Repetitive Shoulder and Neck Stiffness

This may be the biggest issue I have to deal with in clinic. It's an issue because the stiffness and/or pain constantly reoccur. A patient comes in for an adjustment, and appears to constantly have the same problem over and over again. Pain/stiffness around the shoulders or around T3-T4 (Intrascapular pain).
Does this sound like you? Pain goes away after the adjustment, and within 2 days the pain often returns. Does this sound like you? In this blog we will go over the WHAT is happening, WHY it occurs, WHY it reoccurs, and HOW to prevent it.
(many of these pictures came from Dr. Steve's blog from neck solutions.)

What is happening?
Patient comes into the clinic with pain stiffness in the back of the shoulder or in between the shoulder blades (intrascapular stiffness/pain).

Neck and scapular pain without arm or finger pain can be caused by a pinched nerve.

Intrascapular discomfort or neck pain/stiffness are very common signs of a pinched nerve.

This is usually do to a radiculopathy. Radiculopathy is damage to the spinal roots. The doctor will find out where along that spinal root fits that particular radiculopathy. This is what patients need to know.:

A radiculopathy often appears before any symptoms of pain, numbness or even weakness in the arms and fingers. The pain/tingling/numbness one feels in the fingers is usually delayed weeks (maybe months) after the radiculopathy has begun.  

So, what often happens is  this: People will incorrectly assume that muscles are the cause of the neck stiffness /shoulder stiffness and go for a massage or physio therapy. Many times the patient will point to a "general" area  and it's generally localized pain. Sound like you?

The C5-C6 nerve root starts in the low neck and works it's way to the deltoid muscles. The root is above the C5 and C6 vertebrae.

The C8 Nerve root is located right in between the shoulder blades. Since there is NO C8 vertebrae, the vertebrae responsible for the C8 nerve would be below the C7 vertebrae. C7 and /or T1 adjustments often take care of that radiculopathy. 

Sometimes the pain is DIRECT and the patient

can feel it right on the spinous process. That pain is usually at the levels of T3 and T4. An adjustment below those vertebrae will take care

of that pain.

NECK stiffness and pain also can be due to a radiculopathy.

The most common levels of root involvement are C6 and C7; high cervical radiculopathies are less common, but do occur:(C2-C4)

Many people come to the clinic with these common Signs/Symptoms: Do any of these sound familiar? 

Posterior head ache (Occipital headache/suboccipital), temporal pain.  : C2

Suboccipital Headache/ pain behind the eyes, pain behind the ears:       C3

Traps, upper shoulder pain, Base of the neck :                                        C4

Sides of the Upper arm. (deltoid mm):                                                       C5

Forearm pain, Pain in the Thumb and the Index finger:                            C6

Middle Finger Pain:                                                                                   C7

Last two fingers Pain :                                                                               C8

Hypothenar and Medial side of the arm up to the elbow:                          T1

This is why it is very important that the doctor know exactly what symptoms you are feeling. This will better help him to remove any radiculopathies and to restore your health as quickly as possible.

A cervical radiculopathy= Neurological problems with a loss of neurologic functions.

Patients will experience a combination of  : 

1)sensory loss

2) motor loss (weakness)....... or

3) impaired reflexes( in a segmental distribution).

The sensory disturbances are often in a dermatome pattern. this does not necessarily mean that pain has to be along that dermatomes,  In many occasions the pain responses will mask as either facet syndrome or disc pain....this is what separates RADIATING pain from a radiculopahty.  

Radicular Pain and Radiculopathy Definition

Radicular pain(aka radiating pain) is a type of pain that radiates into the extremities directly along the course of a spinal nerve root. Radicular pain is caused by compression, inflammation and/or injury to a spinal nerve root arising from common conditions including herniated disc, foraminal stenosis and peridural fibrosis. Leg pain can be accompanied by numbness and tingling, muscle weakness and loss of reflexes. The most common symptom of radicular pain is usually called sciatica or sometimes radiculopathy, which is pain that radiates along the sciatic nerve down the back of the thigh and sometimes into the calf and foot.

Radicular pain, the characteristic symptom of cervical radiculopathy, is often confused with a radiculopathy in clinical practice. Because specific treatments are exclusively indicated for radicular pain, an accurate distinction is important. True radicular pain follows dermatomal patterns and is usually— though not always— unilateral. Onset is often insidious but may also be abrupt, and the pain is frequently aggravated by arm position and extension or lateral rotation of the head.  

RADICULAR PAIN/RADIATING PAIN: is from a specific point or origin and follows a specific path (down the legs, down the arm). Facet syndrome or disc involvement not a radiculopathy. Understand? 

Wow......SUCH A PAIN IN THE NECK !!!

So, how do these radiculopathies occur? One of the reasonis is work ergonomics. What? Yes, your work place. Stress, lack of a head set for those on the phone all day, people on the computer for hours and hours.  Improper positioning of a keyboard, improper keyboards that create ulnar deviation. Positioning of the monitor, how high the chair is set. The type of chair,....and many many more.


