Can the Cervical Spine Cause Shoulder Pain?

Subacromial impingement (SAI) is a common injury in sporting activities that require overhead motions, especially among pitchers, quarterbacks, and swimmers. Not everyone responds to treatment to the same degree, and a new study that reviewed two specific cases may offer a possible reason: the neck.

One of the two cases involved a high school football quarterback and the other a collegiate swimmer. Both participants presented with signs and symptoms of subacromial impingement with minimal neck complaints and few clinical signs that initially supported neck involvement.

Of interest, both patients had poor posture that included forward head carriage and rounded forward shoulders. During the initial examination, both had shoulder pain and weakness while raising their arm up from the side, a “classic” sign of rotator cuff muscle injury and subacromial bursitis. However, neither case did well when treatment addressed only the shoulder, prompting their doctors to test whether or not the patients’ poor posture had a role in their shoulder discomfort.

Once the patients performed chin retraction exercises followed by chin retraction plus extension exercises (three sets of ten repetitions) to improve their posture, they experienced a complete improvement in shoulder impingement and muscle weakness. 

The author suspects that both patients experienced intermittent irritation of the C5 nerve root in the neck, which innervates the rotator cuff muscles, leading to their shoulder pain and weakness. In both cases, the two athletes performed home-based exercises and returned to their sports and did not have further problems during the rest of the season. 

These two cases are GREAT examples of why doctors of chiropractic evaluate the whole patient to identify any and all factors that may contribute to a patient’s chief complaint. It is very common to find cervical spine joint dysfunction in patients with shoulder pain, and success in treatment favors treating both areas, of which (as noted in these case studies) the neck may be the most important focus.

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Chiropractic Care for Headache Relief?

Woman Suffering From A HeadacheHeadaches have a significant impact on quality of life in both adults and children. Approximately 13% of patients who sought chiropractic care over the last decade did so for headache relief. Several studies have found that manual therapies, such as spinal manipulation and mobilization, can provide significant benefits for patients with both tension-type and migraine headaches—even better than standard medical care, in some cases.

In 2011, Canadian researchers reviewed data from 21 published studies to develop specific recommendations for chiropractic management of headaches. For episodic or chronic migraine and cervicogenic headaches (those caused by specific neck problems), they recommended spinal manipulation and other manual interventions, such as massage. Additionally, researchers noted that joint mobilization and strengthening exercises for the deep neck flexor muscles may also improve symptoms associated with cervicogenic headaches.

For episodic tension-type headache, the investigators did not find enough published evidence to support the use of spinal manipulation. They stated that, at the current time, “a recommendation cannot be made for or against the use of spinal manipulation for patients with chronic tension-type headache” (CTTH). However, they did report that low-load craniocervical mobilization “may be beneficial for longer term management of patients with episodic or chronic tension-type headaches.”

In contrast, following a randomized clinical trial of 80 patients with chronic tension-type headaches, Dutch researchers reported that “Manual therapy is more effective than usual [general practitioner] care in the short- and longer term in reducing symptoms of CTTH.”

Chiropractors utilize many types of manual therapies as a primary form of care for several complaints and conditions, including headaches.

Different Headaches and Chiropractic Care

Adults may experience many different kinds of headaches. A primary headache is a headache that is not a part of another disease process. Secondary headaches can come from a poor eyeglass prescription, diabetes, the flu, or even a brain tumor. The most common primary headaches are tension-type, migraine, and cervicogenic (from the neck).

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In cervicogenic headache, neck function is prominently disturbed. In addition to neck pain, there are usually tight neck and shoulder muscles, and a limited range of motion.

Tension type headaches feel like a tight band around your head. Stress seems to aggravate them and women tend to get this type of headache more frequently.

Females are also more affected by migraine headaches.

There are two types of migraine: classical and common.

The classical migraine headache may start with nausea or sickness in the stomach and proceed to an intense throbbing pain on one side of the head.

The common migraine lacks this nausea and is more common than the classical type.

Research has shown that the three above described headaches can also overlap with one another. In chiropractic, we look to the spine as an often-overlooked factor in headache treatment. By objectively analyzing spine function, the doctor will identify the joints that are restricted in their range of motion or show abnormal posture and alignment. Many patients on x-ray, or through external postural analysis from the side, can show forward head posture. This is where the neck seems to arise from the front of the chest rather than back over your shoulders. The head is very heavy and with this poor posture, the muscles at the back of the neck must contract to restrain this heavy load.

