The Pain in Your Neck, Is it Your Shoulder?

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver. And we're going to talk about the pain in your neck. Is it really your shoulder? How are you doing Wil? 

Wil: Hey, I'm doing great. Thanks, Mark. Yeah. So the pain in your neck, is it coming from your shoulder? So it's a really interesting topic because, you know, I've been seeing a lot of this and especially during the pandemic. But even like before the pandemic, I see this a lot too. And so the common thing is people come into the clinic, even actually, you know, my athletes that I treat, they come in or they come up to me and they say, yeah, I've got this pain right here.

You know, I'm not sure if it's coming from my shoulder and what's wrong with my shoulder and, you know, and really like upon closer examination and also history taking in terms of asking them some more questions, it's actually coming from their neck. 

Mark: So what would the typical symptoms be? 

Wil: So, first off a lot of it is a restriction in range in motion. That's huge, in terms of like their inability to turn and usually it's painful, and stiff, soreness, and it can be like a constant dull type of pain. That's a low grade. And it can also be aggravated a little bit more with the movement that's restricted.

And then even like, and this is the thing can throw them off too why they think it's shoulder possibly because they may try to raise their arms and reach for something in the cupboard up above their head and it causes some stiffness and pain. And that's because the muscles around that shoulder blade, which is technically part of the shoulder is connected to your neck.

Mark: So what are some of the possible causes? 

Wil: So I think strain is number one. And so what do I mean by that? So strain being like, if you over exert those muscles they get really tight. And then you can start the feel the muscles around there being really, really super locked up and basically that can restrict the motion and that can cause that pain that you're feeling or tightness.

Usually it's kind of more of a tightness feeling, which when it gets really tight like that, the other symptom that I didn't mention was you can also present with like a touching type of headache. And the other cause is if you have like a lot of stress, so a stress in your life, that can basically you know, start to manifest up into that area. So the reason why stress is a big factor and this will play into like, if they've also had an injury, is because your fight or flight in your nervous system, those nerves that actually, you know, cause you to get into that fight or flight mode, they basically connect in with the spinal cord and then they have the same connections that kind of come back out to give that flow of feedback back to the muscles that basically cause everything will be tight. 

So when we get stressed, we also noticed that, you know, you tend to do this. And you're like, oh, I'm really tight. That's where our stress tends to manifest, is in those areas. And then you add an injury on top of that. So say you get into a car accident, and you get whiplash or something like that, then that can compound that. 

But for somebody who's never had trauma and like, say it's just something that's gotten like tight in there just from repetitive strain of bad posture. So that's another really good example of a, another way that they can injure it without actually doing anything. Because it's a repetitive sustained motion. So their posture may be off, or maybe it's not even off. If you're sitting all day long, it's just that mere posture of sitting and it can cause a little bit of a more non-optimal activation of those muscles, especially on a laptop or a computer all day long. 

Mark: I guess, as we get into more and more, maybe the Fall, the fires will calm down and people are getting outside more. Maybe falls would be another thing that I know that's one of the places like if you have an extended fall, like you can get that and that can happen in any sport pretty much. 

Wil: Oh, definitely, absolutely. So any kind of trauma, obviously, for sure where you get whiplash, so you're describing classic type of whiplash type of stuff going on. So you don't have to just be in a car accident and you can even just actually be bumped. I treated a rock climber once who was climbing up what's called lead climbing with his rope and he fell and hit the wall. He didn't hit his head on the wall, it was his body, but then he had a bit of a whiplash from that as a result. And he had some neck pain and stiffness. 

Mark: So typical course of treatment? 

Wil: Well typical course treatment, you know, what we find on the diagnosis and the assessment portion of what we go through. And so this is actually really important, when someone comes in with this type of pain and syndrome and they complain about this. We've got to figure out, you know, what's causing it. Is it just a muscle thing going on. Or is it also muscle related with some nerve stuff related to the neck. Quite often it could also be like a conjunction of muscle and shoulder. So the two things combined. So we have to address both. 

So is that pain the shoulder pain, the shoulder issue? Sometimes it can drive it, so we have to do a a proper assessment and really look at it and see what's causing it. So that really varies in that point of view.

And so we do Manual Therapy to really address what parts, in terms of the joints. So from the neck, from the middle part of the neck to the top part of the neck, or is it the bottom part? So there's all these different sections that we have to assess or is it the mid back. Because tightness in the mid back, you know, if that's not moving well, it basically translates to more usage and your upper neck taking more of the load. So that's important to realize as well. So even though you may not feel pain down in the mid back area, that's another issue. 

