Unknotting the Tension: Rapid Neck Relief

Dr. Kevin Q. Ng

Have you ever woken up and felt like your neck was tight for no particular reason? If you said yes, I would not be surprised and in fact I would be surprised if you said no.

Chronic non-specific neck pain is a frequent complaint often attributed to myofascial pain. One study estimated the prevalence of myofascial pain as the chief complaint to be 30% in a primary care practice. [1]. In our practice the prevalence is even higher affecting all levels of activity from professional athletes and fitness enthusiasts to sedentary and chronically immobile patients. 

What is Myofascial pain syndrome (MPS)? It is a regional pain disorder caused by the presence of trigger points within muscles or their fascia. It has been described as “hyperirritable spots, usually within a taut band of skeletal muscle or in the muscle’s fascia that on compression can give rise to characteristic referred pain, tenderness, and autonomic phenomena” [2]. The pain of MPS is of a deep aching quality, occasionally accompanied by a sensation of burning or stinging, or restricted active movement. A useful website to determine if these pain patterns are related to MPS is http://www.triggerpoints.net/.

In our recent post on Chronic Dizzyness we discussed briefly how different providers including chiropractors, osteopaths, physical therapists, massage therapists, body work experts, acupuncturists, prolotherapists, and neural therapists would approach myofascial dysfunction. I would like to highlight one of the modalities in trigger point release. Trigger point release is a manual therapy technique used to alleviate muscle pain and tension by releasing or softening muscle knots. I believe nearly all patients should be doing some form if not multiple modes of self-trigger point therapy. When these self-treatment modalities do not completely resolve the issue, or they seem to recur frequently this would warrant an evaluation. A systematic review and meta-analysis found that wet needling (injection therapy) was more effective than dry needling (solid needle therapy) for sustained relief in the neck and shoulders (3). In my experience the key to a successful trigger point injection is a hybrid technique with elicitation of a local twitch response followed by injection as demonstrated in this video. I believe the key to sustaining a trigger point release is a combination of neural therapy, trigger point release followed by acupuncture.

Information for physicians and health care providers:

Myofascial pain and trigger points are a common cause of neck stiffness and pain that may evolve into headaches, dizziness, numbness and weakness. Conservative management can include hydration with repletion of electrolytes, manual therapies, stress reduction and life style changes.  When the above treatments are inadequate trigger point therapy is a simple and effective tool to consider.

1. Skootsky, S. A., Jaeger, B., & Oye, R. K. (1989). Prevalence of myofascial pain in general internal medicine practice. Western Journal of Medicine, 151(2), 157.

2. Simons DG, Travell JG, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol. 1 – Upper Half of Body, 2nd Edition, Williams & Wilkins, 1998. 

3. Liu, L., Huang, Q. M., Liu, Q. G., Ye, G., Bo, C. Z., Chen, M. J., & Li, P. (2015). Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis. Archives of physical medicine and rehabilitation, 96(5), 944-955.