As an outpatient physical therapist I have seen and will continue to see many, many patients with neck pain. Many of these people are frustrated because they have had imaging but it has not shown anything really wrong with the structure of the spine. However the pain is very real. Most of these patients are suffering from cervical myofascial pain syndrome. It affects the muscles around the neck and shoulders. Luckily, it is highly treatable condition. Read on to learn about cervical myofascial pain. Let’s start with anatomy!
The cervical spine
The cervical spine is the region of the body that is more commonly known as the neck. It is made up of 7 unique vertebrae (spinal bones). It’s job is to support and soften loads to the head and neck while allowing movement. It also functions to protect the spinal cord. The cervical vertebrae are named C1 through C7. C1 is the first vertebra below the skull and C7 is the last vertebrae of the cervical spine.
The shoulder joint
The main shoulder joint is called the glenohumeral joint. It is a large and complex joint that is made when the humerus (upper arm bone) and the scapula (shoulder blade) come together. It is a ball and socket joint. However the ball is much bigger than the socket. Think of a golf ball on a tee. The golf ball is the head of the upper arm bone and the tee is the outside part of the shoulder blade.
This allows the shoulder to have the most movement of any joint in the body. However, it also has the least stability and this is what tends to get the shoulder joint in trouble.
What is cervical myofascial pain?
Cervical myofascial pain is pain in the muscles or surrounding fascia of the cervical spine and scapula area. There may also be accompanying stiffness in the muscle and decreased neck mobility. Myofascial pain is characterized by trigger points in the muscle. Trigger points are areas that are very painful to the touch and are usually located in taut bands of the muscle fibers. When pressed the pain from trigger points will radiate or refer to the problem areas of the neck and shoulder.
The usual suspects
There are several muscles that are typically the culprits that cause pain in the neck and shoulder. These include:
- Upper trapezius – This muscle attaches to the back of the skull and travels down in a fan shape on either side of the neck to attach to the collarbone and shoulder blade. The upper trapezius will side bend, rotate, and extend (looking up) the neck. It also elevates or raises up the shoulder blades. This last action is the one that usually causes problems. Many people will unknowingly elevate their shoulder blades when stressed. This will eventually cause trigger points and pain.
- Levator scapula – This muscle attaches to the sides of the cervical vertebrae and travels down to attach onto the inside area of the shoulder blade. Like the upper trapezius, it elevates the shoulder blades. If continually contracted, this causes trigger points and pain.
- Supraspinatus – This muscle is located on the upper part of the shoulder blade. It’s job is to stabilize the shoulder joint. As mentioned prior in this article, the shoulder joint is inherently unstable. Having poor posture which typically characterized by rounded, forward leaning shoulders will cause trigger points and pain in the supraspinatus.
- Infraspinatus – This muscle is located on the lower part of the shoulder blade. It also works to stabilize the shoulder joint. Like the supraspinatus, prolonged poor posture will cause trigger points and pain.
- Rhomboids – These muscles are located between the shoulder blades. They attach along the spine and travel to the inside border of the shoulder blade. These muscles will bring the shoulder blades closer to the spine. Poor posture causes them to become stretched out and weak. This can lead to trigger points and pain in the area between the shoulder blades.
What are the symptoms of cervical myofascial pain?
- Decreased neck mobility
- Having painful “knots” in the muscles around the neck and shoulders
- Pain in the neck region that might radiate down the arms or the upper back
- Pain could occur suddenly
- Muscles feel stiff and could spasm
- Headache
- Could cause interrupted sleep
What causes cervical myofascial pain?
There are several causes of cervical myofascial pain. However the majority of the causes include poor or abnormal posture. Some of the causes of this condition include:
- Sedentary desk job with poor ergonomics – Neck pain can occur if the keyboard is too high or the chair promotes slouching rather than sitting up straight.
- Stress – Stress can cause neck pain in people that hold their stress in their neck and shoulders. I have seen this in several patients. They will elevate their shoulders towards their ears when under pressure or stress and are completely unaware of it. Maintaining this posture for an extended period of time will cause trigger points and pain.
- Repeated overhead activity – Jobs or activities that require a person to repetitively reach overhead can also cause trigger points and pain. An example of this would include painting a ceiling.
- Motor vehicle accidents – Trigger points can develop in the neck from whiplash in a motor vehicle accident.
Who gets cervical myofascial pain?
