When your shoulder is really a pain in the neck…

An aching shoulder may not necessarily indicate a shoulder problem, and equally a sore neck may not always be a neck problem. The body can often report pain in a confusing, unreliable way. It is common that people with shoulder pain really have a neck problem and vice versa.

Why? Because the neck and shoulder are closely connected by nerves. When injury occurs, referred pain can develop as a result of the brain having difficulty determining the source of pain along the commonly shared nerves. Therefore, often what we feel may not be what is actually occurring.

Because the reported site of pain is often not the source, a thorough examination in combination with a detailed history is required to determine the true source of pain. This involves range of motion testing, provocative neck and shoulder tests, and strength tests.

When the shoulder is the source

Shoulder pain is most often caused by an injury to the rotator cuff, a group of tendons and muscles that stabilize the joint. The rotator cuff can be easily injured by falls, repetitive activities of the arm, sporting injuries etc.  When the rotator cuff is injured we compensate by using different muscles to perform simple tasks like reaching or picking things up. This compensation may cause both shoulder and neck pain.

How do you know it’s your shoulder? You may have a shoulder problem if your pain:

  • Develops in the shoulder itself (at the ball and socket joint)
  • Is on the outside of your upper arm
  • Is dull and aching at the above locations
  • Occurs when you do movements involving the arm
    • reaching overhead
    • reaching behind your back
    • when lifting
    • putting your jacket on
  • Radiates into the upper arm, but not past the elbow
  • Aches at night in the shoulder joint
  • Improves when you rest your arm

When the neck is the source

The neck is made up of eight pairs of joints and many nerves and muscles, which means inflammation of any of these structures can cause neck pain. Considering the neck is responsible for all head movements, including even the slightest nod when in a conversation, there is a good chance you will experience inflammation in the neck at some point!! Common ways to injure your neck include; sleeping awkwardly, turning your head suddenly and awkwardly, holding your neck in one position too long (ie at computer or on the phone), car accidents to name a few.

How do you know it’s your neck? You may have neck pain if your pain:

  • Develops in or on the side of your neck, or develops in the shoulder blade
  • Is sharp or stabbing in the neck
  • Radiates down past your elbow or even into your hand
  • Causes difficulty turning your head, or looking up or down
  • Is relieved when you support your neck

It’s important to see a specialist to get a thorough physical examination of your neck and shoulder to help with diagnosis. Whether the problem lies in your neck or your shoulder, it is imperative that conservative measures are first adopted.

5 ways to help relieve pain from a shoulder problem

  1. Resting from activities that aggravate pain
  2. Osteopathic /physical therapy treatment
  3. Icing the shoulder
  4. Anti-inflammatory medications, as directed by your health professional
  5. Rehabilitation/strengthening exercises for the shoulder

If these measures fail to bring relief, you may need imaging (ie X-ray or MRI) of your shoulder to definitively diagnose if there is a more severe injury such as a tear.

6 ways to help relieve pain from a neck complaint

  1. Osteopathic /physical therapy treatment
  2. Ice or heat
  3. Massage
  4. Resting from aggravating activities
  5. Anti-inflammatory medications, as directed by your health professional
  6. Postural exercises

Whether you have persistent pain in your shoulder, your neck or both, don’t wait to seek advice. Having an osteopath or other physical therapist evaluate your complaints will determine where the main problem is and will get you started on the correct course of treatment for you. The earlier the intervention, the quicker the resolution.

Pregnancy back pain from an Osteopath’s view

Pregnancy is such a special experience. There is something to be said about carrying, growing and protecting your little bundle of joy. It is almost impossible to describe the feeling. The pregnancy experience is often described as all joy, love, glowing and happiness, however in reality it can actually turn out to be all nausea, discomfort and pain. Yes it would be wonderful if we all had a pregnancy full of bliss but unfortunately for a large percentage of women this just isn’t how it happens.

For a large portion of pregnant women, we experience varying degrees of back pain. This can range from a low grade ache and discomfort in bed, or on the couch, to discomfort whilst standing, after walking or being on our feet too long. In some instances it is not uncommon to experience severe debilitating pain in which you have to resort to using crouches or a wheel chair or being almost completely house bound.

Whatever the degree of pain you have suffered throughout your pregnancy it certainly puts a “downer” on the whole experience.

So why does it happen?

Firstly, we all know that a women’s body undergoes dramatic changes throughout a pregnancy whilst growing a baby. There are changes that you can see from the outside, changes you can feel on the inside and changes you have no idea that are happening. It is a combination of all these things that can lead to back pain.

Hormonal changes: Some hormonal changes you will feel – you may feel more emotional or have mood swings, your breasts will feel tender, you may feel more hungry, you may feel nauseous, you may need to go to the bathroom more regularly. What you won’t feel is the softening of the ligaments and changes in the soft tissues or muscles which are all attributable to hormones.

Physical changes: You may notice a growing belly, weight gain, larger breasts, swollen hands and feet, your luscious locks of hair. What you may not notice, as it happens so gradually, are the changes in your posture.

As the pregnancy progresses your once good posture starts to fade away to accommodate the growing baby. Your abdominal muscles stretch and are less efficient at contracting, this results in poor alignment and support of the lower back. Your pelvis tilts forward and your back arches. This posture alone means that your once stable lower back and pelvic joints do not function properly and rely more heavily on the surrounding muscles to provide the support and to maintain some sort of posture. For many women their bodies cope with this change and their muscles are able to adapt and provide sufficient support to the joints. However in a number of women their muscles are insufficient and lack the ability to provide the correct support. When this occurs there is significant strain on the joints and this can lead to pain.

Women with existing back or pelvic dysfunction are more likely to develop back pain during pregnancy. Many of the population are unaware they have a back or pelvic problem due to never having symptoms in this region, however the dramatic changes during pregnancy often highlight the problem.

It is common for women that have had a history of prior injury or dysfunction to the lower back or pelvic region will suffer from this type of pain. However injuries to other areas of the body may also contribute to back pain during pregnancy.

The following previous injuries may contribute to pregnancy related back pain;

  • Back strain/injury
  • Hip strain/injury
  • Ankle or knee injury
  • Surgeries to the hip, knee, ankle, back

Unfortunately many women who suffer from back pain during pregnancy become sedentary, thinking that stopping physical activity and resting will help their pain. Although this is the recommended action for some complaints, the vast majority of pregnancy related back pains require the opposite. It is essential to keep those muscles activated and get them working properly to help support the progressing postural changes throughout pregnancy.

The good news is that in most cases, pregnancy related back pain can be treated and managed so that you can enjoy your pregnancy. It is important however to seek the advice of a medical professional and one that is experienced in pregnancy related problems. This may be your obstetrician, osteopath, physiotherapist or chiropractor.

As an Osteopath and a mother, the best advice I can give is DO NOT WAIT to see how it goes. It is unlikely to go away as your body is changing constantly. The earlier you act and address the back pain the quicker you can manage it and prevent it getting worse, so that you can enjoy your pregnancy and remember it being a joyous time!