Hello rehab team,
I’m a 38 yo male that is not currently training. I work two fairly physical job(s), and since early 2019 I’ve also picked up additional pendemic-related responsibilities that take up a lot of my time. The remaining time is spent on caring for my three toddlers under 4.
My last shift at work, Christmas eve, I had a pretty unremarkable day of work, I don’t recall any specific inciting event. However I woke up Christmas day at the end of my shift with pretty gnarly neck stiffness, unable to rotate to my head to the right without pain. Initially I thought nothing of it, since this wasn’t the first time dealing with neck stiffness after waking up. For about 10 years I’ve had occasional neck stiffness that typically went away relatively quickly on its own without any specific interventions. But this time is different. The pain has progressed, now including my right trap, and radiating down the posterior right arm to the lateral elbow. I’ve also experienced muscle twitching, in my tricep, deltoid, upper pec, and lower lat. I have a very hard time finding any position of comfort, especially at night, which has robbed me of my sleep the past week. Occasionally placing my right forearm on top of my head reduces pain to tolerable levels. Sitting position is by far the worst, and I drive a lot at work. NSAIDs and Tylenol have had limited effect. With the potential high demands of my job I’m being forced by my employer to seek traditional medical care.
To me all of this is pretty consistent with a cervical radiculopathy, but to be honest the muscular twitching in various myotomes has me concerned.
I’m writing this having read the neck series written by Dr. Ray. With that said I’m in a lot of pain and I need some acute phase help and guidance, especially since I’m looking at probably loss of income due to this.
Hi there, sucks that you are having this experience with your neck which is clearly impacting many facets of your life including sleep, activities or daily living, driving, work, etc.
From what you have described, I would agree that this is likely a case of cervical radiculopathy. If you have read the neck series written by Dr. Ray, you will remember that the final article in the series is dedicated to functional management of neck pain. As a general recommendation, I would work on completing cervical and shoulder active range of motion within tolerable ranges (see article for more details) with progression to more of the resistance training exercises that are also described in the linked article.
Stay positive, this is likely going to get improve over the coming weeks. If you need more guidance regarding your specific situation and would like more detailed programming advice, we would be happy to consult with you remotely.
Hannah Mora
Thanks for your reply Hannah,
How concerning are these fasciculations vis-a-vis “red flags”?
I’m also having difficulty completing even the basic active ROM exercises from part IV of the article at this stage (I’ve been doing them for 3 days now). Should I start with just isometrics?
Also, do pharmacological interventions change any of the programming/RPE/progression (I was prescribed cyclobenzaprine and prednisone)? Without them I don’t think I would get any sleep, and I’m also very concerned about missing several weeks of work and the associated lost income so I’m hoping those will help me return to work asap.
Muscle fascinations or “twitches” could be a symptom of an irritated nerve. Based on what you are describing, this would not be concern for any more sinister pathology. It’s likely that the frequency of this will reduce in the coming days/weeks.
Cervical isometrics would absolutely be appropriate, you could start with using the resistance of your left arm/hand. Keep trying the active ROM exercises, even if you can only complete a very small range of motion, but maintain a tolerable level of pain. You could also try chin tucks in supine, while they are not doing anything unique, they are just another way to get your neck moving to tolerance.
Your questions about pharmacological interventions are addressed nicely in our podcast, episode #99. Of note, the term “muscle relaxers” (i.e. Cyclobenzaprine) is a bit of a misnomer; they are central acting medications which we do not typically recommend for acute pain. Check out the podcast for more details.
Tnumrych did this ever get resolved? I’m having identical symptoms since mid January, slowly progressing excercise and range of motion and I believe slowly getting better but just wanted to see if anything in particular helped you.