A Pain in the Neck

No, I'm not talking about your boss, your homework, being stuck in traffic or even all the things on your to do list.  I'm talking about the tightness between your shoulders that can cause pain up into your head, down your arms, sometimes in your chest and can even feel like a sharp pain deep in your inner ear. To explain how and why this happens, let me start with an anatomy lesson.

The main muscle group involved is called the trapezius.  It is so named due to its trapezoid shape, like a kite.  It attaches high up in the neck on the scull, extends down the spine to the mid back and flares out across to the edges to the shoulders.  The upper edge that is marked with an "X" is an area where trigger points can develop.  You know these better as "knots."  They are balled up areas of spasm that make life miserable. 

Underneath the trapezius are the scalene muscles.  They hold your head up straight and get overworked when our posture is bad.  At the bottom edge of these muscles is the brachial plexus.  This is a group of blood vessels and, more importantly, nerves that go down into the arm.  Enough spasm in the scalene muscles will cause pain, tingling and even numbness down the arm that feels similar to a bulged disc in the neck.

The sternocleidomastoid muscle group attach to the skull just behind the ear and attaches to the collar bone and breast bone.  These are the muscles that turn your head from side to side.  When they are in spasm one may feel a burning pain from the shoulder into the neck and side of the head.  This is the muscle that can make it feel like there is a sharp pick down in your ear.  This can especially be bad in those who spend a long time on the phone, holding it without hands between the ear and shoulder.

The levator scapulae muscle lifts up the shoulder blade to which it is attached.  It is responsible for shrugging your shoulders.  It is well known for knotting up on people who spend much of their time in front of a key board, especially if it is too high.  Steadily holding the shoulders in a shrugged position while typing creates constant tension in this muscle group.  It is not uncommon for me to see patients who come in complaining of a deep pain in their chest and are worried that they are having heart pains.  As I talk with them I'll hear clues that this is not their heart.  As I examine them, it becomes readily apparent that they are knotted up in the trapezius and especially the levator scapulae muscle.  I say to myself, "A ha!"  for I know that when there is a spasms in that location, it puts traction on the shoulder blade, pulling it upwards.  This then puts pressure on the other muscles which are attached to it, in this case the pectoralis minor muscle.  This is a small muscle of the chest that sits under the well known pectoralis major muscle, or "pecks."  As seen in the picture, the pectoralis minor attaches to the front of the shoulder blade and extends straight down to the rib cage.  Traction on the shoulder blade then causes a reciprocal spasm in this muscle and results in chest pains.

The number one reason for tightness and spasm in these important muscles is posture.  The head weighs about 20-25 pounds and is built to be supported by the bones in our spine.  If we are hunched forward, even just an inch or two, now those 25 pounds are being supported by the muscles of the neck instead.  I am seeing more and more patients with these problems and it is mostly due to the fact that we spend more and more time in front of a computer screen typing.  I have also seen this in patients who have bad posture while reading, sewing, quilting and even wood carving.  Tune in next week and I’ll discuss ways to help you get rid of your “pain in the neck.”