Saturday, August 6, 2016

Levator Scapula Neck Pain

Levator Scapula Disfunction Can Cause Pain and Stiff Neck Syndrome

Next week I will be teaching a class at the Florida State Oriental Medical Association (FSOMA) Annual Conference. The class will discuss neck pain and stiffness and will specifically highlight acupuncture and manual therapy techniques to treat the levator scapula, a muscle which frequently causes neck pain and stiffness and pain in the shoulder blade region.

Fig. 1 A (left) and 1 B (right): Images from Myofascial Pain and Dysfunction: The Trigger Point Manual, by Drs. Janet Travell and David Simons,

The levator scapula, seen in Fig. 1 A, is a muscle which stretches from the upper neck to the upper part of the shoulder blade. Not surprisingly based on its name, the levator scapula elevates the scapula. But it also rotates bends it sideways. Both of these movements basically move the shoulder blade closer to the neck on the same side. When this muscle develops trigger points (painful nodules within the muscle), it can cause quite a lot of pain and neck stiffness. This pain pattern is illustrated in the Fig. 1B and as can be seen, the pain concentrates at the base of the neck and frequently spreads to the medial border of the scapula. Patients often state that they feel the pain between the shoulder blades. The neck frequently becomes stiff, and pain is worse when patients turn the head to the side of the pain, as in looking over the shoulder.

Fig. 2: Neck position which shortens the levator scapula and can lead to pain.

Fig. 3: The imbalance in the pelvis
and legs, causing an elevation on
of the right ilium which frequently
contributes to an elevation of the
left shoulder girdle. This can
cause pain and stiffness in the
left neck.
This can be a chronic condition, or it can come on suddenly. It is not uncommon for people to wake with this pain after a night's sleep in an awkward position. A cold draft on the neck while sleeping is also frequently reported by patients. This pain can be quite distressing as it interferes with activities such as driving and makes it difficult to find a comfortable position.

In chronic cases, it is found that patients often perform an activity that repetitively shortens this muscle. A common example is a busy office worker, student or parent holding a phone to their ear with their shoulder. Awkward computer workstations, poor sitting posture, poor breathing, and even imbalances affecting the leg length (more on this in a different post) can contribute to pain in the levator scapula (Fig. 3)

Local acupuncture techniques can be an excellent way to address the muscle directly to release muscle contraction. In addition, acupuncture along the related channels and to muscles that are part of the dysfunction, myofascial release (a deep tissue type of massage) to lengthen bound muscles and connective tissue, and corrective exercises to address posture are all tools that can greatly reduce pain and improve range of motion in the neck and treat this 'stiff neck syndrome.'

A self-help exercise is described below. This can be performed several times a day and should not cause pain or aggravation of symptoms. Use your judgment and consult your physician if you have any doubts.

This exercise is described as if there is pain at the base of the neck on the left side, which is worse when turning to the left. The directions can be reversed for pain occurring on the right side.

1) Lie face-up or sit upright in a chair with your feet on the floor.
2) Gently turn your neck towards the painful side (to the left) to the point just before it hurts (this may be only a small turn in severe cases).
3) Place the hand opposite the painful side on your cheek (right hand on the right cheek) and gently, with very little force, turn the head back into the palm (to the right). There should be no movement, and this is an isometric contraction. In other words, you are resisting the gentle turn with your palm and not allowing any movement. Hold this position for about 6 seconds.
4) Relax for about 1 second, and then see if you can turn more towards the painful side (to the left). Still stop before there is actual pain and do not attempt to turn more than your body will allow.
5) Repeat steps 3 and 4.

Note: This exercise is most useful in acute problems when there is severe pain and difficulty turning the neck. The goal is to GENTLY tease out movement. Many times, the body perceives that there is danger to the joints (maybe you fell asleep in a position that was stressing the joints of the neck, for instance) and there is a reflexive spasm to guard and prevent movement. Trying to stretch aggressively and forcefully will often aggravate the condition more in these situations, as the neck muscles such as the levator scapula will contract more to guard the area. In more chronic cases, stretching and range of motion exercises can be employed.

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