REMEDIAL and SPORTS MASSAGE - NECK PAIN
by Donald Budge BSc, RMT, SMTO
Sarah's pain in the neck
Introduction
Sarah, a 37-year old active woman, came to me for treatment
for pain in her shoulders and neck. She had been troubled
by this since falling off a ladder two years previosly.
She described the pain as a toothache-like sensation at
the anterior aspect of her left scapula when her neck was
in a certain orientation. She also felt that her present
condition may have been aggravated by an aquatic aerobics
class she had attended two weeks earlier. Sarah also revealed,
during the consultation, that she sometimes took St John's
Wort to counter periods of depression.
Sarah had already attended physiotherapy, and for the six
months before coming to see me, she had also been treated
at a chiropractic clinic. Neither the physiotherapy nor
the chiropractic treatment she had received had effected
a sustained long-term cure for her. For the previous eight
weeks, Sarah had resorted to wearing a neck collar to bed
so that she could sleep.
Although Sarah had mentioned depression during the consultation,
there was never any indication of this during the conversation
or subsequent treatments. The observed tension around her
neck and shoulders, during the initial examination, indicated
stress and may have been a contributory factor to her condition.
The secondary effects of remedial massage therapy would
assist in relaxation of the nervous system and encourage
progress towards homeostatic balance.
I took a full consultation, recorded her medical history
and noted her general practitioner. I confirmed that she
had not sustained any fractures nor had any accidents and
that she was not on any medication. She did not suffer from
any condition which might have made me consider cautions
or contra-indications to treatment. Also having had a chronic
neck condition myself over the past seventeen years, as
a result of a rugby injury, I was able to relate to her
condition and also the treatment she would have been given
by the Physiotherapist and Chiropractor. With the medical
history and my assessment there was unlikely to be any significant
structural problems in the region of the cervical spine,
and that remedial massage therapy to the soft tissues involved
in the neck and shoulders would be a very worthwhile plan
to follow.
General assessment
I carried out a visual examination on Sarah's posture and
active mobility of her limbs and torso. I recorded that
her left foot was slightly rotated and her left shoulder
elevated. I also noted some imbalances in her neck and shoulder
muscles.
Specific assessment
I asked Sarah to look up and down, side to side and to bring
her ear towards her shoulder and compared sides. She found
it painful to move her head to the right and the movement
was also restricted. Looking up also caused some discomfort.
I then assessed Sarah's shoulder movements comparing sides.
Using my fingers, I then palpated around the areas and noted
the ones that caused either pain or discomfort. Sarah showed
me how she could move to produce the pain over her shoulder
blade.
The assessment did not reveal any major problems with the
superficial muscles around the neck and shoulders though
the area that she complained of, was tender to touch. Sarah's
shoulder mobility was impressive, which I put down to her
job as a hairdresser.
Treatment Plan
We discussed the situation and decided on the following
plan:
- To treat neck and shoulder muscles with neuromuscular
and myofascial-stripping techniques to release deep muscle
tension and improve neck movement.
- To search for any trigger points that may be causing
the pain and making the condition be so resistant to treatment.
- To use movements to help to balance muscles.
To discuss any self help that Sarah could do. Her job as
a hairdresser obviously involves standing for long periods
with extra stresses on neck, shoulders and arms. Stretches
and some postural advice would be useful.
The Treatment
The first treatment. Since this was Sarah's first visit
to a massage therapist, I gave her some information about
Remedial Massage Therapy and how we concentrate on one area
at a time.
In view of her stating that she did suffer from depression,
I considered a full body massage with relaxation techniques.
However, our goal was to reduce neck pain so I concentrated
on remedial therapeutic techniques, the major neck and shoulder
muscles.
At the end of the session, Sarah felt very relaxed. However,
she was not in a position to verify if any significant change
had been made. Sarah's neck rotation remained restricted
and still brought about pain.
On the second treatment, three days later, Sarah reported
that she had slept like a log and felt better in herself.
We repeated the treatment including finding a very active
hot spot that did reduce dramatically during the session.
We discussed posture, awareness and relaxation. When we
have a painful area, it is very easy to maintain a strange
posture. Sarah was much happier after treatment and promised
to try and keep her neck and shoulders loose.
At the third session, one week later, Sarah reported that
she has not needed to wear her collar since her treatment
started. However, examination revealed that full neck rotation
was still a little uncomfortable. I assessed again (I assess
before and after every treatment so that I can see any changes).
Sarah reported that, although she had a slight stiffness
in her neck the day after the last treatment, she was beginning
to get increased confidence with the general use of her
neck. On examination, I detected a slight improvement in
neck rotation.
At the fourth treatment session, four days later, Sarah
stated that she had been gardening two days before and,
despite much lifting and bending, she was happy to report
that her neck did not give her any problems. However, she
was aware of some discomfort around her right shoulder.
During examination, Sarah could perform full active neck
rotation without pain. We agreed that real progress was
being made and I worked more deeply than I had been able
to do before. I used mobilisations to help to balance the
muscles.
Eight days later, at session 5, Sarah returned confirming
that she has had no pain or discomfort with her neck or
right shoulder and thought she would like a relaxation massage.
I pointed out that it would be a good idea to check out
her whole back and pelvis to ensure that all was balanced
there. Sometimes, neck problems can occur as a result of
a problem lower down. I found that her back did have some
areas of tension and worked on them. As Sarah stands a lot,
some Remedial Massage was applied to her legs.
At the next session, 1 month later , Sarah reported no
changes from the last visit. She has now full confidence
in the use of her neck.
During a follow up phone call 6 months later, Sarah confirmed
that she has had the full use of her neck, without discomfort
or pain. She reported that she attends the gym regularly
three times per week and has started a yoga class.
Conclusion
The treatment that Sarah responded to was soft tissue remedial
massage therapy which includes deep massage and mobilisations.
This treatment, after several months of discomfort and pain,
enhanced her own body's powers of self healing to reach
and maintaining an increased homeostatic balance. I believe
also that the relaxation aspects of the treatment were also
a critical contributor. The relief to her discomfort and
consequential increased awareness have given her confidence
in the use of her neck, has reduced her stress levels, thus
helping to maintain her present condition.
About the Author
Donald Budge RMT, SMTO
Donald Budge is a Remedial and Sports Massage Therapist
in practice in Edinburgh.
He can be contacted at (0131) 337 6784
or Email: dbudge@iee.org
