PT Treatment of Cervicogenic Headaches

Navigating the Path to Relief: Physical Therapy for Cervicogenic Headache Treatment

Cervicogenic Headaches- Causes and treatments 


What is a cervicogenic headache? 

A cervicogenic headache is a headache that originates from structures in the neck. It is known as a secondary headache because it is a symptom of an underlying problem such as a neck issue or injury.  These headaches usually accompany a reduced range of motion (ROM) of the neck and may be confused with a migraine, tension headache, or other primary headache syndromes.  

Diagnostic criteria must include all of the following points: 

  1. The source of the pain must be in the neck and perceived in the head or face.
  2. Evidence that the pain can be attributed to the neck.
    • It must have one of the following: demonstration of clinical signs that implicate a source of pain in the neck or abolition of a headache following diagnostic blockade of a cervical structure or its nerve supply using a placebo or other adequate controls.
  3. Pain resolves within three months after successful treatment of the causative disorder or lesion. 


What causes a cervicogenic headache? 

A cervicogenic headache is caused by referred pain arising from irritation of cervical (neck) structures innervated by spinal nerves C1, C2, and C3. Therefore, any structure innervated by the C1–C3 spinal nerves could be the source of a cervicogenic headache. These nerves can radiate pain to the back of the head, behind the ear, and the upper shoulder. 


Nerves of the neck






Image illustrating nerves of the neck and shoulder.


Because cervicogenic headaches arise from problems in the neck, different conditions can trigger this type of pain. These include degenerative conditions like osteoarthritis,  disc issues in the neck, or a whiplash injury. An injury to the neck from falling or playing sports can also trigger these headaches. They may also occur due to your posture while sitting or standing.  Falling asleep in an awkward position can also cause these types of headaches.  A compressed or pinched nerve in or near the neck is another cause of cervicogenic headaches. 


Cervicogenic headache treatment

Physical therapy is considered the first line of treatment.  Your doctor of physical therapy will ask questions about your symptoms, assess your range of motion, joint mobility, posture, and strength. They will then come up with a treatment plan that will help eliminate the underlying cause of the headache. Our doctors of physical therapy provide evidence-based treatments that are backed by science. 


Physical therapy treatment for cervicogenic headaches may include: 

  • Massage
  • Dry needling 
  • Joint mobilizations of the neck and upper back
  • Posture education and retraining
  • Strengthening exercises


Most cervicogenic headaches respond very well to physical therapy treatments. In more severe cases, further medical management may be needed. 

Other treatment options include: interventional therapy (injections, ablations, nerve blocks, etc.) which will differ depending on the cause of the headache. 


Do I need imaging (x-ray or MRI?)

Imaging of the cervical spine is not sensitive enough for diagnosing a cervicogenic headache. Recent studies show no specific radiologic abnormalities associated with cervicogenic headaches, meaning that your imaging may be normal even if you have headaches. MRIs or CTs can be ordered to help rule out some possible causes such as Chiari malformations, nerve root pathology, or identify spinal cord pathology (e.g., asymmetric facet arthropathy or rheumatoid changes around the atlantoaxial joint) but cannot point directly to a cervicogenic headache.  Surgery is performed only as a last resort


If left untreated, cervicogenic headaches can become severe and debilitating. If you have a recurrent headache that doesn’t respond to medication, see a doctor. The outlook for cervicogenic headaches varies and depends on the underlying neck condition. However, it is possible to alleviate pain and resume an active lifestyle with physical therapy treatment. 


Our doctors of physical therapy can help screen for the cause of your headache and help you determine if further medical intervention is needed. 


Take charge of your health today! Request an appointment with one of our skilled Doctors of Physical Therapy to start feeling better now.

More questions? Give us a call at (479) 442-7473.


