If you are experiencing neck pain, there is a good chance that you have some degree of dysfunction in your shoulders and likely also your lower spine and pelvis. This article is intended to educate you that in order to correct a neck problem, it often takes comprehensive approach. While it also usually requires work to correct lower body imbalances simultaneously with neck and shoulders to see the best results, this article will focus on the complex relationship between shoulders and neck.
The neck is made up of the cervical vertebrae (bones), the paraspinal muscles, the sternocleidomastoid muscles, scalene muscles, the levator scapulae, the upper trapezius muscles, suboccipital muscles, spinal cord, intervertebral discs, ligaments, nerve roots that form the brachial plexus as well as other structures. The shoulder is made up of the scapula (shoulder blade), the clavicle (collar bone), the humerus (upper arm bone) and many muscles such as the trapezius, levator scapulae, deltoid muscle, internal and external rotator muscles, biceps, triceps, pectoralis major and minor, latissimus dorsi, rhomboids, and others, some of which directly link the head and neck to the shoulder girdle.
Now that we have a list of some of the key players in the, lets discuss how important it is for the shoulders to be functioning properly in regards to reducing neck pain. There are many problems that may arise in the shoulders and any one (or combination) of the following examples in addition to possibilities not addressed in this article may result in dysfunction and pain of the neck.
If an imbalance in which muscles of the anterior are facilitated (stronger and tighter) and the muscles of the posterior groups are inhibited (weakened), the scapula will begin to protract or come forward around the sides of the rib cage. When this occurs, the free end of the clavicle will also misalign anteriorly. This malpositioning of the skeletal structure will cause the muscles attached to them such as the sternocleidomastoid, trapezius, and levator scapulae to have different resting tone or tension as well as pull the joints in the neck that they are attached to in altered directions resulting in neck pain, headaches and even issues with the TMJ (joint of the jaw).
Altered tone of even just one muscle that is not typically thought of as a contributor to shoulder or neck dysfunction such as the coracobrachialis may cause major muscles to compensate for its inadequate function. The coracobrachialis muscle attaches from the coracoid process of the scapula, a small bony protrusion on the front side of the scapula that serves as an attachment for the biceps brachii and pectoralis minor, to the medial portion of the humerus. It helps to flex the shoulder, adduct the shoulder, internally rotate the humerus, and stabilize the head of the humerus. If for some reason such as a trigger point or myofascial restriction were to occur, the coracobrachialis could cause other larger muscles in the shoulder to have minor alterations in tone which over time can lead to a compounding problems. Just as with the muscle imbalance discussed above, hypertonicity and myofascial restrictions of even one muscle can lead to further issues.
Just as muscular imbalances of the shoulder can lead to neck pain, the same is true for imbalances in the neck causing issues for the shoulders.
Another way in which the neck can create an issue that displays itself in the shoulders is the presence of a neurological deficit. This can be categorized in many different ways but we will focus on 3 major pathways that are commonly affected.
Upper motor neuron lesions are when the problem is located in the central nervous system and causes the spasticity of reflex and hypertonicity of a body part. This can happen if there is a brain injury or a cervical intervertebral disc protudes into the spinal cord above the level of the part being affected. Several tests can be performed to indicate whether this is the problem such as Hoffman’s sign and muscle strength tests, reflexes, and nerve velocity conduction tests. This would result in hypertonic muscles in the shoulders if the nerves controlling the shoulders are involved leading to altered joint function.
Lower motor neuron lesions may also be the result of a disc injury but puts pressure on the peripheral nervous system. This would result in decreased muscle tone, decreased reflexes weakness and fasiculations (twitching) of the muscle being affected. If unresolved, this will lead to atrophy of the muscle. Leading to inability to adequately control the muscle to allow for proper joint function.
The third category is a deficiency in the posterior columns which transmit sensory information. Decreased sensory means decreased proprioception,the awareness of where a body part is in time and space. Proprioception is very important in pain management as increased proprioceptive stimulation closes the gate on chronic pain. Proprioception is also key in maintaining proper muscle tone which is critical for proper joint alignment.
The neck and shoulders are linked bio-mechanically and also neurologically, so maintaining proper posture, muscular balance and joint health is crucial to not only live pain free but to perform at your optimum level. Whether you are an elite athlete or a sitting at a computer all day, our modern lifestyle causes many of us to experience imbalances in the neck and shoulders. Even if you are not currently experiencing pain, you should get your neck and shoulders checked out by a professional chiropractor regularly and learn how to better care for them daily for management of shoulder pain and prevention of shoulder dysfunction.
If you live in the Franklin or Brentwood area contact White Feather Chiropractic at (615)415-0125 for more information and a complementary consultation.