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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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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