Can individuals who sit for long hours daily prevent tight neck and shoulder muscles by improving their posture, regularly stretching, and massaging their trapezius muscles?
Trapezius Self Massage
The trapezius muscle is a triangle-shaped muscle in the upper back that starts at the base of the neck, spans the length of the upper shoulders, and extends into the middle back. This muscle’s main function is stabilizing and moving the scapula/shoulder blade. The trapezius also helps to move the head, neck, arms, shoulders, and torso, stabilizes the spine, and plays an important role in posture. Physical and mental stress can tighten the trapezius muscle, leading to neck and shoulder pain. Learning to perform a trapezius self-massage can ease tension and provide pain relief. (Domingo A. R. et al., 2017)
Anatomy
The trapezius consists of three parts in three different areas of the back. The bottom of the skull, across the shoulders, and down to the mid back. A trapezius self-massage focuses on the upper portion of the traps. This part is located at the top of the shoulders. To find the upper trapezius, cross one arm in front of your body so that you can place the palm on top of the other shoulder.
For a trapezius self-massage, you need to know that there are two areas where your upper traps start and where the muscle connects to a bone. The first point is on the bottom of the skull, close to the center of the back of the skull. Start there with your fingers and trace the muscle down the back of the neck to where the shoulders widen. If you get lost, You can walk your fingers up or down the muscle on either side to relocate its origin at the base of the skull, the vertebra at the base of your neck that sticks out. This is C-7, another of the upper trapezius’s origin sites. (University of Washington Department of Radiology, 2025)
Massage Technique
Massage oil is optional but can hydrate the skin during a massage. You can perform the trapezius self-massage using your hands.
Start at the Base of The Neck
Choose one shoulder to work at a time.
Raise the arm on the opposite side of your body.
Reach this arm across your body and fold it around your neck so that your fingers rest at the back base of your neck.
Apply a decent amount of pressure to the muscle while moving your fingers in a circular motion.
The action is similar to kneading dough.
Massage this area at the base of your neck for about 30 seconds to start.
If this part of your muscle is sore, you can massage it longer.
Slowly Work Out Towards The End of The Shoulder
Once you have spent about 30 seconds massaging the muscle at the base of the neck, work your way out toward the end of your shoulder.
In close increments, in your fingers across the trapezius muscle, spending at least 30 seconds at each point.
Follow the muscle until you reach the end of the shoulder.
Apply enough pressure, and use slow, rhythmic movements so that you feel relief.
If the pressure is not relieving or makes you wince, it’s too much.
Repeat as Needed
Repeat each side two to three times before switching to the other shoulder. After massaging, you may notice a certain trapezius area is particularly sore or tense. Zero in on those areas a little longer. Remember to relax throughout the trapezius self-massage. This is an opportunity to learn where tension is in your neck and shoulders and how to apply pressure to relieve it. This knowledge can also help you be mindful throughout your day, whether sitting, doing chores, or other physical activities. If you notice scrunching or slouching, massage the trapezius and remind yourself to keep your shoulders relaxed.
Benefits
Tension and tightness in the trapezius muscle are common, particularly among individuals who work in an office, do manual labor, or deal with a lot of stress. (Marker R. J. Campeau S., & Maluf K. S. 2017) Trapezius strains are a common overuse injury that is more likely to happen when the muscle is tight. (Salavati M. et al., 2017) The injury can cause unhealthy posture to avoid the pain. This poor posture will place more stress on the muscles, leading to a cycle of poor posture and chronic pain. A trapezius self-massage can benefit in many ways, including:
Improved blood circulation
Better quality of sleep
Improved posture
Improved range of motion
Decreased swelling
Faster recovery after workouts
Reduced risk of injury
Seeing a Healthcare Provider
Like any other muscle in the body, the trapezius can be injured and requires special treatment to recover. Sometimes, the neck or shoulder pain may not come from the trapezius muscle. Consider seeing a healthcare provider if you have pain in your neck or shoulder that doesn’t get better within a week or two, especially if it isn’t responding to at-home treatment. Regardless of how long you have been experiencing pain or stiffness, contact a healthcare provider if it prevents you from getting adequate sleep or interfering with daily activities. Reasons to see a healthcare provider immediately for neck or shoulder pain include: (Mount Sinai, 2025)
There is sudden pressure or pain in the left shoulder, which can sometimes signal a heart attack.
A fall or accident resulted in pain, swelling, or problems moving the neck or arm.
If there is shoulder pain, a fever, swelling, or redness.
The skin on the shoulder area appears discolored.
