Pain in right side of neck, upper back, shoulder and arm

Pain & Rehab Forum [Moderated]
1

Hello,

I’ll preface this by saying I’m a huge fan and follower of BB Medicine programs and content for many years now.

Ever since mid January I’ve been experiencing a constant sort of dull ache with sharp pain during certain movements that seemed to start mostly in the right side of my neck and then eventually continued to progress to my upper right delt/rhomboid, my right shoulder and then go down my right arm in a line almost as if it was drawn with a marker, stopping at my elbow.

As I’ve been training for 11 years now and follow BB Medicine content very closely, I figured it was yet another ache or pain that would eventually go away like many others so I didn’t panick and kept training normally.

Finally after around 4 weeks of it seeming to progress, I tapered way down to doing very light work with just the bar. I should note that the pain isn’t that intense during excercise and I’m not quite sure why.

Because of my wife’s concern, I went to the doctor last week who believes it to be a pinched nerve in my rhomboid and recommended naproxen and PT. I then immediately went to PT but much to my disappointment, I was given cupping, dry needling, KT tape, told to come back 8 more times and told over and over about posture importance. I’m familiar with the research on these methods as well as having prior experience where they didn’t help still all so I can’t even hope to have some progress via a placebo here.

The pain seems to be very low in the morning, get worse as the day goes on (sitting in a chair for a desk job but try to get up.and move as much as possible) and peak around supper time. The only thing that eliminates the pain is laying down on my back. Even if the pain is agonizing, if I lay down on my back it seems to dissipate to a large extent over 10-15 minutes or so. I have no idea why this is and it’s rather frusturating to feel like I need to lay down when I just want to be up and doing something.

I’ve never had an injury impact my sleeping and be present 24/7 and after almost 2 months, its wearing very thin. I’m still trying not to panick about it as I know it can make the pain worse but it’s getting more and more difficult.

I know movement is the key to healing and am still lifting very light weights and trying to walk and move as much as I can but it doesn’t seem to be helping.

I don’t know what to do at this point, it doesn’t seem to be getting better and I don’t want to keep wasting my time with “improving my posture”.

Thanks so much for your time,
Adam

2

Hey man,

Thanks for reaching out. I am sorry that you have experienced this situation which is clearly impacting your sleep, activities of daily living, work, etc.

A few quick questions…Did you have any specific trauma to the area? Do you have any symptoms past your elbow? Any numbness or tingling? Difficulty gripping objects?

Did you go back to this physical therapist? How have training and sleep been recently? I recognize that it’s been some time since your original post.

Hannah

3

Hello Hannah,

Thanks for the follow-up!

I don’t believe there was any specific trauma. The pain started in the right side of my neck and seemed to be a fairly minor thing. I kept training with normal volume and weight and it just seemed to get worse from there.

There are no symptoms, numbness or tingling past my elbow or any difficulty gripping. The pain is most commonly a dull constant ache in my upper right back that seems not to be too bad in the morning but progresses throughout the day and get worse and worse with a pinnacle somewhere around 5-7PM. It also seems that when the pain itself is at its most mild, its mostly localized to my upper back but when the pain increases, it effects the right side of my neck and shoulder and when its at its worst it effects what feels like a thin line from my shoulder down to my elbow.

I didn’t go back to the physical therapist. I don’t have much faith in her methods both through experience and reading a number of studies regarding them.

Sleep seems to be relatively managed. When/if the pain is rather high in the evening (and not calmed down from laying down for an hour or so) I take 480 mg Naproxen before going to bed and it seems to help quite a bit. I’ve only been doing this about 1-2 times a week as of late.

Last week I did my normal routine but with the bar only. This week I did the same routine but with around 50% of the weight I would normally do. The funny thing is, during training, after a bit of a warmup for the first few sets, the pain is nearly 100% gone with these lighter loads and seems to stay gone for about 30 minutes or so after the workout.

