Myofascial Pain: Insights on Neck and Shoulder Issues

Cervical shoulder myofascial pain syndrome

Hello, doctor.
For many years, I have been experiencing frequent soreness in my left shoulder and neck (mainly the neck), which I believe is due to poor posture and long hours of computer work.
I feel sore almost every day.
During a couple of sessions for taking ID photos, the photographers mentioned that my head was slightly tilted to one side.
I hadn’t noticed this before, as no one in my daily life had pointed it out.
However, I recently realized that I have developed a habit of gently tilting my head to the right (approximately less than twenty degrees), which may be contributing to the soreness in the left posterior side of my neck.
I have been trying to pay attention to keep my head straight.
Last year, I visited a massage therapy center, and the therapist noted that my neck, shoulders, and scapula were very tight due to long-term strain, but there were no issues found with my cervical spine.
Recently, I returned to the same center, and the therapist mentioned that I have small fibrous nodules on both shoulders caused by muscle spasms, which are also one of the sources of my soreness (they are not swollen and are not visible externally; I couldn't feel them myself, but I noticed them during the massage).
After hearing what the therapist said, I felt very concerned.
Although he mentioned that my condition is not severe at the moment and that improving my daily posture could prevent further deterioration, he also stated that once fibrous nodules form, they are difficult to eliminate.
Massage can help relax the muscles and prevent worsening, but it may not completely resolve the already formed fibrous nodules.
He suggested that surgery might be necessary for a complete resolution, but he reassured me that my current situation is not severe enough to warrant that.
Could you please clarify whether those fibrous nodules caused by muscle spasms are indeed difficult to treat as he mentioned? If they are difficult to treat, does that mean that even if I improve my posture, I can only prevent the soreness from worsening but not completely resolve the issue? The problem of shoulder and neck soreness has troubled me for several years, and I hope you can provide me with some advice.
Thank you!

sara, 20~29 year old female. Ask Date: 2012/12/12

Dr. Pan Yingda reply Rehabilitation

I apologize for missing your question! The issues you described (fibrous nodules, head tilt) are mostly effects rather than causes! Even surgery cannot resolve the underlying problem; you are still young, and if the root issue is not addressed, you may face significant troubles in middle age! I categorize the root problems into the following types: 1.
Poor posture, especially with prolonged maintenance of certain positions, such as using the internet or playing on your phone...
2.
Body usage habits; for example, improper muscle use related to work or hobbies (such as sports, painting, or playing musical instruments), or uneven use between the left and right sides.
3.
Stress and emotional issues; based on our experience, the left side is often related to anger and a more impatient personality (or the ability to tolerate and accept different matters).
If your soreness is periodic, you need to observe its triggering factors.
Regarding the first two issues, I recommend learning the Alexander Technique, Feldenkrais Method, or Pilates; then change some of your habits.
The third aspect requires you to adjust and make some changes yourself! As for massage therapy, I do not recommend using too much pressure, as that may worsen the situation; instead, opt for gentler techniques that allow you to relax, such as craniosacral therapy or aromatherapy! If you have any further questions, feel free to ask! Department of Rehabilitation, Taitung Hospital, Pan Ying-Da.

Reply Date: 2012/12/12

More Info

Myofascial pain syndrome (MPS) is a common condition that can lead to chronic discomfort in the neck and shoulder regions, often exacerbated by poor posture and prolonged computer use. Your description of persistent left-sided neck and shoulder pain, along with the observation of a slight head tilt, suggests that you may be experiencing muscle tension and potential trigger points, which are characteristic of MPS.

Understanding Myofascial Pain and Trigger Points
Myofascial pain is caused by the presence of trigger points, which are hyperirritable spots in skeletal muscle that can lead to pain in the affected muscle and referred pain in other areas. These trigger points can develop due to muscle overuse, poor posture, or stress, and they can create a cycle of pain and discomfort. The fact that you have been advised by a massage therapist about the presence of fibrous nodules (or trigger points) in your shoulder and neck muscles indicates that your muscles are likely in a state of chronic tension.

The Role of Posture
Your observation of a slight head tilt to the right is significant. This posture can lead to an imbalance in muscle use, causing the muscles on the left side of your neck to work harder, which may contribute to the pain you are experiencing. Over time, this imbalance can lead to muscle fatigue, tightness, and the formation of trigger points. It is essential to be mindful of your posture throughout the day, especially during activities such as computer work, where it is easy to develop poor habits.

Treatment and Management Strategies
1. Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can provide you with exercises to strengthen weak muscles and stretch tight ones, helping to restore balance and improve posture. They may also use techniques such as dry needling or ultrasound therapy to address trigger points.

2. Ergonomic Adjustments: Make ergonomic adjustments to your workspace. Ensure that your computer screen is at eye level, your chair supports your lower back, and your keyboard is positioned to allow your elbows to rest comfortably at your sides.

3. Regular Breaks: Take regular breaks from your computer to stretch and move around. This can help reduce muscle tension and prevent the development of trigger points.

4. Self-Care Techniques: Incorporate self-care techniques such as gentle stretching, yoga, or mindfulness practices to help manage stress and muscle tension. Heat therapy (like warm compresses) can also be soothing for tight muscles.

5. Massage Therapy: While massage may not eliminate trigger points entirely, it can help alleviate muscle tension and improve circulation. Regular sessions may provide relief and help manage symptoms.

Addressing Concerns About Fibrous Nodules
Regarding your concern about the fibrous nodules being difficult to treat, it is important to note that while trigger points can be persistent, they are not necessarily permanent. With consistent management strategies, including posture correction, physical therapy, and self-care, many individuals experience significant improvement in their symptoms. Surgery is rarely required for myofascial pain unless there are underlying structural issues that need to be addressed.

Conclusion
In summary, while the presence of trigger points can be a source of concern, they can often be managed effectively with a combination of physical therapy, ergonomic adjustments, and self-care practices. It is crucial to remain proactive about your posture and incorporate regular movement into your routine to prevent further exacerbation of your symptoms. If your pain persists or worsens, consider consulting a healthcare professional for a comprehensive evaluation and tailored treatment plan. Remember, addressing the underlying causes of your discomfort is key to achieving long-term relief.

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