It’s important to take regular breaks to stretch and move your muscles. You can release tension in the trapezius by doing shoulder shrugs throughout the day and stretching regularly. When the trapezius feels tight or sore, give yourself a massage.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Whiplash Chiropractic Massage Therapy
References
Domingo, A. R., Diek, M., Goble, K. M., Maluf, K. S., Goble, D. J., & Baweja, H. S. (2017). Short-duration therapeutic massage reduces postural upper trapezius muscle activity. Neuroreport, 28(2), 108–110. https://doi.org/10.1097/WNR.0000000000000718
University of Washington Department of Radiology. (2025). Trapezius. https://rad.washington.edu/muscle-atlas/trapezius/
Marker, R. J., Campeau, S., & Maluf, K. S. (2017). Psychosocial stress alters the strength of reticulospinal input to the human upper trapezius. Journal of Neurophysiology, 117(1), 457–466. https://doi.org/10.1152/jn.00448.2016
Salavati, M., Akhbari, B., Ebrahimi Takamjani, I., Ezzati, K., & Haghighatkhah, H. (2017). Reliability of the Upper Trapezius Muscle and Fascia Thickness and Strain Ratio Measures by Ultrasonography and Sonoelastography in Participants With Myofascial Pain Syndrome. Journal of Chiropractic Medicine, 16(4), 316–323. https://doi.org/10.1016/j.jcm.2017.06.003
Mount Sinai. (2025). Shoulder pain. https://www.mountsinai.org/health-library/symptoms/shoulder-pain
Can choosing the right pillow help many individuals with neck pain get a full night’s sleep and reduce pain-like symptoms?
The Effects Of Neck Pain
How often do you feel stiffness in your neck and shoulders after being hunched for an extended period? Does it hurt when turning your neck from side to side? Or have you been suffering from constant headaches or migraines that are making you have a hard time falling asleep? As the second most common musculoskeletal condition, neck pain is a multifactorial disease developed through various risk factors that can impact a person. (Kazeminasab et al., 2022) The multiple muscles surrounding the neck are constantly overstretched and tight, which can cause pain and discomfort to the upper extremities due to environmental factors. Some environmental factors can range from improper posture to injuries that can affect the neck. When many people are experiencing neck pain associated with environmental factors, it can cause considerable personal pain and discomfort, disability, impaired quality of life, and, for adults, loss of time from work. (Ben Ayed et al., 2019) At the same time, when people experience neck pain, they can develop disruptive sleeping habits. We associate with certified medical providers who inform our patients of the effects of neck pain and how it can disrupt their sleeping habits. While asking important questions to our associated medical providers, we advise patients to incorporate various techniques to reduce neck pain and find ways to stay asleep longer. Dr. Alex Jimenez, D.C., envisions this information as an academic service. Disclaimer.
How Neck Pain Disrupts Sleep
Now, many people wonder how neck pain is associated with sleep. Environmental stressors like chronic stress from the workplace or natural disasters can cause a person to have tense neck muscles and can increase sleep disturbances. (Yabe et al., 2022) When environmental stressors impact the body, the musculoskeletal system becomes tight and tense in different body areas. In the neck, the muscles that surround the cervical can become tense and develop trigger points in muscle tissue, causing referred pain and discomfort. When neck pain causes disruptive sleep problems, it can cause impairment to the multifunctional protective role of sleep via physiological homeostasis and restoration. (Van Looveren et al., 2021) At the same time, some of the pain-like symptoms that can be increased with neck pain associated with disruptive sleep include: (Chin et al., 2021)
Soreness
Pain
Numbness
Difficulty in movement
However, there are ways to reduce the effects of neck pain and get a full night’s sleep, starting with the bedroom.
Low Back & Neck Pain Rehabilitation-Video
Choosing The Right Pillow For Neck Pain
Now, when it comes to getting a full night’s sleep, it is important to find the right mattress to stay asleep as well as feel refreshed. However, as important as it is to sleep in the right mattress when dealing with neck pain, finding the right pillow can do wonders for the neck and help people get enough sleep. When it comes to finding the right pillow, the individual needs to find a pillow with an appropriate height that can provide adequate support for the head and neck to reduce cervical spinal stress and relax the surrounding neck and shoulder muscles. (Lei et al., 2021) This is because when it comes to quality sleep, many people prefer sleeping positions, pillows, and mattresses aimed at comfort. Many pillows have a variety of materials that can help aid in comfort and help reduce neck pain. Some of the types of pillows include:
Memory foam
Polyfilled pillows
Down Pillow
Latex
Combo style
Finding the right pillow for neck pain allows the individual to have their neck fully supported while having the pillow in a lateral position to reduce neck fatigue and improve sleep quality (Son et al., 2020). By doing so, many people can finally get a good night’s sleep and wake up feeling better. By choosing the right pillow, many people will begin to be more mindful of their bodies and make small changes to their routine while getting the sleep they deserve.
