Cervical Spine pain is the second-most common patient complaint treated in most orthopaedic physical therapy clinics. Frequently, this neck pain is also associated with shoulder pain, with both causing variable degrees of difficulty with completing daily activities, such as driving, reaching, lifting, dressing, sleeping, among others. Evaluating, and treating, patients with both shoulder and neck pain can be a challenging task, requiring a thorough evaluation of the neck and upper quadrant, helping determine a patient’s appropriateness for physical therapy and provides a good starting point for treatment. Described below are two different scenarios how one problem can affect the other, and how treating one area allows the other area to begin improving and vice-versa.
When a patient has an onset of shoulder pain, it typically affects the normal ability to use the shoulder, decreases the available range of motion and causes pain when the affected muscle(s) are activated during tasks. Reaching and lifting, for example, are functional activities that people cannot avoid during the day. If it hurts to do those tasks normally, we will avoid the pain by using compensation patterns. If you have ever seen someone with shoulder pain attempt to raise their arm, you will notice the arm raise their arm with a slight (or large) shoulder shrug. This is done to avoid activating the painful muscle, but will also causes the upper trapezius, the sternocleidomastoid (SCM), the levator scapulae, and the scalene muscles to excessively contract. All four of these muscle groups attach to the cervical spine, and apply excessive compressive stress to the cervical spine joints when used in this fashion. Over time, this altered movement pattern can cause these muscles to become painful, can be a cause of chronic neck headaches, and/or cause neck pain from increased joint stress. It also changes normal movement patterns of the rotator cuff and scapular musculature, causing weakness to those muscles and further impeding normal shoulder function.
When a patient has an onset of neck pain, of insidious onset, often poor posture is playing a significant role. Slouched sitting posture, for example, rounds the thoracic spine and shoulders forward, and causes a forward-head posture of the head and neck. This causes various stiffnesses of the upper cervical spine, and upper thoracic spine, and leads towards increased shearing of the mid-cervical spine joints. Over-time, this shearing force can lead towards joint pain, hypermobility, and facilitation of muscles of the rotator cuff, causing future shoulder pain/dysfunction. The rotator cuff muscles are innervated by the same nerves that innervate the mid-to-lower cervical spine joints and soft-tissue structures. When a spinal segment is stressed repetitively, the local nerve structures in the area can become sensitized, overexcited, and hyperirritable, known as ‘facilitation’. Once a segment is facilitated, all structures innervated by the same spinal nerve can be negatively affected in the form of muscle tone, and tenderness. In this case it may lead to rotator cuff muscle fatigue and tenderness, and create muscle injury from activity secondary to fatigue and weakness.
Both of the above scenarios are difficult cases to treat, requiring treatment to both areas in order to obtain successful results. The more chronic the case gets, the more time it takes for the problem to resolve, as compensation patterns thicken, leading to more joint stiffness, muscle imbalance, increased fear of further injury, and increased facilitation. The quicker someone comes in for treatment, the quicker the results are by preventing this cascade of events. At Life’s Work Physical Therapy, our clinicians are specifically trained in evaluating and treating patients presenting with both shoulder pain and neck pain. We pride ourselves in the ability to differentially-diagnose your condition, and ability to design an individualized, evidence-based treatment program aimed at returning you back to normal function. If you are experiencing shoulder pain and/or neck pain, contact Life’s Work Physical Therapy today, to have an evaluation and get back to your activities without compensation or chronic pain.