In physical therapy, we see many patients with neck and shoulder pain. This can be rather tricky to evaluate and treat. Often time’s pain from the neck may refer symptoms to the shoulder. On the other hand, pain from the shoulder can refer to the neck. Our job as therapists is to help the patient define the source of their symptoms and treat the condition accordingly. For the purpose of this article we will discuss neck pain that leads to shoulder pain as a secondary issue.
When an individual suffers neck pain from a chronic condition or a traumatic accident, it can lead to muscular imbalances. The muscular imbalances can be a result of direct trauma to the muscle, or weakness that develops from postural strain. When a patient is suffering from neck pain, they may begin to adopt a guarded posture. This may include rounding of the shoulders, slouching of the low back, and a forward head position. In a guarded posture, certain muscles groups across the back and shoulders may become stretched out, while muscles across the chest may become tight. Muscles that are over stretched or too tight cannot function properly. If the muscles along the shoulder blades and upper back become over stretched and weak, this tends to lead to poor shoulder mechanics. In turn, poor shoulder mechanics can lend to pain and irritation of the structures around the shoulder joint, namely the rotator cuff. This condition makes it difficult for patients to elevate the shoulder overhead.
So how do we address this condition in physical therapy?
Our job is to help the patient define the muscular imbalances and figure out why they are occurring. In most cases we need to treat the neck and shoulder simultaneously. Neck treatment usually involves hands on manual therapy to reduce pain and increase the range of motion. This alone will help significantly. As the pain reduces, the guarded posture may reduce by itself, therefore restoring proper muscle balance. In most cases however, the patient will likely require strengthening of the shoulder and upper back muscles to facilitate proper postural alignment and muscular balance. Once we’ve reduced the neck pain and restored balance to musculature surrounding the shoulder, dynamic stability will be restored to the shoulder joint. Once the shoulder pain and irritation is gone, specific rotator cuff exercises may be added to further improve stability at the shoulder joint.
If you are dealing with neck and/or shoulder pain, contact us at Prairie Spine and Pain Institute. Our medical staff can perform a comprehensive orthopedic spine evaluation to help determine the cause of your symptoms. Likewise, our physical therapy department will perform a complete biomechanical examination of your neck and shoulder as described above. We are trained to provide advance manual, hands-on therapy to help reduce pain, restore range of motion and improve strength.
About The Author: Jeremy W. Przybylo, PT, DPT, DMT is the Prairie Spine and Pain Institute’s lead physical therapist. He is a key component of our integrated care program. Jeremy works one-on-one with patients to perform an initial evaluation that allows him to design a comprehensive treatment program tailored to each individual. He typically works with patients weekly, utilizing a combination of hands on manual therapeutic techniques and a scientific approach to rehabilitative exercise.