References
Ben Ayed, H., Yaich, S., Trigui, M., Ben Hmida, M., Ben Jemaa, M., Ammar, A., Jedidi, J., Karray, R., Feki, H., Mejdoub, Y., Kassis, M., & Damak, J. (2019). Prevalence, Risk Factors and Outcomes of Neck, Shoulders and Low-Back Pain in Secondary-School Children. J Res Health Sci, 19(1), e00440. https://www.ncbi.nlm.nih.gov/pubmed/31133629
Chin, W. S., Chen, Y. C., Lin, T. T., Guo, Y. L., & Shiao, J. S. C. (2021). Short sleep and chronic neck and shoulder discomfort in nurses. J Occup Health, 63(1), e12236. https://doi.org/10.1002/1348-9585.12236
Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M. J. M., Kolahi, A. A., & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord, 23(1), 26. https://doi.org/10.1186/s12891-021-04957-4
Lei, J. X., Yang, P. F., Yang, A. L., Gong, Y. F., Shang, P., & Yuan, X. C. (2021). Ergonomic Consideration in Pillow Height Determinants and Evaluation. Healthcare (Basel), 9(10). https://doi.org/10.3390/healthcare9101333
Son, J., Jung, S., Song, H., Kim, J., Bang, S., & Bahn, S. (2020). A Survey of Koreans on Sleep Habits and Sleeping Symptoms Relating to Pillow Comfort and Support. Int J Environ Res Public Health, 17(1). https://doi.org/10.3390/ijerph17010302
Van Looveren, E., Bilterys, T., Munneke, W., Cagnie, B., Ickmans, K., Mairesse, O., Malfliet, A., De Baets, L., Nijs, J., Goubert, D., Danneels, L., Moens, M., & Meeus, M. (2021). The Association between Sleep and Chronic Spinal Pain: A Systematic Review from the Last Decade. J Clin Med, 10(17). https://doi.org/10.3390/jcm10173836
Yabe, Y., Hagiwara, Y., Sekiguchi, T., Sugawara, Y., Tsuchiya, M., Yoshida, S., & Tsuji, I. (2022). Sleep disturbance is associated with neck pain: a 3-year longitudinal study after the Great East Japan Earthquake. BMC Musculoskelet Disord, 23(1), 459. https://doi.org/10.1186/s12891-022-05410-w
Experiencing a whiplash injury can be disorienting and painful. Can recognizing the signs of more serious complications, seeking timely medical intervention, and following a structured whiplash rehabilitation plan help individuals find relief and restore function and quality of life?
Whiplash Rehabilitation
For individuals who have recently been in an automobile accident, once the initial neck pain and stiffness have passed, it’s crucial to recognize potential delayed symptoms, such as nerve damage. While many recover quickly, some may experience prolonged symptoms requiring more aggressive treatment and management.
Neck Injury
Whiplash injuries result from sudden, forceful whipping back and forth of the head, commonly occurring in rear-end vehicle collisions, and are one of the most common neck injuries. Other potential causes include: (Johns Hopkins Medicine, 2024)
Following a healthcare provider’s recommendations regarding medication use, including dosage and duration, is critical to managing symptoms while effectively minimizing potential side effects.
Rehabilitation Steps
To determine the appropriate treatment whiplash rehabilitation plan, a healthcare provider will assess how much the pain affects daily life, including mental health and the ability to do regular activities (American Academy of Physical Medicine and Rehabilitation, 2024). X-rays or other imaging tests will be done to determine how serious the damage to the neck or spine is. Resting and icing the injured area are recommended to relieve inflammation. A provider may recommend slowly increasing neck movements several times daily and continuing with normal daily activities, as exercise will help maintain flexibility. Not moving the neck may prolong pain, stiffness, and healing. Physical therapy may be recommended if symptoms continue for over one or two weeks. (American Academy of Physical Medicine and Rehabilitation, 2024)
Symptoms last longer than the healthcare provider estimated
Other symptoms develop, like weakness, numbness, or a sensation of pins and needles.
Long-Term Injury Side Effects
Individuals in whiplash rehabilitation usually recover in a few weeks to months, but some may have longer-lasting pain as the injury can cause nerve damage. (Fundaun J. et al., 2022) Discuss any new or worsening symptoms with a healthcare provider for guidance. (Johns Hopkins Medicine, 2024)
Over-the-counter pain relievers, such as acetaminophen or NSAIDs.
Muscle relaxants for tightness and tension.
Prescription pain medications.
