A Real Pain in the Neck
For the past two weeks, I’ve been in some pretty excruciating pain. It mainly impacts my neck and left shoulder, but it doesn’t stop there. In a surprise move, it also radiates up and down my left arm down to my fingers. It’s a strange feeling, like something is pulling on your veins and twisting my muscles.
To top if off, three of my fingers on my left hand were numb, and I was unable to lift my arm up over my head. My mobility was seriously compromised. I couldn’t pull myself up without assistance, let alone lift my squirming toddler. I needed to find immediate relief in order complete all the countless tasks that we normally take for granted. Actions that (surprise-surprise) require movement from your back, arms, & shoulders.
At first, I had no idea how this new pain suddenly happened. I just woke up one morning, and there it was! Awful neck pain and dramatically reduced mobility. Now the neck pain in itself was not new. I’ve had recurring lower back pain for the past several years. It hasn’t been pleasant, but it was manageable.
Pre-Existing Low Back Pain
Being a fairly proactive guy, recurring low back pain is actually something I had been trying to work on. I had been attempting to treat it with regular exercise, as well as periodic visits to the chiropractor or osteopath. After our recent move to Japan, I had also begun to take up jogging again and was increasingly mindful of my eating habits. Given some more time, I had hoped that the pain would soon sort itself out.
I was gradually settling into a routine and genuinely thought that I was on the mend. In fact, I was still feeling optimistic about the chronic pain relief, when suddenly I got hit up with this new pain. It wasn’t emanating from my back as in the past, but along the left side of my arm and shoulder. The pain was swift and acute. I thought perhaps I had torn a muscle.
It could have been a tear. I wondered if perhaps I hadn’t stretched properly. Or maybe I was guilty of over-stretching, without the proper warm-up first. Although I didn’t know how or what had happened, it was pretty obvious that the feeling of intense pain with every movement was clearly unsustainable. I needed relief, and quick!
Thankfully, I eventually discovered both the cause and solution to this mysterious pain! It was quite a journey, but one that’s worth sharing. Indeed, this whole experience has been pretty revealing. I’ve since discovered so many things that I didn’t know before! I hope that by documenting it here, I can also help others find their own pain relief.
Unravelling the Mystery
After the second consecutive day (and long night) of pain, I visited the hospital. I normally try to avoid hospitals unless absolutely necessary, but the pain was becoming unbearable. I could manage the affliction well enough when standing or sitting, but lying down was beyond my tolerance. When upright, the pain was perhaps 3 or 4 on a scale of ten. However, when I tried to lie back, the pain jumped up to at least an 8.
Attempted Pain Relief (Round 1)
So off I went to the doctor and explained the situation. I was given painkillers & anti-inflammatory medication (as well as stomach strengthening meds, to counter the side-effects of the prescription). Doc didn’t identify the cause, but told me to take the meds and return in two weeks for a follow-up. As you might expect, I wasn’t particularly satisfied by the lack of explanation. Still, I was grateful for the hope of some pain relief, and immediately went to get my prescription filled.
I was to be disappointed on that end as well. Turns out, the pain medication didn’t actually do anything to alleviate the pain. Despite taking the medication, I felt the pain with the same intensity. I was to learn later that the prescribed dosage here in Japan is a small fraction of what doctors would start you off with in the US or Canada.
The pain was still so bad, that I wasn’t yet able to simply lie back and get some rest (obviously important during an injury). So I spent the would-be sleep time, perched up on pillows and researching online. I wanted to find out for myself what could be the source of my pain, and what to do about it.
Thoracic Outlet Syndrome
That’s when I came across Thoracic Outlet Syndrome (TOS). It’s a condition whereby the muscles around the neck and shoulders are overly compressed. As a result, they end up pinching the collection of nerves and veins that run beneath the collarbone. Blood circulation to the muscles in the region is compromised, consequently generating a considerable amount of pain and numbness (hopkinsmedicine.org).
One of the potential causes of TOS is from over-worked neck and shoulder muscles. This happens from repetitive work & muscle fatigue, that is exasperated over long periods of time. It is also associated with bad sitting and posture, carrying heavy packs for too long, as well as certain types of athletic activities such as tennis and baseball.
The Effects of Poor Posture
There are other potential causes, but when I read the posture part I immediately felt this might be my issue. I had become recently conscious of the fact that I often sit & stand with my back curved and my shoulders rolled forward (see nerd neck). Sitting at a computer for long periods of time undoubtedly accentuates the neck strain (see also ergonomic tips).
Finally, regularly carrying around heavy backpacks (school, military, and beyond), as well as constantly shouldering a wiggly toddler, doubtlessly contributed to the strain. Despite the current pain however, it did feel like some pressure dissipated with the realization that I may have figured out what was wrong with me.
Pain Relief: Round Two
Armed with this new information, off I went to another hospital for a consultation and the validation of my theory. The new doctor (this time specialized in orthopedics) did initially agree with my assessment, but sent me out for an x-ray of my neck to be sure that I hadn’t actually broken anything. After viewing my x-ray the doc was on board.
Given my symptoms, the doctor agreed it was most probably TOS. At which point, I was prescribed new, stronger painkillers, as well as a medication that was to disrupt my nervous pain receptors (pregabalin). I was to take the meds twice a day, and go back in two weeks.
