Monday Memo 4/15/19

The Monday Memo

April 15, 2019                                                                           PITT DPT STUDENTS



Resistance Training, Headache, and Cervical Spine Pain


Headache and/or neck pain associated with musculoskeletal disorders pose a significant problem not only to patients who report these symptoms but to society as well. The high prevalence of these disorders contributes to decreased productivity and increased time-off in workers (Schwartz et al., 1997). Many of these patients benefit from progressive resistance exercise to address cervical, periscapular, and glenohumeral musculature. However, there is much variation in the selection of resistance exercises, and innumerable factors to consider when seeking to drive adaptation in these patients. First, consider the FITTE principle:

  • Frequency
  • Intensity
  • Time
  • Type
  • Enjoyment

Above all else, clinicians must find a way to dose an appropriate volume – sets and reps – to drive positive adaptation that is enjoyable to the patient or client. There is research to support that exercise volume is a larger driver of hypertrophy than frequency of exercise or even intensity (Figueiredo et al.). However, pertinent contextual factors must be accounted for such as a patient’s current fitness level, lifestyle, occupation, previous level of activity, and training history. These factors play a large role in response to exercise, and the clinician must appropriately modify exercise dosage to account for them. Andersen et al. studied the effects of frequency of resistance training and found that, when weekly volume was consistent, patient outcomes did not differ between experimental groups for individuals with cervicogenic headache.

This means that the clinician and patient can tailor a program to fit the patient’s schedule and lifestyle. As clinicians we often hear, “I don’t have enough time to do my home exercises.” By carefully interviewing patients, it is possible to identify and agree upon the appropriate frequency for their program that will drive change and fit their schedule. For example, a patient may be willing to exercise 3 times per week for 20 minutes at a time, whereas another may only have two days per week to work out. The patient with only 2 days could then perform two 30-minute workouts.         Andersen et al. found that even 2 minutes a day of resistance exercise was enough to reduce neck/shoulder pain and tenderness! This short dose of exercise may be enough to get an otherwise sedentary patient to engage in physical activity. However, as discussed previously, volume is important to drive hypertrophy and develop strength in our patients. Once 2 minutes a day becomes manageable, the volume may be increased based upon patient tolerance. Let’s go over some exercises and progressions to address neck and/or shoulder pain. These are not all-inclusive.

  1. Seated cervical retraction + isometric sidebending:

Sample dose: 3 x 10; 10” 2 x 15 with isometric hold.

  1. Quadruped cervical retraction

Sample dose: 3 x 10; 10” 2 x 15 with isometric hold.

  1. Quadruped Y/T

Sample dose: 4 x 12; can add isometric holds or hand weights for progression.


  1. Blackburns Circuit

Sample dose: 6-10” holds in each position for 2 “laps.” Perform 3-4 sets.



-Joe Dietrich, SPT, ATC



Andersen, Lars L.a,*; Saervoll, Charlotte A.a; Mortensen, Ole S.a,b; Poulsen, Otto M.a; Hannerz, Haralda; Zebis, Mette K.a. Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: Randomised controlled trial. Pain. Volume 152(2), February 2011, p 440-446

C.H. Andersen, R.H. Jensen, T. Dalager, M.K. Zebis, G. Sjøgaard and L.L. Andersen; Effect of resistance training on headache symptoms in adults: Secondary analysis of a RCT. Musculoskeletal Science and Practice, 2017-12-01, Volume 32, Pages 38-43.

Figueiredo, V.C., de Salles, B.F. & Trajano, G.S. Volume for Muscle Hypertrophy and Health Outcomes: The Most Effective Variable in Resistance Training. Sports Med (2018) 48: 499.

April 15, 2019 |

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