Saturday, January 29, 2011

Occupational Therapy for Neck and shoulder pain

The neck and shoulder are one of the most used parts of our body, after the brain of course! The neck and shoulder share a lot of muscles that are common to both the joints.  That is these muscles support the neck as well as the shoulder.

The trapezius is one large muscle that attaches on the vertebral column near the neck and the shoulder.
The shoulder muscles in comparison are very small and help the shoulder in all its movement. These muscles also get less nutrition when compared to the large trapezius muscle. The trapezius supports the shoulder and the neck whereas the shoulder muscles only support the shoulder.

Due to small size and less nutrition the shoulder muscles tend to weaken before the trapezius. The weakened shoulder muscles stop supporting the shoulder and the trapezius is now overloaded. As a
result after few days the trapezius starts hurting and is wrongly diagnosed as neck pain or cervical spondylosis. This is a common phenomenon, which is followed by a visit to the family doctor/orthopaedic surgeon and intake of painkillers.

The human body adapts to this pain and the pain subsides for some time. This cycle is repeated a few times before the trapezius and other neck muscles just give up and the patient is in tremendous pain.

This is followed by some more painkillers, X-ray and MRI and sometimes surgery for cervical spondylosis.
If you have been reading so far, even though you may not be a doctor you know that this is not cervical spondylosis, but incorrectly diagnosed shoulder weakness.

One may argue at this point that the x-ray and MRI show changes and prolapsed disc that indicates cervical spondylosis. Also the patient suffers from tingling numbness in his/her hands and arms. These are secondary changes due to weak muscles at the neck and shoulder.

If the initial shoulder weakness, which was incorrectly diagnosed as cervical spondylosis was treated for shoulder weakness this whole scenario would never had taken place.

Some medical practioners may diagnose the problem correctly and advise SHORT WAVE DIATHERMY, ULTRASOUND OR PULLEY AND SHOULDER WHEEL exercises. These methods prevent excellent short-term relief but never treat the root cause, which is weakness, the heat delivered via short wave diathermy or ultrasound DOES NOT strengthen the muscles.

Pulley and other generic shoulder exercises do more harm than good as straining the shoulder muscles in presence of weakness invariably leads to further damage than good.

The evidence based and right way to manage neck or shoulder pain is to consult a specialist Shoulder surgeon or shoulder therapist. A shoulder surgeon is an orthopaedic surgeon who SPECIALISES in shoulder problems. These are different from a regular Orthopaedic surgeon who practises general orthopaedics. A shoulder therapist could be an Occupational Therapist who has specialised in treatment of SHOULDER.

 (In no way is it suggested that a general orthopaedic or a general therapist cannot diagnose or treat shoulder problems, but it merely states the fact that a specialist is better versed with these issues.)

Once your problem of neck or shoulder pain has been correctly diagnosed by a battery of clinical tests the treatment plan is chalked out.
This typically involves band exercises for shoulder/neck, exercises for movement of the shoulder and neck and a physician referral to evaluate certain vitamin levels.

Note- A True shoulder and neck therapy program rarely involves any heating, painkillers or painful movements. Patients usually report 50% improvement in the 1st 5-10 days. They are usually pain free by 3rd or 4th day.
For any further questions or suggestions - contact the author.

Article provided by:

Neck and Shoulder Pain Clinic-Mumbai
Dr.Amol Sangekar
Shoulder and hand Therapist
BOT (Mumbai). OTR/L (USA).
Fellowship in Shoulder rehabilitation.


Anonymous said...

--Ontario Society of Occupational Therapists--

I am a MBA student from Vancouver, Canada. My classmates and I created a Facebook Page for OSOT (Ontario Society of Occupational Therapists) which is celebrating 90 years of its presence this year. I am sure the OSOT page will serve as a valuable platform for occupational therapists throughout the world to come together and share their valuable insights. Here is the Link to the OSOT page:

Don't forget to "LIKE" our page and leave your valuable comments!

Ravneet Sandhu

Anonymous said...

Hi I am looking for a occupational therapist in mumbai specializing in hands. I have already got the splints in Uk from a hand therapist ,but need to follow up on the same in India
I t would be of great help if I can get a reference. Thanks