Question
QUESTION: I have been suffering from Neck & right shoulder pain since more than an year. and started doing some exercises. felt happy for some time. Now started getting the right EAR & JAW pain and feeling heavy. Last year, I went to a neck specialist and he said your neck is shrinking, may be that is the cause.. and had visits to chiropractor as well for the neck. Felt happy for some days & getting the EAR pain regularly. Please advise me, what could be the problem & if you are in NJ area, I would like to visit you. Could this be related to SCM & what is the treatement ?

ANSWER: Dear Sreeni,

Yes this could be related to the SCM muscle as far as the continued pain is concerned.  The pain referral patterns of the SCM encompass the ear, jaw, temple, eye and forehead on the same side.  There are great illustrations of this in a book by Travell and Simmons called:  Myofascial pain and Dysfunction:  The Trigger Point Manual.  You should be able to find this in your local library, if not check a medical library.

The treatment for trigger points in this area is with soft tissue techniques such as deep tissue massage, Graston technique, Active Release Therapy (ART), and stretching.  You can look up ART or Graston online for more information.  Chiropractic adjustments will help to reduce the pain in the short term, but the muscular component will need to be addressed for resolution.  Then you want to get to the root of the cause... such as determining if you have forward head posture, chronic job stress/abnormal desk positioning etc...  If the cause is not corrected the problem will return.

I have a question though...the neck specialist said you neck is shrinking?  Did she clarify this statement as it is not very descriptive or meaningful from a clinical standpoint. This could mean that your height has decreased due to the position of the head forward of the chest, this could mean that you have lost height in the disks due to degeneration, or it could mean something completely different.  Did you actually get a diagnosis from the neck specialist/possibly and orthopedist, or the chiropractic physician?

Lastly, if you neck is forward of the head and you have lost overall height and have some disk degeneration because of that, it can be corrected. Check out the below statements:

揊or every inch of forward head posture, it can increase the weight of the head on the spine by an additional 10 pounds.?Kapandji, Physiology of Joints, Vol 3.

揕oss of the cervical curve stretches the spinal cord 5-7 cm and causes Disease.? Dr. Alf Breig, Neurosurgeon (Nobel Prize Recipient)

揊orward head posture leads to long term muscle strain, disc herniations, arthritis and pinched nerves.? The Mayo Clinic, Nov. 3rd, 2000

Dr. Sperry (Nobel Prize Recipient for Brain Research), demonstrated that 90% of the energy output of the brain is used in relating the physical body to gravity.  Only 10% has to do with thinking, metabolism, and healing, so when you have forward head posture and a loss of active range of motion, your brain will rob energy from your thinking, metabolism, and immune function to deal with abnormal gravity and posture relationships and processing.  He further commented, ?0% of the stimulation and nutrition to the brain is generated by the movement of the spine?

You may not be able to get back to perfect, but you should be able to obtain At least a 50% reduction in the position with active care.  I do this in my office with the patients who need it and get great results...over 90% success ratio in reducing forward head postures and reducing stress on the spine...pain levels reduce and frequently are eliminated with it as well.  The technique is called chiropractic biophysics and you can research it online at www.idealspine.com.  

I am flattered that you would like to be treated in my clinic, but I am located in northern Florida so that is probably not an option.  Go the the website www.idealspine.com and enter main website.  On the second screen there is a tab on the left that says find a chiropractor, click it and then click on your state. There are many certifed doctors in your area.  Specifically, Dr. Lenny Siskin, and Dr. Peter Lope are great choices...they are instructors with the CBP organization and I have actually been trained by them. Both are in NJ.

Good Luck Sreeni.  Fell free to write back if you feel the need.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net

---------- FOLLOW-UP ----------

QUESTION: Excellent answers !! I very much appreciate the response :-).
As a follow up, there was an MRI done by Neck/ortho specialist and impression was "minimal degenerative change" & "congenitally small canal". The spinal card at the c4-c5 small difuse of disc bulge seen and at c5-c6 congenitally small canal seen. so, with the above 2 factors the output is "congenitally small canal causes moderate spinal canal stenosis & mild spinal canal narrowing". I hope you will get a good picture from this. Dr. also mentioned a possible of  "Brachial Neuritis ( parsonage turner syndrome). The similar MRI observation has been identified with the chiropractor as well last year and had some sessions and then dropped out.. After doing the excerices at GYM feel better. But EAR & Jaw pain started couple of days ago.. Now the question is, is  this curable and whom shld I contact ( neurology or chiropractor or any other specilaist) ? I am really thankful to you for my whole life, if you can give me some guidance or any specific exercises on this..

Regards,

Answer
Dear Sreeni,

There isn't anything that you can do about a congenitally small canal size that results in minor stenosis.  However the disk bulge can be lessened with devices like the posture pump, cervical traction, and intervertebral disk decompression. However, I don't think that either of those issues are the cause of your ear and jaw pain as the nerves associated with those ares of the spine do not innervate the head or face, they go into the shoulder and arm. Even if the nerve roots aren't involved and only the disk, ligament or cartilage was damaged, the referral patterns for pain would be into the neck and upper back, not the face and head.

I think you were better on track with the SCM being the cause of pain.  I have often seen patients with worse MRI results that have no associated pain, and I have also seen patients with nothing wrong on MRI who have a considerable amount of pain.  Those tests don't always give you a diagnosis, the clinical examination and history are more important, and should be reconsidered by the treating physician...if they did a thorough exam and history!!!

Lastly brachial neuritis seems like possibility but does not relate to the ear and jaw, because again the brachial plexus does not innervate the face or head...the cranial nerves do.  Brachial neuritis results in a sudden onset of pain in the shoulders and arms.  And as far as Parsonage Turner Syndrome goes this is a rare condition that starts with shoulder pain and eventually leads to loss of motor control of the shoulder and arm, and even paralysis.  It is possible, but in my opinion this doesn't really fit either as you said you have improved and do not have any loss of strength.

Bottom line, you have been given ideas but no definitives by the doctors.  I think you should focus on the muscular components first, and eliminate trigger points and muscle spasm as this is easy with deep tissue work.  Have the structure of the spine looked at closely by a chiropractor who is trained to correct abnormal structures (www.idealspine.com), and if you are getting no relief, then a neurologist may need to perform some electrodiagnostic tests of the brachial plexus, or you may wish to get a brain MRI to look at the cranial nerves.  However, clinical testing of the cranial nerves would be the first step before the MRI.

Good Luck Sreeni.

Respectfully,
Dr. J. Shawn Leatherman