Neck and Shoulder tension and pain

Coverage of the problem of neck and shoulder tension in the literature

The issue of neck and shoulder tension, as evidenced by my observations at my massage therapy clinic, is notably prevalent. Consequently, any information pertaining to this concern holds significant relevance.

In the existing literature and client materials, the issue of neck and shoulder tension tends to be addressed superficially and in a one-sided manner. Frequently, there is a lack of clear and precise definitions, and at times, the provided information can be inaccurate, potentially leading clients and massage therapists astray. Furthermore, the causes of neck and shoulder tension are often oversimplified, failing to reflect the complex reality of the situation.

Given these circumstances, I find it challenging to recommend specific and readily available materials about neck and shoulder tension to clients of my massage clinic, as such resources could potentially create confusion rather than provide clarity.

Therefore, I present my perspective on this issue in straightforward, everyday language, tailored for the general public and individuals without medical expertise. As a result, I’ve intentionally simplified and employed a more accessible style. My primary aim is to convey the core concepts without being bound by overly scientific or technical jargon.

These materials can also be advantageous for massage therapists, especially for those who prioritize hands-on practice over the review of theory.

What is the neck and shoulder tension

So, neck and shoulder tension refers to discomfort, often accompanied by pain, resulting from muscle disbalances in the neck and shoulder region. Prolonged sitting is a primary contributing factor among various causes.

The muscles implicated in neck and shoulder tension can vary, influenced by their degree of involvement and level of development. Consequently, the specific posture an individual adopts, such as when sitting, can engage different muscle groups. This diversity in muscle engagement leads to a wide range of symptoms. It’s evident that effective therapeutic approaches must consider these distinct patterns to address the issue adequately.

Causes

From my previous articles, you may already be aware that the causes of neck and shoulder tension typically fall into two categories: “simple” and “complex.” However, it’s important to note that this classification is relative, as even a seemingly “simple” cause, which can often be self-managed, may escalate to a point where medical intervention becomes necessary.

Simple and most common causes of the neck and shoulder tension

1. Prolonged sitting.

Sitting for extended periods may seem like a passive activity, but in reality, your neck and shoulder muscles are actively engaged. They play a crucial role in supporting your head, maintaining its position at eye level, and stabilizing your shoulders for optimal posture. Additionally, these muscles facilitate the freedom of movement in your arms, enabling you to use your hands effectively.

Consequently, neck and shoulder muscles gradually accumulate fatigue. Unlike the noticeable fatigue experienced during physical activity, this process often goes unnoticed for extended periods, making it easy to disregard.

The situation can worsen significantly if your workspace isn’t tailored to your individual needs. Issues like an improperly adjusted chair height, a chair back that doesn’t align with the curves of your back, or a desk and monitor that doesn’t promote a relaxed sitting position can exacerbate the problem.

2. Poor posture

This cause is intricately connected to the previous one but differs in terms of quantity and quality. In terms of quantity, it often arises as a consequence of the previous cause. In terms of quality, it goes beyond mere neck and shoulder muscle fatigue, encompassing more persistent compensatory disturbances in the alignment of body parts.

3. Repetitive physical activities

This scenario is more common among individuals engaged in manual labor that involves repetitive hand movements. Normally, these activities, when not excessive, actually help strengthen the specific muscles and allow you to adapt without issues. However, in cases where the physical workload exceeds a certain threshold, overexertion and even minor muscle injuries can occur.

I’d like to highlight that this is a relatively smaller subgroup, notably less prevalent than the previous categories.

Complex causes of the neck and shoulder tensions

Given that this category demands the attention of medical professionals, I will now provide a concise list of the most prominent causes.

• Injuries – which can result from sports, exercise, or routine daily activities.
• Lupus – an autoimmune disease that can affect virtually any organ in the body. It’s characterized by episodes of flare-ups when symptoms worsen and periods of remission when symptoms may improve.
• Lyme disease – transmitted to humans via tick bites. When left untreated, it can lead to various symptoms, including muscle aches, pains, and neck stiffness.
• Infectious mononucleosis – a contagious illness that is frequently found among teenagers and young adults.
• Polymyalgia rheumatica – a prevalent source of widespread stiffness and aching throughout the body, primarily affecting individuals over the age of 50.

Pathogenesis and clinical presentation

In one way or another, whether through intense physical activity leading to fatigue or prolonged passive sitting, where certain neck and shoulder muscles remain in a state of sustained tension, overworking of specific muscles can take place. This is the first step in a series of pathological changes.

The progression toward overworking the muscles can sometimes bring about uncomfortable, typically non-painful sensations. These sensations serve as initial signals that are advisable not to ignore.

Regrettably, many clients often disregard these signals, attributing their inattention to being overly occupied or not wanting to be distracted by what they perceive as minor concerns.

As fatigue in neck and shoulder muscles progresses, discomfort intensifies, and soreness becomes increasingly pronounced, varying in its presentation. The exact manifestation of soreness depends on factors such as overall physical condition, individual sensitivity, and one’s pain threshold.

To alleviate these sensations, the body may attempt to compensate by engaging additional muscle groups and adjusting the positioning of the shoulders and head. Typically, this provides some relief, but only for a relatively brief duration.

