Neck and Shoulder Pain

Neck and shoulder pain can be classified in many different ways. Some people experience only neck pain or only shoulder pain, while others experience neck and shoulder pain in both areas.

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For many people, headaches start as pain or tension at the top of the neck. As the pain worsens, it may spread to the back of the head, the temples, and forehead or behind the eyes. Moving the neck or bending forward for a long time tends to make it worse.

This happens because the nerves in the upper part of your neck are connected to the nerves in your head and face. A disorder of the upper neck joints or muscles can cause referred pain to your head. Any of the following points could suggest that your neck may be causing the headache:

• Headache associated with neck pain. Does the pain radiate from the back to the front of your head?
• Headache with dizziness or light-headedness;
• Headache brought on or worsened by neck movement or staying in the same position for a long time;
• Headache eased by pressure to the base of the skill

The neck and the shoulder regions are very closely related - both in their anatomy and in their function. Neck and shoulder pain can co-exist with each other and it is common to have a mixed pattern of both neck and shoulder pain at the same time.

All of the tissues that make up your shoulder come from the same development area of the growing embryo - the fifth neck segment.

This means that pain from any of these "shoulder bits" is felt in the same part of the arm - and at times all the way to the wrist. This skin area runs down from the shoulder on the outer part of your arm, over the elbow and towards the base of the thumb. It also means that pain from the bones or joints or discs of the fifth neck segment is felt in the same area.

This is why it can be difficult to work out if neck and shoulder pain is arising in the neck or in the shoulder - as far as the brain is concerned, these body areas are very closely related.

What causes neck pain?

The neck (cervical spine) is composed of vertebrae that begin in the upper torso and end at the base of the skull. The bony vertebrae along with the ligaments (which are comparable to thick rubber bands) provide stability to the spine. The muscles allow for support and motion. The neck has a significant amount of motion and supports the weight of the head. However, because it is less protected than the rest of the spine, the neck can be vulnerable to injury and disorders that produce pain and restrict motion. For many people, neck pain is a temporary condition that disappears with time. Others need medical diagnosis and treatment to relieve their symptoms.

Neck pain may result from abnormalities in the soft tissues—the muscles, ligaments, and nerves—as well as in bones and joints of the spine. The most common causes of neck pain are soft-tissue abnormalities due to injury or prolonged wear and tear. In rare instances, infection or tumors may cause neck pain. In some people, neck problems may be the source of pain in the upper back, shoulders, or arms.

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Inflammatory Diseases

Rheumatoid arthritis can destroy joints in the neck and cause severe stiffness and pain. Rheumatoid arthritis typically occurs in the upper neck area.

Cervical Disk Degeneration

The disk acts as a shock absorber between the bones in the neck. In cervical disk degeneration (which typically occurs in people age 40 years and older), the normal gelatin-like center of the disk degenerates and the space between the vertebrae narrows. As the disk space narrows, added stress is applied to the joints of the spine causing further wear and degenerative disease. The cervical disk may also protrude and put pressure on the spinal cord or nerve roots when the rim of the disk weakens. This is known as a herniated cervical disk.

Other Causes

Less common causes of neck pain include tumors, infections, or congenital abnormalities of the vertebrae.

What causes shoulder pain?

The shoulder is a ball and socket joint with a large range of movement. Such a mobile joint tends to be more susceptible to injury. Shoulder pain can stem from one or more of the following causes:

• Strains from overexertion
• Tendonitis from overuse
• Shoulder joint instability
• Dislocation
• Collar or upper arm bone fractures
• "Frozen" shoulder
• Pinched nerves (also called radiculopathy)
• Arthritis in the joints about the shoulder (gradual narrowing of the joints and loss of protective cartilage).
• Bursitis (inflammation of a fluid-filled sac, or bursa, that lies between tendon and skin or between tendon and bone). Normally a bursa protects the joint and helps make movement more fluid.

Sleeping position

Quality sleep is an elusive commodity for millions. The complex process of attaining a quality sleep pattern can be compromised by a number of factors that you may or may not have even considered. One such factor is simply the wrong pillow.

Stress is an important factor when trying to physically get to sleep in the first place. When stress levels are high, muscles will be tense, blood flow is decreased, and the brain is overactive. This often leads to muscle tension in the neck, especially if the pillow being used is not comfortable and supportive, as such giving rise to mild or at times, severe neck and shoulder pain. Aside from reducing stress, a comfortable, cozy, yet supportive environment, with low pressure and low shear is required in order to:

• allow for muscular recovery
• remove pressure from bony prominences (shoulders, hips, knees, and ankles)
• enable the musculo-skeletal system to relax

Effects of Pillows on Sleep and neck and shoulder pain

Choosing the right pillow is very important in achieving a good night’s rest. A good pillow will support the skull and neck without applying undue pressure, as it conforms to the exact shape of the sleeper, thus spreading the weight evenly and uniformly along the vertebrae.

