Tag Archives: neck pain

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Trigger Points: A Pain in the Neck

by Dr. Marc Brodsky and Ron “Bumblefoot” Thal

Trigger Points, or knots, in the neck and shoulder muscles from repetitive use are common in musicians. In addition, chronic muscle-related pain of the head and neck may be exacerbated, or caused, by other conditions such as whiplash, migraine and tension headaches, temporomandibular joint (TMJ) disorders, fibromyalgia, and even cancer. This article explores how integrative medicine can be used to ease neck and upper back pain.

Case Study

A guitarist in his 40s continued to have neck and upper back pain following a car accident two years prior where he was rear-ended at a stop. An MRI revealed a herniated disc in his neck. He described the pain as a splinter that was permanently in his body, irritating him every day. His pain intensified while moving around stage playing his guitar, as well as during travel for touring. The pain persisted despite steroid injections and pills, physical therapy, and a trial of self-medication with alcohol. The guitar player finally found relief with a self-care program that included acupressure—pressing strategic points to release muscle knots in his neck and upper back. He also ate an anti-inflammatory diet and exercised with an arm bike and did push-ups. He specially designed a guitar case to take off some of the load from moving gear.

Highlights of Integrative Medicine Approach

If you are experiencing neck and upper back pain, a hands-on physical exam may find neck and upper back pressure points. They are most commonly found in two muscles: the trapezius (below, left) and splenius capitis (below, right):

A medical professional may use trigger point injections (TPI) to treat painful areas of muscles that contain muscle knots. In the TPI procedure, a small needle is inserted into the trigger point. The injection contains a local anesthetic or saline, which inactivates the trigger point to alleviate pain. Several sites may be injected in one visit. A brief course of treatment often results in sustained relief. Acupuncture and massage by licensed professionals may relieve muscle knot pain as well.

You may take an active role in relieving your own neck and upper back pain by pressing the acupressure points on your arms, neck, and upper back. Try these three techniques: 

1) Press on a point two inches down from the crease of the elbow.

2) Interlock the fingers and press the thumbs into the tender points below the base of the skull.

3) Place two tennis balls in a stocking and press them against a wall with your back using the weight of the body to access the pressure points below.

The recommended self-care routine for muscle knots in the neck and upper back is to press each of the acupressure points for the duration of three relaxing breaths (about 15 seconds) one to three times each day. This is a natural muscle relaxant and stress reliever.

For persistent neck and upper back pain always seek treatment from a medical professional.

Marc Brodsky, MD, is a 2017 member in good standing of the Performing Arts Medicine Association (PAMA). Ron ‘Bumblefoot’ Thal is a solo artist and producer. Images courtesy of Katrina Franzen, Junghwa Choe, and World Health Organization.

neck pain
Health, Resources

Finding Relief from Neck Pain

Editor’s note: Always check with a physician if you are experiencing pain, as well as before beginning a new physical activity.

Chronic neck pain stems largely from poor posture and daily exertion. Taking simple measures to realign one’s body can decrease the odds of having to live with chronic pain. 

Our bodies are designed to work in concert with gravity. Poor posture causes a slew of problems such as inflammation, nerve compression, and limited range of motion. In some cases, it leads to acute conditions such as degenerative disc disease. If the neck is habitually thrust forward, in front of the shoulders, the pull and weight of the head places undue stress on the vertebrae of the lower neck. Our heads can weigh 10-15 pounds, which is a lot of strain. The muscles of the upper back must compensate to balance the weight. Simple stretches and exercises performed on a regular basis can offer long-term relief.

The Alexander Technique

A popular component of voice and music instruction is the Alexander Technique, which focuses on the head and spine. This correlation determines the quality of overall coordination. The exercises within this curriculum are well established and offer positive physical benefits. The approach centers on not overworking the neck muscles and the head being properly positioned and balanced, at the top of the spine. For more information, go to the American Society for the Alexander Technique at http://www.amsatonline.org/alexander-technique.

Take Care Moving Instruments

Never carry a heavy instrument with one hand or on one shoulder. For better distribution of weight, straps should be long enough to go across the chest. Use a bag or case with wheels whenever possible to transport heavier stringed instruments. Bend from the knees and keep the weight close to the body when picking up heavy equipment.

Gentle Neck Stretches

Free Up the Muscles. Let your neck muscles relax, and let your head rotate slightly forward, and go up. Slowly, and very slightly lower the tip of your nose while the crown of your head moves up. Let your sitting bones release down into the chair, in opposition to your head moving up, neither slumping nor straining. Reduce the neck tension again. Let your head rotate forward, and go up.

With practice you can release neck muscles and reduce neck tension. In time, you will realize when and how you are creating tension in your neck.

Seated Neck Release. Sitting cross-legged on the floor, or in a chair with your feet flat on the ground, extend your right arm next to your right knee or along the right side of the chair. Place your left hand lightly on the top of your head and slowly tilt your head to the left. Apply gentle pressure with your hand to increase the stretch. For a deeper stretch, hold onto your right knee or the seat of the chair. This stabilizes the torso and allows you to isolate the stretch on the side of your neck. Hold for 30 seconds, slowly lift your head and repeat on the other side.

Seated Clasping Neck Stretch. For a deep stretch for the back of your neck and your upper back, sit comfortably in a chair or on the floor. Clasp your hands and bring both palms to the back of your head. Sitting tall, ground your hips firmly into your seat. From there, begin to gently press your hands down toward your thighs, tucking your chin into your chest. As you press down, use the heels of your palms to softly pull your head away from your shoulders to intensify the stretch. Hold for at least 30 seconds, slowly lift your head and release your hands.

Behind-the-Back Neck Stretch. This standing stretch provides a deep stretch in the sides of your neck. Stand with your feet slightly apart, about hip distance, arms by your sides. Reach both hands behind your buttock and hold onto your left wrist with your right hand. Use your right hand to gently straighten your left arm and pull it away slightly. To increase the stretch in your neck, slowly lower your right ear toward your shoulder. Hold for 30 seconds and then switch sides.

For more neck stretches to reduce tension, go to http://www.arthritis.org/living-with-arthritis/exercise/workouts/simple-routines/neck-pain-exercises.php.