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