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The root of your neck pain

Have you ever dealt with neck pain and were unsure of where it came from?  Could it be long hours at the computer?  Looking down at your phone for too long?  Did you sleep on it the wrong way?  Or you have absolutely no idea?  Fortunately this is a condition we see a great deal of in our office.  Most of the neck pain we see may also be called cervical spine pain, cervicalgia, cervical spine stenosis, cervical radicular pain or radiculopathy.  Most of these are going to present as what we call referred neck pain.  What does referred pain mean?  Let’s talk about it!

Often times in our office we have patients come in with pain in their upper Trapezius muscle or between their shoulder blades, sometimes even down into their arm.  But what if I told you that the pain was coming from the neck?  How is that possible?  That pain is what we call radicular pain or referred pain coming from the nerve roots or joints of the cervical spine.  If these nerve roots become impinged or irritated they can refer pain to the tissues that the nerves travel to.

Quick anatomy lesson about spinal nerves.  We have 8 pairs in the cervical spine, 12 pairs in the thoracic spine, 5 in the lumbar spine, 5 in the sacral region, and 1 in the coccygeal region.  Here we’ll focus on the cervical region.  The image below shows a map of where the nerves of the cervical spine travel to.  We call these dermatomes. 

So let’s say that there is pressure on  the C6 nerve root.  A patient might report neck pain, but also pain that runs down into their thumb and index finger.  If you look at the dermatome map, the C6 nerve root covers the lateral forearm and the thumb/index finger.  So if you’ve ever felt pain in your neck that travels down to your thumb and first finger, it is possible that you have a cervical disc bulge or herniation that is putting pressure on the C6 nerve root.

Alternatively you may have felt pain in your neck, along your traps, or even between your shoulder blades.  If you look at this pain chart it shows the pain referral pattern for facet joint referral pain, meaning the nerve that passes between the facet joints at these levels might be irritated. 

For example, a patient may be feeling pain between the left shoulder blade, but the pain itself is actually coming from the facet joint at C5-C6 or C6-C7.

So how are you supposed to know if your arm or shoulder blade pain is coming from the neck?  Or more importantly how are you supposed to treat it?  The answer in our office is actually going to be the same.  In office we use the McKenzie Method (MDT) to find your specific directional preference to reduce your symptoms.  Let’s say that a patient comes in with pain next to their left shoulder blade.  We will typically start by checking range of motion of the cervical spine and determine if any motions are painful or restricted.  We then begin with performing cervical retractions, or chin tucks.  Often times after a few rounds retractions we see this start moving the pain from the shoulder blade up into the lower cervical spine.  This is what we call centralizing pain or centralization.  This occurs when we move the joints of the cervical spine the way they need to be moved which then takes pressure off of the nerves that pass by the joints.  Sometimes we get quick responses like this, other times it can take longer to see a response.  We may also need to explore a different motion to move the joints in, possibly retraction then extension, or retraction and lateral flexion.  Each patient will respond differently, which is why it is very important to perform the Mckenzie assessment on each individual patient, regardless of what symptoms they have.

Have you ever experienced pain like this?  Are you currently experiencing pain like this?  Are you interested to see if our assessment and treatment can help you?  Give us a call or book online to see one of our excellent providers today!

Looking for more informs on neck pain and or referral pain from the neck a? Check out Dr Powers video below!


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