By Timothy Agnew

A patient walks into your office complaining of neck and shoulder pain and stiffness, and you notice she has great difficulty turning her head. She tells you she cannot rotate her head anymore when backing out of the driveway, and even reaching for a cup in the cupboard has become a challenge. How do you, as a massage therapist, treat this patient? And how many times must you see her to solve the problem?

Neck and shoulder pain is a common complaint from many people, and if you have been a bodyworker for any length of time, you have probably experienced discomfort yourself, or you have treated patients with it. Why is the neck and shoulder region such a tender area? Let’s examine this question and some of the muscles that cause pain, and then discuss a treatment modality called Clinical Flexibility and Therapeutic Exercise (CFTE) as a way to help shoulder dysfunction.

First, for the purpose of this article, it is necessary to think of the cervical and shoulder areas as one unit. After all, they do not work separately, as many neck muscles share movements with the shoulder. Neck pain goes hand in hand with shoulder pain, and vice versa. The human head weighs about 8-10 pounds, and support for the skull comes from the neck and shoulder musculature. The trapezius muscle, as it starts at the base of the occiput and winds its way to the spinous processes of T-12, is a superficial supporter of the head (upper fibers). But it is also a major “retainer” of stress, and this muscle often becomes sore and ischemic. The rhomboid muscles, located between the scapula and vertebral column, lie deep to the trapezius. These muscles are almost always involved in neck problems because of their location (antigravity muscles along the spine, running across gravity) and action (as adductors and elevators of the scapula). Also, these muscles have a large pain referral path up to the neck. Many other muscles such as the scalenus, located on the anterior, lateral neck, and deep to the sternocleidomastoid and trapezius, are restricted in range of motion (ROM) and will contribute greatly to neck discomfort.

In the shoulder, most of the small rotator muscles such as teres minor, teres major, supraspinatus, subscapularis, infraspinatus and rhomboid are most always involved with shoulder pain. Usually there is an imbalance—either in flexibility or strength—that predisposes the shoulder (and neck) to injury. Parts of the rotator cuff muscles must pass underneath the small space of the acromion to attach on the humerus, so when they are shortened or swelling is present, impingement results.

So exactly what causes shoulder pain and stiffness? The muscles of the neck and shoulder work in unison to allow us our fantastic range of motions, and when they work properly, this movement is smooth, flexible, and pain-free. For example, restricted movement in the scapula (rhomboid, serratus anterior), can disrupt the scapular-thoracic rhythm. Compensation occurs by other muscles to give us the ability to perform the movements. The result? Over-used, damaged musculature.

Weak, inflexible muscles of the neck and shoulder cause eighty percent of all neck-related problems. As I said previously, the weight of the head is supported by our neck and shoulder musculature. The rhomboids hold the shoulder back, the trapezius helps keep our head extended in the midline of the body, and many other neck/shoulder muscles assist. When these muscles become weak—which they often do from overuse, age, or atrophy—the muscles can no longer do their job. Small tears develop in the muscle fibers, and the patient develops a “pain in the neck,” or worse, frozen shoulder.

CFTE is a commonsense modality that is derived from traditional kinesiology, biomechanics, and physical therapies. Its philosophy is to educate the patient at all times. Unlike many healthcare modalities, CFTE allows the patient to learn the exercises to help solve his/her own problems. In CFTE, no patient leaves a treatment without learning exactly what caused the problem, what they can do to help it, and exercises they can start immediately, without supervision or assistance. At the core of CFTE is the method of Active Isolated Stretching (AIS), a safe, effective protocol that anyone can learn to do on his or her own.
How do you treat shoulder problems? How many times must you see the patient to solve the problem? Ninety percent of all neck pain can usually be solved in two treatments using CFTE. Is this good for your business? After all, if a patient only sees you twice it can’t be. Yes, it can. Solve that patient’s pain for good, and she will refer you over and over again. People in pain want solutions—not treatment after treatment.

To solve neck and shoulder problems, several things must happen:

  1. Flexibility to the neck and shoulders must be restored.
  2. Those muscles must then be strengthened.

But that’s not all. The patient must be taught how to maintain her injury to prevent pain from reoccurring. Education of the patient is part of the solution! If you’re already performing massage in your practice, it becomes a powerful treatment when combined with CFTE. Gentle massage can help expedite the healing time and aid in relaxing the patient.

Neck and shoulder pain can literally drain the body’s energy systems, and many people become “adjusted” to the pain and assume it will always be there. For this reason, this area must always be treated gently. The type of flexibility you perform on your patient is important, too. Many types of stretching support long holds of muscle tissue, which could damage ischemic tissue more. Isometric-type resistance to the neck also poses many risks. The CFTE method has been proven to help release muscle tissues quickly and effectively, and the best part is the patient always leaves with new knowledge to help solve neck and shoulder dysfunction for good.

Timothy Agnew will be at DSM, September 25-26, 2004, teaching CFTE for the Cervical Spine and Shoulder. For more information, contact the school at (207) 832-5531.

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