help with neck pain

[Aarif Ameen]

i could use some advice. i'm still a student, so please be gentle with me

my neighbor called me up this evening begging for help. she was complaining of a "pinched nerve" in her neck that was causing pain in her neck, back, shoulder and almost down into her chest. her new job involves her sitting at a desk with a keyboard that sits way too high for her and she drives an SUV - so her shoulders are up to her ears all day. i found trigger points all over her neck, shoulders and back. the worst ones were in the levator scapulae (one side was far worse than the other) and rhomboids minor. her traps were tight from top to bottom and her scalenes were like guitar strings. when i felt like i did all i could - i was afraid to do any more. i took my time warming her up and addressed each muscle individually and slowly. it was still pretty deep and painful for her and i didn't want to over do it. anyway, her pain was significantly reduced and her ROM was far better. except for one thing. turning her head away from the side with the most pain was done with ease at the end of the massage (something she could barely do when we first started). but when she turned her head into the pain her movement was restricted by pain, although she said not as bad as before. but still, it was not something i liked seeing. i'll admit that i'm still a bit gun shy when it comes to the anterior (and especially medial) side of the SCM. is this what i missed? or do you think it was something else entirely?

i told her to drink lots of water and be very conscious of the way she holds her shoulders for the next two days. after two days of rest i'd be willing to work on her some more. aside from hitting the usual suspects again, i'm not sure what more to do. specifically for her not being able to turn her head into the side with pain. i mean, aside from referring her out - which i already tried to do, but she's grateful for the relief she got tonight and is willing to let me continue to work on her for my educational benefit what else... t017

thank you guys for your help!!

 

[Ella_Fitzzy]

help with neck pain

Sounds like you're doing great, just keep doing the same work and adjust as she has more pain free days. Massage can be really helpful in pain relief, but it doesn't usually happen in just one session (sometimes it can, but those are few and far between)! If she doesn't change what she was doing to create the pain in the first place, she will always be having those types of issues. Don't let the fact there was still some pain discourage you, you'll find the longer your in this field that will be the general norm. The fact that there was some improvement is good. When my clients don't notice a bit of relief by the second or third session then I change what I'm doing or refer them out.

One suggestion that seems to work for clients who hold tension in their bodies without realizing it that I demonstrate is have them do this exercise while laying in bed, maybe when they bed down for the night or just anytime they have about ten or fifteen minutes. While laying down, starting with their jaws -- clench the muscles hard for about five seconds, take a deep breath and then relax after repeating a couple times, move to the neck, the shoulders, the forearms, the hands, the buttocks, the thighs, etc until they reach their feet. After a few days (or maybe the first time) of doing this ex, they will be more aware of when they are clenching up during the day and that will help them end that habit.

Usually pain that occurs in the neck while turning head is in the superior traps of the side the head is turned towards (in my practice). Again, the fact there was some improvement is good enough, here is where you'll find massage is best when used on a regular basis along with changes the client makes in their daily postural habits.

 

[Ekklesia]

help with neck pain

Anytime I have folks complain of severe pain & find their bodies to be extremely tight, I often suggest icing the regions involved. Generally speaking whether they use real ice, ice packs, or frozen packs of veggies (this works very well by the way!) make sure they first of all have at least a towel between their skin & the cold therapy pack of their choice. They should leave it in place for 15 to 20 minutes max & then off for about 45 minutes to an hour & back on again. This will usually cut down on the pain & any muscle spasms. Drinking fluids - especially water & also taking a good powdered Magnesium supplement
(I really like Peter Gilham;s Magnesium Calm) can all help.

It sounds like the work you did really helped your friend - though she should continue to get more work done by you or someone else & she will need to focus more on both stretching & working to release her body to avoid a repeat episodes. She should check her posture & body mechanics, as well as taking breaks from her computer work as well. If the keyboard is to high for her - suggest that she put a chair pad or other cushion on top of the desk chair she is using until something can be done about the desk or keyboard setup. That may help to balance out the problem at least somewhat!

Keep up the good work - it sounds like you are getting some good experience under your belt already!

 

[Daniel]

help with neck pain

From your description, SCM isn't the problem, though it will be part of the overall picture. As kathryn noted, it is more likely to be upper traps, or levator scap, or both. Serratus posterior superior is a good possibility too, but good luck getting to it! This person will need pec work too, especially pec minor. If you don't know how to do it yet - DON'T. Consider referring this person to a working professional instead.

