One Weird Trick To Eliminate Shoulder Pain?
December 1, 2019 11:36 AM   Subscribe

This is a longstanding problem which has waxed and waned over more than a decade. I've had several stints of physiotherapy, and I use the stretches and exercises I learned, plus foam roller and lacrosse balls PRN for muscle knots, but the pain comes back. Primary trigger seems to be sleeping position, since I usually wake up with the pain. I've already changed my sleeping position. What else can I try?

I have a history of injuries, plus jobs with poor ergonomic conditions. The pain is primarily in my right trapezius, and it will extend up into my neck and eventually trigger a migraine. It will sometimes refer down my right arm. There are muscle knots aplenty. I also get pain in my right piriformis. Basically it feels like a cold iron rod has been jammed down the right side of my body, like I'm a gaffed fish. The diagnosis has varied: pinched nerve, "chronic micro-tears" in my trapezius, "upper crossed syndrome," possible arthritis in the AC joint. In addition, one of my legs is a little shorter than the other, though no one has ever suggested orthotics or lifts, just stretches.

I do finally have a job where they give me a chair, and that chair finally fits me properly, which has reduced my hip pain and also helped with the shoulder pain. I could potentially obtain a sit/stand desk -- not sure if this would help or hurt, though. I've taught myself to sleep on my back, since side-sleeping was resulting in daily pain. I already have a cervical pillow as recommended in this Ask, which has also helped. My mattress is about two years old, but it's in pretty good shape and reasonably firm -- and I definitely can't afford to replace it for a while, so hopefully that's not the only answer remaining.

I wake up in pretty severe pain at least once a week, unrelated to other triggers like weather changes or lifting/strain or having to stand on my commute (reaching up to hold a pole tends to trigger pain). Once I'm in pain, I stay in pain for a good 24h at least, often longer. Heat, Biofreeze gel, and stretching help, but only a little. OTC methocarbamol/ibuprofen can help a little also, but I often hit the daily max dosage without improvement, and no other NSAIDs do a dang thing. I can't afford massages at the moment, and I'm not able to get a referral for PT or further assessment until after the new year -- any ideas I can try to keep me going until then?
posted by halation to Health & Fitness (11 answers total) 5 users marked this as a favorite
i got this exact kind of radiating knotted crushing migraine pain from my neck injury; have you ever had an mri of your c-spine? unfortunately in my case absolutely no kind of medical treatments made any real difference for more than a day or two other than spinal surgery. lidocaine patches are a great band-aid solution though.

also for me massage/foam rolling/lacrosse ball rolling/etc made it better initially and then EXTREMELY worse the next day.
posted by poffin boffin at 11:52 AM on December 1, 2019 [1 favorite]

I have almost your same symptoms including the frequent progression to migraine. I also did lots of pt and the rolling and that was a good thing and a nice tool to have but the most helpful thing short term was a prescription for tizadine, a muscle relaxant with relatively short half life. I take a half or whole pill (1 or 2 mg) depending on severity and it does make me a little loopy and unsafe to drive for a few hours but then wears off (and typically gives me release of that muscle during that progression). This strategy doesn’t work with a cyclobenzaprine, which is what many gps had prescribed me. Cyclobenzaprine has a long half life and would make me loopy and depressed for 24+ hrs. I came to this solution by seeing a migraine specialist, also part of a pain clinic. I know that may not help you too much right now since you can’t get another assessment right away, but something to think about. (I also have sumatriptan for when a migraine is triggered but the sumatriptan of course doesn’t touch the muscle spasms in my shoulder so I need the combo.)

