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Neck pain caused by tight muscles

Peter BPPeter B Posts: 511
edited 06/11/2012 - 8:28 AM in Neck Pain: Cervical
Went to a new pain dr today and he gave me a physical exam, feeling the deep muscles in the neck. He was very thorough, and this is the first time that any such examination has been done.

His opinion was that the x-rays didn't indicate anything really bad for the nerves, and that my very tight and sore muscles were probably more likely to be the cause of my neck and shoulder pains.

I tend to agree with him as I've always had a problem with muscle tension, particularly from stress. The computer is my biggest muscle pain contributor.

He explained with a muscle chart which of mine were tight. It matched my symptoms exactly.

Physios would send me away saying that I was too tense to work on!
So he has suggested a Clinical Exercise Physiology Program, which once learnt can be continued at home as a regular exercise regimen.

He was not keen to maintain the steroid injections, feeling that it is not a good long term plan, though he didn't elaborate.
He said that he would recommend a rhizotomy (nerve burning) instead, as it lasts much longer, if the nerves are in fact a problem.

So for others with neck and shoulder pain, I'd suggest that you also have yourself checked out for severe muscle tension. Hopefully easier to treat and not so much medication.


  • I would suggest that for percausionary measure too have an MRi done of your neck. I thought that my pain was due to tension,stress,and there was something more than that. It was real bad,migrains daily with lots of pain in my neck, burning pain, unbearable.I had MRI done and found that I have Cervical Spinal Stenosis.

    I understand that there is tension,but if you think you can handle your job,and that you handled your job when you first began without that tension,stress that, I suggest you re-think what your Dr is telling you,and if you think what he is doing for you is helping than leave it at that.But,I would get a second opinon. There could be possibly something more going on than what you think.

    I never had back or neck problems when I started my job, as a NAR,and after 5 yrs. I am in pain daily,and medicated for the pain.And I'm still in pain after a yr of not working.

    I have cervical spinal stenosis c2-c5 If you feel like you need to talk more give me a shout K.

    You friend,

  • hI agree with Dar... there is a real difference between what an MRI/CT and an what an x-ray can show. xrays can show bone; but can' show quality of the discs and nerves (as i understand it) Like you... for years, i had off and on neck pain. I chalked it up to stress, as did my PT, my osteopath, and the masseus i went to... no one ever mentioned cervical discs... ddd... etc. Then about 2 months + ago now... my neck went, with such excruciating pain, the radiculopathy set in down my shoulder and arm... then muscle weakness. I immediately sought medical treatment, got my mri, got more PT, steroids, etc. once i saw the NS.... it was surgery. I just got my MRI.. it says i have complete obliteration of the CSF!!!(spinal fluid)and DDD, amongst other things. Little did i know.... Sooooo one never knows what the cause is of neck pain. I agree, if it ain't broke... don't fix it... but if youre in alot of pain... get it checked out by a qualified physician and seek the appropriate tests... we are our own advocates!!

    Now... with all that being said lol, i truly hope your situation is just stress related... you don't want this road!

    Good luck!
    L4-L5 fusion 1998; ACDF C4-6 2008; DDD
  • Peter - I have some questions. I ask this becasue I have the same symptoms of really tight muscles with little to no nerve probplems. I have large bulge at c5-6 and minimal bulges at c6-7 and c7-t1. I was thinking maybe I have facet joint problems and these are causing all my pain. I will be getting a my yearly MRI soon and they are going to look at the facet joints.

    Why are they suggesting rhizotomy if there are no nerve problems? Did the facet injections help at all? I've read in some many articles that if your problems are facet joints the injections work. Apparently that is one way to be certain if it is facet joint problems if the injections don't work no facet joint problems. That's what I've researched but never asked some who has had it done.

    I hope the pt does you good. Let me know how you are doing because our symptoms are so a like.
  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    So so very true!
  • While all my problems are mild to moderate, for three to five months before I had even an x ray done, my neurologist thought it was just anxiety, tension, stress that was making my neck and upper back tight. Then I had an X ray and then an MRI (results below) and it turns out to be way more than that.

    I mean looking back at it now, sure I was depressed and had anxiety, but anxiety never gave me pain or headaches before. It just seemed odd that it was nothing but tension. So now I get the treatment for my problem better.

