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A Pain in the Neck Society, Myofascial Pain, Neck Pain

We have become a society that constantly traumatizes the cervical spine, more and more individuals are suffering with chronic myofascial pain of their neck. What causes neck pain? Neck pain can occur anywhere in your neck, from the bottom of your head to the top of your shoulders. It can spread to your upper back or arms. It may limit how much you can move your head and neck. Life's demands create stress and although some stress may be good, too much can cause health problems. Did you know neck and back pain can be stress-related too?

Our Physical Therapists can help to decrease the abnormal and excessive stress to the neck, shoulders and spine. There are numerous techniques that can be used in a treatment plan. Muscle Energy, Trigger Point, Traction, Therapeutic Exercises, Various Massage, Myofascial Release, Strain Counter Strain, Ergonomic Training, Ischemic Compression, Electrical Stimulation and Ultrasound.

Your doctor and therapist can determine the cause of your neck pain and whether it is likely to quickly get better with simple measures such as ice, mild painkillers, physical therapy, and proper exercises. Most of the time, neck pain will get better in 4 - 6 weeks using these approaches.

Trigger Point

The "Pain in the Neck" Muscle - posterior cervical muscles: An important group of muscles involved in chronic neck pain and headaches are the deep posterior cervical (neck) muscles on each side of the spine. These muscles develop myofascial trigger points when we sit with our head slightly bent forward for long periods of time. This means that our desk work and/or computer work can place a great burden on these muscles. Then if we work under stress we add insult to injury. These muscles can also develop severe chronic myofascial trigger points secondary to whiplash injury.

One of the most commonly involved shoulder-neck muscles that are injured by acute or chronic stress is the levator scapula muscle. This muscle starts at the upper inside corner of your shoulder blade and runs up the side of your neck to connect to the upper four bones (vertebra) of your spine. This is the trigger point that can give you that deep burning ache at the top corner of your shoulder blade and runs up your neck.

Trigger points in the upper trapezius muscle are the most common muscle knots to cause complaints of neck pain and headaches.

What is Myofascial Pain?

In the word “myofascial,” “myo” refers to muscle and “fascia” is a continuous layer of connective tissue that spreads throughout the body. Fascia is like a three-dimensional web that extends from head to foot and protectively surrounds every muscle, bone, nerve, blood vessel, and organ in the body.

The fascia in the neck and surrounding areas loses its pliability. It becomes tight, restrictive, and a source of tension affecting the entire body. This fascia produces pain or a decreased range of motion (ROM), affects flexibility and stability, and even hinders the ability to cope with strain and stress. Unfortunately myofascial restrictions do not show up in standard testing, so it can be misdiagnosed for a long period of time, thus compounding the issue.

Myofascial release technique involves the physical therapist finding the area of tightness. A light stretch is applied to the tight area. The physical therapist waits for the tissue to relax and then increases the stretch. The process is repeated until the area is fully relaxed, thus stretching the targeted muscles.  As a result, the fascia is softened and stretched, and trigger points—hyperirritable “knots” in the tissue that send pain elsewhere—will be released. The client will usually experience increased range of motion, increased strength, and improved circulation.

Ideal Candidates for Physical Therapy

In order for Physical Therapy to be truly effective, the patient must be willing to take the responsibility for getting better. This includes regularly attending scheduled appointments to learn postures, techniques, and exercises to be employed as part of a "home program" to address the neck or back pain. While "passive modalities," including massage or various electrical or thermal agents, may be used initially in conjunction with therapeutic exercise and postural training, it is "active" things like postural and body mechanics awareness and commitment to the exercise program that are responsible for the most significant and lasting decreases in pain. An ideal candidate for PT is someone who says, "I want to learn what I can do to get rid of this pain once and for all, or at least to know how to control or prevent it." This is in contrast to a less ideal candidate who comes to PT looking for something external to be applied that will "fix" the problem.

Case Study

The efficacies of an integrated neuromuscular inhibition technique on upper trapezius trigger points in subjects with non-specific neck pain: a randomized controlled trial

Currently, large levels of practice variability exist regarding the clinical deactivation of trigger points. Manual physical therapy has been identified as a potential means of resolving active trigger points; however, to date the ideal treatment approach has yet to be elucidated. The purpose of this clinical trial was to compare the effects of two manual treatment regimens on individuals with upper trapezius trigger points. Sixty patients, 19-38 years of age with non-specific neck pain and upper trapezius trigger points, were randomized into one of two, 4 week physical therapy programs. One group received muscle energy techniques while the second group received an integrated neuromuscular inhibition technique (INIT) consisting of muscle energy techniques, ischemic compression, and strain-counterstrain (SCS). Outcomes including a visual analog pain scale (VAS), the neck disability index (NDI), and lateral cervical flexion range of motion (ROM) were collected at baseline, 2 and 4 weeks after the initiation of therapy. Results revealed large pre-post-effect sizes within the INIT group (Cohen's d = 0.97, 0.94 and 0.97). Additionally, significantly greater improvements in pain and neck disability and lateral cervical flexion ROM were detected in favor of the INIT group (0.29-0.57, 0.57-1.12 and 0.29-0.57) at a 95% CI respectively. The findings of this study indicate the potential benefit of an integrated approach in deactivating upper trapezius trigger points.

Further research should be performed to investigate the long-term benefits of the current treatment approach.

Keywords: INTEGRATED NEUROMUSCULAR INHIBITION TECHNIQUE; ISCHEMIC COMPRESSION; MUSCLE ENERGY TECHNIQUE; STRAIN-COUNTERSTRAIN; TRIGGER POINTS