Once again, I left the hospital feeling pretty ambivalent about the experience. The doc had confirmed my conclusion, but hadn’t given me anything to actually solve my issue. Painkillers were potentially welcome (turns out they still didn’t do any better in relieving my pain), but they wouldn’t help untangle or release the caught nerves and veins.
What’s more, I found it curious that the doctor didn’t bother to physically examine the area. As with the last doctor, there was no physical contact. I thought it strange that a doctor wouldn’t want to poke around and observe what was happening. That’s simply my opinion, but I should think that the scientific method would encourage you to use your senses and explore for yourself. At least, that’s what I would do if someone came to me complaining of pain (ex. my wife & kids).
Relief was still out of reach, but I remained motivated. The constant pain and my dissatisfaction with conventional medical practices, compelled me to look for alternatives.
Searching For Relief
That’s how I discovered Trigger Point Therapy. I went to visit a Holistic Health Clinic in my Tokyo neighborhood, where I met with the wonderful Dr. Motoaki Otani. At his clinic, Dr. Otani specializes in therapeutic massage, chiropractic adjustments, and physical therapy (hhoc.jp). Thankfully, he also happens to speak English! Having done a degree in the US, his English language skills were excellent!🙌
My luck held for more than the communication. Through the application of therapeutic massage, Dr. Otani was actually able to determine the cause of my pain. Go figure! The first health professional to actually poke around into my neck and shoulder tissue, was also the first to determine what was going on in there. He quickly identified the pain points and immediately set work. This is what he does. Dr. Otani helps alleviate his patients’ suffering through what he refers to as trigger point therapy.
A Definite Win👌
It was pretty impressive! Dr. Otani found what he explained were my pain trigger points and applied systematic pressure to allow for the increased flow of blood through those areas. Relief was immediate. Not cured of course, but I quickly felt the effects. As he worked, Dr. Otani explained what was happening. Turns out, that the intense pain along the back of my upper arm was what he described as referral pain.
The referral pain was the clue, but not the source. The actual source of this pain was apparently radiating from the muscles beneath my shoulder blade (the Teres Minor & Subscapularis). It was in these muscles, as well as major neck muscles (the Scalenes), that he identified the compression. The scalene muscles connect all the way down past the clavicle to the first and second rib. Which makes sense, given that the previous doctor I had followed up with actually proposed performing surgery to remove my first rib in order to alleviate the pain. Thankfully, I did not take him up on his offer.
So Much Learning!
For those of you not currently experiencing pain from TOS, the above explanation might appear overly detailed, but I was all too happy to learn. I was admittedly surprised by how much I had to learn. I mean, until this thing happened to me, I knew so little about how the muscles of my own body actually worked!
Sure, I started off with a decent grasp of the fundamentals of biology, but had never actually taken the time to analyze my own specific motor functions. My wife and I have since noticed that most of the time it took us getting sick for us to learn about the cause and how to improve our health, but we hadn’t yet applied this approach to our own day-to-day mechanics.
Sustainable Pain Relief
Fortunately for me Dr. Otani took the time to explain what was going on and help point (>_･ ) me in the right direction. He provided me with the information and techniques with which to remedy my issues. Furthermore, he loaned me this book (pictured above), The Trigger Point Therapy Workbook, with which to help treat the pain myself. It’s a great book!
Written by a former piano tuner who eventually became an expert in this type of therapy after his own frustrating experiences with chronic pain. The book’s authors, Clair and Amber Davies, translate the science behind this effective therapy and offer images and practices for locating and self-treating trigger points.
An Amazing Discovery
As explained in the book, as well as by Dr. Otani, working on your trigger points is a means of resetting the pain relay, as you slowly work through undoing those knotted muscles. It’s comparable to performing micro-stretches in the targeted areas.
Once the pain is eventually gone and you’ve regained your mobility, then you can move on to the larger muscles stretches and exercises (see the video below) in the hopes of avoiding such problems again in the future.
Some Useful Exercises for TOS
Don’t Give Up!
While my pain is not yet gone, I do feel as though I am making progress. I now work on those trigger points a few times a day and am certainly more mindful of my posture and the manner in which I sit, sleep, and walk.
As unpleasant as this experience has been for me, I take it as a learning opportunity and hope others out there will gain value from this. Indeed, pain & poor health totally impact your motivation. It effects your ability to address all the issues we face on a daily. There are however sustainable solutions out there! Stay persistent. You can find pain relief and discover more about yourself in the process.
👉 The Final Twist (Post Update – July/2019)
After a few more visits to Dr. Otani (2-3 times/week), my neck and shoulder pain was still quite intense. He then recommended I visit yet another clinic (the Tokyo Medical and Surgical Clinic) for additional help. Dr. Otani suggested I visit this other clinic in order to inquire about the possibility of having some pain-numbing medication injected directly to the site.
It was there that I spoke with a spinal specialist. One of the first things he did was dramatically increase my medication, but he also sent me in for an MRI. Given the amount of pain I would get simply from lying down, the MRI was excruciating. But it was also quite fruitful. The doc was able to ascertain that one of the discs had herniated, and was likely the cause of the pain (pinching the nerves).
My options were to hold out and hope that my body would sort itself out (white blood cells would remove the part of the damaged disc that was creating the pinch), or proceed with surgery.
Once again I took the path to avoid the surgery, and continued with the trigger point therapy. After a few more weeks, the pain did gradually diminish and my mobility returned.
It’s now been over a year since I first published this post, and the pain is entirely gone.🙏