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Neck & Shoulder Pain Overview by Jason Gruss, MD, FAAPMR
NECK AND SHOULDER PAIN OVERVIEW
by Jason Gruss, MD, FAAPMR
It is estimated that 2/3 of the population will suffer from neck pain at some point in their lives. While short durations of neck and shoulder pain may be common, chronic neck pain can be devastating. Neck pain incidence is on the rise and the numbers are only expected to shoot higher in the years ahead. This is in part due to the New American Lifestyle, a lifestyle that involves computers, smart phones, iPads, and video games. In addition to electronic devises add oversized purses, computer bags and backpacks not to mention a fast paced high stress world and it spells chronic neck and shoulder pain.
"It's not hard to figure out" says Jason Gruss, MD a physiatrist and head of the Physical Medicine and Rehabilitation Department at First Health Associates in Arlington Heights. "If I gave you a bowling ball and told you had to carry it around in one hand all day your arm would be tired. Your head weighs about the same as that bowling ball and is meant to be balanced over your spine. When we sit, stand or sleep in bad posture it's like carrying around that bowling ball, our neck and shoulder muscles get overworked. When muscles are overworked for prolonged periods of time they start to knot and the tendons they attach to become strained".
Neck pain is a common complaint and fortunately most causes of neck pain aren't serious. Neck muscles can be strained from poor posture - whether it's leaning into your computer at work or hunching over your workbench doing hobbies at home.
Prolonged abuse to the muscles and joints in your spine ultimately cause wear-and-tear on the joint linings. We call this arthritis and is a common sequela of long-term, chronic neck pain.
After back pain, neck pain is the most frequent musculoskeletal cause of consultation in primary care worldwide. A UK survey of 7669 adults found that 18% had neck pain at the time of the survey, and half of those (58% of the symptomatic patients responded) still had pain when asked one year later.(1)
"The patients with pain one year later are a major concern because when pain lasts that long structural changes start to occur", says Gruss. "It's generally easy to fix short-lived problems but once muscles, tendons and ligaments start to alter in size and shape rehabilitation becomes a long-term proposition".
But sometimes neck pain can signify something more serious. Seek immediate medical care if you experience shooting pain into your shoulder or down your arm, numbness or loss of strength in your arms or hands, change in bladder or bowel habits or inability to touch your chin to your chest.
"Once we rule out the more serious reasons for neck pain we can decide on a course of treatment," says Gruss. "Most often when a patient comes in with neck and shoulder pain that's of gradual onset we need to look at his daily activities and habits. Eliminating the pain with medications will do no good if the patient doesn't break the habits that caused it in the first place. Things we must review are work station posture and set up, hobbies, recreational activities, even sleeping postures and pillows can be a factor. Once we review and correct bad habits it's time to reverse the damage. I work closely with a physical therapist who does a lot of spine work. I also use a chiropractor to help relieve muscle spasm and restore movement. Spinal manipulation is great for restoring movement and relieving pain and a good physical therapist can restore strength and muscle balance."
In a recent study published in the Annals of Internal Medicine researchers at the Northwestern Health Sciences University in Minnesota recruited 272 neck pain subjects from a large HMO and through advertisements. The subjects were split into three groups and their treatment followed for three months. One group was given prescription medications typically prescribed for neck pain, the second were assigned to do exercises taught by a physical therapist and the last underwent an average of 15 spinal manipulations. After 12 weeks, the people in the non-medication groups did significantly better than those taking the drugs. About 57 percent of those who met with chiropractors and 48 percent who did the exercises reported at least a 75 percent reduction in pain, compared to 33 percent of the people in the medication group.
A follow up one year later revealed that 53% of the exercisers and the manipulation group were still experiencing at least a 75% reduction in their pain, whereas the medicated group reported a 38% reduction in pain.(2) "This is not at all a surprise," says Gruss. "Medications relieve symptoms whereas physical therapy and spinal manipulation restore the lost function that creates the pain in the first place."
Treatments are as varied as the people who seek them. Aside from medications, physical therapy and chiropractic manipulation many have found success with acupuncture, exercise and massage. Stress victims have found counseling, meditation and yoga of benefit. "The steps are simple," says Gruss. "Find and correct the source, control the pain, restore normal function and strengthen the structure."
(1) ^ a b c Binder AI (2007). "Cervical spondylosis and neck pain". BMJ 334 (7592): 527-31. doi:10.1136/bmj.39127.608299.80. PMC 1819511. PMID 17347239.
(2) Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain http://www.annals.org/content/156/1_Part_1/1.abstract January 3, 2012 vol. 156 no. 1 Part 1 1-10