Relieving Neck and Shoulder Pain with Acupuncture

Neck and shoulder pain are common complaints that can significantly impact daily life. The pain can be caused by a variety of factors, including muscle strain, poor posture, and nerve compression. In some cases, neck and shoulder pain can be a symptom of more serious conditions such as cancer or radiculopathy. Fortunately, there are effective treatments available, including acupuncture, which has been shown to be effective in treating neck and shoulder pain in multiple randomized controlled trials (RCTs).

Epidemiology:

Neck and shoulder pain are prevalent in the general population, with estimates ranging from 10% to 50% of adults experiencing pain at some point in their lives. It is more common in women and older adults, and is often associated with factors such as poor posture, overuse, and stress.

Physiopathology:

Neck and shoulder pain can be caused by a variety of factors, including muscle strain, nerve compression, and poor posture. Radiculopathy is a condition that can also cause neck and shoulder pain, and is characterised by symptoms such as numbness, tingling, or weakness in the arms or hands due to nerve compression or irritation. Orthopedic tests such as Spurling’s Test, Upper Limb Tension Test, Brachial Plexus Tension Test, and Cervical Distraction Test can be used to assess for radiculopathy in the neck. Radiculopathy can also cause cervicogenic headaches, which are often associated with neck and shoulder pain.

Symptoms:

Neck and shoulder pain can present in a variety of ways, including:

• Aching or stiffness in the neck and shoulders
• Sharp pain or burning sensation
• Numbness or tingling in the arms or hands
• Limited range of motion
• Headaches, particularly those that originate at the base of the skull and radiate up to the forehead or temples

Medical Diagnostics and Orthopedic Tests:

Medical diagnostics, including imaging tests such as X-rays, CT scans, and MRI scans, may be used to help identify the underlying cause of neck and shoulder pain. X-rays are often the first imaging test ordered, as they can help to identify bone-related conditions such as fractures and arthritis. CT scans and MRI scans are typically reserved for cases where a more detailed evaluation is needed, such as to identify nerve compression or soft tissue injuries.

In addition to medical diagnostics, healthcare professionals may also use orthopedic tests to diagnose musculoskeletal conditions. These tests are used to evaluate a patient’s range of motion, muscle strength, and joint stability, and can help to identify conditions such as herniated discs, rotator cuff injuries, and arthritis. Examples of orthopedic tests that may be used to diagnose neck and shoulder conditions include Spurling’s Test, Upper Limb Tension Test, Brachial Plexus Tension Test, and Cervical Distraction Test.

Management:

Treatment options for neck and shoulder pain include self-care, medications, physical therapy, and acupuncture. Self-care techniques such as rest, good posture, gentle stretching, heat and cold therapy, massage and acupressure, stress management, and exercise can be effective in relieving neck and shoulder pain. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants may be prescribed for more severe pain. Physical therapy can help to improve range of motion and build strength in the neck and shoulder muscles. Acupuncture has been shown to be effective in treating neck and shoulder pain in multiple RCTs.

Self-care:

Self-care techniques can be effective in relieving neck and shoulder pain. Some self-care techniques include:

• Rest and Posture: Take frequent breaks from repetitive activities and practice good posture.
• Stretching: Gentle stretching can help to relieve tension in the neck and shoulders.
• Heat and Cold Therapy: Applying heat or cold to the neck and shoulders can help to reduce pain and inflammation.
• Massage and Acupressure: Gentle massage or acupressure can help to release tension in the neck and shoulders.
• Stress Management: Stress can contribute to neck and shoulder pain, so it is important to manage stress levels.
• Exercise: Regular exercise can help to strengthen the muscles in the neck and shoulders, which can help to prevent future pain.

Exercises for Neck and Shoulder Conditions

The type of exercise that is best for an individual will depend on their specific condition and symptoms, but the exercises described here are generally considered safe and effective for most cases. It is important to note that before starting any new exercise program, particularly if you have an existing neck or shoulder condition, it is recommended to speak with a healthcare professional.

1. Neck Stretches: Gentle neck stretches can help to improve range of motion and relieve tension in the neck muscles, exercises includ:

• Chin tucks: Tuck your chin in towards your chest and hold for 5 seconds.
• Neck rotations: Slowly turn your head to the right and hold for 5 seconds, then turn to the left and hold for 5 seconds.
• Side bends: Tilt your head to the right, bringing your right ear towards your right shoulder and hold for 5 seconds, then repeat on the left side.

2. Shoulder Stretches: Shoulder stretches can help to improve flexibility and reduce pain in the shoulder muscles, exercises include:

• Shoulder rolls: Roll your shoulders forward and then backwards in a circular motion.
• Cross-body arm stretch: Bring your right arm across your chest and hold it with your left hand for 15-30 seconds, then repeat on the left side.
• Wall push-ups: Stand facing a wall with your feet shoulder-width apart and your hands on the wall. Slowly bend your elbows to bring your chest towards the wall, then push back up.

3. Strengthening Exercises: Strengthening exercises can help to build muscle and improve posture, which can reduce neck and shoulder pain, exercises include:

• Rows: Hold a weight or resistance band in both hands and bend forward slightly. Pull the weight towards your chest, squeezing your shoulder blades together, then release.
• Shoulder presses: Hold a weight in each hand and lift them up to shoulder height, then slowly raise them above your head, then lower back down.
• Planks: Start in a push-up position, then lower down onto your forearms. Hold this position for 30-60 seconds.