Carrie Lynch









Written by Carrie Lynch, PT, DPT



Image source:



jaw pain treatment

Taking a Bite Out of TMD: Physical Therapy Treatment of Jaw Pain

Physical Therapy for TMD

Have you ever seen someone on TV clutching their jaw in pain and exclaiming, “I have TMJ!”? Well, the truth is, they’re not wrong–we all have TMJ, two of them to be exact. The TMJ, or temporomandibular joint, refers to the joint between the jaw bone and the temporal bone of the skull. What people are actually referring to when they have pain in these joints (there is one on each side), is TMD, or temporomandibular dysfunction.


What is the TMJ?

The TMJ is responsible for opening and closing the jaw, as well as assisting with speech. The TMJ consists of the two joint surfaces that contact a cartilaginous disc in the center, which provides cushioning and stability to the joint. Pain associated with TMD may be felt in the jaw, face, ear, neck or head. Associated symptoms may also include ear fullness, ear pain, tinnitus, headaches, clicking, popping, grinding, or getting stuck with your mouth open or closed.


What is TMD?

TMD refers to dysfunction of the TMJ and associated structures. There are several categories of TMD that are culprits for causing pain in the jaw and surrounding areas. 

Muscle Disorders

  • Tightness in the muscles responsible for moving the jaw (primarily closing) can cause pain that may be felt in the temple, cheek, face, jaw, or head.

Disc Displacement

  • Disc displacement is generally characterized by abnormal movement (too much or too early) of the internal disc during opening and closing of the jaw. Normally the disc should slide forward during jaw opening, but sometimes this occurs too early or the disc can remain stuck in a forward position, causing increased pain with jaw opening or closing. Sometimes the jaw can even get stuck in an open or closed position. 


  • Just like any other joint that moves, there can be arthritis in the TMJ. This occurs due to normal wear and tear over time, but it can cause pain and what is known as “crepitus,” or abnormal joint sounds that may sound like crunching or grinding. However, disc issues can also cause noise when opening or closing the jaw. 


What to do if you think you have TMD

  • The good news—Physical Therapy is an excellent, though often underutilized first-line treatment for TMD.
  • Your PT will assess your jaw and neck movement and check for any tightness in the muscles and joints.
  • There are many treatment options for TMD. They might consist of stretching, range of motion exercises, stretches for posture, and hands on therapy on your jaw, muscles of mastication (eating) and neck and jaw joints. Dry needling is also well supported by current research as a treatment for TMD.
  • Your PT will also work with your dentist or orthodontist if they think that any mouth guards or other dental intervention is needed. 


Take charge of your jaw health today! Request an appointment with one of our skilled Doctors of Physical Therapy to start feeling better now.

More questions? Give us a call at (479) 442-7473. You can also check out additional TMD resources here.


rise physical therapy









Written by Alyssa Lindau, PT, DPT



Front desk checking your deductible

Fiscal Fitness: Leveraging Your Deductible and HSA/FSA for Year-End Physical Therapy Benefits

As the year draws to a close, it's essential to take advantage of the health benefits you've earned through your insurance plan. Insurance can be confusing, and it’s essential to understand your benefits and how your deductible can be used to your advantage at the end of the year. 


What Is A Deductible?

A health insurance deductible is the amount you must pay out of pocket for covered healthcare services before your insurance plan starts to contribute. In simpler terms, it's your initial financial responsibility for medical expenses. Once you meet your deductible, your insurance coverage typically kicks in, and you'll only be responsible for co-payments or co-insurance for the remainder of the year.


Why Meeting Your Deductible Matters

For many patients, meeting their deductible means they've reached the maximum amount they need to pay for covered services in a given year. This presents a unique opportunity, especially if you've been considering physical therapy.


If you've met your deductible, scheduling a physical therapy evaluation before the end of the year can be a smart financial move. Since you've already fulfilled your deductible, you can take advantage of your insurance coverage without worrying about additional out-of-pocket expenses. This allows you to receive the care you need while maximizing the benefits you've paid for throughout the year.


