Chronic Neck and Shoulder Pain: Seeking Solutions

Q: Chronic Neck and Shoulder Pain: Seeking Solutions

Hello： Your question is quite common, and many people experience this issue. <br>If there is no history of injury, based on my clinical practice, I would first inform the patient of some precautions and arrange for rehabilitation therapy. <br>If there is no improvement after a mo

Neck issues

Hello doctor, I have been experiencing tightness and soreness in my neck and shoulders for a long time, about four to five years.
My condition is such that I find it easier to turn my neck to the left, while turning to the right feels tighter.
I often need to tilt my head back to hear a popping sound to feel more comfortable.
Additionally, I have been having trouble sleeping; I cannot sleep on my side because I wake up with significant neck pain.
When the pain is severe, it radiates to the muscles in my back.
I also cannot sit at my computer desk for too long.
I suspect that my poor posture may have developed due to long hours in front of the computer since my sophomore year of high school.
However, I would like to have a more thorough examination.
Recently, I visited the rehabilitation department at Chang Gung Memorial Hospital, and when I requested an examination, the doctor believed my symptoms did not warrant one.
He suggested that my strabismus might be the cause, even though I had surgery for it before and my balance is still the same as before, indicating that my posture is still incorrect.
When I asked him to examine me, he said he couldn't identify any issues just by looking at me and mentioned that if every patient requested examinations, it would be a loss for the health insurance system.
However, I genuinely believe there is a problem and want to get checked out.
I am unsure whether the issue lies with my cervical vertebrae or nerves, or if it is related to my spine.
Should I get an X-ray first? Please give me some advice, doctor.
Thank you.

Mr. Cheng, 20~29 year old female. Ask Date: 2006/02/08

Dr. Pan Yingda reply Rehabilitation

Hello: Your question is quite common, and many people experience this issue.
If there is no history of injury, based on my clinical practice, I would first inform the patient of some precautions and arrange for rehabilitation therapy.
If there is no improvement after a month, I would consider taking an X-ray.
Generally, unless the symptoms are particularly unusual (beyond my initial assessment) or worsen, I do not immediately order an X-ray for the patient.
Most issues can be reliably assessed through physical examination, allowing for an initial diagnosis.
Strabismus could be one of the contributing factors, but it is likely not the primary cause (as your strabismus has not been a recent development).
Spending too much time at a computer desk combined with poor posture is probably the main issue! Adjusting your posture along with some exercises (stretching and strength training) would be very beneficial, but this is better conveyed in person rather than in writing (and there are not many specialists in this field domestically).
An X-ray can certainly be taken (which might provide you with some reassurance), but unless there is a serious issue that requires further action, taking an X-ray is really just for our peace of mind.

Reply Date: 2006/02/08

More Info

Chronic neck and shoulder pain can be a debilitating condition that significantly affects your daily life and overall well-being. Based on your description, it seems that you have been experiencing these symptoms for several years, which can often be attributed to poor posture, especially from prolonged computer use. This is a common issue in today's digital age, where many individuals spend hours in front of screens without proper ergonomic support.

Your symptoms, including the tightness and discomfort in your neck, particularly when turning to the left or right, as well as the need to tilt your head back to alleviate discomfort, suggest that there may be underlying musculoskeletal issues. The fact that you experience pain radiating to your back and have difficulty sleeping comfortably indicates that your condition may be more complex than just simple muscle strain.

It is essential to consider that chronic neck pain can stem from various sources, including muscle tension, nerve compression, or even issues related to the cervical spine, such as herniated discs or degenerative changes. The tightness you feel on one side of your neck could be due to muscle imbalances, which are often exacerbated by poor posture. Additionally, the fact that you cannot sleep on one side without experiencing pain suggests that there may be an underlying structural issue that needs to be addressed.

Regarding your visit to the rehabilitation specialist, it is unfortunate that you felt your concerns were not taken seriously. It is crucial to advocate for your health, especially when you believe there is a significant issue. While the physician may have suggested that your symptoms could be related to your previous strabismus surgery, it is still important to rule out other potential causes, including cervical spine issues or nerve involvement.

In terms of diagnostic imaging, an X-ray can provide some insight into the alignment and structure of your cervical spine, but it may not reveal soft tissue issues such as muscle strain or nerve compression. An MRI is often more informative for assessing soft tissue structures, including discs, nerves, and muscles. If you are experiencing persistent symptoms that interfere with your daily activities, it may be worth pursuing an MRI of your cervical spine to get a clearer picture of what might be happening.

In the meantime, there are several strategies you can implement to help manage your symptoms:
1. Ergonomic Adjustments: Ensure that your workstation is set up ergonomically. Your computer screen should be at eye level, and your chair should support your lower back. Take regular breaks to stretch and change positions.

2. Physical Therapy: Consider seeking a physical therapist who can provide targeted exercises to strengthen your neck and shoulder muscles, improve posture, and increase flexibility.

3. Heat and Cold Therapy: Applying heat can help relax tight muscles, while cold therapy can reduce inflammation. Alternating between the two may provide relief.

4. Mindfulness and Relaxation Techniques: Stress can exacerbate muscle tension. Techniques such as yoga, meditation, or deep breathing exercises can help reduce overall tension in your body.

5. Sleep Position: Since you mentioned difficulty sleeping, consider using a supportive pillow that maintains proper neck alignment. Avoid sleeping on your stomach, as this can strain your neck.

6. Consultation with a Specialist: If your symptoms persist despite these interventions, consider seeking a second opinion from a neurologist or an orthopedic specialist who focuses on spinal issues.

In conclusion, your chronic neck and shoulder pain is likely multifactorial, and addressing it may require a comprehensive approach that includes both lifestyle modifications and medical evaluation. Don't hesitate to seek further medical advice if you feel your concerns are not being adequately addressed. Your health is paramount, and you deserve to find relief from your symptoms.

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