Your symptoms are suggestive of myofascial pain syndrome. Muscles of the neck and shoulder girdle, namely; trapezius, scalene, sternocleidomastoid, levator scapulae etc can develop myofascial trigger points. These are hyperirritable tender spots in palpable tense bands of skeletal muscle that refer pain. This can be associated with degenerative disc disease in neck causing pinched nerves and can be related to the whiplash injury. Trigger points may develop after an initial injury to muscle fibers. This injury may be a noticeable traumatic event or repetitive microtrauma to the muscles. The trigger point causes pain and stress in the muscle or muscle fiber. As the stress increases, the muscles become fatigued and more susceptible to activation of additional trigger points. The treatment is following;
1) passive stretching of the affected muscle after application of sprayed vapocoolant.
2) physical therapy; simple muscle stretch, augmented muscle stretch, post-isometric relaxation.
3) deep electrotherapy; iontophoresis, phonophoresis, short wave diathermy, electrical stimulation, high voltage galvanic stimulation, biofeedback.
4) local analgesic patch / ointment / spray
5) anti-inflammatory analgesics; Ibuprofen (Motrin / Advil)
6) ischemic compression therapy; pressure on the points
8) steroid shots
A concomitant pinched nerves in the neck can also cause neck, upper back and shoulder girdle pain. This can be due to;
1) Herniated/degenerated disc in neck
2) Cervical spondylosis; bone spurs in the neck vertebrae pressing on the nerves.
Following investigations would be required for the confirmation of the diagnosis;
1) X-ray of the neck spine
2) MRI of the neck
Following measures would be helpful;
1) Neck care in the activities of daily living.
a) No working on computer for more than half an hour in a single stretch. Same for TV.
b) Monitors and televisions exactly in front (180 degrees).
c) Contour pillow: Should fill the hollow when lying on back or straight. Available over the counter.
2) Cervical Collar or Brace
3) Cervical traction
4) Anti-inflammatory analgesics like Ibuprofen
5) Physical therapy: gradually increasing exercises from passive stretching to active against resistance regime.
6) Electrotherapy in the form of TENS, interferential and laser and ultrasound.
7) Hot fomentation
8) Local analgesic patch / ointment / spray
You can consult following specialists;
b) MD in Physical medicine and rehabilitation
Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
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In response to your answer, I’ve tried the following of your recommended therapies
1) passive stretching of the affected muscle
3) deep electrotherapy; iontophoresis, phonophoresis, short wave diathermy, electrical stimulation, high voltage galvanic stimulation, biofeedback. – TENS unit
9) acupuncture and cupping
Both X-ray and MRI were grossly normal with the MRI showing some mild disk degeneration ~C5-7. I was told the amount of degeneration seen is typical for my age.
2) Cervical Collar or Brace - Is there a style or brand you recommend?
3) Cervical traction – Unsure what you mean
4) Anti-inflammatory analgesics like Ibuprofen – being taken
5) Physical therapy: gradually increasing exercises from passive stretching to active against resistance regime. – already tried three times. PT helps, but pain lingers.
6) Electrotherapy in the form of TENS, interferential and laser and ultrasound. – I have a home TENS unit I use ~2x week 30 min
7) Hot fomentation -
8) Local analgesic patch / ointment / spray – I use Mentholateum or Arnica.
a) Orthopedist – done, they recommended PT, steroid shot, stretching and the TENS. At this point they have no further recommendations.
When I turn my neck I feel a clicking sound in one spot, repeatedly. This is why I suspect it may be related to a tendon or ligament. Also, there is an increase of pain associated with the clicking. Sometimes the pain is immediate and sometimes a slight (few minutes) delay.