Pain in neck and shoulder radiating down the arm
Neck pain is a common musculoskeletal presentation that most people experience through their lifetime. Occasionally neck pain can present accompanied by radiating pain down the arm. There are different causes and structures for this presentation but before we dive straight into them let’s clarify some important points.
First of all we need to discard structural damage to the spine or the spinal cord. This can be done based on the characteristics of the experienced symptoms, through imaging if necessary and through an orthopaedic assessment where specific diagnostic tests can be carried out.
Once the previous point is cleared we can focus on the soft tissue looking at the following elements to create an effective treatment plan:
- Postural assessment. This will allow us to identify patterns with shortened myofascial lines and areas of weakness that might be causing the pain.
- Range of motion: This will allow us to identify restrictions and narrow down the structures involved.
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- Active: Patient does the movement
- Passive: Therapist does the movement
- Resisted: Client does the movement against therapist’s resistance
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- Quality and quality of the pain. When does it happen, intensity of pain, type of pain (dull, sharp, pins and needles), things that make it worst/Better… etc.
After this initial assessment the therapist will have a pretty good idea of what the problem might be and will develop a treatment plan accordingly.
What are the most common soft tissue structures involved in neck and shoulder pain radiating down the arm?
There are a few muscles located in the neck and shoulder area that can cause pain locally. Due to our postural patterns and lifestyle these muscles usually carry a lot of weight and are overused which means that they are very vulnerable to develop and host Trigger Points and myofascial restrictions.
Trigger points (LINK) are defined as hyper irritable spots within a taut band of a muscle fibre. They are also known as “knots” and they can feel like a little not or bump in the tissue. Trigger points can refer pain locally to where they are located or radiating pain somewhere else in the body. In case of the neck and arm, there are several muscles that can cause both local pain and radiating pain down the arm.
When both neck and arm pain are present on the same side we usually find that the whole shoulder girdle and neck structures are hosting trigger points and need work. This is of course not always the case, we also see cases where quite a specific area or a muscle is causing most of the problem.
The following muscles are some of the most common to refer pain locally into the neck:
- Levator scapulae
- Scalens
- Splenius capitis
- Trapezius
- Suboccipitals
The following muscles are some of the most common to refer pain down the arm:
- Scalens
- Pectoralis minor
- Rotator cuff muscles
- Lattissimus dorsae
The job of the therapist in the short term is to identify which muscles and Trigger Points are causing the symptoms and release them.
The therapist is able to do this after the initial assessment and history taking described above and thanks to the work of Dr. Janet Travell who discovered Trigger Points and realised the pain pattern caused by each muscle was the same for every person. This meant that she could identify the origin of the pain by the location of the pain described by the patient. She captured these maps of pain with their respective Trigger Point of origin leaving as an incredibly powerful tool. We now use these maps of pain to locate the origin of the pain.
Treating the direct cause of the pain is usually enough to considerably reduce or eradicate the pain but usually on the short term only. If nothing else is done, the chances are high that the presentation will repeat itself in the future.
The job of the therapist in the long term is to address the system or structure and correct the ultimate cause of these Trigger Points and restrictions. We achieve this by looking at the body as a whole, identifying patterns that can be causing the problem and creating a treatment plan combining treatment with strength training to change these patterns. We release the areas where the fascia has become shortened and we strengthen the areas that are weak.
The job of the therapist in the short term is to identify which muscles and Trigger Points are causing the symptoms and release them.
The therapist is able to do this after the initial assessment and history taking described above and thanks to the work of Dr. Janet Travell who discovered Trigger Points and realised the pain pattern caused by each muscle was the same for every person. This meant that she could identify the origin of the pain by the location of the pain described by the patient. She captured these maps of pain with their respective Trigger Point of origin leaving as an incredibly powerful tool. We now use these maps of pain to locate the origin of the pain.
Treating the direct cause of the pain is usually enough to considerably reduce or eradicate the pain but usually on the short term only. If nothing else is done, the chances are high that the presentation will repeat itself in the future.
The job of the therapist in the long term is to address the system or structure and correct the ultimate cause of these Trigger Points and restrictions. We achieve this by looking at the body as a whole, identifying patterns that can be causing the problem and creating a treatment plan combining treatment with strength training to change these patterns. We release the areas where the fascia has become shortened and we strengthen the areas that are weak.
We must mention here the Myofascial lines without getting too deep into details. Let’s quickly look at it in a very simplified way. The fascial is a connective tissue in the body that provides structural support (as well as having other incredible properties that we’ve already covered in previous posts). Part of this structural fascia is organised in what we now know as Myofascial lines.
These lines run in different directions through the body connecting our muscles in chains. This is important because when part of the line is restricted it directly affects the position and functionality rest of the line and the whole body.
When looking at releasing neck and shoulder pain and pain down the arm and preventing the issue from re-occurring we need to look at what the Myofascial lines are doing and how they can be contributing to the presentation. These must be included in the treatment for more effective long-lasting results.
Some parts of these Myofascial lines are shortened and other parts are stretched and weak. The shortened structures need to be released and the stretched structures need to be strengthened in order to reestablish the order within the system.
This last strengthening step requires the client’s involvement and compromise to carry out the exercises and work through their patterns. It’s usually the hardest step for clients as it requires compromise and constancy and it’s also the step that really makes a different in quality of life and functionality for the long term.