When I get someone complaining of generalized shoulder/neck pain and/or restricted range of motion I immediately look to 3 areas. The first area is the upper traps. If the upper traps are “shrugged” up at rest this is a good indication that they are overactive and causing narrowing in the pathways of the joints that make up the shoulder complex. I use various techniques such as massage and stretching to help “release” the muscles associated with the upper traps to see if this provides some immediate decrease in symptoms.
If there is neck involvement or radicular symptoms down into the arm I also check the window where the supraspinatus, levitator scapulae, and lower traps/rhomboids come together. This area is both the origin and insertion for many muscles and can cause havoc in the brachial plexus. The brachial plexus is essentially a forest of nerves that get fed from the spine and branch into peripheral nerves down into areas of the body including the arms. More times than not I will find a big knot right at that spot, and when I get in there with some deep massage or ART (Active Release Technique,) there will be an instant relief of symptoms. As you start to break up that knot or adhesion and get blood flowing into the area it will help to reduce the pain and speed up the recovery process. It is important to look at all of the muscles, fascia and tendons of the body as if they are playing tug of war with each other. When one of the areas begins to lose the war, a trigger point can pop up and start causing symptoms.
Also related to the window where the supraspinatus, levitator scapulae and lower traps/rhomboids comes together in an area on the anterior (front) part of the shoulder where the greater/lesser tubercles and bicipital groove sit. Many of those same muscles that originate or insert in the previous spot also come around and attach right at this spot. Some massage and ART to this area can also help to achieve some initial improvement of symptoms.
The last thing I look to initially in cases of shoulder and neck dysfunction is thoracic mobility and posture. If the shoulders are rounded forward, and the thoracic spine shows kyphosis (rounded back,) this can lead to immediate dysfunction. Many times just cueing to help improve posture and thoracic mobility can work to help fix the dysfunction or stop it from getting worse. In cases where individuals have had poor posture for the majority of their life, their structure itself can go through changes. So for these people the primary goals would be to “stop the bleeding” so to speak and just make sure it doesn’t get any worse from this point forward.
In Part III I will address dysfunction and pain in the hip/abdomen/groin area.
