Deep, chronic pain in levator scapulaeand upper trap


I've been having deep, pulling pain in between the shoulder blade area for several months and have been struggling to sleep at night, rotating among 3 pillows and sleeping in all positions.

While this pain has subsided through massage therapy sessions, the pain is now localized to a very specific area and won't go away - the left levator scapula and the left upper trap.

I am a Pilates instructor and have tried all self-trigger point release techniques and have used various movements to loosen up any entrapments in the areas I feel are locked up.

I have also been seeing a massage therapist weekly and occasionally a chiropractor. I can turn my head to the RIGHT fully but feel some tightness in the LEFT rhomboid. When I turn my head to the LEFT, the muscles left of the cervical spine starts to pull. When I tilt my head to the left, it's fine. When I tilt my head to the right,there's a popping noise in the neck and sometimes there's a deep cracking noise and things move around like getting a chiropractic adjustment.

When I reach for something, occasionally, I feel a sharp, stabbing pain the cervico/thoracic area that makes me jolt.

When I swing my left arm back, up, and around like a swimming stroke, there's a deep "grinding" noise in my left scapula area. When I hold onto the infraspinatus/teres muscles and do the same muscle, there's no grinding.

When I internally rotate my left arm and press back, I have a sharp pain up the left levator scapula.

This nagging pain leaves me fatigued and incapable of moving my arms in different angles w/o causing some sort of spasm.

I have had an MRI done of my cervical and thoracic. The readings show that there is a reversal of the cervical lordosis, indicating spasm. There is a 2 mm central disc protrusion at C4-C5 and 4 mm at C5-C6 effacing the thecal sac. There is a mild canal stenosis and uncovertebral joint spurs.

What treatments do you recommend to resolve this pain and what type of exercises to alleviate (and not exacerbate) this pain?

Even before I read the MRI report, that's precisely what I was thinking.

This is a referred pain from your lower neck; and because C5 is the motor nerve to the rhomboids and levator scap you may start to get wasting; a denervated muscle hurts. A lot.

Medically a reversal of the lordosis is considered to be "muscle spasm" but in my book it's far more serious; as in your case there is usually an underlying disc bulge.

I gather you've had only occasional, or a few chiropractic adjustments. I think you need to go for two treatments a week for possibly a month, or something like that.

Traction sometimes can make a significant contribution when combined with chiropractic, but on its own the research suggests it won't help. If you decide to do that, purchase the kind done lying down. Or make one. It shouldn't cost more than 100-150 dollars. Recommended is up to 7kg, but if you go up slowly, you can go higher in my opinion, but you need to be guided by your chiropractor. Lie in the traction for about 20 minutes, perhaps more than once per day. Avoid turning to the left and simultaneously looking up. In fact any extension of the cervical spine may increase your pain.

Don't carry heavy stuff in your left arm.

Good luck; this is a difficult and trying condition. It's an old injury to your neck, most likely.

Dr B

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