 

[Mommy to 2 Nis and Teagan]

help with neck pain

One way to think about this is to consider the muscles involved in turning the head into the painful side. If the side she is turning into hurts, then think about the muscles on that side that are being stretched by that movement. Lev. scap., subocc., and so on.

 

[Helpless]

help with neck pain

thank you so much for your help! even though i get nervous about "causing" pain - i knew i was doing what i was taught. i just felt so unsure of myself after i got home. i really appreciate the encouragement and the reminders that i can't fix it all in one hour (although i'd be willing to bet some of you can :altwink: ). i was very careful to warm her up and work slowly, causing the least amount of pain as i can. overall, i'm proud of the work i did.

i did talk to her about using ice, ibuprofen and lots of water. we talked about how she can pay attention to her posture and changes she could make in her activities to prevent this from happening again. i checked on her yesterday and she was very sore. i encouraged her to stretch like i had shown her the night before, and she nodded and said "ok", but the look on her face said "yeah right". her ROM and stiffness was still better than it was before our session, but i would have liked to see her looser. she said she expected the soreness - comparing it to working out. but i couldn't help but get the feeling she blamed me for it. maybe that's just my own issue. she still didn't want a referral and insisted on scheduling another session when the soreness subsides, so maybe i'm just projecting my own guilt. which is totally off topic.... (i'm extremely eager to learn gentler and less invasive techniques - classes i can't even register for until i'm certified.)

her sup. traps didn't really have any distinguishable TPs. they were more like solid hard muscle. when i finished working on them they were still tight but since i had already spent so much time on them i wanted to give them a breather. i'm relieved that at least the pain (turning her head into the side with pain) is being caused by a "work in progress" and not something completely overlooked.

pec minors. i have been taught and we have practiced in clinic. i really don't like working on them because of how tender they are. and i didn't even think to check them but now that you've mentioned it, it's suddenly obvious. thank you!

~~crossing my fingers and hoping she feels some relief today~~

and i am soooo grateful to have this forum in my "toolbox". thank you guys so much!!

 

[That Guy!]

help with neck pain

I know what you mean about the tenderness of pects. I've found that using hot stones on the pects really helps relax those muscles in a kinder way. I love my stones. I joke with the clients when they oooh and ahhh about how good they feel that hot stones turn 'mad muscles' into happy ones.

 

[LilMissLi]

help with neck pain

Sounds like you are doing great! One additional thing I would do it work on the scalp. It is amazing how much ROM you can regain by really working this area!

Come in close to the scalp and grab hair, it is important to start close to the scalp. Pull outwards for 10-15 seconds, then rotate your hand, with the hair counter clockwise, then rotate clockwise. Go all around the head, paying special attention near the base of the skull. It may be tender to boardline painful, so go slow and communicate.

This is really good in a chair massage too if they will allow it! LOL

 

[T.J.]

help with neck pain

Sounds like you are doing great! One additional thing I would do it work on the scalp. It is amazing how much ROM you can regain by really working this area!

Come in close to the scalp and grab hair, it is important to start close to the scalp. Pull outwards for 10-15 seconds, then rotate your hand, with the hair counter clockwise, then rotate clockwise. Go all around the head, paying special attention near the base of the skull. It may be tender to boardline painful, so go slow and communicate.

This is really good in a chair massage too if they will allow it! LOL

Oh yeah.. that's one of those techniques that while you are doing it you are sitting there thinking, "Man! I wish someone was doing this to me right now". :grin:

 

[Jackie M]

help with neck pain

I had a similar issue myself....work all the trigger points you can in the obvious regions....i'd suggest encouraging her to do some scapular depression exercises to keep her scapula down...mine were elevated and relasing trigger points was only temporary relief. Once she goes back to her work and driving they'll be elevated and "stuck" once again unless she works on scapular depression.

Also, i realized i had issues with my finger extensors...if you look at anatomy trains it shows a fascial line running from your hands up your arms and then wrapping a lot of your upper back and part of the neck. There's one that also runs from pinky in a straight line up the tricep and to the scapula.... A third on the front runs from the thumb up the bicep and through the pec minor. Therefore, i'd suggest really concentrating on the arms now and the hand especially. Have her extend her fingers and check to see which feel restricted and lack extension.

She probably has head forward posture, so her platysma is probably tight as well, Especially in the lower area where it blends into the chest, right below the clavicle. Forward head posture also is tightening up her neck extensors (back of neck). After i did all this i had TERRIBLE soreness the day after in my neck extensor area because they finally released, relaxed, and stretched out.

 

[Mario (Backup)]

help with neck pain

AWSOME replies that's all I can say. Thanks
Mary