So there's all these things that we look at in terms of mobility. In terms of the joints. And then obviously the muscle mobility, because then now you're looking at the muscles that are causing the stiffness in the joints.

So they work hand in hand. There's the joint mobility and the muscle mobility. So then we want to do things to release the muscles. So we do manual therapy techniques to release that. We do IMS, which is a dry needling technique, which works really good for things that have sort of a nerve muscle connection relationship.

And when I say that it's a nerve muscle connection relationship, you know, it's basically a different type of tightness, than say if it's been overused muscle kind of thing. So there is a differentiation. And then obviously we would want to make sure we reinforce proper mobility patterns.

So there's specific things that we woud do to personalize and individualize an exercise rehab program to make sure that you're reinforcing like your optimal movements. So that's important, retraining the movement pattern and then to strengthen what's weak. And then to make sure that we keep whatever is like really tight, joint and the muscle aspect to be able to be more mobile.

And then lastly, you know, the most important thing is education. You know, just teaching you if you're coming in with a neck pain, that maybe is the shoulder, you know, about different things that are going on. And this is where we need to get a little bit more and extract more information from the history about, you know, what do you do for work? Oh, you're on the computer all day long, or, you know, maybe we need to get a sit to stand workstation for you, and maybe we need to change the keyboard, get a wireless keyboard on your laptop. So that's one aspect of it. 

And then maybe it's looking at like, okay, well, what are you doing like physical activity wise, like maybe there's something that you're doing in your workout routine and your training routine or running. Now here's a big one. Like a lot of people don't think that running can actually impact your neck, but that's a form of impact loading on your spine. And from your head all the way down to your tailbone and your pelvis is considered your spine.

So you want to make sure that you've got good proper mechanics when you're running. So if you're not actually you know, utilizing proper form and you're running with your technique off, that can effect the impact loading and that travels all the way up to your neck. So it all really depends on what's going on.

Like, if you're a rock climber, and you're like really, you know, gripping on things and your core is really weak because, your strong arms, you've got Popeye arms, but your core is just not even there. Then you're going to have lots of problems in that neck related to that, which then can actually lead to more peripheral stuff. So, yeah, it's a really good question, but it's like lots of stuff sort of related with it. 

Mark: Why you need to see a professional, get a professional diagnosis from somebody who knows what they're doing and finds the root cause. So what's the treatment? The treatment course of therapy to get, back what's the typical timeframe it takes? 

Wil: Yeah. So that's another good question. It all depends on how long this is going on for. So, because if you're moving patterns are like very chronic and you've developed a lot of non optimal movement patterns of the muscles and some are just like this and it takes a bit of time to retrain that. Takes a bit of time to try and break that pattern and reset that. And then get the joints moving properly in the muscle, and mobility moving properly. And then strengthening. Like I would say like, if someone that has had this problem for, I dunno, like very briefly, you know, it's something that's very fixable within four to six weeks.

And it's hard to say, like sometimes people just started developing the problem, but they've actually aren't aware of the symptoms. And then they've actually had the problem though with the movement dysfunction for years, but they've just gotten away with it without being symptomatic. So that's another issue to consider.

So it may only take, like I said, four to six weeks or sometimes it may take like, you know two sessions I've had that before too. And they're able to make all those changes that I suggest and then I get them going on an exercise routine and you reset things and it's like, boom. It's like amazing.

And then other times it takes like a good four to six months. And it also depends on whether or not there's other stuff going on related with that neck pain in relation in the shoulder, if there's anything else that radiates down into the elbow or arm. 

Mark: Would it be fair to say shoulder, neck is probably the most complex area of the body you treat. In terms of musculature, nerves. How it all chains together, has to fire in the right order, all that stuff. 

Wil: Yeah. I would say it's pretty complex. Primarily because there's just so many different, like connections related to the neck, mid back and the shoulder and how they all play together. And think it's a very complex area to really treat, but it's also very fun, for me a really fun sort of areas of the body to really work on. A lot of it is because I do a lot of sports and I've looked at these areas as specialties to really work with that. 

Mark: If you're having some neck pain, it might be your shoulder. Call Insync physio. You can reach them at 604-566-9716 to book an appointment, or you can book online, There's two locations, one in Vancouver on Cambie Street, or in North Burnaby. The phone number there for the Burnaby location 604-298-4878. Check them out. They'll get you feeling better quickly. Thanks Wil. 

Wil: Thanks Mark.