid going too far and activating the bigger superficial muscles in your neck. Hold for 10 seconds x 10 repetitions.

Cat/ camel stretch 

Four point kneeling. Exhale as you tuck tailbone between your legs peeling up through one vertebrae at a time lifting up through the ribs and taking the spine up into a C-shape position bringing your chin in to your chest. Inhale release the tailbone articulating slowly back through your spine into a U-shape. You can repeat it in both directions to improve and work on segmental spinal movement. Repeat x 10 repetitions.


If you have any questions, feel free to contact me at [email protected]  Look forward to seeing you soon.