If pain becomes chronic, antidepressants such as serotonin and norepinephrine reuptake inhibitors may be prescribed. These medications can help manage pain and improve sleep quality. (Ferreira G. E. et al., 2023) For severe inflammation and pain, corticosteroid injections directly into the affected area can provide relief. Healthcare providers administer these injections, offering long-lasting effects. (Harvard Health Publishing, 2015)
Injury Medical Chiropractic and Functional Medicine Clinic
Navigating a whiplash injury can be challenging, but understanding the whiplash rehabilitation process can significantly aid in recovery. A healthcare provider can determine the most effective treatment strategies. It is important to talk with a healthcare provider to determine the cause and extent of the injury to provide individualized patient education regarding treatment. This can include physical therapy, rest, health coaching, medication, and surgery, which may be recommended in certain cases. Overcoming these limitations is possible. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
American Academy of Physical Medicine and Rehabilitation. (2024). Cervical whiplash. https://www.aapmr.org/about-physiatry/conditions-treatments/musculoskeletal-medicine/cervical-whiplash
Rush University Medical Center. (2014). 5 facts about whiplash. https://www.rush.edu/news/5-facts-about-whiplash
National Library of Medicine. MedlinePlus. (2024). Whiplash. Retrieved from https://medlineplus.gov/ency/imagepages/9853.htm
National Health Service NHS. (2023). Whiplash. https://www.nhs.uk/conditions/whiplash/
University of Rochester Medical Center. (2024). Whiplash injury. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=85&contentid=p01388
National Library of Medicine. MedlinePlus. (2020). Pregabalin. Retrieved from https://medlineplus.gov/druginfo/meds/a605045.html
Fundaun, J., Kolski, M., Baskozos, G., Dilley, A., Sterling, M., & Schmid, A. B. (2022). Nerve pathology and neuropathic pain after whiplash injury: a systematic review and meta-analysis. Pain, 163(7), e789–e811. https://doi.org/10.1097/j.pain.0000000000002509
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2023). Back pain: diagnosis, treatment, and steps to take. Retrieved from https://www.niams.nih.gov/health-topics/back-pain/diagnosis-treatment-and-steps-to-take
Ferreira, G. E., Abdel-Shaheed, C., Underwood, M., Finnerup, N. B., Day, R. O., McLachlan, A., Eldabe, S., Zadro, J. R., & Maher, C. G. (2023). Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews. BMJ (Clinical research ed.), 380, e072415. https://doi.org/10.1136/bmj-2022-072415
Harvard Health Publishing. (2015). New recommendations aim to improve safety of pain-relieving spinal steroid injections. Harvard Health Publishing
Harvard Medical School. https://www.health.harvard.edu/blog/new-recommendations-aim-to-improve-safety-of-pain-relieving-spinal-steroid-injections-201505077991
Can cervical retraction be a good addition to a home exercise program for individuals with neck pain, spinal arthritis, or needing to strengthen their neck muscles?
Cervical Retraction
Cervical retraction is a neck exercise that involves gently sliding the head backward while keeping the chin tucked. It can help with:
Neck pain
Stretching and loosening the muscles at the back of the neck.
Headaches
Tightness
Improve posture
Improve flexibility and mobility
Preparation
Basic steps for performing a cervical retraction exercise:
Sit upright with good posture.
Tuck your chin as far as you can comfortably.
Look up while keeping your chin tucked.
Rotate the neck 1-2 inches to each side.
Return to the starting position.
Stop the exercise if you experience pain.
You want to get good at this without loading the joints while learning the movement. Gently and accurately moving your head in alignment with the neck will help you find the correct head action as it moves. Then, it can be performed as a full exercise. Performing the movement correctly requires focus. This is why cervical retraction is done while sitting in a chair with proper posture. Individuals can also stand, but it is more complicated for the body to coordinate than sitting, but it can be done once the individual has practiced.
Sitting or Standing
Gently tuck your chin down toward your neck.
The focus is alignment.
Keeping your chin where it is, press your head back.
There will be soreness, especially for those with pain symptoms, but the neck should feel better.
Be mindful of any intense or severe pain resulting from cervical retraction.
Individuals with cervical spondylosis (neck arthritis) stop if pain presents. (Cleveland Clinic, 2023)
Other Neck Exercises
Another good neck-strengthening exercise is the isometric neck press. In this exercise, you move your head forward, backward, and to each side while your hand provides resistance. This develops flexibility and is recommended for those with arthritis in this area. (Sadeghi, A. et al., 2022) Other exercises include: (Pain Consultants of West Florida, 2019)
Neck extensions: Backward bending can help relieve nerve compression and ease the strain on the cervical spine.
Side rotation: This exercise can improve neck mobility.
Shoulder rolls: This exercise can help keep the neck and shoulder joints fluid.
Injury Medical Chiropractic and Functional Medicine Clinic
If you have a neck condition or radiculopathy that causes pain or other symptoms going down the arm or are unsure how to do it, check with a healthcare provider or physical therapist before trying the exercise. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Neck Injuries
References
North American Spine Society. (2012). Cervical exercise: The Backbone of Spine Treatment. https://www.spine.org/KnowYourBack/Prevention/Exercise/Cervical-Exercise
Cleveland Clinic. (2023). Could your neck pain actually be neck arthritis? https://my.clevelandclinic.org/health/diseases/17685-cervical-spondylosis
Pain Consultants of West Florida. (2019). Chronic Neck Pain: How Core Exercises Can Help. Our Blog. https://pcwfl.com/chronic-neck-pain-how-core-exercises-can-help/
Sadeghi, A., Rostami, M., Ameri, S., Karimi Moghaddam, A., Karimi Moghaddam, Z., & Zeraatchi, A. (2022). Effectiveness of isometric exercises on disability and pain of cervical spondylosis: a randomized controlled trial. BMC sports science, medicine & rehabilitation, 14(1), 108. https://doi.org/10.1186/s13102-022-00500-7
An axillary nerve injury can cause pain, weakness, and shoulder mobility loss. Can physical therapy help restore and maintain shoulder joint flexibility?
