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Shoulder & Neck Pain

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Neck pain is a very common symptom and one for which many people consult a physiotherapist. Initially in the subjective examination the physio will want to know how the pain came on and how long ago. Some people can recall a particular event such as cricking their neck or injuring themselves in some way, but many neck pains come on gradually with no precipitating factor.



The type and area of the pain are very useful to the physio in determining where the likely site of the lesion is. Shoulder, scapular, thoracic and arm pains are common with neck pain and the pattern will explain what kind of pain problem the patient has. A sprained neck joint gives very sharp, defined pain in one area, a postural cause or degenerative neck changes will give more generalized pain and a nerve root impingement from a slipped disc will give severe arm pain.

Many diseases and conditions could mimic neck, shoulder or arm pain so physios exclude serious underlying conditions by checking the patient's medical history, how well they sleep, any change in their appetite or weight, control of their bladder and bowel function, general health and use of drugs. Once cleared the physiotherapist will start the examination by looking at the postural shape of the cervical spine, trunk, arms and shoulders. Typical poor posture is a slumped trunk, poking head and round shoulders, often seen at a computer and which leads to problems.

The neck has typical ranges of motion which are disturbed in pain conditions and the abnormalities give useful evidence about the underlying joint mechanics. The physio goes through cervical flexion, cervical extension, cervical rotations, cervical retraction and cervical side flexions to check which movements are limited and which are unaffected. Nerve conduction to the arms is then tested by investigating the sensation, muscle strength and reflex response.

To narrow down the area responsible for the pain the physiotherapist will employ mobilization techniques in assessment of cervical spine lesions as well as treatment. The individual joint levels can be assessed for movement dysfunctions in a systematic manner, palpating the neck in lying when the spine is relaxed. If the symptoms are brought on by pressure on the spinal joints at a certain level then the physio can infer that the changes at that level are important in the diagnosis and subsequent treatment.

Manual mobilizations are used to treat neck joint dysfunctions, with gentle repeated pressures easing the small joints movements and reducing pain. Stronger movements can be used to push stiff joints into their restricted ranges and increase their motion, leading to overall better movement of the neck. Mobilizing exercises are given to back up the improvements gained by manual treatment of the neck segments.

Typical physio treatments are exercise programmes, nerve mobilizing techniques, correction of poor posture, pacing technique, trunk segmental mobilization and strengthening of the deep flexor muscles of the cervical spine. Nerve root compression of a cervical nerve root can cause severe arm pain, loss of sleep and distress from a cervical slipped disc. Cervical traction can decrease the pressure on the affected segment and reduce pain enough t
Shoulder & Neck Pain
Jim:“The muscle strain in my leg is doing much better."

RT:“You should be able to return to playing racquetball this weekend. But take it easy. Ease back into the game so we don’t re-injure that muscle."

Jim:“I can’t wait to play again. Incidentally, do you have anything I could do for soreness in my neck?"

RT:“Yeah, I could show you a few stretches. It’s easy stuff. Try them over the weekend. And if they don’t help make an appointment with your doctor, get a prescription and we’ll evaluate and treat your neck pain."

Jim:“Hey, I can feel these stretches pulling on the sore areas. I’ll try them over the weekend. How often?"

RT:Try once or twice each day until your next visit on Monday. Say, you said you work at a computer all day, didn’t you?"

Jim:“Yeah, as a programmer.

RT:"How many hours per week?"

Jim:“About forty-five to fifty."

RT:“Anyone else complaining about neck soreness where you work?"

Jim:“Yes, all of them."

RT:“And how many people is that?"

Jim:“About sixty."

RT:“My, my, my. Somebody needs to look into this."

I came to this conclusion after similar conversations with teachers, lawyers, administrative assistants and customer service representatives, just to name a few. Happily, on Monday Jim reported that the soreness had gone, and that he was going to use these stretches as a preventative measure during his work day.

Looking into research on the matter I found that between 15% and 30% of those working in an office setting had neck injury requiring medical intervention. My own inquiries revealed higher numbers of people battling with intermittent neck pain, soreness and stiffness from extended time at a computer.

These are healthy individuals, for the most part, who may mention their neck shoulder pain complaint during a routine checkup at the doctor’s office. In many cases they have resigned themselves to the fact that neck soreness is part of their work situation and is something they have to live with. In an attempt to eliminate soreness they have used over-the-counter pain medications, topical creams, hot showers, or just sitting and waiting for the soreness to go away. Often their neck complaints escalate to the point that they need to see a doctor and have four or more weeks of physical therapy treatments.

But a few simple preventative techniques can be used in the work setting to avoid neck back pain or provide neck pain relief from office activities. The goal is not only to prevent injury but to avoid turning it into a chronic neck pain condition. My clients have these techniques as part of their home exercise plan and use them as needed.

Although people are busy today, few are active enough to help maintain muscle tone. These tired and busy office workers and managers have to fit in an exercise regime in addition to their other activities.

I have seen active and sedentary people needing prevention. Even active individuals with proper muscle tone need to add appropriate stretching to their daily routine to quell their neck soreness.

A healthy routine should consist of at least 30 minutes of activity per day. This activity can be split up into 10 minute bouts at opportune times throughout the day. Add more on less busy days and as you are able. Stretches and movement activities can be performed proactively before prolonged activities at your desk or computer. They are also helpful during time spent at your computer, and after to reduce the after-effects of prolonged sitting.

Keywords:neck shoulder pain, chronic neck pain, neck back pain, neck pain relief, neck pain.

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About Author
Both Jonathan Blood-smyth & Rob Tworek are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.

Jonathan Blood-smyth has sinced written about articles on various topics from Health, Physical Therapy and Health. Jonathan Blood-Smyth is a Superintendent Physiotherapist at a large NHS training hospital in South-West England. He publishes articles on injuries and accidents in journals and on his website for. Jonathan Blood-smyth's top article generates over 3600 views. Bookmark Jonathan Blood-smyth to your Favourites.

Rob Tworek has sinced written about articles on various topics from . Rob Tworek is The Office Coacha Physical Therapist (Physiotherapist) providing prevention information to those individuals who work in an office setting, at a desk/computer.. Rob Tworek's top article generates over 1600 views. Bookmark Rob Tworek to your Favourites.
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