SOME INDONESIAN COMPANIES DO PAY FOR CHIROPRACTIC SERVICES
Ergonomic issues have increased due to long work hours, lap top computers, and the amount of stress the job entails. I have many patients from one particular company that always appear to have the same issues. Intrascapular stiffness and pain. Pain in between the shoulder blades and pain below the shoulder.  The issue I have with this is that the patients from this company are "limited" on the amount of chiropractic care  or medical care they can have. The amount is directly dependent upon the amount of salary they make. Does that make a lot of sense to you?...........So, these are the hard working employees who truly don't get to experience the true benefits of chiropractic because they use chiropractic simply as a "pain relief" clinic. Many do no get to experience structural repair, biomechanical repositioning, or long term affects of chiropractic because they are constantly caught in this "rat mill" of insurance limitations. In addition, many of the patients are not motivated enough to do anything outside of the clinic that would promote their wellness or well being. So, it's a double edged sword. 

However, that being said, there is one patient from that particular office that did manage to restructure his spine and create muscular balance. This picture you see,....only took this patient 3 months.

Unfortunately, as I told you prior this patient recently told me that since his " insurance " benefit is up at work, they will not be able to come to clinic for the next 3-4 months. So, we certainly hope this patient continues on this path of success. He certainly worked hard at it.

So,... this comes to the second way radiculopathies occur.... POSTURE....Bad posture leads to bad health. As simple as that.

Let us review the basics to many postural problems.
1) A subluxation occurs in the body and the body recognizes that subluxation, and over a period of time, that "LOAD" or structural mechanical stress becomes too much for the body, so it creates a postural shift. In addition, the musculature changes as well. Your
overbearing one side and therefore will create tight muscles on one side and weak muscles on the other.  Sometimes, I will get people come into my clinic and they will say, "but,...I feel no pain, so I must be okay. THESE people don't wish to understand what their body is truly going through. They are merely looking for justification that "they're alright" so they can continue living the life they have been living, and then they can say,..."but the doctor told me I was alright". Putting the blame or burden on the doctor for THEIR decreased quality of life and not taking on any responsibility themselves. These are the PAIN patients.

I am now going to post a few postural pics, of prospects who never became patients or PAIN patients. The prospects often INSISTED that they were " JUST FINE", the pain patients were looking for a "miracle pill", and chiropractic certainly isn't that.
So,.......You make the call...Do these people look fine to you? If you say "yes",......you need new glasses.

This women has moderate to sever scoliosis. Pain every single day.  She is under 30 years of age. In addition to her scoliosis let's review this posture?
* Left shoulder is high
* High Left hip
* anterior shoulders
* left thoracic rotation (look how the left hand you can no longer see)
* Left posterior pelvic rotation
* Right head lateral flexion (partly due to her scoliosis)

I told this person about the fact that pinched/pressured nerves in her body are throughout her spine. Where there is a decreased amount of nerve flow transmission to that part of the body where the nerves are supposed to go to, will mean she will have issues later on in life.............She didn't believe me........Ignorance is bliss. She will continue to have difficulty throughout her entire life without proper chiropractic care.

Now,...let's look at this guy. His posture is AWFUL.

* Anterior Head Translation
* Bilateral Anterior Shoulders
* Posterior Pelvis
* Right foot flair

"But Doc,...I don't see or feel any pain?".........You will,...you will.

Now, this person actually became a patient, but was expecting a miracle.  Do you think this posture happened overnight? No way! This took years and years to get this way.

* Left thoracic shift
* High Right shoulder
* Anterior Pelvis
* Right foot flair
* Muscular imbalance

Some of the issues is that the patient thinks chiropractic is merely a "therapy"...not understanding it's a way of life. So,  "GET ME OUT OF PAIN" is their only goal.
That often occurs,..but, as I tell every patient,........that pain will return quite easily after the adjustment. For they haven't done anything structurally to change that. Musculature imbalance,  postural re-training, soft tissue repair, establishing ligament laxity to allow postural re-training,.......Do you think this guy had a lot of shoulder stiffness and low back pain? YOU BET!!!!.......He'll be caught on that proverbial wheel of ointments, medications, massages the rest of his life for impatience and lack of willingness to work at his posture is evident.

Oh,...here is one of my favorites. This young boy is a MESS.  Let's review his posture.

* High right shoulder
* anterior rotation of Left shoulder
* bilateral shoulders have gone anterior and inferior
* valgus knees
* (YOU cannot see) flat feet
* Anterior head translation
* head translation
* widened stance
* hyperlordosis
*anterior pelvis
* Obesity
  >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
You can see head lateral flexion, spinous rotation, left convexity of  the cervical spine.
Think this patient had intrascapular pain? You betcha!

<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
 You can see hyperlordosis and anterior pelvic rotation









    <<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<

You can see high right shoulder, thoracic re positioning.


With all of these issues, there was ZERO importance of trying to restructure his spine. This teen-ager will have serious difficulty as an adult. His body is speaking to him and his family and he don't see an urgency because he's NOT IN PAIN.




The Posture is the Window to your health. If your posture looks horrific, what do you think the possibility is that your health is not good also? 100%


When you start thinking about whether or not your health is being affected, look at the posture first? What does your posture say to you? If you think standing in an improper fashion is "normal",...then you are kidding yourself, and as long as you cannot admit the truth, you'll never be able to truly improve your health.

Dr. G