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What Exercises are Safe After an Exertion Headache?

I am often asked the question “What exercises are safe after an exertion headache?”   Assuming that your headache is a primary exertion headache or exercise headache it is safe to reintroduce progressive exercise after a 4-7 day rest.  Here are some guidelines to and progressions to follow in the early reintroduction phase:

You begin with low-threshold activities.  Those are the movements least likely to bring about a relapse of symptoms.  Those are low intensity movements that keep the athlete upright, keep the neck neutral, are low impact and do not require aggressive upper trap activation.

High Threshold activities that are re-introduced last include:

1) Bearing down or valsalva monouvers.

2) Increasing intracranial pressure by lowering the head below the waist. (Bench press, burpee, deadlift)

3) Extending the neck during a lift. (Burpee, The bottom of an overhead squat)

4) Aggressive Upper Trap Activation. (Clean grip shrug, power snatch, deadlift)

5)  Jarring impact (Reboundig box jumps)

Early on in the process it is important to eliminate all of these factors and slowly re-introduce these challenging elements phase by phase WITHOUT reproducing any headache symptoms. This is critical to avoid chonicity of these episodes. Picture letting a scab heal without ripping it off and causing scar tissue formation.

Today’s post will focus on safe initial re-introduction movements.

Keep the above criteria in mind with all of the following movements as all can be done in a way that will trigger a vulnerable condition.  To keep it simple, apply this guideline to the following movements for best success:  Exhale during the concentric phase of all motions, keep the head and neck neutral, avoid shrugging motions  and eliminate jarring impact with the ground.

Phase one introductory movements:

Belted Sled Drags and Reverse Sled Drags

  • Reverse or backwards sled drags are at the core of your exertion work this early phase.  Use them as the base and integrate the following low-threshold movements in alternating fashion
    •  Reverese Sled Drag- Belt the sled off from the hips and walk backwards looking back at the sled with the hips sitting back and the neck in neutral.
    • Sled Drag- Belt the weight from the hips and walk forward with a consistent, slow and even pace focusing on hamstring recruitment and neutral neck position.
  • Banded Shoulder traction cervical stretches
  • Supine Deep Neck Flexor Drills 3 planes, 10 reps
  • Towel traction
  • Isometric Supine extension
  • Upright Towel Isometric Extension
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Dr. Skylar Pond is a sports medicine chiropractor in Seattle, Washington. sportsmednw.com