Neck Pain and Muscle Tension: When to See a Specialist

Physical issues

Hello, doctor.
For the past 3-4 months, I initially experienced pain and tightness in the left side of my neck.
I had an X-ray, and the orthopedic specialist said that the bones appear to be fine, suggesting that it might be due to tight muscles, particularly around the sternocleidomastoid muscle and the suboccipital nerve, which occasionally makes sounds.
However, I later noticed that whenever I tilt my head back, the area where my neck connects to my head shakes.
This shaking only occurs when I look up, and I also feel a tremor when I raise my arms in a T-pose and when I lower them.
Bending over also gives me a sensation of shaking, which varies in intensity.
Additionally, my neck muscles remain consistently tight.
I would like to know which specialist I should see for further evaluation, as I am quite worried.

H, 20~29 year old female. Ask Date: 2020/02/26

Dr. Jiang Junyi reply Neurology

Hello, based on your description, the common cause of left-sided neck pain is cervical myofascial pain.
Prolonged periods of looking down can lead to overuse of the trapezius muscle at the back of the neck, resulting in neck and shoulder discomfort.
Initially, resting may alleviate the pain, but it can progressively worsen, affecting daily activities.
Some patients experience severe neck pain upon waking, accompanied by stiffness, tightness, and intolerable pain levels.

In addition to cervical X-rays, nerve conduction studies or electromyography may be conducted.
It is recommended to:
1.
Change positions: Alter your posture every 15 minutes to allow the neck tissues to rest.
Maintaining any posture (including a normal one) for an extended period can lead to tissue fatigue and inflammation, so moving around briefly can reduce the risk of muscle inflammation.

2.
Rest: Resting allows the muscles to utilize their self-repair capabilities, and vigorous exercise should be avoided during this time.

3.
Apply heat to the neck: Use a heating pad for 15 to 20 minutes, ensuring the temperature is safe to avoid burns.

4.
Non-steroidal anti-inflammatory drugs (NSAIDs): If there are no contraindications such as a history of peptic ulcers, allergies to NSAIDs, or normal kidney function, consider using NSAIDs to reduce inflammation and alleviate pain as needed.

5.
Neck muscle stretching exercises: After the acute pain phase, develop a habit of performing slow and gentle neck stretches every 15 to 20 minutes, ensuring the angles do not cause discomfort.

I recommend consulting a neurologist or a rehabilitation physician to discuss further evaluation and treatment.
However, due to the recent COVID-19 pandemic, it is advisable to wait until the situation stabilizes before going to the hospital for examination, or to implement self-protection measures and maintain cleanliness and disinfection.

Wishing you good health and safety.

Dr.
Jiang, Department of Neurology, Taoyuan Hospital, cares for you.

Reply Date: 2020/02/26

More Info

It sounds like you have been experiencing a range of concerning symptoms related to your neck and shoulder area, including pain, muscle tension, and unusual sensations. Given the complexity of your symptoms, it is important to approach this situation methodically to determine the underlying causes and appropriate treatment options.

Based on your description, it seems that your symptoms may be related to muscle tension and possibly nerve involvement. The tightness in your neck muscles, particularly around the sternocleidomastoid muscle and the suboccipital region, can lead to discomfort and may also affect the nerves in that area, resulting in sensations such as shaking or trembling when you move your head or arms. This could be indicative of muscle strain or even a condition known as cervical radiculopathy, where nerve roots in the cervical spine become compressed or irritated.

You mentioned that you have already undergone X-rays, which showed no significant issues with the bones. This is a good first step, but if your symptoms persist or worsen, further imaging studies such as an MRI may be warranted. An MRI can provide a more detailed view of the soft tissues, including muscles, ligaments, and nerves, and can help identify any underlying issues such as herniated discs or other structural abnormalities that may not be visible on X-rays.

In terms of specialists to consult, a neurologist or a physiatrist (a specialist in physical medicine and rehabilitation) would be appropriate choices. These specialists can perform a thorough clinical evaluation, assess your symptoms in detail, and recommend further diagnostic tests if necessary. They can also provide guidance on rehabilitation strategies, including physical therapy, which can be very effective in managing muscle tension and improving mobility.

Physical therapy may involve exercises to strengthen the neck and shoulder muscles, improve posture, and increase flexibility. Techniques such as manual therapy, ultrasound, or electrical stimulation may also be utilized to relieve pain and tension. Additionally, addressing any ergonomic issues related to your daily activities, such as computer use, can help prevent further strain on your neck and shoulders.

If you are experiencing symptoms such as tremors or shaking, it is crucial to discuss these with your healthcare provider, as they may require further investigation to rule out any neurological conditions. It is also important to consider factors such as stress, anxiety, and overall physical fitness, as these can contribute to muscle tension and discomfort.

In summary, given your symptoms of neck pain, muscle tension, and unusual sensations, it is advisable to consult with a neurologist or a physiatrist. They can provide a comprehensive evaluation and recommend appropriate diagnostic tests and treatment options. In the meantime, consider incorporating gentle stretching and relaxation techniques into your routine, as these may help alleviate some of the muscle tension you are experiencing. Remember to prioritize your health and seek medical advice promptly if your symptoms persist or worsen.

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