    I started with headaches, went into neck pain, then I got radioculpathy pain down my left arm with some slight weakness, then the same happened down my left leg and hip. And now I have all that, but the headaches have decreased.

    So hopefully all u have is tension, but if you can afford it, I'd go for a second opinion and or an MRI to be sure,
  • dilaurodilauro ConnecticutPosts: 9,850
    There is no question that muscle tension and stress can play a big role in showing up as pain in one part of your body or another. When you body tries to fight one area, it will tend to leave another area semi-protected. For example, if we had a bad toe that caused us to limp for a bit, it is very likely that because of this un balance you might wind up with a sore back, or some other problem.

    Muscles left untreated can create more problems. And over time if not taken care of, those muscles can become so rigid that they will put unnecessary stress on your spine.

    As far as asking for MRI, I would just add that when you make up your mind to do this, put it in a way that the doctor would suggest the MRI vs you telling them that you need it.
    Its so much better placing the doctor in the position that they suggest the plan. I have talked with doctors who have had patients come to them and tell them they want this that and that diagnostic test. That is upsetting to a doctor.

    Plus, we cant say if a MRI would be justified. Today, doctors need to communicate with insurance companies WHY
    a certain test needs to be done. With the cost of MRI's in the $2,000 range, Insurance companies are not just doing blanket approvals.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • i agree with ron - i have recently received botox injections due to rigid muscles. I was given 4 injections into the left and right trap muscle in the neck and thoracic area. I am having a hard time at the moment (been told it gets much worse before it gets better -esp the neck, but i can testify that the thoracic isn't much fun either). The hope is to get this muscle to lighten up. I have several ( @ 8 ) lumps that i can reach in my upper back. I am amazed at how powerful my muscles are - i have tingling as well through my upper back, shoulder blades that they believe is a result of these rigid muscles.

    i will let you know when the 'worst' wears off if the botox was worth it.
  • i agree with ron - i have recently received botox injections due to rigid muscles. I was given 4 injections into the left and right trap muscle in the neck and thoracic area. I am having a hard time at the moment (been told it gets much worse before it gets better -esp the neck, but i can testify that the thoracic isn't much fun either). The hope is to get this muscle to lighten up. I have several ( @ 8 ) lumps that i can reach in my upper back. I am amazed at how powerful my muscles are - i have tingling as well through my upper back, shoulder blades that they believe is a result of these rigid muscles.

    i will let you know when the 'worst' wears off if the botox was worth it.
  • Thanks for all of your replies.
    I am amazed at the number of people who post or mention MRI results.My GP wouldn't even give me new x-rays when I suggested it, saying that we know what my problem is, and it will just show the same arthritis.
    I had to agree, as it was pretty much the same, I was just a bit curious-probably dwelling on it too much.
    So I'd have no chance of an MRI. I am retired but with private health cover, but is an MRI an unnecessary expense at the moment?
    I have had bad muscle tension for over 20 years, brought on by work stress, then compounded by computer work. I have been fully retired for 4 years, after being retrenched in 1998 and going back on a casual basis.
    It has concerned me that none of the doctors, specialists or physios have done such a simple but telling neck exam on me up until now.
    Once I had described the pain areas, they pronounced their verdict.
    I know that my tight muscles are a big problem-I can feel the knots. The new pain dr was able to trigger my pains by pressing on the various muscles, proof enough for me.
    I still have facet joint pains, and occipital neuralgia on occasions, but I just wonder which is cause and which is effect now.
    So the plan is to give the new treatment a go, and report back in 6-8 weeks.
    It has also concerned me that no-one has suggested any sort of regular exercise, so my muscles are just getting weaker all of the time. That's another reason to try the new plan.
    It's described as a Biopsychosocial Model of pain, which correlates physical, psychological and social factors. It encourages self-management of pain with emphasis on emotional, mental, behavioural and social factors-all to help cope more effectively with pain and associated problems.
    Sounds a whole lot better than my narrow range of treatment to date, and I am looking forward to it.
  • Good luck to you.

    Just wanted to point out that my x-ray results were different than my MRI results. Which baffles me. Obviously both had something...The x ray revealed arthritis and impingement while the mri only showed herniation and stenosis.

