Chronic upper back and neck pain

[Im_Reyz]

Hi, long-time follower. I’m posting today because I’d really appreciate some advice regarding my girlfriend’s situation (22yo) .

Medical History

I have never broken any bones and had never experienced any significant back problems before this started.

Onset of the Pain

I started weight training (strength/hypertrophy) in 2021 or 2022.

About six months after I began training, I started experiencing a very localized pain around my left shoulder blade. At first, the pain mainly occurred when I pressed directly on that area.

Progression of the Symptoms

Initially, the pain was very localized (see image), almost as if I were pressing on a nerve or an especially sensitive spot. I also remember having a mild, persistent discomfort in everyday life.

Over time, I began to notice that staying in the same position for too long would trigger the pain.

If I sat for an extended period, I would develop pain in my upper back. If I stood for a long time, my lower back would become painful instead.

Today, the situation has changed considerably. The pain has become much more constant.

It seems to start in my neck and radiate down into my upper back, particularly around my trapezius muscles and shoulder blades.

My back feels extremely stiff, and twisting movements are often painful.

When I bend my head forward and to the right, I experience a very unpleasant stretching sensation. I also have the impression that the entire area is constantly tense.

Overall, I feel that the pain has gradually spread and has become increasingly difficult to cope with.

Healthcare Professionals Consulted and Diagnostic Tests

I have consulted an osteopath and four kinesiologists.

I also underwent an MRI scan and X-rays.

To date, none of the healthcare professionals I have seen has been able to clearly identify the cause of my pain.

Current Situation

At the moment, I am no longer under the care of a healthcare professional.

After several consultations and different treatment approaches without any significant improvement, I was no longer sure whom to turn to.

I now feel that the pain is gradually becoming more severe, or at least increasingly difficult to manage in my daily life.

I also have the impression that it is no longer confined to the area around my left shoulder blade, but now affects a larger portion of my upper back and neck, mainly on the left side.

Thanks in advance for any advice !

[Jordan_Feigenbaum]

Howdy. Good to hear from you again, though I wish we were hearing about PRs and not an injury. Let’s see what we can do here:

First, a negative MRI and X-ray after three-plus years of symptoms is good news, generally speaking. It means the odds of this being a structural problem needing a structural fix are low. The trouble is that “we didn’t find anything” often gets delivered as “there’s nothing to be done,” and those aren’t the same thing.

As far as diagnosis and treatment goes, I don’t think an osteopath (assuming you’re located outside of the US) or a kinesiologist would be helpful. Osteopathy and a lot of kinesiology work is largely passive and often not evidence based. Passive treatment can feel good in the moment, but it doesn’t build tolerance, and after three years without meaningful improvement I think that’s the signal to change the approach rather than find a fifth kinesiologist.

A few things I’d want to know before getting more specific:

• What is she doing for training right now, i.e. still lifting, modified, or stopped altogether?
• What did those treatments actually consist of? Manual therapy, exercise, both?
• When was the imaging done relative to symptom onset?
• How are sleep, stress, and “life load” re stress?
• Any symptoms like numbness, weakness, dropping things, grip changes?

In the meantime, and without knowing anything else, I suspect the general direction should be is graded exposure. Pick movements she tolerates, do them consistently, increase gradually over weeks, and expect some symptoms during and after without reading that as damage. If she’s stopped training entirely, that’s usually part of the problem rather than the solution. Deconditioning plus wariness of movement tends to make everything more sensitive.

These two cover our approach in more detail:

Pain in Training: What To Do?

The 3 Biggest Mistakes You're Making with Lifting Rehab

Given this has run three years and she isn’t working with anyone right now, this is squarely what our pain and rehab team does, as a real diagnosis and individual management plan is a bit beyond the scope of what we can do on a forum.

Barbell Medicine Coaching | Get Matched With the Right Coach

-Jordan

[Im_Reyz]

Hi Jordan, thanks for your reply,

To respond to your question:

Her training hasn’t really changed. She has never stopped training, and her pain does not significantly affect her training or performance. Likewise, training does not seem to aggravate her symptoms.

She follows an upper/lower split alongside arm wrestling-specific training. Her program includes both compound and isolation exercises, around 8 to 20 sets per musle group per week. She does not feel excessively fatigued from training, and her session RPE is usually no higher than 8.

The treatments she has received so far include:

• Soft tissue massage around the painful area.
• Mobility exercises mainly targeting the thoracic spine and scapular region.
• A home exercise program consisting primarily of mobility exercises.

The physiotherapist suspected a right scapulohumeral dyskinesis and a pain syndrome involving the superior medial border of the right scapular spine, and therefore requested an ultrasound of the scapular region.

The ultrasound showed significant right-sided muscle atrophy involving the trapezius and the deep rhomboid muscles inserting onto the scapular spine.

She also had plain radiographs, which were unremarkable and showed no significant abnormalities.

These investigations were performed in 2023, when her symptoms first became more bothersome and began to spread to the upper back and cervical region.

Her sleep is good, and her general life stress is well managed, although she does experience some anxiety.

She does not report any numbness, grip problems, or weakness. However, as far as “weakness” she has difficulty voluntarily retracting and squeezing her shoulder blades fully together during training and outside of training.

[Jordan_Feigenbaum]

Yea, I think there is more going on here with the atrophy, weakness (but no decrease in performance), and continued wrestling that would benefit from additional, specific management. I thought you mentioned MRIs and X-rays (plain films) as well, but this seems like u/s and plain films, though maybe this was in addition to an MRI (presumably of her neck). Unfortunately , this is not something we can do address through the forum, as we need to have more information and follow-up. Our pain and rehab team is standing by should that be something you want to pursue.

[Im_Reyz]

Thank you for your input and for all the content you guys have been putting out for free. You guys are truly gems in the fitness and health space. I understand her issue isn’t something that can be fully addressed through the forum. I’ll discuss with her and see what we can do from here.