I’ve had two patients referred to me recently with difficult neck and shoulder pain issues. Their complaints were of the typical pain distribution–from the base of the skull down the neck to the shoulder blade and across the top of the shoulder as well as pain in the front of their shoulders. MRIs and X-Rays were negative for disc or other pathologies. They had been through several specialists and felt no relief other than with steroids and Vicodin.

After examining both women, I found they had very similar problems in that the shoulder blades were sitting too low on the trunk (Figure 1.).

Figure 1. Depressed Right Shoulder Blade (Copyright Boone Publishing. 2009)

Also the  humeral head was sitting too far forward in the shoulder socket (Figure 2) causing pain in the front of the shoulder. I taped both the humeral head and the shoulder blades in a corrected position and their pain was eliminated–until the tape was taken off a few days later. This told me my diagnosis was correct. But how could I get them to hold these corrected positions on their own? Our attempts at specific corrective strengthening only met with irritation of their pain.

Figure 2. Humeral Anterior Glide (Copyright Boone Publishing. 2010)

Because the shoulder blades’ position on the trunk is partially determined by ribcage orientation, I revisited this aspect of their pain and found that by elevating their rib cages, pain was eliminated. This did two things: 1. it reduced the anterior tilting of the shoulder blade and, 2. activated key scapular positioning muscles that were deficient. The other maneuver I discovered to be of great help was asking them to place their painful side’s hand on the opposite shoulder. This elevated the painful shoulder blade and posteriorly  glided (pushed back) the humeral head into a corrected position in the shoulder socket. Both felt about 80-99% relief from their symptoms during the following week.

Both are now able to begin their strengthening program without pain. If  irritation does occur, they know exactly how to eliminate it, finally giving them a means to control their own pain.

Both of these women had one more issue in common. They were self-conscious of their breast size and therefore slouched  their shoulders. Over time, I believe this established the environment for these mechanical issues to become painful. Both commented that upon fixing their posture, they felt they were sticking their chests out too much, drawing attention to themselves. They clearly saw the mechanical connection, however, as their pain returned after resuming their slouched postures (Figure 3). Ultimately they needed to come to terms about their personal issues of drawing attention to themselves in order to be better.

Figure 3. Posture & Shoulder Blade Position (Copyright Boone Publishing. 2010)

This reinforces to me that, although my point of view focuses more on the mechanical causes of chronic pain, there are also significant emotional or psychological causes. I believe often there exists a combination of dietary, musculoskeletal, and psychological issues that contribute to chronic pain. There are probably others as well. Each person’s pain is a function of a different combination of these issues. My training is in understanding the musculoskeletal aspects of pain but occasionally I bump into someone with more psychological issues instead.

I just had an interesting session with a client suffering from chronic neck, shoulder, and back pain for well over a decade. Much of her chronic pain is related to her slumping posture–it affects her spine and scapular positioning and therefore significantly contributes to her pain. In the past, I’ve focused on addressing her neck, shoulders, or back with separate exercises, cueing specific behaviors I wanted to see happen. Her response to these corrections was that they fatigued her too much. She happens to have chronic fatigue syndrome as well as a host of other syndromes and issues so this complaint never really registered with me as something unexpected.

We were going through her lower abdominal strengthening program when she commented that she couldn’t feel the appropriate muscles tightening. So I came up with a new cue of lifting her rib cage. Suddenly she could feel her lower abdominal muscles working. We then stood up and I asked her to lift her rib cage again. This instantly relieved stress to her neck, shoulders, and back! By her own admission (which is saying a lot), she felt she just had a huge breakthrough. I saw changes in her neck and shoulder positioning that I had been trying to create for months! The best news was that she felt it was almost effortless to maintain.

This is a new development for me. I’ve treated displaced ribs before but never thought to address the rib cage as a whole to affect other areas of chronic pain. It makes sense because looking at the spine, the rib cage is positioned to act as a huge lever arm, affecting spine and scapular mechanics. I’ll be very excited to experiment with this phenomena to work out the nuances of its application.

I have been writing a book detailing some very powerful self-treatment techniques I use to treat patients with chronic pain. It’s been an interesting venture because, in the process of writing the book, I now understand how my subconscious or intuition has been working to guide my treatments. This understanding, in turn, has helped guide my treatments.

Each chapter of the book addressed a different area of the body. For instance neck pain & headaches, shoulder pain, elbow pain, back pain, hip pain, knee pain, foot & ankle pain and back pain & sciatica during pregnancy. The feedback I’ve received is that the information was too technical for laypeople (who happen to be my audience). In the process of breaking the information down even more, each chapter has expanded to become its own book.

The title of the series will be Fixing You. The first book out will be Fixing You: Back Pain and will be followed by seven other books all to be published this year. It will be a busy year for me! My sincerest hope is that these books help the thousands of people out there living with chronic pain. So often with just a little attention to the right areas, pain will vanish. I hope the Fixing You series can guide people to pain-free lives.

Most back, neck, hip or shoulder pain I treat is resolved with correction of biomechanical problems. However there is a small percentage of people who need some soft tissue work- usually in the form of trigger point release- to get them over the final hump.
Usually this is the case for shoulder and neck pain clients. I think this is so because the shoulder is essentially a floating system which relies on muscle tone to hold it in place rather than joint compression due to gravity. Therefore it is more susceptible to stress due to errors in movement or usage.