This condition is very common, and I have treated it more times than I can count. It tends to occur in adults rather than kids. The prevalence is higher in women than in men.
Who should I see?
- Physical therapy – Physical therapy has good success with treating cervical myofascial pain. A physical therapist can help improve mobility of the neck and upper back with mobilization and manipulation techniques. Also releasing some of the musculature around the neck and shoulder blades with soft tissue mobilization or dry needling will help decrease the pain. Physical therapy can also help strengthen the neck and shoulder muscles and improve posture.
- Primary care physician – If your condition does not respond to physical therapy, then going to see your PCP would be the next step. Your primary care physician can examine you and provide medications such as anti-inflammatories or muscle relaxers if appropriate. Imaging might also be ordered to provide more detailed information. A referral to a specialist might also occur depending on your symptoms and the results of the imaging.
What can I do?
- Aerobic exercise – Performing low impact aerobic exercise is very beneficial for the spine. It increases the flow of nutrients and blood and decreases pressure on the discs. It can also be a good way to relieve stress. Examples of low impact aerobic exercise include walking, swimming, and biking. If you don’t currently have an exercise program, then carefully work into one. You might begin by walking for 5 to 10 minutes a day and slowly work up to 30-60 minutes over several weeks or months. Be sure that whatever you choose does not exacerbate your symptoms
- Ice – Ice can help decrease irritation and pain in the muscle. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
- Posture – Having forward rounded shoulders causes the chin to poke forward and the neck to forward flex. This takes the cervical spine out of it’s natural alignment. The shoulders should be back so that they are in line with the hips. They should also be held down the back so that the upper trapezius and levator scapula do not become overly tight. To prevent the chin from jutting out, the ears should be in line with the shoulders. This will automatically bring the chin in and align the cervical spine. If the pectorals and biceps are tight, they will cause the shoulders to round. Below is a video showing how to stretch the pecs and biceps and also how to use a wall to check your posture.
- Ergonomics – Because proper posture might feel very abnormal and will be difficult to maintain, especially at first, it is important to have a good setup at your work area. This could include an ergonomically designed chair. This type of chair will help support proper posture. These chairs can be expensive so one could improve the ergonomics of most chairs with pillows and towel rolls. Having a lumbar support (this could be a lumbar pillow or just a towel roll) will prompt one to sit up straight. The chair back should be high enough to support the shoulders and upper back. All of this can aid in maintaining good posture with little muscle energy.
- Strengthen and stretch the muscles around the cervical spine – Strengthening the deep neck flexors are vital in strengthening the neck and being able to maintain proper posture.The deep neck flexors are attached to the vertebrae and are the key stabilizers of the cervical spine. The upper trapezius and levator scapula are muscles that attach to the neck and shoulder. These muscles are commonly tight and can cause neck pain and headaches. Below is a video on how to strengthen the deep neck flexors and stretch the upper trapezius and levator scapula.
- Strengthen the scapular stabilizers –The scapular stabilizers are the muscles around the shoulder blade which help stabilize the shoulder joint while your arm is performing different activities. They are also very important in maintaining good posture. Activating these muscles will help properly align the thoracic spine which will help with proper posture of the cervical spine. The videos below review some strengthening exercises for the scapular stabilizers. Using loop resistance bands and resistance bands can increase strength and difficulty.
- Latex pillow – There has been some research showing that an ergonomic latex pillow can help decrease neck pain. The pillow can support the spine and the head which can improve sleep and decreased pain.
In review
- Cervical myofascial pain is pain in the muscles or surrounding fascia of the cervical spine and scapula area.
- There may also be accompanying stiffness in the muscle and decreased neck mobility.
- Myofascial pain is characterized by trigger points in the muscle.
- Trigger points are areas that are very painful to the touch and are usually located in taut bands of the muscle fibers.
- There are several muscles that are typically the culprits that cause myofascial pain in the neck and shoulder.
- Upper trapezius
- Levator scapula
- Supraspinatus
- Infraspinatus
- Rhomboids
- There are several causes of cervical myofascial pain. However, the majority of the causes include poor or abnormal posture.
- Physical therapy is very successful at treating this condition.
- There are things that you can do
- Aerobic exercise
- Ice
- Posture
- Ergonomics
- Strengthen and stretch the muscles of the neck
- Strengthen the scapular stabilizers
- Ergonomic latex pillow
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://emedicine.medscape.com/article/305937-overview