Physiotherapy treatment for chronic neck and shoulder pain ============================================== Chronic neck and shoulder pain is one of the most common musculoskeletal problems and is more common in people with a history of inactivity, working at the computer, or using mobile phones for a long time. Statistics show that 30 to 50 percent of adults have experienced neck pain at least once in the past year, and about half of them may return to chronic pain. 🔍 The main causes of chronic neck and shoulder pain **1. Bad sitting behind the desk and mobile phone (postural loading) Sitting for a long time with an improper posture such as hunching or forward head posture significantly increases the pressure on the neck structures. Even just one inch of deviation of the head puts additional load equivalent to several kilograms on the neck. Studies have shown that spending more than 75% of working hours sitting at a desk is a risk factor for developing chronic neck and shoulder pain. This continuous loading tires and irritates the muscles and in the long term causes changes in their structure and function. **2. Sports injuries or accidents (whiplash) A sudden blow to the neck, such as a road accident, can cause damage to muscles, ligaments, and joints. Even months later, the patient may still have pain. Whiplash is particularly well-known because even the initial injury causes long-term symptoms, and treatment is sometimes delayed due to the difficulty of ignoring it. **3. Continuous muscle tension such as Levator Scapulae** The levator scapulae muscle, which is connected from the upper vertebrae of the neck to the shoulder, becomes tense and painful due to excessive use in incorrect positions and carrying a bed bag. Studies have shown that this muscle is probably involved in 20 to 30% of people with neck-shoulder pain. Also, the muscle is very affected by "trigger points". The consequence of these tensions is the reduction of the range of motion and even the production of pain referred to the inside of the shoulder. ### 🔄 Psychological explanation of the causes of chronic neck and shoulder pain Perhaps the root cause of chronic neck and shoulder pain isn't one big event, but millions of small, repetitive stresses: staring at a cell phone screen for hours, bending your head, gentle but persistent pressure—like water drops breaking down a stone. If we do not take these factors seriously, we will soon impose them on our bodies. Wrong movement patterns gradually become a permanent pattern and bring chronic pain; Pains that are not only physical, but also significantly reduce the quality of life. **🧩 Why do root canal treatment? - Long-term effectiveness: focus on the cause, not just the apparent relief. - Prevention of return of pain: by removing the main factor, the probability of return of pain is reduced to half or less. - Effectiveness of physiotherapy treatment: correcting the sitting posture, strengthening the neck and shoulder structure, and relieving muscle tension, is an approach that is completely in line with scientific evidence. How does physiotherapy work in the treatment of chronic neck and shoulder pain? ### 🧠 Accurate and personal assessment of chronic neck and shoulder pain In the first session, the physiotherapist asks about the age, history of pain, intensity, time pattern and previous treatments, and performs a physical examination including checking the range of motion, muscle strength, nervous condition and possibly special tests. The goal is to accurately diagnose the main cause of pain and develop a personalized treatment plan. If needed, imaging tests such as MRI, X-Ray or ultrasound are also requested. ### 👐 Manual therapy for chronic neck and shoulder pain In the manual therapy phase, the specialist mobilizes the joints and performs soft tissue massage with his hands. Purpose: 1. Reducing muscle tension and pain by stimulating the nervous system to inhibit the pain message (neurophysiological effects). 2. Increasing local blood flow that facilitates tissue regeneration. 3. Improving the range of motion and flexibility of joints by removing movement restrictions. Methods include: deep massage, joint mobilization of the cervical and thoracic spine (to assist with posture), myofascial release, and joint-specific techniques. Studies have shown that the combination of manual therapy and consistent training leads to faster performance improvement and pain reduction. ### ⚡️ Electrotherapy and auxiliary heating for chronic neck and shoulder pain The use of devices such as TENS, ultrasound and hot/cold compresses are used to reduce pain and inflammation. - TENS (transcutaneous electrical nerve stimulation): mild current with the aim of inhibiting the transmission of pain messages through the control gate mechanism and stimulating the production of endorphins. Studies show that TENS can relieve chronic neck pain, although the quality of the evidence is moderate. - Ultrasound therapy: sound waves produce heat in deep tissues, increase blood flow and accelerate the healing process. - Heat/cold: heat relaxes muscles and increases blood circulation, and cold is anti-inflammatory and reduces swelling. New network research (up to July 2024) shows that HILT and shockwave and TENS have different effects; The right choice depends on the patient's condition. 