Myofascial shoulder strains are prevalent. They are probably among the most common causes of shoulder pain, and I bet unless you have had one, you’ve never heard of them.
“Myo” refers to muscle. Fascia is the thick Gore-Tex-like covering of many muscles. Myofascial strains refer to irritation of muscles and their overlying fascia.
Myofascial shoulder strains arise from several causes. They may result from trauma, overuse, or unusual shoulder function due to another intrinsic shoulder issue. This last cause is also an overuse phenomenon – but of a slightly different flavor than typically thought of for overuse issues.
Myofascial Shoulder Strains and Their Symptoms
“Burning” or aching are often the words used to describe the symptoms of a myofascial shoulder strain. The pain is usually constant but frequently increases with activity. The most affected areas are the base of your neck, muscles along the top of your shoulder, and muscles around your shoulder blade, particularly those that connect to its inner border.
As mentioned, the symptoms are often worse with activities requiring the use of your shoulder. Additionally, they can also increase with nonstrenuous activities such as reading, keyboarding, and driving.
Causes of Myofascial Shoulder Pain
As mentioned above, there are several reasons for myofascial shoulder strains. These causes fall into three main groups: acute trauma, overuse, and dysfunction due to other shoulder problems.
Injuries that cause this problem are often abrupt events in which very rapid stretching of the injured muscle occurs while it is trying to contract or shorten. Common injuries that often cause this are whiplash-type injuries. These often occur during car accidents. Other everyday events can result in this same problem. Myofascial shoulder strains often result from trying to lift something heavier than expected or lifting something that suddenly becomes heavier, such as when trying to help someone out of a chair who then stumbles and falls.
An overuse mechanism may be the most common cause of this problem. Activities like prolonged reading, driving, and keyboarding require keeping our head and torso in one position for extended periods. The muscles now used for these activities were not designed to do this. They especially weren’t designed to do this for hours (and days) on end.
These muscles evolved ideally to help us scan the horizon for prey and threats and to help us position our hands in space to gather and consume food and defend ourselves. Either way, they were initially intended to be moving. With the advent of the personal computer and cell phone and our work, and play, becoming more sedentary, these muscles are now used for prolonged postural purposes – a completely different task. One they don’t seem to like.
Dysfunction From Other Shoulder Problems
Many shoulder issues alter the way our shoulder functions. Injuries to one structure require another to work differently and harder to pick up the slack. Other shoulder problems, such as a frozen shoulder, shoulder arthritis, and while recovering from shoulder surgery, frequently lead to stiffness of the shoulder joint. This stiffness results in us using our shoulder blade muscles to work uncharacteristically. As a result, myofascial shoulder pain can develop.
Other Causes Of Myofascial Symptoms
Several issues can cause symptoms that are often confused with myofascial shoulder strains. Mostly these are nerve problems of the neck and shoulder. Disc herniations and arthritis of the neck can cause similar burning pain in the shoulder region. Nerve irritation or injury to the nerves of the Trapezius muscle and those that control the shoulder blade can also give similar symptoms. These symptoms occur either directly from a nerve injury or indirectly if the nerve impairment causes malfunction of the shoulder blade.
Diagnosing Myofascial Shoulder Strains
Like most problems around the shoulder, obtaining the proper diagnosis starts with getting a good history of events surrounding the onset of your symptoms. Was there an injury? New activities? New job?
Because myofascial strains can arise due to other shoulder problems, it’s essential to know if there have been any shoulder issues before this one – any prior diagnoses, evaluations, or treatments. Additionally, symptoms such as pain, numbness, or tingling below your elbow indicate a diagnosis other than a myofascial shoulder strain and point towards a nerve issue originating from your neck or, more rarely, your shoulder.
Your doctor should examine your shoulder and, on occasion, your neck. There often is tenderness in the painful areas. Sometimes there may be a notable muscle spasm. An evaluation of your shoulder from your back, with particular attention to how your shoulder blade lies and functions, is also critical. Does your shoulder blade pop out or wing? Does it move normally? Is there cracking or popping with motion? These are all important things to note.
X-rays and other imaging studies of the shoulder, such as MRIs, are only helpful to rule out other potential shoulder problems. Similarly, if a nerve issue of the shoulder seems to be present, an evaluation of your nerves with a nerve conduction study test may help make that diagnosis. However, no imaging or testing findings define myofascial shoulder strains. It is a clinical diagnosis made by appropriate history, symptoms, exam findings, and excluding other pain sources.
Like with most medical issues, the exact cause determines the ideal treatment. However, sometimes the cause is unclear, so it may be wise to attempt a period of safer and simpler treatments with the hope that this treatment matches the cause and corrects the problem.
When other intrinsic shoulder issues, such as a rotator cuff tear or shoulder instability, are the culprit, the goal is to correct the underlying issue. So the causative diagnosis will dictate the appropriate treatment.
Myofascial strains that occur from acute trauma often resolve reliably with time, like other muscle strains. Sometimes you may need medications to control the short-term pain. Likewise, physical therapy with or without dry needling can be helpful to reduce muscle spasms, rehabilitate the injured muscle, and potentially eliminate recurrences.
The most challenging cases to treat are those arising from overuse. The difficulty is that the cause of the problem, often one’s job, usually cannot be stopped. It’s like running a marathon every day and having sore feet – medicines and treatments may help with the symptoms. But the answer to eliminating the issue is reducing the activity. That makes this more of a social problem than a real medical one. In these cases, a cure can be difficult to achieve. But sometimes, we can help.
The advice I often provide centers around changing one’s work environment since eliminating it is rarely an option. Some of the recommendations that I suggest:
1. Fit your workspace to you – Not you to it
If you work in an office, you might find yourself working in a space designed or arranged for the person who used it before you. For those at home, you may be doing work wherever you can. In either case, the workspace may not be ideal for you. Your chair may be too low, your monitor in the wrong spot, your desk at the incorrect height – Whatever the case, your workspace may be requiring your muscles to work in a less than ideal manner and putting tremendous strain on them. Sit down, make yourself comfortable, and adjust your workspace to fit you.
2. Alternate body positions – Use a standing and sitting desk
Even if your workspace is ideal, you may need to be in that space for too long. By alternating your body position from sitting to standing and then back again, you get to use different muscles. Even those muscles that you are continuing to use may be used in a subtly different manner.
3. Take Breaks
You have fit your space to you and have alternated your body positions throughout the day, but you are still doing the same job eight or so hours a day, multiple consecutive days a week. Taking breaks throughout the day can allow your muscles to rest, even when your work schedule says you can’t.
4. Don’t “Chunk” your work
Most of us group our tasks into large “chunks” of time for efficiency. We do all our phone calls, then all our computer work, then reading, etc. When doing this, we must sit in one position and use the same muscles in the same way for extended periods. I suggest spending no more than a half-hour or so on any activity. Then move from one activity to another, like a circuit. Repeat the pattern as many times as needed to complete all of your work.
5. Use headsets or voice recognition software if possible
Using a headset or voice recognition software reduces keyboard and phone call time and allows you to get up, change your position, and use different muscles while getting your work done.
Those who are physically fit have muscles that have greater endurance and capacity. By exercising, even if you are not focusing on the specific muscles involved in myofascial shoulder strains, these muscles will become stronger, have greater flexibility, and gain more endurance.