Benefits of Scheduling Physical Therapy Before Year-End

  • Cost Savings: With your deductible met, you can potentially receive physical therapy services at a lower cost or even at no additional expense.
  • Optimal Health: Addressing physical issues promptly can prevent them from becoming more severe, leading to better long-term health outcomes. Addressing your pain now can get you feeling better before your deductible resets at the start of the new year!
  • Maximize Insurance Benefits: By scheduling before the end of the year, you ensure that you make the most of the insurance benefits you've worked hard for throughout the year.


Utilizing Your HSA or FSA Before Year’s End

Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are financial tools that enable individuals to set aside pre-tax dollars for qualified medical expenses. Some plans have a "use-it-or-lose-it" feature, where any remaining funds at the end of the year may be forfeited. Scheduling a physical therapy appointment before the year's end can be advantageous for those with HSA or FSA balances to spare. By utilizing these funds for physical therapy sessions, patients can optimize their health benefits and prevent potential forfeiture of unused dollars. This proactive approach not only promotes well-being but also maximizes the financial benefits associated with these accounts, contributing to a healthier and fiscally responsible start to the new year.


Are you ready to take advantage of your year-end health insurance benefits? Request an appointment now and start feeling better before the New Year!


rise physical therapy









Written by Alyssa Lindau, PT, DPT



apple health app

Unlocking Your Balance: How Smart Devices Can Help Assess and Improve Your Gait

In this era of smart technology, our gadgets are not just for convenience but are becoming indispensable tools for our health. There is an increasing interest in using sensor systems embedded in smartwatches/smartphones for health care purposes. The Apple Health app can now assess your gait and balance and let you know if your gait has changed. 

Gait (walking) performance is an important marker of functional ability, independent living, and survival. Studies show that a smartphone can be used as an assessment tool to quantify ambulatory tasks while navigating both unobstructed and obstructed surfaces. Smartphone-based assessment using the Apple Health app, regardless of phone placement, is shown to be reliable and valid for all gait parameters across obstructed and unobstructed conditions, both indoors and outdoors. 

How Does the Apple Health App Assess Your Balance?

When you carry your iPhone in a pocket or holster near your waist, the Apple Health app uses custom algorithms that assess your balance, strength, and gait. You can receive a notificationif your walking steadiness becomes low or stays low, and you can automatically share the notification with friends or family. According to Apple, walking steadiness is calculated using factors like walking speed, step length, double support time, and walking asymmetry data that is stored in the Health app. This provides a sense of the way you walk and is also related to your fall risk. As steadiness goes down, your risk of falling goes up. Walking steadiness is not an indication of how likely you are to fall in any given moment but an overall sense of fall risk in the next 12 months. 


According to the National Institute of Health (NIH), falls in older adults are an indicator of “frailty, immobility, and acute and chronic health impairment." They can lead to serious health complications and injuries such as fractures and head injuries. However, even if you or a loved one are at risk for falls, a physical therapist can assess your balance and strength and provide interventions to significantly reduce risk of falls.


How Can I Assess My Fall Risk?

To assess your fall risk yourself using your Apple Health app:  

  • Open the Health app on iOS. It looks like a small red heart in a white square.  
  • Then tap "Show All Health Data" and scroll down. 

Android also has a version of this feature. 


While your device might spot the poor stability in your stride, this is just the first step. Don't wait until an accident happens – take action now! Request an appointment with our expert physical therapists to have your balance and fall risk assessed. Your journey to improved stability begins with a single step.



Carrie Lynch









Written by Carrie Lynch, PT, DPT

Photo by Oliur on Unsplash


shoulder anatomy tendonitis treatment

What Is Tendonitis/Tendinopathy?