💪 Prescribing specific exercises for chronic neck and shoulder pain Targeted exercises strengthen the deep muscles of the neck, improve strength and prevent the return of pain: - Chin Tucks: maintaining the alignment of the vertebrae and reducing pressure - Strengthening the deep muscles of the neck and extensors: which strengthen the supporting function of the spine - Shoulder and chest stretching: especially for correcting kyphosis and reducing pressure on the shoulder joints Exercises to improve posture, increase range of motion, and strengthen back muscles are also recommended. Of course, exercise is not the only reliever; Combining it with manual therapy is more effective. ### 🪑 Correcting the ergonomic situation and behavior These simple but effective modifications reduce the constant pressure on the muscles and prevent the return of pain. The physiotherapist teaches the patient: - Correct sitting: proper support, proper seat height and monitor placement - Intermediate stop and stretching every 20-30 minutes - Using a standard backpack and a suitable neck pillow 🛠 Specialized techniques for chronic neck and shoulder pain For chronic neck and shoulder pain, the physiotherapist may use more advanced methods such as: - Dry Needling: inserting thin needles into trigger points to release local pressure - Shockwave Therapy: creating high-intensity sound waves to stimulate healing and reduce pain - Foam roller or ball for myofascial release: effective in reducing chronic tensions and strengthening the connective tissue Studies show that both methods can be significantly effective in releasing trigger points; Each is used in specific situations. Five key equipment-free home exercises for chronic neck and shoulder pain ### **1. Chin Tucks** **🧍‍♂️ Doing this exercise correctly: 1. Sit or stand straight, shoulders relaxed 2. Move your chin back slowly (as if you are making a new chin), without looking up or down. 3. Engage deep neck muscles (such as Longus Colli and Capitis) and hold for 5-10 seconds, then release. Repeat 10-20 times Why is it useful? - Strengthening the deep muscles of the neck and preventing incorrect postures such as forward head - Improving the flexibility of the neck by stretching the posterior muscles - Reducing headache and shoulder and upper back tension It is recommended to perform 5 to 7 sets of this exercise daily, even while working at a desk. ### 2. Neck Lateral Stretch **🧍‍♂️ Doing this exercise correctly: 1. Without turning the trunk, slowly bend the head towards one shoulder 2. Place the hand on the head and dip until you feel a gentle stretch on the opposite side 3. Hold for 20-30 seconds, repeat for both sides **🎯 why do it? - Increasing the lateral flexibility of the neck, reducing the tension of the side muscles such as the scallions, and preventing pain in the corners of the neck. ### 3. Shoulder Shrugs & Rolls **🧍‍♂️ Doing this exercise correctly: 1. Shrug: Raise shoulders up to ears, hold for 3-5 seconds, then release slowly. 2. Roll: Roll the shoulders back, while the chin is still, then reverse the movement. **🎯 why do it? - Reducing the tension of upper shoulder and neck muscles - Correcting the posture of the neck forward and improving the physical mood ### 4. Chest stretch (Chest Opener) **🧍‍♂️ doing this exercise correctly** (wall version): 1. Stand facing a wall, arms at a 90-degree angle to the body, elbows on the door or on the wall 2. Slowly move the trunk away from the wall to feel the tension in the chest muscles (pectoralis major and minor). 3. Hold for 20-30 seconds, repeat 3 times **🎯 why do it? - This exercise improves the position of the shoulders, reduces the hump, and corrects the "kip front" posture of the neck. ### 5. Thoracic Rotation **🧍‍♂️** Basic method (on the chair): - Sit straight, put your hands on your shoulders, turn your trunk to the right - Hold for 15-20 seconds, then move to the next side **🧍‍♂️** More professional way: - Open the arm to the side (Book Opener), turn the body to the opposite side (Thread the Needle) in the arch position on the floor. **🎯 why do it? - Increasing the mobility and flexibility of the upper back (Thoracic), improving breathing mechanics, reducing pressure on the neck and shoulders ### ✅ Simple suggested daily program to reduce chronic neck and shoulder pain - Morning: a set of chin tucks and shrag - Every few hours: a set of lateral neck stretches - Noon: Shrug + chest stretch - Evening: stretching above the waist or sitting Rotations ###