Levator Scupula Muscle Related Neck pain

When you wake up in the morning with neck pain, a crick in your neck, feel a burning pain on the top inner corner of your shoulder blade, or have trouble turning your head to look behind you while driving etc., the culprit may be a Levator Scapula muscle in spasm. The pain can be described as a throbbing, ache, or tightness. It usually presents from the top inner corner of the shoulder blade up along the neck. The Levator Scapulae muscles are located on either side of the neck. They originate on the four upper vertebrae of the cervical spine (neck). They insert, or attach, to the scapula, also known as the shoulder blade at the superior, medial border. These two muscles are involved in elevation, downward rotation and abduction of the scapulae. They are also involved in flexion and extension of the cervical spine(neck), turning of the neck slightly left and right, along with side bending of the neck left and right.

 

What Causes Levator Scapula Spasm / Trigger Points?

A trigger point is a tight area within muscle tissue that causes pain in that area and/or other parts of the body. The trigger points are shown above as two dark red circles, with the pain referral area also shaded in. Muscle spasm is a tightening of a muscle usually, due to overuse or overstress. It  can in itself cause pain and loss of mobility.

Causes

The following events and activities are likely to activate, or reactivate, tension / pain and trigger points in the levator scapulae.

• whiplash from an automobile accident
• sleeping on the stomach with the head turned/or sleeping in an odd position
• chilling of the muscle during sleep from an air conditioner or draft from an open window
• working at a computer with the head turned for long periods
• holding a phone between the shoulder and ear
• carrying a heavy bag with a shoulder strap
• use of crutches that are too tall and elevate the shoulder
• emotional and mental stress
• Working with your arms raised above your head for prolonged periods of time can also irritate the Levator Scapula. To help reduce neck pain, stabilize your shoulder blade when you raise your arm.
• poor posture with a forward head position puts this muscle under continuous strain causing overuse.

Treatment for Levator Scapula Muscle Spasm / Trigger points

Usually the condition settles after a few days if it is only a once off. Proper hands-on deep tissue massage and dry needling, when used together, can be great to settle the condition either in the short term, or if the condition has become more chronic. Also for the long term, correcting posture, stretching and strengthening of the upper back(particularly middle / lower traps, serratus posterior, rhomboids etc.) and the neck muscles(specifically the posterior neck muscles) can help prevent the condition from returning.

Posture

Posture is key to a healthy neck and spine. Try and sit up straight on a comfortable supportive chair, when at work or at home. Allow your shoulders to relax by using the arm rests of the chair. When at a computer, pull the screen close and try to get the screen up at eye level (say using books underneath it). This will mean your head won’t have to be protruding forward. The same applies when driving a car. Pull the seat in close to the steering wheel(within reason). Try to position yourself so the shoulders are relaxed and the head isn’t jutting forward. Activities like reading in bed, playing computer games for hours etc. can really tighten up the levator muscles. They are a disaster for thoracic and cervical posture in the long term.

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Thoracic outlet syndrome is a disorder that occurs when the blood vessels or nerves in the space between the collarbone and first rib (thoracic outlet) become compressed. This can result in any of the following symptoms ; 1. pain in your shoulders and/or neck , 2. numbness / pain / tingling down the arm and / or in a finger / fingers. Common causes include physical trauma, i.e. car crash ; repetitive injuries from job or sports related activities; anatomical defects (such as having an extra rib); poor posture( protruding neck / rounded shoulders); and pregnancy.

You may notice symptoms of thoracic outlet syndrome if your job requires you to do a repetitive movement continuously for long periods, i.e. typing on a computer; working on an assembly line; or lifting things above your head. These repetitive activities tend to tighten up neck and shoulder muscles. Athletes, such as baseball pitchers and swimmers can also develop thoracic outlet syndrome from the years of repetitive movements.

Obesity can put an undue amount of stress on your body structures and joints leading to the development of thoracic outlet syndrome. Carrying around an over sized bag or backpack or having somebody sitting on your shoulders for long periods, say at a concert can compress nerve structures etc. and lead to the condition. You may suffer symptoms during pregnancy as muscles, ligaments, tendons and joints come under strain. This is as a result of the release of the hormone relaxin around week twelve of pregnancy, and also due to the increase in bodyweight.

The two most common types of thoracic outlet syndrome are:

1. Neurogenic (neurological) : This form of thoracic outlet syndrome is characterized by compression of the brachial plexus ( nerves coming from the spinal cord (neck). This network of nerves controls muscle movements and sensations in the shoulder, arm and hand. This is the most common cause of thoracic outlet syndrome.

Signs and symptoms include:
• Numbness or tingling in your arm or fingers.
• Wasting of muscles through which the compressed nerve travels; either in the arm or fingers or both.
• Pain in the neck , shoulder or hand.
• Weakened grip in hand / loss of strength in the arm.

Treatment : Often if neurogenic thoracic outlet syndrome is caught early, deep tissue work on neck, shoulders and arm to loosen out tightened muscles; joint mobilisations / manipulation of the cervical and thoracic spine; electro acupuncture along the affected nerve pathway; postural correction exercises, can usually bring great relief within one or two treatment sessions. If the condition is chronic ( i.e. there a month or months), it may take more time for the irritated nerve to settle. You may need to lose weight if obesity is the cause of your thoracic outlet syndrome.

2.Vascular (venous or arterial): This type occurs when one or more of the veins or arteries are compressed in the area between the collarbone and first rib.
Signs and symptoms include:
• Discoloration of the hand (bluish colour).
• Arm pain and swelling, possibly due to blood clots.
• Blood clots in veins or arteries in the upper area of your body.
• Lack of colour in one or more of your fingers or your entire hand.
• Weakened or no pulse in the affected arm.
• Cold fingers, hands or arms.
• Arm fatigue after activity.
• Numbness or tingling in your fingers.
• Throbbing lump near your collar bone.
• Weakness of arm or neck.

Treatment : For vascular (venous or arterial) thoracic outlet syndrome…you need to consult with your doctor. This condition may require thrombolytic medications, anticoagulant medications or surgery.