    But if you are happy then go with your gut.
  • That's a bit odd, isn't it? I would have expected the MRI report to be more informative than an x-ray, given that x-rays can be unclear. In mine, one of the side views was at a slightly different angle from the old one, so a direct comparison was not possible.
    Mine did show a marked degree of bone density loss between x-rays. I wonder if an MRI would have picked that up.
    I'm going into the new treatment keenly but also carefully, being on the lookout for psycho babble.
    I want a good exercise and stretching routine tailored for me, and some stress handling skills. It gets too hard to think or instigate exercises when you have chronic pain, so this may give me a bit of momentum.
    Funny thing is that about 20 years ago my then GP prescribed some medication for my muscle soreness. I was in a really bad way from work stress, agony all day.
    I started taking it, but then my wife, a nurse, expressed some concerns about it, thought it a bit strong and potentially problematic. So I stopped taking it.
    When i told the GP I had stopped, he was shocked and asked why? He said that all it was was a muscle relaxant.
    So all those years ago he was on the right track and I didn't trust him. Boy, have I paid for that.
    Perhaps he could have explained it better at the time.
    Still, I'm much more aware now of my problems so I can make these judgements myself.My body, my choice.
  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    Has to do to all the metal in my neck ...

    Spine-health Moderator
    Welcome to Spine-Health  Please read the linked guidelines!!

  • I have 2 level fusion C4-5 C5-6. My family physician left it untreated for 3 years before I finally went searching myself. 4 years into it I finally was able to get the surgery. However, since it took so long I now have permanent muscle spasms in my neck/shoulder that causes chronic pain as well. I take 5 Tramadol a day, 3 Darvacet a day, plus 2 muscle relaxers, and ibuprophen and it still does not relieve the pain entirely. I've done the botox, acupunture, facet injections, myofacial injections - just about everything there is. Still no relief. And others just do not understand. Makes life hard. Anyone with any suggestions on how to retrain a muscle that thinks it's still protecting something??
  • Hi Stacy, sounds very painful and debilitating.
    I'm going to see a new chronic pain dr tomorrow, specifically to look at my muscle tension problems, so there may be something from that to pass on to you.
  • Thank you Peter for your response!! I await to hear the results of your visit.
  • I too had neck pain and muscle soreness/tightness that got pretty bad in September. I thought it was stress, as did my GP. So she sent me for physical therapy. During therapy, I had two really bad episodes of pain and stiffness. After about 3 1/2 months of therapy, my PT suggested that I follow up with an OS. He felt that since I had not gotten any better with therapy that my muscles might be protecting something else that was wrong. The OS took xrays, and thought it looked like I might have a bulging disc. Meds, more therapy later with no improvement. I also started to experience numbness in my fingers. After having an MRI, it turns out that my "stress" was actually a herniated disc that is impinging on nerves. I have surgery scheduled for March 23rd.

    I guess what I'm trying to say is that you never know what is really causing tight muscles. Your body reacts to protect injuries. Having an MRI is a good idea, just to be sure. And if your doc isn't willing to explore that, then I think I'd find another doctor. Just my opinion! :-)
  • So right.
    Is it the cause or is it the result?
    Necks are very complex.
    It also gets quite difficult trying to get to the bottom of it, talking to different doctors, reading about it all, trying to explain symptoms time and again-all the while with either a thick head or a pounding, all conquering headache.
    I went to my GP today and as luck would have it I was into my second day of Occipital neuralgia, so looked a bit crook and was able to describe it clearly.
    He said that they was no known cause or cure for ON, and that epilepsy meds have been known to help.
    He gave me some to try.
    None of the usual pain meds or muscle relaxers made a dent in it, and so it looks like it is not caused by tight muscles.
  • Seems like tight muscles may cause occipital neuralgia. Just found this:
    Occipital Neuralgia

    November, 2006

    Occipital neuralgia is a common cause of headache. It involves the two pairs of nerves that originate in the area of the second and third vertebrae of the neck – the occipital nerves. The pain typically starts at the base of the skull by the nape of the neck and may radiate to the back, front, and side of the head, as well as behind the eyes.


    Occipital neuralgia is a headache syndrome that can be either primary or secondary. Secondary headaches are associated with an underlying disease that may include tumor, trauma, infection, systemic disease, or hemorrhage.

    Although any of the following may be causes of occipital neuralgia, many cases can be attributed to chronically contracted neck muscles/neck tension or are idiopathic (unknown).