Axillary Nerve
The axillary nerve, or the circumflex nerve, is a peripheral nerve that runs through the shoulder and supports movement and sensation in the upper limbs. It originates in the neck at the brachial plexus, a network of nerves that extends from the neck and upper torso to the shoulders and arms. Its primary purpose is to supply nerve function to the shoulder joint and three muscles in the arm and also innervates some skin in the region.
Anatomy
Except for the cranial nerves, all the body’s nerves branch off from the spinal cord, emerge from between vertebrae and continue to branch off as they travel to various muscles and other structures. The axillary nerve is named after the axilla, the medical name for the armpit. Individuals have two, one on each side. After leaving the spinal column, the axillary nerve runs behind the axillary artery and continues to the shoulder blade’s lower edge of the subscapularis muscle. It winds back and travels down the arm along the posterior humeral circumflex artery, which then passes through the quadrangular space (a small area of the shoulder blade just above the armpit where there is a gap in the muscles that allows nerves and blood vessels to pass through to the arm before it divides into terminal branches, which are:
Anterior Division
Supplies motor innervation to the deltoid’s anterior and middle heads, allowing the arm to abduct or move away from the body.
It winds around the neck of the humerus/funny bone, goes beneath the deltoid muscle, and then connects to the forward edge of the deltoid.
A few small cutaneous branches serve the skin in that area.
Posterior Division
Innervates the teres minor muscles and the lower part of the deltoid.
It enters the deep fascia and becomes the superior lateral cutaneous nerve.
It then wraps around the lower edge of the deltoid, connects to the skin over the lower two-thirds of the muscle, and covers the long head of the triceps brachii.
Articular Branch
Comes from the trunk of the axillary nerve and enters the glenohumeral joint, which is in the shoulder, below the subscapularis muscle.
Anatomical Variations
In a case report, healthcare providers noted an incidence of the nerve branching directly off the upper trunk of the brachial plexus rather than the posterior cord. (Subasinghe S. K. and Goonewardene S. 2016) In this case, it innervated the subscapularis muscle, latissimus dorsi, and the deltoid and teres minor muscles and also had a communicating branch to the posterior cord. Another case documented multiple abnormalities in the course of the axillary nerve in an individual with pain and severely limited shoulder mobility. (Pizzo R. A. et al., 2019) During reverse shoulder arthroplasty, the surgeon discovered that the axillary nerve ran beside the coracoid process instead of underneath and stayed close to the subscapularis muscle instead of traveling through the quadrangular space. The case noted earlier reports of axillary nerves not running through the quadrangular space. In those cases, the nerve pierced the subscapularis muscle or split into branches before reaching the quadrangular space.
Function
The axillary nerve functions as a motor nerve that controls movement and a sensory nerve that controls sensations like touch or temperature.
Motor
As a motor nerve, the axillary nerve innervates three muscles in the arm and includes:
Deltoid
Allows flexing of the shoulder joint and rotating the shoulder inward.
Long Head of the Triceps
It runs down the back of the outer arm, allowing straightening, pulling the upper arm toward the body, or extending it backward.
The radial nerve can also innervate this muscle.
Teres Minor
One of the rotator cuff muscles starts outside the shoulder and runs diagonally along the bottom edge of the shoulder blade.
It works with other muscles to allow for the external rotation of the shoulder joint.
Sensory
In its sensory role, the nerve carries information to the brain from the following:
Glenohumeral joint or the ball-and-socket joint in the shoulder.
The skin on the lower two-thirds of the deltoid muscle through the superior lateral cutaneous branch.
Injuries and Conditions
Problems with the axillary nerve can be caused by injuries anywhere along the arm and shoulder and by disease. Common injuries include:
Dislocations
Of the shoulder joint, which can cause axillary nerve palsy.
Fracture
Of the surgical neck of the humerus.
Compression
This stems from walking with crutches, also known as crutch palsy.
Direct Trauma
This can be from an impact sports, work, automobile accident, collision, or laceration.
Added Pressure
This can be from wearing a cast or splint.
Surgical Accidental Injury
An injury or damage can come from shoulder surgery, especially arthroscopic surgery on the inferior glenoid and capsule.
Quadrangular Space Syndrome
This is where the axillary nerve is compressed where it passes through that space, which is most common in athletes who perform frequent overhead motions)
Nerve Root Damage
Between the fifth and sixth cervical vertebrae, where the nerve emerges from the spinal cord, which can be caused by traction, compression, spinal disc prolapse, or a bulging disc.
Systemic Neurological Disorders
Example – multiple sclerosis
Erb’s Palsy
A condition often is the result of a birth injury called shoulder dystocia, in which a baby’s shoulder/s becomes stuck during childbirth.
Axillary Nerve Palsy
Damage can result in a type of peripheral neuropathy that can cause weakness in the deltoid and teres minor muscles.
This can result in losing the ability to lift the arm away from the body and weakness in various shoulder movements.
If the damage is severe enough, it can cause paralysis of the deltoid and other minor muscles, resulting in flat shoulder deformity, in which individuals cannot lay their shoulders flat when lying down.
