Shoulder Pain From Swimming? Treat Your Neck

Yes, your shoulder pain is coming from your neck

I had a really interesting case this past week. A patient who's an elite swimmer comes in to our clinic complaining of shoulder pain.

An ultra sound scan and MRI that was done confirms the diagnosis of shoulder subacromial impingement (usually the tendon of the supraspinatus muscle gets irritated from hand above head activities under the acromium).

The doctor my patient saw the the Singapore Sports Institute suggested a steroid (or cortisone) injection to "solve the problem".

R shoulder impingement

Well, the Physiotherapists reading this must be thinking "yeah, what's the big deal". All elite swimmers (or athletes involved with overhead sports like badminton, tennis etc) always get shoulder pain from subacromial impingement at some point of other in their sporting career.

Well, here's the thing, I got the swimmer better just be treating the swimmer's neck. This swimmer did not have any neck pain or signs of nerve root irritation.

I've seen other cases of shoulder impingement when the patient had obvious clues suggesting it was the neck and/ or nerve root irritation causing the shoulder impingement.

This swimmer did not have any neck pain or nerve root irritation signs. The patient did have a forward head posture which can contribute to a C5 nerve root involvement.

Similar to the article referenced below, the swimmer got better very quickly just by cervical retraction, as taught by Gwen Jull. Of course treatment also included other things and not just cervical retraction.

My swimmer went back to full training in three days with no recurrence of symptoms. Good thing my patient said no to the steroid or cortisone injection.

Reference

Pheasant S (2016). Cervical Contribution To Functional Shoulder Impingement: Two Case Reports. Int J Sports Phys Ther. 1196): 980-991.

"Text Neck" On The Rise

Is that YOU using your phone?

If you have read the Straits Times article in page 4 under the Mind Your Body section today (ST 060214)you may read about why neck pain is on the rise here in sunny Singapore.

Well, it is mostly due to our love for our mobile devices - our heavy usage of our mobile devices. Before your neck pain becomes chronic, make sure you read one of our popular post on treating your chronic neck pain.

*Picture by my friend Chang Tzu Han during his visit to Singapore

The article in today's Mind Your Body

Treat Your Chronic Neck Pain

Women keep saying that we men don't get it, well that's quite true in some cases. We've written before on why women get neck pain (take a look at the video too).

A sustained forward flexion (or poke chin) posture is associated with increased cervical (neck) compressive loading and creep response (or deformation) in the connective tissue.

Here's more evidence from Australian researchers that people with chronic neck pain demonstrated a reduced ability to keep an upright posture when distracted. This means you may start sitting in your office chair with a good posture but your posture deteriorates when you get distracted (e.g. when your boss calls you or when your workload piles up).

58 female subjects with greater than 3 months on chronic neck pain (and 10 control subjects with no pain) participated in the study. Changes in the participants' cervical and thoracic (neck and upper back) posture were measured every 2 minutes during a 10 minute computer task.They were then split in two different exercise groups.

One group received training of the cranio-cervical flexor muscles - picture below (CCF, for which renowned neck researcher Gwen Jull is known for) while the other group received endurance-strength training of the superficial cervical flexor muscles.

Longus Colli and longus Capitis (from Wikipedia)

The researchers showed that after an exercise program targeted at training the deep neck flexors (CCF), people with chronic neck pain demonstrated an improved ability to maintain a neutral neck posture with prolonged sitting.

So here's why you should come to either of our clinics if you have neck pain. Aized has trained under Gwen Jull and she can definitely help you with your neck pain.

Reference

Falla, D Jull G et al (2007). Effect Of Neck Exercise On Sitting Posture In Patients With Chronic Neck Pain. Physical Therapy 87(4) : pg 408-417.

* Thanks to Ming and Dew for helping me get the article.