    * Osteoarthritis of the upper cervical spine
    * Trauma to the greater and/or lesser occipital nerves
    * Compression of the greater and/or lesser occipital nerves or C2 and/or C3 nerve roots from degenerative cervical spine changes
    * Cervical disc disease
    * Tumors affecting the C2 and C3 nerve roots
    * Gout
    * Diabetes
    * Blood vessel inflammation
    * Infection

  • Had a really bad sore neck/ shoulder episode,and went for a massage today.
    She found a lot of muscle tightness, knots etc in the neck and shoulder muscles, particulatly attached to the scapula.
    So my neck pain was caused by these shoulder muscles.
    Will have shorter weekly massages for a while until the muscles are sorted out.
    This probably also explains why I had patchy results from the facet injections, as the main problems were not being addressed.
    Sometimes there was very little improvement, others a noticeable one. But it may have all been related to my shoulder muscles and what I was or wasn't doing at the time.
    It's been over 4 months since the last injection and I have no sense that i need any more at the moment.
    I'm quite sure that my pain Dr, physio and masseuse are right when they say my chronic neck pain is caused by muscle problems, even though I have cervical arthritis, DDD etc.
    This may be of interest to others with neck pain that is not going away with injections.
  • Hi Peter,
    Thank you for taking the time to explain what you've learned.
    I don't know if I have what you are describing, but I do think my neck muscles and the nerves are all a part of what causes my pain. You've given me some things to think about.
  • I would strongly suggest trying to gently steer your doc into ordering an MRI. I had neck pain for 5-6 yrs & saw a chiropractor 1st when it started & he told me my muscles were all tight & it was due to stress & posture. I only saw him for a short time because of my busy work schedule. Fast forward to this January. My pain had been getting worse over the last year & massage, heat, skelaxin were not helping at all & I had some mild tingling in both arms & hands. I went to my primary care doc hoping to get an order for PT to help me get rid of the knots & tightness in my neck. She ordered an MRI "just to be safe"...results below. I was shocked that I had any spine problems. Long story short my symptoms rapidly progressed & I had surgery to prevent a very real potential for paralysis.

    Just my opinion but I am so thankful my doc was proactive. I thought she was being a little dramatic when she ordered the MRI. Thank God she did. Good luck & I hope you find relief from your pain.
  • let me know if the massages really help out and get rid of the lumps.
    I had several PT's tell me to ask my Dr. about going for massages PT.
    Dr. said they will not help, my muscles are going to always be like this due to the nerve damage I have. Seems like if I try and mess with the muscle it just irritates it more. So maybe he is right in my case.

    I hope you have good luck with it.:)
  • If you have chronic muscle tension and/or bone pain of inexplicable origin, you may want to consider taking a vitamin D test. Recent research has shown that chronic muscle tension can be caused by a vitamin D deficiency. See vitamindcouncil.org for more info. For me, the main symptoms were chronic tension in the neck, shoulders, back and hamstrings. It took me three years before I figured out what was wrong. After I started taking an ultra high (50,000 IU/week) prescription dose of vitamin D (D3 to be exact) the symptoms gradually went away over the course of a few weeks.
  • My pain seems to be similar Peter, all my tests looking for spinal/nerve issues came back negative. My Physical Therapist today was unnerved by how tight my muscles actually are. She pushed as hard as she could on a knot near my collarbone as I breathed out, and was shocked how bad it was. When I woke up later, that caused pain that radiated down my arm, so I think I may have found one of the major points of my pain.
  • OMG I could not of put it better. I had my pain since 1996, then a car accident in 1999, and finally surgery in 2008, that is how long it took for a doc to decide it is time. now that I was facing severe danger of course, they didn't care how tight my muscles were everyday, (it's only muscle) when they saw those nerves being crushed and the canal narrowing so bad it was time. I am worse now than before surgery. i still have the xtreme muscles spasms, my neck is so tight, my shoulder blades ache constantly, and my left shoulder, and elbow are shot. I walk around the same as before surgery, except now, I can't move my neck as well with that metal in there, and I get an annoying stinging they can't explain, if i use my arms too much. acdfc4-6 10/08, pain getting worse by the day. there is not a tx I did not try. all are temporary, and of course the most painful surgery that was suppose to cure all, well, that just made it worse!!!
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