Pillows are a constant cause of frustration for many. Aside from aggravating any neck and shoulder pain, the shoulder should not be placed at 90 degrees to the mattress as this may trigger spasms in the trapezius muscles. The trapezius muscles perform a variety of actions, including acting as a platform for elevating the skull, so it is very important that they relax completely during sleep. If the shoulder is placed slightly forward on the mattress, in front of the sleeper, assuming the mattress can accommodate this position, the risk of applying pressure on the trapezius muscles and forcing the scapula (shoulder blade) towards the spine is reduced. In contrast, when positioned in the 90 degree position, sleepers may wake up with neck and upper arm pain and altered sensation to the little and ring fingers.

If a pillow applies excessive pressure to the neck in the back sleeping position, particularly the C2, C3, vertebrae, then treatment that has been provided will almost always be compromised. Pressure can irritate the nerve sheaths, sensitive muscles, and facet joints in the neck. Equally, if the joints are not resting easy, the inflammatory process may be sustained and any recovery will be much more difficult.

Shoulder compression on a firm surface will often force the scapula (shoulder blade) towards the junction of the upper spine and neck, and affect the C6/C7 vertebrae. The nerve pathway at this site travels down the arm, and causes either upper arm pain or pins and needles in the little and ring fingers or both, especially if there is already a problem in this area.

Shoulder problems are also often caused by referred pain from the neck. Therefore, stabilizing the neck during sleep is of paramount importance! Put some thought into choosing a good pillow - In addition to finally getting a great night’s sleep, you may end up saving yourself from neck and shoulder pain too!

A Good Pillow is designed to keep the spine in natural alignment

The human neck curves slightly forward (to sustain the weight of the head when upright), and it is very important to maintain this curve when in a resting position. If the height of the pillow is too high when sleeping sideways or on the back, the neck is bent abnormally forward or to the side, causing muscle strain on the back of the neck and shoulders. This type of position may also cause narrowing of the air pipe, resulting in obstructed breathing, and sometimes snoring, which can hinder sleep. Conversely, if the height of the pillow is too low, the neck muscles can also be strained and thus causing neck and shoulder pain.

Based on the body’s measurements and personal preference, the pillow should maintain a height of 4 to 6 inches, properly supporting the head and neck (and shoulders when lying on back), thus preventing the formation of any neck and shoulder pain.

Treatments for neck and shoulder pain

Physical treatments
Physiotherapists, chiropractors and osteopaths are all therapist treating neck and shoulder pain relating to muscles. Manual treatments carried out by one of these therapists may be all that is needed. Sometimes manipulation is uncomfortable at the time, so it is important that you understand what is involved. Make sure you talk to your therapist about the treatments before they start.

Collars
There is no evidence that these are of any help for long-lived neck pain. Some people find they help at night to keep the neck in a good position while they are asleep. For acute short-lived pain, collars can be used to relax the neck muscles thereby stopping the pain. Can only use them for 1 week continuously, after which it shouldn’t be used. Long term use of collars can weaken the muscles, causing more problems in future.

Injections
In some cases an injection may help. The injection may be a long-acting local anaesthetic or a steroid preparation, injected into the tender trigger points of the neck or painful ligaments.

Surgery
Only rarely is surgery necessary. Surgery may help if a nerve is pinched and it is causing weakness or severe pain which won't go away. The surgeon will ask for a scan to look at the nerves and bones before discussing with you the need for the operation and the pros and cons of surgery.

Interventional Pain Procedures
Minimally invasive pain procedures can get rid of the underlying pain generators with no risk and no down time. Nucleoplasty decompression can shrink the slip disc through a specialized needle (see condition). Facet denervation can treat inflamed facet joints (see condition). Nerve decompression can be treated with neuroplasty (see condition).

Other treatments
Acupuncture is one of the oldest recorded forms of medicine, having been used for over 3000 years in China. Modern science has shown that acupuncture stimulates the brain to produce natural pain relieving chemical - endorphins. These help the body to heal itself and give pain relief.

The Chinese medicine theory is that 'Qi' (energy) flows round the body in channels known as meridians If the qi is flowing freely the body is in a healthy state, but if the energy stagnates or there is blockage in a meridian it causes pain The insertion of needles into acupoints helps to unblock the meridian and so relieve pain.

Research has shown that most people gain pain relief from acupuncture, although it does not work for everyone. The effects are cumulative, with pain relief building up as treatment progresses. Some people have a good response to treatment, while others less so.

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