There isn’t one particular bone that is treated for these different types of headaches, the premise being that the headache is a symptom of another problem in the spine.

Chiropractic care has an excellent safety profile and several studies have shown that patients with headaches positively respond to chiropractic care without the side effects often seen with drug treatments. Chiropractic care is one of the most researched non-drug options available for patients. Unfortunately, many patients choose over-the-counter and prescription medications and don’t consider more natural approaches that may get at the cause of the condition rather than just its effects.

 

Concussion and Whiplash – Is There a Connection?

Whiplash or whiplash associated disorders (WAD) represent a constellation of symptoms that are very similar to those reported by patients who have sustained a concussion or minor-traumatic brain injury (mTBI). These shared symptoms include (but are not limited to): headache; neck pain; nausea/vomiting; dizziness; balance issues; vision problems; and difficulty concentrating. Chiropractic care focused on the cervical spine has been demonstrated to benefit patients with WAD. Is it possible that the same form of treatment can help the mTBI patient as well?

Delayed-Whiplash-Injury

In the March 2015 issue of the journal The Physician and Sportsmedicine, researchers looked at case studies involving five patients with concussion symptoms that did not resolve within 30 days and had become chronic. The mechanism of injury in three of the cases was sport-related, while the other two stemmed from a slip and fall and a motor vehicle collision. Treatment focused on the cervical spine and included the use of either spinal manipulative therapy (SMT) or mobilization; active release technique (ART) to stretch tight neck muscles; and exercises aimed at strengthening the deep neck flexor muscles and/or other surrounding neck musculature.

Case 1: A 25-year-old professional mixed martial arts male injured from sparring presented four months after the injury. After three treatments, he reported a significant reduction in symptoms, with full resolution after eight treatments.

Case 2: A 59-year-old female who hit the back of her head on the ground after a fall presented with 31-month duration of symptoms that reportedly improved significantly within three months of twice-per-week treatments.

Case 3: A 19-year-old male junior hockey player presented two years after the initial injury and reportedly experienced an 80% improvement in his symptom after four treatments spread out over a three-week time frame.

Case 4: A 19-year-old male injured in a car accident presented 14 weeks after the injury and reported a nearly 50% reduction in symptoms after one treatment and full resolution after eight treatments.

Case 5: A 51-year-old female hockey player who was struck on the left side of the head presented five weeks post-injury and reported a full resolution of symptoms after three treatments per week for six weeks.

The important point here is that treatment was aimed ONLY at the cervical spine, not the concussion, with excellent results in each case. These findings indicate the need for larger studies concerning the use of conservative chiropractic care for cases of mTBI that do not resolve within a month’s time.

What Causes Shoulder Pain?

Each year, Americans make 7.5 million doctor visits related to shoulder/upper arm pain. After neck and back pain, shoulder pain is one of the top reasons patients seek chiropractic care. So, why are shoulder injuries so prevalent?shoulder pain

Though there are many possible explanations that address this question, there’s a simple answer: anatomy. There are essentially three joints that make up the shoulder: 1) scapulothoracic joint, 2) the glenohumeral joint, and 3) the acromioclavicular joint. These joints work simultaneously and in harmony to carry out the many tasks we throw at our upper extremities from swimming to swinging a tennis racket or even reaching up to hang a curtain or change a light bulb. The overall structure of the shoulder favors mobility over stability and as a result, there is a greater chance for injury. So, what can we do to prevent shoulder injuries?

Perhaps the most important strategy is to think before you act; that is, don’t take unnecessary chances such as over-lifting in especially awkward positions. Try asking someone else for help instead. Also, use proper form and stay conditioned. Research shows that a strong core (back and belly) can help prevent shoulder injuries.

Common shoulder conditions include (but are not limited to): inflammation (bursitis and tendinitis), instability (“sloppy” joints), arthritis (bone/cartilage injury/wear), fracture, and nerve injuries. Injuries can be acute (from an obvious cause) or more commonly, they can be chronic from wear and tear and can occur gradually over time (from no obvious, single cause).

It’s important to understand that a shoulder complaint may be the end result of dysfunction throughout the body, just as a knee problem can place added stress on the hip (or vice versa). So in addition to direct treatment of the shoulder, your doctor of chiropractic may identify and treat problems elsewhere in the body (forward head carriage, poor core strength, leg length deficiency, etc.) that likely contribute to your shoulder pain complaint. In order to promote a speedy recovery, your chiropractor may also recommend certain food or vitamins/supplements with the aim of reducing inflammation.

