Neck, Shoulder, and Frozen Shoulder

Neck, Shoulder & Frozen Shoulder Pain

Long hours at a desk, working on a laptop, looking down at a phone, commuting, carrying bags, and the accumulated effects of stress can all make themselves felt in the neck and shoulders. Over time, patterns of muscular tension and restricted movement can become surprisingly persistent, sometimes remaining even when the original aggravating activity has stopped.

Neck and shoulder pain is one of the most common musculoskeletal complaints we see after low back pain. Some patients come in with a relatively straightforward muscular problem; others have pain involving the cervical spine, shoulder joint, rotator cuff, or nerves traveling into the arm. Often several factors are contributing at once.

Our approach begins by looking beyond the place that hurts. We consider movement and range of motion, muscular tension and compensation, work and exercise demands, previous injuries, headaches or jaw tension, and any neurological symptoms that might suggest the need for further evaluation.

What we treat

• Chronic neck stiffness and pain — including pain associated with prolonged desk work, repetitive activity, muscular tension, and previous injury
• Acute wry neck — waking with a painful, restricted neck and difficulty turning the head
• Upper trapezius and shoulder tension
• Cervical radicular pain — pain, tingling, or numbness traveling from the neck into the shoulder, arm, or hand
• Frozen shoulder (adhesive capsulitis) — see below
• Rotator cuff-related shoulder pain
• Shoulder pain that interferes with sleep
• Post-operative shoulder pain and rehabilitation
• Whiplash and persistent post-accident neck pain, following appropriate medical assessment when indicated
• TMJ and jaw tension, which frequently coexist with neck and upper shoulder tension — see our tension headache and TMJ page
• Headaches associated with the neck — see our migraine and tension headache pages

Neck pain

Neck pain is one of the most common musculoskeletal problems we treat. Sometimes the problem is relatively local — an acute spasm, restricted movement, or persistent muscular tension associated with work, exercise, or prolonged time at a computer. In other cases, the pattern is more complex, involving the upper back and shoulder girdle, an old injury, headaches or jaw tension, or irritation of a cervical nerve that produces symptoms into the arm or hand.

Treatment begins with understanding which structures and movement patterns appear to be involved rather than simply needling the place that hurts. We look at cervical range of motion, muscular tension and compensation through the neck, shoulders, and upper back, previous injuries, and any neurological symptoms. Acupuncture may be combined with cupping or manual therapy when appropriate.

Acute muscular neck pain can sometimes change quite quickly. Longstanding neck pain usually requires more attention to the factors that continue to load the area, including work habits, exercise, mobility, strength, and patterns of muscular tension.

Shoulder pain

Shoulder pain can arise from the rotator cuff, joint, surrounding muscles and tendons, or from a combination of these structures. Because the shoulder depends so heavily on coordinated movement of the shoulder blade, upper back, chest, and neck, we rarely treat the painful area in isolation. We look at range of motion, strength, muscular compensation, previous injuries, and the movements that reproduce the pain.

Acupuncture can be particularly useful when pain and muscular guarding are making normal movement, sleep, exercise, or rehabilitation difficult. Treatment may be combined with manual therapy and appropriate movement work, and we frequently work alongside physical therapy when strengthening or rehabilitation is needed.

We also treat patients following shoulder surgery, once their surgeon has cleared them for this kind of care. Acupuncture can be incorporated into post-operative rehabilitation to help manage pain and muscular guarding while movement and strength are gradually restored. Treatment is adapted to the stage of healing and works alongside — rather than in place of — the rehabilitation plan established by the surgeon and physical therapist.

Frozen shoulder

Frozen shoulder deserves separate discussion because it follows a course unlike most other causes of shoulder pain, and because patients are often given little sense of what to expect.

The condition typically unfolds in stages. During the initial “freezing” phase, pain is often the dominant problem: it may be persistent, particularly troublesome at night, and increasingly accompanied by loss of movement. In the “frozen” phase, the pain may begin to recede while stiffness becomes more pronounced, sometimes making ordinary movements — reaching overhead, fastening clothing, putting on a coat, or reaching behind the back — surprisingly difficult. The final “thawing” phase is one of gradual recovery, as mobility slowly returns.

The entire process can extend over many months and, in some cases, considerably longer.

Treatment has a different emphasis at each stage. Early on, the priority is often to reduce pain, improve sleep, and preserve as much comfortable movement as possible. As stiffness becomes the principal limitation, treatment shifts toward improving mobility, combining acupuncture with appropriate manual work and carefully directed movement. During the thawing phase, the aim is to support the recovery already underway and help restore comfortable, functional range of motion.

