Breaking the Cycle of Chronic Migraines

Subjective & History

Jim presented with a history of chronic migraines and neck pain since age 15. Previous interventions include pharmaceuticals, chiropractic care (2-3 times per week), and pain management, which provided temporary symptom management but no reduction in migraine frequency. Jim received Botox injections every 3 months but only got relief for 2 weeks after the injections in the years 2021-2025.  A 2-year course of functional dry needling successfully decreased migraine frequency and intensity, though symptoms persisted.  He was referred to formal physical therapy to address poor posture and increased thoracic kyphosis.

Objective Assessment

• Posture: Severe forward head posture, decreased cervical lordosis, and increased thoracic kyphosis.

• Mobility: Hypomobility noted throughout the cervical and thoracic spine.

• Muscular Strength/Activation: Poor postural strength noted in the lower trapezius (LT), middle trapezius, infraspinatus, and teres minor.

Intervention & Progression

Initial treatment consisted of standard postural re-education, scapular/rotator cuff strengthening, and manual therapy to improve spinal mobility.

On visit 3, KineMotion biofeedback was utilized to assess upper trapezius (UT) versus infraspinatus activation during postural exercises. Assessment revealed aberrant movement patterns, characterized by excessive UT recruitment and poor infraspinatus activation. Visual biofeedback was successfully implemented to train UT down-regulation and facilitate proper infraspinatus recruitment.

Outcomes & Re-assessment

• 10 Days Post-Biofeedback: Patient reported significant subjective postural improvements, noting his family commented he "looked completely different and healthier," and stated he previously felt "stuck in a really bad spot."

• Re-assessment (April 27): Patient reported a mild headache on April 26 but remained entirely migraine-free from March 30 to April 27. This represents his longest symptom-free period since age 15.

• Objective KineMotion Re-assessment: Demonstrated sustained, functional baseline activation of the UT and significantly improved recruitment of the infraspinatus.

  
  

The focus of the biofeedback was then progressed to UT vs. LT recruitment to target lower trapezius strength. Two specific exercises were prescribed for his Home Exercise Program (HEP) to reinforce LT activation.

The Discovery

An initial assessment revealed severe posture imbalances, spinal stiffness, and profound weakness in his key postural muscles (the middle/lower trapezius and rotator cuff).

While we started Jim on standard postural exercises, the real breakthrough happened on his third visit. We used KineMotion biofeedback technology to see exactly which muscles were firing. The data revealed a hidden culprit: Jim was doing his exercises incorrectly by over-activating his upper trapezius (the neck/shoulder muscles) instead of using his infraspinatus (the rotator cuff).

Using real-time visual biofeedback, we taught Jim how to "turn off" his overactive neck muscles and properly recruit the right postural muscles.

Result/Discharge Summary

At one-month post-assessment, the patient remains entirely migraine-free and reports zero neck pain. He demonstrates normal independent standing and sitting posture without verbal or tactile cueing. The patient is independent with his HEP to progress functional strength and is discharged from formal physical therapy with all goals met.

Jim has not had a Botox injection in 6 months and has only seen the chiropractor twice in the last three months.

He was very unaware of his body, and if sEMG were not a part of his rehabilitation, I feel that he would not have made the connection with down training the UT with his strength training or postural re-education.