At this time, the only constants seem to be:

  • The pain is very minimal in the morning and progresses as the day goes on with a peak around 5-7PM and then dips back down after that before bed due to usually laying down for 30 minutes- an hour
  • The only 3 things that seem to lower the intensity rather than increase it are during/shortly after lighter load training, laying on my back and taking Naproxen

Thanks again for your time. I’ve had numerous injuries over the past 11 years but never one that has effected me 24/7 like this one has.

I should add, the full achy pain never fully goes away, the worse the pain gets the sharper it gets and even when the symptoms are relatively mild such as they are in the morning, head movement, particularly looking all the way up or down brings on a sharp pain to my neck, back and shoulder.

4

The positive thing, based on the information that you have provided, is that it does not sound as if you have any major red flag symptoms that would warrant significant clinical investigation.

Do you have full range of motion in your neck and shoulder? Are there any specific movements that are provoking your symptoms? Any movements in your training that provoke your symptoms (I know you said that this has generally been fine since moving to lighter overall intensity)?

Has anything else changed in your routine recently?

How have symptoms been progressing since your last post?

5

Hello Hannah.

I seem to be lacking a bit of range of motion when looking to the left as far as possible when compared to.looking to the right and I get pretty sharp pain looking all the way up or down.

There don’t be appear to be any specific excercises that aggrevate or alleviate symptoms and I’m having a hard time correlating and understanding flare ups. For example, I hiked for an hour or so yesterday in some very thick wooded areas, climbing on top of and under branches, jumping over a stream multiple times etc. and during that and afterwards for the rest of the evening I felt very low pain, almost none in fact. Then, today I went for a drive with my wife for about 20 minutes, sat in a chair for about an hour and then went to lunch and the pain was so intense I had to take naproxen just to continue on with my day and somewhat alleviate the pain. I have no idea if the hiking yesterday was a delayed sort of situation or just stress and other life factors caused a random flare up today.

Nothing else has changed recently.

Symptoms seem to be the same. I feel good in the morning but the afternoon and evening are when it gets the worst. Some days it doesn’t progress too far (like yesterday) and I start to think it’s going away finally, then other days (like today) I get my ass kicked by it and have a hard time seeing an end in sight.
sight.

Thanks again,
Adam

6

Hello Hannah,

I’m still not getting much improvement on this and was wondering if you have any additional advice. I’ve been trying to do neck excercises with a band and lighter workouts but still experience pretty intense flare ups.

Thanks,
Adam

7

I see Hannah’s status shows banned. Has anyone else had experience with this sort of thing? I’ve been trying to address it by doing a large deload, daily neck excercises as per the Barbell medicine post on neck pain and trying to move and do cardio as much as possible.

I honestly don’t know at this point if this is getting better. I still experience near constant pain to some degree with huge variability day to day and usually even throughout the day.

8

Hi Adam,

Sorry to hear about this frustrating situation. If you are experiencing worsening symptoms after your exercise sessions, it suggests that those sessions are probably a bit too much (either in terms of volume or intensity of the selected exercises) at that particular time, and the exercise program probably needs additional modifications. It’s tough to say what exactly those modifications should be in your individual situation via a forum post, though an emphasis on range of motion and sleep are always good targets for improvement.

If you are experiencing persistently worsening symptoms despite your best efforts with our publicly available content and recommendations, it would be a reasonable next step to consult with a healthcare professional. This could be someone you trust who is local to you, or a consultation with our rehab team for further guidance.

9

Thanks Austin, I really appreciate your prompt reply.

I think your completely correct in terms of finding the proper loading protocol, its just been very difficult with the delay associated with flare ups when I often feel perfectly fine during the session itself.

The emphasis on range of motion and sleep are very much appreciated and I will try to better implement them as I have to admit that sleep has been fleeting as of late due to factors outside of my control to some degree (pregnant wife+toddler).