Tendonitis Treatment

Before we discuss tendonitis treatment, let's first consider the anatomy! Tendons connect our muscles to bones, and therefore are the main way that we produce force.1  Before the 90s, it was thought that inflammation was the primary cause of tendon pain, so people used to call these issues “tendonitis”. As more research came out focusing on the damage in the tendon (primarily due to degenerative changes) being the main driver for both pain and decreases in function, this terminology shifted to “tendinopathy” (largely based on the work of Mafulli et al.). 2, 3  


Stages of Tendinopathy


So, there has been damage to a tendon, and the most prominent model currently followed is Jill Cook’s three-stage model (reactive, disrepair, degenerative).4  The first stage, reactive tendinopathy, has also been called the “injury” stage, and is typically an acute response.5 Another way of putting this is you may have jumped into something too rapidly or advanced load or volume too quickly.  An example of this could be starting a new workout routine or doing a lot of repetitive movements. Another potential mechanism is direct trauma – let’s say that you fell directly on your knee or shoulder. This could trigger the reactive stage as well. 


The second stage of tendon disrepair has also been called the “failed healing” stage, where changes in the extracellular matrix become more pronounced, and the tendon is thus more susceptible to the damage. Typically, this occurs when that initial stage continues to be handled poorly and advances to this stage. An example of this would be continuing to work out or perform the same repetitive motions once you already have tendon pain. 


The final stage is the degenerative stage, also labeled the “clinical presentation,” as this is typically when patients seek medical attention. This is when tendons are most susceptible to ruptures, and also where we start to see large scale degenerative changes in both the extracellular matrix and within the tissue cells (which is what may lead to those ruptures). 


Symptoms of tendonitis include difficulty and pain with movement, joint stiffness, swelling, and a “crackling” or grinding sensation.



I think I have tendonitis/tendinopathy. What do I do now?

Seeing a physical therapist is a great place to start for tendonitis treatment. Our skilled doctors of physical therapy will identify contributing factors such as muscle imbalances or improper biomechanics (movement of joints and muscles). Based on this evaluation, a personalized exercise program is developed, incorporating targeted stretches and strengthening exercises to gradually restore the affected tendon's integrity and flexibility. Manual therapies, such as soft tissue and joint mobilization, can further aid in reducing pain and promoting blood flow. Additionally, our doctors of physical therapy will educate you on proper body mechanics and ergonomic practices to prevent future recurrence.


I shouldn't start physical therapy for tendonitis treatment unless I have imaging first, right?

Medical imaging, such as ultrasound or MRI, is not always necessary to diagnose tendonitis. In many cases, a skilled healthcare professional, such as a physician or physical therapist, can diagnose tendonitis based on a thorough clinical examination, medical history, and a discussion of symptoms. Our highly trained doctors of physical therapy will assess your pain, range of motion, strength and functional movements in addition to your symptoms and medical history.


Tendonitis can often be effectively managed and even resolved with physical therapy alone, especially in mild to moderate cases. Physical therapy plays a significant role in promoting healing, reducing pain, and restoring normal function to the affected tendon and surrounding tissues.

If you think you are dealing with tendonitis/tendinopathy, request an appointment so we can help get you back to the activities you enjoy!



Matt Harper

Written by Matt Harper, PT, DPT, CSCS



1. Canosa-Carro, Lorena, et al. "Current understanding of the diagnosis and management of the tendinopathy: An update from the lab to the clinical practice." Disease-a-Month 68.10 (2022): 101314. 
2. Khan, Karim M., et al. "Time to abandon the “tendinitis” myth: painful, overuse tendon conditions have a non-inflammatory pathology." Bmj 324.7338 (2002): 626-627. 
3. Maffulli, Nicola. "Overuse tendon conditions: time to change a confusing terminology." Arthroscopy: The Journal of Arthroscopic & Related Surgery 14.8 (1998): 840-843. 
4. Cook, J. L., and Craig R. Purdam. "Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy." British journal of sports medicine 43.6 (2009): 409-416. 
5. Fu, Sai-Chuen, et al. "Deciphering the pathogenesis of tendinopathy: a three-stages process." BMC Sports Science, Medicine and Rehabilitation 2 (2010): 1-12. 



Photo by Alan Calvert on Unsplash