 

This information should not be substituted for medical or chiropractic advice. Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your updated medical history.

What Exercises Are Best for Neck Pain?

Past research has demonstrated that combining spinal manipulative therapy (SMT) with exercise yields the best long-term results for individuals with neck pain. So what neckpain-e1464705188848exercises should we consider when neck pain rears its ugly head?

In the acute phase of an injury, rest and ice may be appropriate, but patients will often benefit from lightly applied isometric exercises. Place your hand against the side of your head and lightly push your head into your hand for a count of five seconds. If tolerated, tip your head sideways five to ten degrees and repeat the process. This can be repeated multiple times at progressively greater angles until you’ve accessed your full range of motion (ROM).

The above isometric exercise can be repeated in the opposite direction as well as forwards, backwards, and into left and right rotation directions. The KEY is to always stay within reasonable pain boundaries—no sharp/”bad” pain allowed!

You can then move on to isotonic neck exercises. Using the same amount of light pressure, gently push your head into your hand as you did before, but this time, allow the head to move slowly toward the shoulder against the pressure of the hand. This too can be repeated on the opposite side, forwards, backwards, and into left and right rotation.

Using only one or two fingers rather than the whole hand helps to prevent you from pushing too hard with your hand or head when performing isometrics or isotonic exercises. Also, the same movements of the head can be done without any hand/finger resistance, but faster results seem to occur when pressure is applied.

Studies also show that weakness of the deep neck flexor muscles is

very common in people with chronic (more than three months) neck pain. These are deep, involuntary muscles, so to properly strengthen them, look straight ahead, tuck in your chin as far as you can, hold for five to ten seconds, and repeat five to ten times.

Beyond treatment options for neck pain such as spinal manipulation, mobilization, and exercise, your doctor of chiropractic may utilize soft tissue therapies such as myofascial release, active release technique, as well as various physical therapy modalities, ergonomic modifications, and more in the effort to help you get out of pain and return to your normal activities.

How Does Chiropractic Help Whiplash Patients?

Whiplash associated disorder (WAD) injuries usually result from rear-end, low-impact crashes with about 90% occurring at speeds less than 14 mph. Approximately 40% of all WAD patients develop long-term, chronic problems. Let’s look at how chiropractic care can help crash-injured patients recover and return to their normal lives…

neck painREDUCE INFLAMMATION: Inflammation occurs when ligaments and muscles are injured. However, the pain associated with inflammation may be delayed and not show up right away. Rather, you may wake up the next morning with acute neck and/or back pain, as WAD injuries are NOT limited to only the neck. Several studies have shown that chiropractic spinal manipulation results in the release of anti-inflammatory Interleukin 6 (IL-6), which helps reduce inflammation.

RESTORE MOVEMENT: Injured joints quickly become stiff from pain and swelling. Muscles often “splint” in response to pain as a way to protect a deeper ligament or joint-related injury. Both factors can lead a patient to unnecessarily restrict their movement, weakening that area of the body, and increasing the risk of further injury down the road.

REDUCE SCAR TISSUE: As injured tissue heals, the body’s “Band-Aid” is actually scar tissue that is made up of similar cells as the surrounding tissue but is laid down quickly and in an unorganized way. Scar tissue reduces the ability for the injured tissue to stretch and can lead to tissue shortening. If it is performed early enough, Chiropractic adjustments help to stretch out and—in a sense—break up the scar tissue.

RELIEVE LOCALIZED PAIN: Many studies report spinal manipulation (SM) to be a safe, fast, and effective way to reduce pain. As a result, SM is now strongly recommended in treatment guidelines published throughout the world.

REDUCE WIDESPREAD PAIN: Some WAD-injured patients develop pain not just in the neck or back but more widespread throughout their body. This is thought to be caused by “sensitization” of parts of our nervous system. Spinal adjustments have been shown to stimulate the nervous system in such a way as to reduce this hypersensitized effect.

REDUCE STRESS & CHRONIC PAIN: Due to initial high pain intensity, stress and anxiety levels often soar following a WAD injury. Chiropractic care includes patient education, exercise, nutrition, and more to help patients cope with ongoing problems. The importance of  cannot be overemphasized in quest of preventing chronic, long-term pain and disability.