In recent years, I have had a lot fewer episodes and I think this is related to another ‘strategy’ from the migraine doctor, to take some dance classes or yoga for stress and posture improvement. I eventually stumbled into a frenetic type of barre class, which I find meditative (so reduces stress) but also has really improved my posture. Sometimes I have a muscle spasm when I start the class and leave with it gone. The class always involves some shoulder-engaging weight exercises, with very light weights. I’m on my phone but would be happy to send some examples if that’s something you’d want to try.
posted by Tandem Affinity at 12:10 PM on December 1, 2019 [1 favorite]

Have you tried a shoulder specific icepack? I keep one in the freezer - it's big and has straps to keep it in place. Helps a lot - and can be heated if heat helps more. CBD might help as might doing some kind of regular gentle movement like a restorative yoga class. Also a few sessions with a good trainer to develop a safe and careful weight-lifting regimen might help. I find if I don't do both yoga and weights regularly I'm in a lot of pain. It might seem counter-intuitive but really helps keep things from being tight. And yes seems like some sort of imaging might be a good idea to figure out more specifically what's going on.
posted by leslies at 12:59 PM on December 1, 2019

I had exactly this for so long. Poor neck posture really exacerbates it, so make sure you're keeping your head level even outside of work (books and my phone now have to be held up instead of at chest level, which was a challenging habit to learn).

I go to a chiropractor regularly, which helps a ton, though I know a lot of people dont like chiro. It works for me, ymmv.

I also have uneven hips, which does make the problem worse -- your entire torso, neck and head will shift to compensate, resulting in tension. Orthotics will help, but only when you're standing or walking. I found learning some hip-specific pilates stretches / exercises to be helpful in releasing the tension in my hip flexors the unevenness causes, which in turn helps my hips stay more level when I'm seated.

Good luck!
posted by ananci at 1:30 PM on December 1, 2019

How old is your mattress? Can you sleep in a different bed for a couple of nights, to see if that makes a positive difference?
posted by Iris Gambol at 1:31 PM on December 1, 2019

Oops just noticed an important typo - the drug I find helpful is tizanidine, not as spelled above...
posted by Tandem Affinity at 1:44 PM on December 1, 2019

Dry needling is pretty amazing if you can get a PT to do it for you. The PT I go to will see me up to I think three visits without a referral, I don't know if something like that is an option for you?
posted by Medieval Maven at 2:03 PM on December 1, 2019

I have a neck injury and poor sleep position exacerbates it. I also sleep on my back, and place a folded hand towel under each elbow/upper arm, which elevates my arms slightly and keeps my arms from pulling down on my neck while sleeping. This makes a huge difference for me.

I always thought standing desks were gimmicky until I started working at a company where sit/stand desks are standard issue, and they're great for me. Just make sure that you have proper standing posture—you need to raise your monitor up a few inches compared to sitting.
posted by radioamy at 2:04 PM on December 1, 2019

a 1/4 to 1/2 tablet of magnesium really helps relax my muscles when I've slept wrong. Since you're having such severe problems, I don't know how much it would help you but it should be okay to add to ibuprofen. Be careful of taking too much. It can cause diarrhea.
posted by stray thoughts at 3:17 PM on December 1, 2019

This is a longshot but do you by any chance wear a watch or bracelet of some kind on your right wrist? If so, try switching to the other hand or loosening the strap by at least two notches.

I had similar sounding pain in my left shoulder for several years, and went through all kinds of tests and things to get rid of it, with no results. One day a receptionist checking me in for an appointment mentioned that her mom had had a similar problem, and that it turned out to be a circulation thing caused by a too-tight watch. I loosened my strap on the spot. The pain went away and has never come back.

Apparently, something similar can happen if you sleep with a ring on (wedding bands are the most common culprits).
posted by rpfields at 8:55 PM on December 1, 2019

YES! I fight a continuing battle with my traps and it sometimes touches off a migraine. Side sleeper, yes. Always had shoulder trouble, figured I had it coming since I'm a rock climber.

The game changer for me is not in addressing my traps. It's my pecs.

Your pecs oppose the traps. Those tighten up from climbing for me, and for almost everyone from the everyday desk hunch, and because pulling motions are so much more common than pushing. Get your stretching on here: this stretch is required for me daily but that mostly keeps me out of neck trouble, unless I do something out of the ordinary. It's pretty much cured my shoulders, which is saying a lot.
posted by Dashy at 9:42 PM on December 1, 2019 [3 favorites]

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