Particularly during the painful freezing stage, we do not believe that restoring movement requires repeatedly forcing the shoulder through severe pain. Treatment is adjusted to what the shoulder can tolerate, with the aim of reducing pain and guarding while gradually restoring useful movement.

We are also careful to be realistic about time. Frozen shoulder is rarely a condition that resolves in a matter of weeks, and progress is usually measured over months. Acupuncture cannot make the underlying process disappear overnight, but treatment can be used to address pain, muscular guarding, sleep disruption, and restricted function while the shoulder progresses through recovery.

What treatment looks like

Acupuncture treatment is individualized according to what is contributing to the pain. Needles may be placed in the neck, shoulder, upper back, or surrounding musculature, along with distal acupuncture points on the arms, hands, legs, or elsewhere.

When we find specific areas of muscular tension or restriction, these may be treated directly. We also look at the larger pattern around the painful area. A shoulder problem, for example, may involve not only the shoulder itself but also the scapular muscles, upper back, chest, neck, or arm.

Cupping is frequently used across the upper back and shoulders when muscular tension is prominent. Tui na, therapeutic massage, and other manual techniques may also be incorporated to address tight or restricted tissue and help restore comfortable movement.

Heat and moxibustion may be added when appropriate. Chinese herbal medicine is used less commonly for these conditions, but may occasionally be incorporated when the presentation calls for it.

The frequency and length of treatment depend on the condition. Acute muscular neck pain may change relatively quickly, while longstanding neck and shoulder problems generally require a longer course. Frozen shoulder is different again: because its natural course is measured in months rather than days or weeks, treatment is adjusted as the shoulder moves through its different stages.

Working with exercise and physical therapy

Acupuncture can work well alongside physical therapy, strengthening, mobility work, and a gradual return to normal activity.

We don’t generally want patients to stop moving altogether. Instead, we look at which activities are aggravating the problem, what can safely be continued, and where temporary modification may help. With frozen shoulder in particular, the amount and intensity of stretching need to be appropriate to the stage of the condition rather than simply forcing a painful shoulder to move farther.

For people whose work continually places demands on the neck and shoulders, we may also discuss workstation habits, movement breaks, exercise, and other ways of reducing the cycle of repeated irritation.

When to seek medical care first

Neck or shoulder pain sometimes requires medical evaluation rather than — or before — acupuncture treatment.

Seek prompt medical assessment for:

• New or progressive weakness in an arm or hand
• Increasing loss of sensation or significant persistent numbness
• Loss of coordination, difficulty walking, or problems with balance
• Neurological symptoms involving both arms or the legs
• Neck pain accompanied by fever, severe headache, or marked neck stiffness
• Severe pain following significant trauma
• Unexplained severe or persistent pain, particularly when accompanied by other systemic symptoms

If something in your history or examination suggests that further evaluation or imaging is appropriate, we will tell you.

Common questions

How many treatments will I need for a stiff neck?

It depends on whether the problem is acute or longstanding and what is contributing to it. An acute muscular neck spasm can sometimes improve within a small number of treatments. Chronic neck and shoulder pain usually requires a longer course. We reassess based on how you respond.

Can you treat pain going down my arm?

Yes, but we first want to understand what is causing it. Pain, tingling, or numbness traveling into the arm can come from irritation of a cervical nerve root as well as other conditions affecting the shoulder or peripheral nerves. New or progressive weakness requires medical evaluation.

Is frozen shoulder treatable with acupuncture?

Acupuncture can be used throughout the course of frozen shoulder, with treatment changing as the condition evolves. Early treatment focuses primarily on pain, sleep, and comfortable movement; later treatment places more emphasis on mobility and function. Because frozen shoulder has a prolonged natural course, we set expectations accordingly.

Will cupping leave marks on my shoulders?

It can. Cupping commonly leaves temporary circular discoloration that fades over several days. If you have an event coming up or simply don’t want visible marks, tell us and we’ll use other techniques.

I get headaches from my neck. Which page applies?

There is considerable overlap. Neck and upper shoulder tension can contribute to some headache patterns, so you may also want to read our tension headache and TMJ page.

My shoulder hurts most at night. Does that mean I have frozen shoulder?

Not necessarily. Night pain can occur with frozen shoulder, but it is also common with rotator cuff-related shoulder pain and other shoulder conditions. The pattern of restricted movement and examination of the shoulder help distinguish between them.

Should I keep going to the gym?

Usually some activity can continue, but what should be modified depends on the injury. We can help you identify movements that are aggravating the problem while keeping you as active as reasonably possible.

Does massage come with the treatment?

Manual therapy may be recommended when we think it will be useful as part of your overall treatment plan.