Axillary nerve damage also can lead to a change, reduction, or loss of sensation in a small part of the arm just below the shoulder.
Nerve Injury Statistics
Three times more common in men than women.
It may be present in as many as 65% of shoulder injuries.
The risk of injury due to dislocation is significantly increased after age 50.
Tests
If a healthcare provider suspects a problem with axillary nerve function, they’ll test the shoulder’s range of motion and skin sensitivity. A difference in the range of motion between the shoulders can indicate a nerve injury. Individuals may be sent for electromyography and a nerve conduction study to verify nerve palsy. In some cases, an MRI and/or X-rays may be ordered, especially if the cause of possible nerve damage is unknown.
Rehabilitation
Depending on the severity and cause of the injury, non-surgical treatments may be recommended, with surgery as a last resort. Non-surgical treatment can include some combination of immobilization, rest, ice, physical therapy, and anti-inflammatory meds. Physical treatment typically lasts about six weeks and focuses on strengthening and stimulating the muscles to prevent joint stiffness, which can impair long-term function.
Surgery
If conservative treatments don’t work, surgery may be recommended, especially if several months have passed without improvement. Surgical outcomes are generally better if surgery is performed within six months of the injury, and regardless of the time frame, the prognosis is considered positive in about 90% of cases. Surgical procedures performed for axillary nerve dysfunction or injury include:
Neurolysis
This procedure involves targeted damage/degeneration of nerve fibers, interrupts the nerve signals, and eliminates pain while the damaged area heals.
Neurorrhaphy
This procedure stitches a severed nerve back together.
Nerve Grafting
Grafting involves transplanting a portion of another nerve, usually the sural nerve, to reconnect severed nerves.
This helps, especially when the damaged portion is too large to be repaired by neurorrhaphy.
It allows a pathway for signals and encourages the regrowth of nerve axons.
Neurotization or Nerve Transfer
Similar to grafting but used when the nerve is too damaged to heal.
This procedure involves transplanting a healthy but less important nerve, or a portion of a nerve, to replace the damaged one and restore function.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Shoulder Pain Chiropractic Treatment
References
Subasinghe, S. K., & Goonewardene, S. (2016). A Rare Variation of the Axillary Nerve Formed as Direct Branch of the Upper Trunk. Journal of clinical and diagnostic research : JCDR, 10(8), ND01–ND2. https://doi.org/10.7860/JCDR/2016/20048.8255
Pizzo, R. A., Lynch, J., Adams, D. M., Yoon, R. S., & Liporace, F. A. (2019). Unusual anatomic variant of the axillary nerve challenging the deltopectoral approach to the shoulder: a case report. Patient safety in surgery, 13, 9. https://doi.org/10.1186/s13037-019-0189-1
For individuals with cervical arthritis, can physical therapies help manage symptoms and bring pain relief?
Cervical Arthritis
Cervical spondylosis, more commonly known as cervical arthritis or arthritis of the neck, refers to the wearing down of neck bones, discs, tendons, ligaments, and joints. The primary symptoms are neck pain and stiffness. However, it is also possible to have cervical spondylosis and not have any symptoms. The condition affects over 85% of individuals over age 65. (American Academy of Orthopaedic Surgeons, 2021) Treatment can consist of conservative therapies and includes physical therapies, alternative medicine therapies, at-home self care, and over-the-counter and prescription medications. Severe cases of cervical spondylosis are treated with surgery to repair damaged parts of the spine.
Symptoms
Neck pain and headaches at the back of the head are usually the first symptoms. (Kazeminasab S. et al., 2022) The neck can also feel stiff, with worse morning symptoms that improve throughout the day. (Johns Hopkins Medicine, 2024) Symptoms can range from mild discomfort to severe pain. As cervical spondylosis progresses, individuals can experience:
Inability to turn the head or bend the neck.
A clicking or grinding noise when turning the neck.
Tenderness with pressure on the neck.
Pain that radiates to the shoulders or shoulder blades.
Pain and symptoms that disrupt sleep, sometimes causing waking up throughout the night.
Symptoms that decrease with rest.
More severe symptoms include:
Cervical Bone Spurs – Osteophytes
Some with cervical spondylosis have bony growths that can place pressure on the spinal nerves (a pinched nerve) (Bon Secours, 2024). Compression of spinal nerve roots produces cervical radiculopathy, which leads to pain, tingling, and weakness that radiates into the shoulders, arms, and hands.
Cervical Myelopathy
This refers to spinal impingement that leads to spinal cord dysfunction. (Spinal cord dysfunction is a nervous system disorder with interruptions in the spinal cord’s motor, sensory, and autonomic functions.) Symptoms include pain, tingling, numbness, muscle spasms, and weakness in areas below the neck. Spinal cord dysfunction can affect mobility, hand use, and bladder or bowel function control.
Causes
Where degenerative changes are commonly associated with cervical spondylosis, other conditions, and factors can lead to it and include:
Autoimmune Diseases
Rheumatoid arthritis and psoriatic arthritis can cause chronic inflammation in the cervical spine.
