The effects of neck pain
With neck pain being one of the three most common types of pain in Americans, it makes it imperative to make sure that the muscles in this region are properly functional in order to minimize this pain. The muscles involved in this region include the levator scapulae, rhomboids, trapezius, sternocleidomastoid, scalenes, cervival erector spinae, suboccipital, and deep cervical flexors.
This being said, and understanding how the body is connected via the kinetic chain, it is safe to say that pain or discomfort in this region may produce effects in other regions, such as the shoulder. When the muscles of the neck become overactive and tight, they can make the head begin to migrate forward, causing the forward head posture and upper crossed syndrome seen in postural assessments. This is often coupled with rounded shoulders. When the head is in this position out of alignment, the stresses that are placed on the muscles and connective tissue of the cervical region increase, which can ultimately lead to injury, especially in the shoulder.
Do you suffer from a shoulder injury?
Shoulder injuries associated with cervical dysfunction include shoulder pain trapezius-levator scapula dysfunction, acromio-clavicular impingement and thoracic outlet dysfunction. The scapula is the connecting bridge between the shoulder complex and the cervical spine and functions to maintain stability and mobility of the neck and shoulder region. When there is dysfunction in this region, injuries can occur.
These injuries can become as a result of a tear in the connective ligaments and muscles of the neck, or an injury to one of the intervertebral discs of the neck with the involvement of the nerve root causing sensation to the extremities. Neurologists have explained that these pains come as a result of compressed nerve roots generated from a herniated disc within the cervical region. Studies by Wedell and Feinstein showed that there was a constant discomfort in the tender area around the scapula, which is indicative of involuntary muscle spasm of the muscles in that region.
Where does the pain come from?
The muscles that surround the scapula and create stability within that joint are all innervated my nerves that branch out from the cervical region. The levator scapula is innervated with C3 and C4, the rhomboids are supplied by C5, the supra and infraspinatus muscles are supplied by C5 and C6, while the subscapularis and latissimus dorsi are supplied by C6 and C7. This information gives insight that the probable cause of the pain felt in the shoulder and upper extremities are tight to the motor control rather than sensory stimulus.
Studies over the past three years have shown the effects of cervical discography in relation to referred pain in the shoulder and extremities. Cervical discography involves inserting a needle into the intervertebral disk of the individual. When pressure is applied deeper inside the capsule, the vertebral bodies can be easily assessed. The individual can inform the doctor as to where the pain is being felt as the doctor is lightly touching the nerves. Individuals often expressed that pain could be felt around the shoulder blade and scapula. This pain is most likely due to a reflex response of the muscles of the shoulder girdle.
Going back to scapular dysfunction, there is clinical evidence to suggest that scapular dysfunction plays a major role in the occurrence of neck and shoulder pain in individuals. This neck pain is also experienced with noticeable postural abnormalities, as seen in individuals who sit for extended periods of time. The slouched posture associated with the rounded shoulders of upper crossed syndrome will have an overall affect on the way that the scapula moves, its overall shoulder muscle strength, and overall range of motion.
With these problems, as stated above, overactive muscles in the upper neck and pectoralis major pull the shoulders and neck forward causing this rounded back and forward head posture. This leaves a lack of strength in the underactive muscles of the middle/lower trapezius, rhomboids, and serratus anterior to name a few. What needs to happen in a structured corrective exercise plan is to inhibit and lengthen these overactive muscles of the pectoralis major, latissiumus dorsi, and upper neck region in order to increase the overall flexibility of these areas.
Next, strengthening of the underactive muscles needs to be done in order to bring the body back into alignment by working with the length-tension relationships and force couples of the associated muscles. Finally, integrating more complex dynamic exercises to teach the muscles how to work together again, via nerve input, will further intensify the effects of the force couples . When this is done correctly, the pressure will be taken off of the neck and shoulders because one segment won’t be overpowering the whole body, thus allowing for increased range of motion and pain-free motion of the neck and shoulder region.