Over a more extended period and with repeated episodes akin to the one described, deeper alterations can occur within the muscles, sometimes leading to inflammatory processes, and consequently, more pronounced and noticeable symptoms.

In later stages, this process can extend to involve overstretched ligaments and neck joint surfaces, subjecting them to increased pressure, resulting in the emergence of specific symptoms.

If a nearby nerve trunk becomes entangled in the process, it can lead to neurological symptoms such as sharp, often radiating pain, numbness, tingling, and so on.

Prolonged, involuntary compensatory positions of the head and shoulders can contribute to the development of postural disorders. These postural issues, in turn, may trigger secondary symptoms, often affecting different muscle groups and sometimes manifesting at a distance from the original problem area.

Diagnostics

The diagnostic process is inherently complex and falls beyond the purview of a massage therapist. Nonetheless, gaining a basic understanding of it can be a valuable exercise. Therefore, I will provide a simplified approach to forming your own perspective on the matter.

Hence, endeavors to comprehend the complexities of the neck and shoulder conditions described above can be intricate and often shrouded in confusion. However, the diagnostic process should revolve around the systematic identification of both causative and pathogenic factors.

1. To begin, we focus on understanding the symptoms and their precise location, enabling us to pinpoint target areas. This can be easily unveiled during the client interview by inquiring about their sensations and requesting them to indicate the specific locations using their finger.

2. Following that, an examination of the client’s daily routine is crucial, particularly how they spend the majority of their working day. This step helps us pinpoint the primary causative factors.

3. Subsequently, we inquire about the client’s physical activity and engagement in sports. This assessment aids in gauging the overall physical fitness of the body and its muscles, shedding light on the organism’s compensatory capabilities.

The nature and specific location of discomfort or pain in the neck and shoulder provide insights into which anatomical structures are implicated in the pathological process. This helps determine whether it primarily involves muscles or if there are indications of ligament, joint, or nerve involvement.

4. Furthermore, it’s essential to identify and take into account supplementary factors, including emotional stress, anxiety, and any coexisting health conditions, as these elements may exacerbate the client’s existing condition and demand your attention.

In the end, it is crucial to ascertain: WHAT anatomical structures are implicated in the pathological process (muscles, ligaments, joints, nerves), pinpoint WHERE these issues are precisely located, and determine HOW LONG this process has been ongoing. Even if the mechanism and full extent of tissue involvement aren’t entirely clear, meticulous documentation of these findings will aid in gradually gaining a more comprehensive understanding of the situation over time.

Treatment

Frequently, the client’s desires may not align perfectly with what you, as a massage therapist, believe to be the most suitable course of action. This inherent contradiction can be effectively addressed through thorough client education.

A considerable number of clients hold the firm belief that periodic massages every few weeks, coupled with occasional chiropractic visits, will suffice to resolve their issues.

It’s essential to recognize that the diagnostic abilities and therapeutic interventions of a massage therapist are relatively constrained. Hence, it is prudent to adhere to straightforward yet effective approaches.

Considering the affected area of the body

Considering the precise localization of the issue established earlier, identify the primary affected area.

Taking into account the positioning and interaction of muscles, ascertain the regions of synergistic muscles that could potentially be engaged in compensating for the pathological changes, as well as the areas of antagonist muscles that play integral roles in the pathological process.

The massage therapist can select any sequence for addressing these areas, with the choice influenced by factors such as the extent of the changes and tissue soreness.

In massage literature, a common recommendation is to initiate the massage treatment in more distant areas and progressively work toward the primary ones. Nevertheless, this approach is typically not thoroughly explained.

Considering the nature of the affected tissues

If, during the interview and examination, the nature of the affected tissues (muscles, tendons, ligaments, joints, nerves, etc.) has been identified, it is advisable to consider this information when carrying out the massage treatment.

Numerous massage techniques have been devised for targeted interventions on joints, ligaments, muscles, and tendons. However, delving into the specifics of these methods is beyond the scope of this article.

It is important to note that some of these methods may fall into the realm of pseudoscience. Employing pseudoscientific techniques is unlikely to yield the desired results and should be avoided.

When dealing with a substantial volume of affected tissue, it would be advisable to suggest a consultation with a specialist or a medical doctor.

Considering the etiological factors

When etiological factors of the neck and shoulder tension are pinpointed, it is essential to offer guidance on minimizing them. For instance, if prolonged sitting is identified as an etiological factor, it’s crucial to recommend assessing and meticulously adjusting the workspace, and providing the client with pre-designed recommendations. Encouraging a reduction in sitting time, if feasible, should also be considered, even though some may approach this advice skeptically.

Indeed, recommendations and advice constitute another integral and equally significant facet of a massage therapist’s role.

It’s true that massage therapists may encounter varying limitations in offering such advice, which can differ from one region or country to another. Nevertheless, educating the client and fostering their understanding of what specific changes are necessary remains a pivotal component of achieving success.

Hence, recommendations regarding physical exercises and stretching routines for the muscle groups involved in the process hold immense significance.

Assorted printed materials, compilations of exercise regimens, tips, and recommendations can be invaluable resources. Clients often find it challenging to retain all the advice provided verbally, and over time, a significant portion of the information may be forgotten. Therefore, having reference materials readily available can be highly beneficial.