Unfortunately. I don’t have a healthcare professional that I trust at this time as my experience with many different providers over many years seems to be to lean on popular recovery modalities (acupuncture, massage, cupping etc.) resulting in little to no improvement (as would be expected given the data) rather than a properly dosed exercise regimen. I will l likely require a consult (I’ve done this before with your team) but am hoping to avoid it at this specific time if possible due solely to the cost associated as I have a new child being born in 3 months.

The only additional questions I would have if you would have the time to review would be:

  • While I certainly don’t expect an exact or even accurate answer, based on my descriptors above, does this sound to you as a pinched nerve in the rhomboid as the doctor seemed to suspect? The only reason I ask is solely for its relevance in terms of exercise selection and potentially facilitating an easier approach to identifying exercises that may be causing flare ups of symptoms (squats due to bar pressure on the muscle or something of the sort)

  • Does my situation sound like a decent candidate for the shoulder rehab template? With some personalized adjustment where required for dosing and exercise selection with this template, I’m wondering if this may be a slightly more cost effective option than a consult for rehabing this pain using properly dosed exercise regimen?

While I hate not being able to train properly, my only goal at this time is to try and get rid of this constant pain before my new child is born in 3 months time. I can live with pain during training and/or decreased performance until I’ve completely sorted the matter out but I cannot afford to be in pain all the time while trying to care for my wife, my toddler and my newborn child.

Thanks so much for your time, it really means a lot,
Adam

10
  • While I certainly don’t expect an exact or even accurate answer, based on my descriptors above, does this sound to you as a pinched nerve in the rhomboid as the doctor seemed to suspect? The only reason I ask is solely for its relevance in terms of exercise selection and potentially facilitating an easier approach to identifying exercises that may be causing flare ups of symptoms (squats due to bar pressure on the muscle or something of the sort)

A “pinched nerve in the rhomboid muscle” isn’t really a thing, to be honest. I would be selecting your exercises via trial-and-error based on how they feel during and afterwards, rather than on some hypothetical mechanism like this.

  • Does my situation sound like a decent candidate for the shoulder rehab template? With some personalized adjustment where required for dosing and exercise selection with this template, I’m wondering if this may be a slightly more cost effective option than a consult for rehabing this pain using properly dosed exercise regimen?

Tough to say; the templates are designed to provide a lower price point, of course, but this comes with the downside of a lack of individualization. If you are comfortable with modifying the template yourself based on your individual situation, then it could be helpful to provide some structure and direction. However if you aren’t comfortable modifying things on the fly, we obviously can’t guarantee it would be ideal as-written.

While I hate not being able to train properly, my only goal at this time is to try and get rid of this constant pain before my new child is born in 3 months time. I can live with pain during training and/or decreased performance until I’ve completely sorted the matter out but I cannot afford to be in pain all the time while trying to care for my wife, my toddler and my newborn child.

I understand the motivation and hope you experience some improvement. Unfortunately these things do not always follow the timelines we want them to; it’s important to be aware of that possibility and have flexible strategies that allow you to meet your responsibilities as much as possible in the meantime.

11

Thanks Austin,

Again I really appreciate the assistance.

I will weigh the pros and cons of a self modified shoulder template against a rehab consult with your team and figure out what makes sense for me.

Thanks again,
Adam

12

Hey Adam,

As it looks like this has been going on at least a few months this is typically when a consult is a better option. Our recommendations typically take care of many issues but sometimes a more individualized approach is warranted and it is just as good to think through the problems with a clinician. It sounds like it would be beneficial to discuss the overall plan for your sessions and way to titrate weight to start connecting some good sessions prior to going back to normal programming. Sometimes the real game is being able to undershoot what you want to do, in favor of what you can do to work through symptoms. It also can be the instances where we can talk about ways to work around a problem as well as trying to work through it.

13

Thanks Derek. I talked this over with my wife and decided to pursue the consult. I just submitted the intake paperwork.

Hopefully I can get this pain eliminated or at least to tolerable levels for everyday life by the time the new baby shows up.

Thanks again to you and Austin for your time, your groups no BS and science based approach to pain and training is why I’ve been a part of this community for so many years and why I intend to stick around.