Neck pain and shoulder pain are very common. They can occur independently but they often occur together.
In fact, many patients present to the clinic with what they describe as shoulder pain, yet they point to the upper trapezius. As a practitioner, I would normally relate pain in this muscle to neck pain.
Regardless, it’s important to recognize the relationship between the neck and the shoulder and that dysfunction in one can often impact the other.
Neck and Shoulder Pain
Over the last ten years, a lot of research on athletic shoulder injuries has focused on the scapula (often known as the shoulder blade). In particular, the research has looked at the movement of this bone and the activity of the muscles that work on the shoulder blade. Scapular dyskinesis has become a common term used by practitioners to describe aberrant movement of the shoulder blade. Interestingly, this aberrant movement and position of the shoulder blade is not just related to shoulder injury, but also neck pain.
The altered movement in the shoulder blade (and the shoulder blade muscles) can be linked to sitting at a desk for long periods. Slouching can make this worse. Those who slouch at a desk all day and complain of neck pain may also have dysfunction around the scapula despite the pain being primarily in the neck.
In terms of how the muscles are recruited differently, there are many possibilities. The common ones include too much activity in the upper trapezius and reduced activity/ability of the serratus anterior, lower and middle trapezius. The pectoral muscles can also tighten and certain muscles in the front of the neck can also become weak. Many people use different terms to describe similar changes in the muscle; knots, spasm, trigger points. Essentially, many of these words mean the same thing. A change in the muscle that is painful and related to various factors, often being overuse secondary to poor posture.
So how do we fix neck pain that is related to dysfunction in and around the shoulder blade? This is a difficult question to answer in a blog. It often requires a number of things. Recovery usually involves some improvement in areas where the movement is limited (improved flexibility), re-training of muscular firing patterns and movement patterns, as well as re-training the control of the shoulder joint and the strength in the muscles of the shoulder and neck.
Sound simple? Unfortunately, it isn’t. Recovery from neck pain related to chronic scapular dysfunction can be complex and require a number of treatment approaches. It also requires an astute clinician who can identify the subtle changes in the area. We’re confident that we can help you!
Do you have neck pain? Pain around the shoulder blade? Give us a call!
By: Dr. Kevin McIntyre B.Kin., DC
Cools AM, Struyf F, De Mey K et al. Rehabilitation of Scapular Dyskinesis: From the Office Worker to the Elite Overhead Athlete. British Journal of Sports Medicine 2014; 48: 692-697.
Kawasaki T, Yamakawa J, Kaketa T, et al. Does scapular dyskinesis affect top rugby players during a game season? J Shoulder Elbow Surg 2012; 21: 709–14.
Kibler WB, Sciascia AD, Uhl TL, et al. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation. Am J Sports Med 2008; 36: 1789–98.