A 32 year old young man who hails from Mumbai and who was temporarily stationed in Delhi due to a work assignment, presented with pain at the back of the neck and right shoulder since 1 week. This was associated with a tingling sensation in the whole body and extreme fatigue which was affecting his work. He had a history of a similar problem since the past 7 years for which he had consulted various specialists. His MRI revealed that he had mild degenerative disease of the cervical spine. He had obtained no relief from medications and physiotherapy.
In February 2019, he visited a pain specialist in Mumbai who diagnosed him to have Myofascial Pain related to the neck and shoulders. He underwent 7 sessions of dry needling as well as a cervical epidural injection and trigger point injections. This gave him complete relief of pain and his other associated symptoms.
The present exacerbation of symptoms had occurred since the one week. It was probably due to overexertion at work with few hours of sleep. Examination revealed that he had knots and taut bands in the muscles of his shoulders especially on the right side. After two sessions of dry needling, the pain in the back of the neck and shoulder as well as the tingling sensation in the body subsided dramatically. He is now able to carry on with the professional work that he was assigned to do at Delhi without any further discomfort.
This is what the patient has to say….
“I have been suffering with acute pain in my neck that is followed by severe tingling sensation in my entire body since the past 7 years. Have seen various doctors to strike out the possibility of a neurological or a bone related ailment that could have possibly caused the tingling in my body. Post multiple MRI’s advised by various doctors, it was concluded that it is myofascial pain that triggers the tingling in body. I was surviving on analgesics to cure the pain & tingling for the past 2 years.
A few months back I came across Ashirvad Pain Relief clinic in Mumbai where I took a few sessions of dry needling therapy along with a cervical epidural and trigger point injections and it provided immense relief. The pain and the tingling sensation went down considerably after almost 7 years of trial and error with various therapies. I was hoping to get to normal soon.
Though the frequency has reduced considerably, sometimes the pain resurfaces when I have to go through a lot of exertion at work. For instance, now I have been working non-stop for the last 40 days in Delhi. Hectic schedules and strenuous work caused the pain in the neck and the tingling sensation to resurface. The intensity was lesser than before but enough to cause a lot of discomfort. Two sessions of dry needling did wonders to my health and I am back in my elements.”
Myofascial pain
Muscles, is often called the ‘orphan organ’ as there is really no separate speciality in medicine that addresses dysfunction of the muscles, despite the fact that there are more than 600 muscles in our body. In fact, 85 to 90 % of patients who go to a pain clinic have some kind of myofascial pain.
What is myofascial pain?
It is called ‘myofascial’ because the pain originates in various muscles of the body and its surrounding fascia. It could present as back pain, shoulder pain, neck pain, leg pain, arm pain and even headaches. Very often, it can be mistaken for sciatica, cervical spondylosis and even migraine. It can occur in young as well as older people. Nowadays, myofascial pain is being given its due importance and pain specialists, physiatrists (doctors specializing in Physical Medicine), chiropractors and physiotherapists are treating it at their respective facilities. The characteristic features of myofascial pain is the presence of taut bands or knots in the muscle which are invariably tender and painful. This usually limits the range of motion of that particular area as muscles are involved in movement of any part of our body. The pain can also radiate to other specific areas depending on the site of pain.
Myofascial pain of the neck and shoulder, as in this young man, can very frequently be associated with tingling sensation usually in the arm, decreased range of movement of the head and even the arm and pain radiating to the arm, back of the head and even the forehead. The pain can be so severe and crippling that it can affect the normal daily activities of a person which includes professional work, sleep and even mood.
What are the causes of myofascial pain in the neck and shoulders?
The predisposing factors for myofascial pain in the neck and shoulders include poor posture, poor ergonomics while working on the computer/laptop, overuse or repetitive use of the arm, vigorous overhead sports, lack of exercise, injury due to falls or road traffic accidents (whiplash injury), lifting heavy backpacks and bags, excessive use of cellphones and even stress.
How is myofascial pain of neck and shoulder managed?
After confirming that it is indeed myofascial pain and not some other more serious condition like cervical spine disease, treatment is started with analgesics, muscle relaxants, dry needling, trigger point injections (if there are painful knots and taut bands), physiotherapy, stretching and strengthening the muscles of the neck and shoulders and even something as simple as application of analgesic creams or sprays and ice packs.
In this young gentleman, a treatment approach that included analgesics, dry needling, trigger point injections, stretching exercises and ice pack application relieved him of this very troublesome pain and he could resume his work with alacrity.