SPECIAL FOCUS: BACK AND JOINT HEALTH

For months, 52-year-old David Moen tried to relieve excruciating pain between his shoulder blades. Hot baths helped, but one day the bath and the heat went on too long, and he suffered heatstroke. That sent him to the doctor.“I suspected I had rotator cuff injuries. It was getting to the point where the pain was debilitating. It was putting me in a foul mood,” says Moen, who lives in Bedford. “I never thought it was a neck injury.”Neither did his doctor — at first. But as Moen’s case shows, the intricate working relationships among the tendons, muscles and nerves of the neck and shoulders mean that a pain in the neck could be a shoulder injury — and vice versa.Moen isn’t sure how he was hurt or even when the pain started exactly. It may have been a motorcycle accident in the mid-1990s, or just his tendency as a former Marine to work hard lifting heavy loads despite pain or strain. About two years ago, the pain started but bothered him only when he did heavy work. As time went on, the pain worsened and took longer and longer to subside.Complicating Moen’s diagnosis were his problems with carpal tunnel syndrome. When he grabbed his motorcycle handlebars, his hands went numb. He’s worked at Bell Helicopter in Hurst for 27 years, sitting at a table that was never meant to be used as a desk.A doctor suspected the carpal tunnel issues could be causing his upper back and shoulder pain, but an MRI revealed a severe neck injury. Surgery to his C5 and C6 neck vertebrae have finally alleviated the pain in his shoulders.“We call the shoulder ‘the great pretender’ because it has a complicated structure of nerves and tendons,” says Dr. Carla L. Young, a physical medicine and rehabilitation physician at Texas Health Arlington Memorial Hospital. “It’s important to tease out the cause because the treatments are different.”

Common complaint

Pain in the neck and shoulder is extremely common because their complex workings are vulnerable to age-related changes, poor posture, lack of exercise and stress.

Degenerative disk disease, an ominous term, happens to everyone starting about age 20. Disks, which cushion the vertebrae, aren’t able to hold as much water, which makes them more delicate, Young says. Meanwhile, tendons in the shoulder’s rotator cuff start changing about age 40.

As those parts lose resilience, stressors like underuse or overuse of muscles and tendons and even emotional stress can cause strain or injury.

Posture is the problem for most people, says Jeffrey Manning, a chiropractor who owns the Manning Wellness Clinic in Dallas. “People look down at their computer, their phones. So the muscles in the front of the neck will start to become shortened and less flexible, and across the shoulder blades they’ll become stretched, but not in a good way. It’s like trees leaning into the wind.”

This begins a cycle that can change joints and bones as they react naturally to the physical demand. “Good stress, like healthy exercise, strengthens bones. But if you stress bones in an imbalanced way, they react in an imbalanced way, and that messes up the mechanical balance of the working joint,” Manning says.

The stress of busy, complicated lives or the emotional toll of bad days or sad life events are often manifested in stiff muscles in the neck and shoulders. Stress hormones worsen the problem, Young says.

“Your muscles get knotted up by very real physical tenseness,” Young says. “But the stress is twofold: Your stress does tend to be carried in the form of shortened muscles in the neck but it also changes the biochemical markers in the body. The same chemicals that are released when you are in stress or in pain are fuel for the pain of muscle tension.”

When to see a doctor

Moen says he wishes he’d gone to a doctor after six months of suffering rather than two years. But Young says to go after more like six weeks.

For one thing, she says, studies show that chronic pain can rewire the brain so that discomfort continues even after the cause is resolved. Plus, many issues can be addressed with conservative measures such as physical therapy, ergonomic changes to the workplace, exercises, modified activity and medication — as long as the problem is accurately diagnosed and caught early.

For stiffness without pain, seeing a doctor may not be necessary. But it’s probably a signal to make changes, these experts say: Be sure you work at a computer with your neck in a neutral position. Exercise regularly; the blood flow helps keep muscles and tendons healthy. Don’t constantly look down at your phone; look up and enjoy the scenery.

“It may start out as a posture issue. Then after six months or a year it becomes a matter of the joints just not working properly anymore,” Manning says. “Your body is such an intricate machine.”