Trauma
Neck trauma, including injury and repetitive stress on the neck.
Cervical spondylosis is commonly seen in occupations that involve neck-stressing activities, such as sports.
Age
Wearing down of the spinal discs cartilage between the vertebrae.
Genetic components have been identified in connection with cervical spondylosis, meaning that some types of arthritis that lead to spinal damage are hereditary. (Kazeminasab S. et al., 2022)
Treatment
Treatment begins conservatively, using protocols to preserve function and avoid surgery. Nonsurgical treatments include medications, physical therapy, at-home exercises, and alternative medicine. The treatment method a healthcare provider chooses will depend on how severe the spondylosis is and other factors like age, how much pain is being experienced, the cause, and overall health. The main objectives are to relieve pain, prevent long-term damage to the spinal cord and nerves, and help maintain performing daily activities. (Bon Secours, 2024)
Medications
Medicines used to treat cervical spondylosis include:
Nonsteroidal Anti-inflammatory Drugs NSAIDs
NSAIDs, including ibuprofen and naproxen sodium, are available without a prescription to relieve pain and inflammation.
A healthcare provider can prescribe a more powerful NSAID to help manage severe symptoms.
Corticosteroids
A corticosteroid injection or a short course of an oral corticosteroid, like prednisone, can ease pain and reduce inflammation.
Muscle Relaxants
If cervical spondylosis causes muscle spasms, a healthcare provider can prescribe cyclobenzaprine, a muscle relaxant, to manage symptoms.
Antidepressants
Some types of antidepressants can ease neck pain from cervical spondylosis.
Anti-seizure Meds
Some anti-seizure drugs can cause nerve pain resulting from damaged nerves.
Physical Therapies
Physical therapy will help manage pain and stiffness and keep muscles loose and relaxed.
A physical therapist will teach the patient exercises to stretch and strengthen neck and shoulder muscles.
At-Home Self Care
At-home exercises can help relieve pain, stiffness, and swelling. Some can include:
Reducing inflammation and stress on the neck through posture training.
At-home targeted stretches and exercises will help bring pain relief.
Ice treatment reduces swelling.
Heat will increase circulation.
A neck brace may be recommended briefly to avoid muscle weakness and stiffness.
Alternative Medicine
Chiropractic adjustments and massage therapy are alternative treatments that will help manage cervical spondylosis.
Acupuncture can also be beneficial in reducing neck pain and increasing energy circulation. (Gu C. L. et al., 2019)
Various therapeutic massage therapies will help relieve neck pain and stiffness. Talk to a healthcare provider before starting treatment so they can advise on whether neck massages are safe.
Surgery
A healthcare provider may recommend surgical treatment when all other treatments have failed, if neurological symptoms are severe, or if neck arthritis causes extreme pain or disability. Surgery to treat cervical spondylosis can involve removing bone spurs, part of the cervical vertebra, or a herniated disc. The removed portions of the cervical spine are fused with hardware and bone grafts.
Injury Medical Chiropractic and Functional Medicine Clinic
Chiropractic therapy is among the more conservative treatment options and may be tried first before proceeding with surgery. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution.
Arthritis Explained
References
American Academy of Orthopaedic Surgeons. (2021). Cervical spondylosis (arthritis of the neck). https://orthoinfo.aaos.org/en/diseases–conditions/cervical-spondylosis-arthritis-of-the-neck/
Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M. J. M., Kolahi, A. A., & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC musculoskeletal disorders, 23(1), 26. https://doi.org/10.1186/s12891-021-04957-4
Johns Hopkins Medicine. (2024). Spinal arthritis (arthritis in the back or neck). https://www.hopkinsmedicine.org/health/conditions-and-diseases/spinal-arthritis
Bon Secours. (2024). Cervical osteoarthritis (arthritis in the neck). https://www.bonsecours.com/health-care-services/spine-care/conditions/cervical-osteoarthritis
American Chiropractic Association. (2024). Neck pain. https://www.acatoday.org/patients/neck-pain-and-chiropractic/
Jenkins, H. J., Downie, A. S., Moore, C. S., & French, S. D. (2018). Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropractic & manual therapies, 26, 48. https://doi.org/10.1186/s12998-018-0217-8
Gu, C. L., Yan, Y., Zhang, D., & Li, P. (2019). An evaluation of the effectiveness of acupuncture with seven acupoint-penetrating needles on cervical spondylosis. Journal of pain research, 12, 1441–1445. https://doi.org/10.2147/JPR.S199798
Can knowing the characteristics of each stage of healing help expedite recovery for individuals who are healing after neck and back injuries?