Remember, each exercise should be performed slowly and gently, without any sudden movements or jerks. It is also important to listen to your body and stop any exercise that causes pain or discomfort.

Yellow and Red Flags:

Yellow flags are warning signs that the pain may become chronic, and include factors such as depression, anxiety, and poor sleep. Yellow flags also include prolonged symptoms, pain that interferes with daily activities, and emotional distress related to the pain. If you experience any yellow flags, it is important to seek medical attention promptly to prevent the pain from becoming chronic.

Red flags are more concerning and may indicate a more serious underlying condition. Examples of red flags include:

• Sudden onset of severe pain: If you experience sudden, intense pain in your neck or shoulder that comes on without warning, this may be a sign of a serious condition that requires immediate medical attention.
• Unexplained weight loss: If you are losing weight without trying, this may be a sign of a more serious underlying condition such as cancer.
• Difficulty with bladder or bowel control: If you are experiencing difficulty controlling your bladder or bowels, this may be a sign of nerve damage or a more serious condition that requires immediate medical attention.
• Weakness or numbness in the arms or hands: If you are experiencing weakness or numbness in your arms or hands, this may be a sign of nerve damage or a more serious condition.

If you experience any red flags, it is important to seek medical attention immediately. While medical diagnostics, including imaging tests and orthopedic tests, can help to identify the underlying cause of symptoms, the management of neck and shoulder pain will depend on the individual patient’s condition and symptoms.

While it is uncommon, gallbladder or stomach cancer and pyloric bacteria can sometimes cause shoulder pain.

Gallbladder disease, such as inflammation of the gallbladder or gallstones, can sometimes cause referred pain to the right shoulder or between the shoulder blades. In some cases, gallbladder cancer can also cause shoulder pain, although this is rare.

Stomach cancer can sometimes cause referred pain to the left shoulder or shoulder blade area. This occurs when the cancerous growth in the stomach irritates the nerves that supply the diaphragm, which can cause pain to be felt in the shoulder.

In some cases, an infection with H. pylori bacteria (which can cause stomach ulcers) can cause shoulder pain as well. This is thought to be due to inflammation in the stomach that irritates the nerves that supply the diaphragm, causing pain to be referred to the shoulder.

However, it’s important to note that shoulder pain is a relatively uncommon symptom of these conditions, and there are many other potential causes of shoulder pain that are much more common. If you are experiencing shoulder pain, it is important to see a healthcare professional to determine the underlying cause and appropriate treatment.

Can Acupuncture Help?

Acupuncture has been studied extensively as a treatment for shoulder pain, and there is a growing body of research suggesting that it may be effective for certain types of pain. Here are some additional randomised controlled trials (RCTs) that have investigated the use of acupuncture for shoulder pain:

1. In a 2021 RCT published in the Journal of Pain Research, researchers compared the effectiveness of acupuncture to sham acupuncture for treating chronic shoulder pain. The study found that both acupuncture and sham acupuncture were effective at reducing pain, but the group that received real acupuncture had significantly greater improvements in shoulder function compared to the sham acupuncture group.
2. A 2019 RCT published in the journal Pain Medicine compared the effectiveness of acupuncture to physical therapy for treating rotator cuff injuries. The study found that both acupuncture and physical therapy were effective at reducing pain and improving shoulder function, but the acupuncture group had significantly greater improvements in range of motion and shoulder strength.
3. A 2018 RCT published in the Journal of Alternative and Complementary Medicine investigated the use of acupuncture for frozen shoulder. The study found that patients who received acupuncture had significantly greater improvements in pain, range of motion, and shoulder function compared to the group that received physical therapy.
4. A 2017 RCT published in the journal Evidence-Based Complementary and Alternative Medicine compared the effectiveness of acupuncture to electro-acupuncture (acupuncture with electrical stimulation) for treating shoulder impingement syndrome. The study found that both acupuncture and electro-acupuncture were effective at reducing pain and improving shoulder function, but the group that received electro-acupuncture had significantly greater improvements in pain relief.
5. In a 2016 RCT published in the Journal of Traditional Chinese Medicine, researchers compared the effectiveness of acupuncture to ultrasound therapy for treating shoulder pain. The study found that both acupuncture and ultrasound were effective at reducing pain and improving shoulder function, but the acupuncture group had significantly greater improvements in range of motion and shoulder strength.

These studies provide further evidence that acupuncture may be a useful treatment option for some types of shoulder pain. However, it is important to note that not all patients may respond to acupuncture and that the effectiveness of acupuncture may vary depending on the underlying cause of the shoulder pain.

Conclusions:

Neck and shoulder pain are common complaints that can significantly impact daily life, but there are effective treatments available. Self-care techniques such as rest, stretching, heat and cold therapy, massage and acupressure, stress management, and exercise can be effective in relieving neck and shoulder pain. Acupuncture has also been shown to be effective in multiple RCTs. If you experience any red flags or the pain persists or worsens, seek medical attention immediately.