October 30

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Upper Arm Spasm Painful Neck with Wil Seto

By Wil Seto

October 30, 2023

shoulder pain

Mark: Hi, it's Mark Bossert. I'm here with Wil Seto of Insync Physio in Vancouver and North Burnaby in British Columbia, Canada. And we're going to talk about a bit of a sleuthing that needed to happen here. A nagging upper arm muscle spasm with a very painful neck. How are you doing Wil? 

Wil: I’m doing good. Thanks. How about you? 

Mark: Good. So obviously the symptoms when this patient came in, was a painful neck. But what was causing this? 

Wil: Yeah. So the history intake is really important in this one because this person didn't have any trauma. And so they came in and exactly what you said, you know, they had this endomology and so they asked them more questions. They started to talk about what they did for work and, you know, they sit all day long. And so the chair they thought was very optimal. I mean, for what he thought. But then it was also some other interesting things. His activity pattern, he worked out a lot and then lifted weights, home gym.

And then he also had a hard time sleeping. So this was a concern and this has been ongoing now for about a week and a half to two weeks when he came in and see us. And so that's usually a concern because when it starts affecting his sleep, that means it's a little bit more now moved up to an acute level.

So there's something going on where now it's like, yep, you know, it's causing inflammation and it's definitely escalating. So the other interesting thing that he didn't like, you know, you're asking people questions and It was revealed that he actually had a shoulder injury over 20 years ago. And the shoulder injury was a past shoulder dislocation, and they never actually did anything for it.

And this person was also very active. So the 5 to 6 days a week or whatever before that person used to do a lot of other sports, but then now they just stick with this routine because they have a busy life, you know, kids and work, full time job. And so those are all really important things to understand because it builds a picture of how things can build up and what factors are involved before we actually take a look at what's going on. Because now we have an idea of like, okay, yeah, so this being something that didn't happen like from acute trauma, like a sports injury or anything like that specifically, but having said that, the right shoulder I think was a sports injury. But that just never got rehab at all. 

This person just did their own rehab on their own. And you can see the compensation patterns. This was an old injury. And this person is also fit, in their 40s, but relatively fit. So now you go into the assessment thinking okay, so this could be like a neck issue, definitely, coming from the neck and he stated neck pain.

And so that's what's probably driving. this shoulder issue. And now is it a herniated disc or is it a sprained joint. It could be a number of different things. We don't know what it is. And so I think you have to rule all those things out. 

So on the assessment portion, when we're examining them, our physio has to be able to really take the person through a gamut of different things to make sure that, yeah, you know what, like, we don't think the likelihood of this is like a nerve issue, or maybe it is.

So with this person, specifically, it happened to be being driven by his shoulder. So he had this old shoulder injury and it was all this compensation. The shoulders were all off in terms of the alignment. The shoulder muscles should be like this, but they were just like all bound up.

And coincidentally, the upper arm spasming was coming from that same side where they had their old previous shoulder injury. So everything was pulling on that side and you can see it. You can see everything was being not only pulled through one direction, but also in forward forward, so multiple directions.

So that's like that part where an objective exam when we're looking at how everything just looks, after we've asked them all these questions, and then we take them through all the different tests. Okay, we'll make sure, rule out rotator cuff issues, rule out any torn tendons, or any other instabilities in the neck or in the shoulder. Any torn ligaments that might be also contributing to this.

So that was all ruled out, apparently. And so I think that based on this physio's assessment, looking at what was happening with the shoulder and how that was driving the neck, then there was this aspect of the tension in the nervous system. 

And then we looked at the person's posture, and they said they thought they felt like they were sitting at a pretty good depth, but that's the problem though, sitting is still sitting. And it doesn't matter if you have like, you know, the best chair. I think there's this brand called the Herman Miller chair. I think it is. That's one of the best chairs out there. It's like the Ferrari of all chairs. If you're sitting in one of those all day long, you're still sitting all day long.

So one of the biggest recommendations we gave to this person was you got to limit your sitting, and you got to switch it up a lot. He can't stand all day long either, so it was really changing the positioning. 

So the factors here with this person related to this neck tension was definitely a nervous system tension. And the posture was leading to all these imbalances where things were getting really tight. And then others were getting really weak. And ultimately leading to this gradual malalignment of the whole neck too, because the shoulder was just not in an optimal position.

And this person liked to work out four to five, up to six days a week, with weights. And the other factor was they didn't stretch. Okay. So no recovery. Nothing. And this person did this for like 20 years and then was surprised. Yeah, I never had this pain before. Normally, I mean, if they didn't have a shoulder issue, this is the thing to, the past history of having a shoulder dislocation in this example, it doesn't even have to be as dramatic as a past dislocation where they had surgery. It could have been like some overuse injury strain that they didn't fully recover from. But it just happened to be the case with this person. And then the deviations and the compensations were a lot more obvious.

First session, we fixed a lot of the things and we took the pain level, so the pain level of this person's experience was like 7 out of 10, sleeping. Within that first night, they were able to sleep, no pain. But they were still getting on a sitting level, the same 5 out of 10 pain. So that's how we know that a lot of it was a movement dysfunction issue related to these kind of factors, as we addressed them. Because the fact that they went from a 7 out of 10 pain to no pain sleeping. But still had the 5 out of 10 pain with sitting, meant that changing a few things, doing things to reset things with the therapist on the patient, trying to correct the muscle imbalances, getting the joint moving a little better, definitely made a difference.

Mark: So what's the long term then course of treatment to get this patient to feel comfortable sitting and standing and not have spasms in the arms and shoulder? 

Wil: Yeah, that's a great question. And so this particular person had been seeing the physio since September, and that's six weeks now. So at the six week mark, the person has no more pain sleeping still, no more pain with hitting. And now they just feel stiff and weak, but less stiff and weak, no more pain. 

Now there's still a lot of issues going on. From what I gather, that the alignment has a lot of work to do. So it takes a good several weeks, if not months, to really retrain those muscles. And so the benefit and the value of this person coming in to see their physio is that the physio can help reset all these compensations, all these imbalances. So that way things go back to more of a normal movement pattern. 

So that's the manual therapy, where you're doing hands on things to release the soft tissue or joint manipulation, whether it's the shoulder or the neck, or even the nerve tension mobilizations, to IMS or whatever it is. But the key, the real key, is then reinforcing those patterns.

Once they go back to their old pattern and it starts to get all tight and imbalanced again, sometimes they need that reset, they need that kickstart. And so the value, like I said, with coming into physio is to really help reset that so that puts them in the right direction, right path. And then a specific exercise prescription designed for him really puts him to a road to success. 

The thing with him is that right now, now it's no longer about the pain, especially when they first came in about sleeping pain, and now sitting pain, and now it's more of an endurance thing. Now it's more of a full mobility thing. And I think a large part of this is that the movement pattern that he developed, it's been over two decades.

Mark: And that's not going to change overnight. 

Wil: Exactly. 

Mark: If you're having some shoulder issues, neck issues and you're in Vancouver or North Burnaby, the people to see are Insync Physio. You can book online at insyncphysio.com or you can call to book. In Vancouver (604) 566-9716. In Burnaby (604) 298-4878 to book. You have to book. They're always busy. Insync Physio. Thanks so much for watching and listening. We appreciate it. Thanks Wil. 

Wil: Thanks Mark.

Wil Seto

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