Back or Neck Injury Healing Stages
At each stage, different things happen at the injury site. This means recommended exercises and activity levels will vary depending on how long it’s been since the injury. The stages to know about when healing from a neck or back injury. (Brumitt J., and Cuddeford T. 2015)
Inflammation or Acute Stage
Also known as the inflammatory stage, the acute stage occurs during the injury and can continue for 72 hours. The body releases repair chemicals in response to tissue damage, causing inflammation and pain. Symptoms of inflammation, including redness, swelling, pain at rest, and diminished function, are expected. Inflammation and pain during the inflammation stage are caused by the body’s repair chemicals released in response to tissue damage. (Wu, Y. S. and Chen S. N. 2014) The biological reaction decreases mobility so the injured area can rest and heal, but the substances that promote healing also cause pain and swelling. (Shah A. and Amini-Nik S. 2017) Scar tissue also begins to form during the inflammatory stage. (Wilgus T. A. 2020) Initial treatment focuses on reducing pain, swelling, and muscle spasms. Individuals are encouraged to use ice packs, compression, and over-the-counter anti-inflammatory medications like ibuprofen or naproxen. (Duchesne E., Dufresne S. S., and Dumont N. A. 2017)
Subacute Stage
Inflammation decreases, and new connective tissue and capillaries grow to help repair damaged structures. The subacute phase generates new connective tissue and capillary growth and reduced inflammation. (Brumitt J., and Cuddeford T. 2015) Scar tissue continues to grow during this time, as well. The tissues are still fragile at this stage, stressing the injured area should be limited to when the therapist or doctor is examining or working with the patient. Most physical therapists recommend beginning with gentle movement during the subacute phase and gradually building up the intensity of exercise. Mild isometric and low-intensity exercises are often used. Because activity is restricted, the muscles may seem weak. Depending on the severity of the injury and the type of tissue that was injured (i.e., tendons have less blood circulation and tend to heal more slowly, it can take a few days to several weeks. (Brumitt J., and Cuddeford T. 2015)
The Chronic Stage or Maturation
The inflammation disappears entirely during the chronic or maturation stage of neck or back injury healing. The new collagen fibers build strength, and the wound shrinks. (Brumitt J., and Cuddeford T. 2015) During this stage, pain associated with the injury tends to be limited to the end joint’s range of motion. The first ten weeks of the chronic stage are essential for engaging in exercises that enhance healing and help remodel the fibers so they will function as close as possible to the way they did before the injury. (Azevedo P. S. et al., 2016) Exercises during the ten weeks are important because otherwise, individuals can permanently lose some of their ability to move and function.
After around ten weeks, the scar tissue can permanently change, so re-acquiring strength and flexibility may necessitate surgery or manual release treatment from a physical therapist or chiropractor. During this time, the scar tissue can be remodeled with exercise, meaning that the activities and motions performed on the injured area will affect the formation of new tissue fibers. The chronic stage of healing begins after 21 days and doesn’t end after the 10-week prime time (Brumitt J., and Cuddeford T. 2015). It can continue for quite some time.
Treatment
Treatment focuses on engaging the injured muscles in light isometric contractions to help align new collagen fibers. Physical therapy helps rebuild mobility, strength, balance, and flexibility and can also help learn about injury and how to recover. A treatment that may also help during these phases is massage therapy. Extended bed rest or immobility can prolong symptoms and delay recovery. Tips to manage pain and recovery:
When sitting for long periods, get up and move around frequently.
Wear comfortable shoes.
When driving long distances, stop frequently to stand up and walk around.
Sleep on the side with a small pillow between the knees.
Limit how much weight is carried.
Add exercises gradually.
Most symptoms of back strain or sprain improve in about two weeks. Individuals may need additional treatment if symptoms continue for longer than two weeks. Maintaining exercises will continue to make the body stronger, more flexible, more functional, and pain-free.
Chiropractic Care for Healing After Trauma
References
Brumitt, J., & Cuddeford, T. (2015). CURRENT CONCEPTS OF MUSCLE AND TENDON ADAPTATION TO STRENGTH AND CONDITIONING. International journal of sports physical therapy, 10(6), 748–759.
Wu, Y. S., & Chen, S. N. (2014). Apoptotic cell: linkage of inflammation and wound healing. Frontiers in pharmacology, 5, 1. https://doi.org/10.3389/fphar.2014.00001
Shah, A., & Amini-Nik, S. (2017). The Role of Phytochemicals in the Inflammatory Phase of Wound Healing. International journal of molecular sciences, 18(5), 1068. https://doi.org/10.3390/ijms18051068
Wilgus T. A. (2020). Inflammation as an orchestrator of cutaneous scar formation: a review of the literature. Plastic and aesthetic research, 7, 54. https://doi.org/10.20517/2347-9264.2020.150
Duchesne, E., Dufresne, S. S., & Dumont, N. A. (2017). Impact of Inflammation and Anti-inflammatory Modalities on Skeletal Muscle Healing: From Fundamental Research to the Clinic. Physical therapy, 97(8), 807–817. https://doi.org/10.1093/ptj/pzx056
Azevedo, P. S., Polegato, B. F., Minicucci, M. F., Paiva, S. A., & Zornoff, L. A. (2016). Cardiac Remodeling: Concepts, Clinical Impact, Pathophysiological Mechanisms and Pharmacologic Treatment. Arquivos brasileiros de cardiologia, 106(1), 62–69. https://doi.org/10.5935/abc.20160005
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
