What is upper trap pain?

Cervical radiculopathy occurs when a nerve root coming off the spinal cord becomes compressed. The compression can occur for various reasons. In younger people, it may occur when a cervical disc herniates due to trauma. In older individuals, it commonly occurs spontaneously as a result of arthritis or decreased disc height in the neck region.

The cervical spine consists of 7 cervical vertebrae (the bones that form the neck region). Each vertebra is separated by a gel-like disc. The discs provide shock absorption for the spine. The spinal cord travels through a canal in the cervical vertebrae. Spinal nerve roots extend from the spinal cord and branch off going to specific locations in the arm. The spinal nerves send signals to our muscles for movement as well as sensations that we feel in the entire arm. The spinal cord is like a tree trunk, and the spinal nerves are like the tree branches. If an impingement or abnormal pressure is placed on a branch near the trunk, everything along that branch will be affected.

What are common causes of upper trap pain?

Spinal nerves can be impinged by:

• Arthritis or disc wear-and-tear with age
• Herniated or bulging discs from trauma or degeneration
• Spinal stenosis, which is a narrowing of the spaces in which the nerves travel
• Tumor, which can be benign or malignant, impinging the nerve root

When the spinal nerves are impinged, they cannot properly send messages to the muscles from the brain, nor receive proper sensation from the specific arm location the nerve travels. Everywhere the spinal nerve travels will be affected. That is why a pinched nerve in the neck can cause pain, weakness, and loss of sensation in the arm, even though the pinch is in the cervical region.

What are symptoms of upper trap pain?
Symptoms of cervical radiculopathy vary depending on the nerve root involved, and commonly occur on the same side of the body as the affected nerve. The symptoms may include:

Pain in the neck, shoulder blade, shoulder, upper chest, or arm, with pain possibly radiating into the fingers following the path of the involved nerve root.

• Pain described as “sharp” or “pins-and-needles” or “popping sensation” in cervical region.
• General dull ache or numbness anywhere along the pathway of the nerve.

• Weakness in the shoulder, arm, or hand.
• Pain that worsens with certain neck movements.
• Pain that improves when the arm is lifted over and behind the head (relieving tension on the spinal nerve).

These symptoms may also be specific to the nerve root involved:

• C5 nerve root – weakness in the deltoid muscle (front and side of the shoulder) and upper arm; shoulder pain and numbness
• C6 nerve root – weakness in the bicep muscle (front of the upper arm) and wrist muscles; numbness on the thumb side of the hand
• C7 nerve root – weakness in the triceps muscle (the back of the upper arm and wrist); numbness and tingling in the back of the arm and the middle finger of the affected hand
• C8 nerve root –weakness with hand grip; numbness in the little finger

The most common nerve root levels for this condition are C6 and C7.

Where does it hurt?

In most cases of upper trap pain, patients report constant ache and burning muscle pain right in the upper trap muscle and neck area. This can happen on one side or both sides. If this is a chronic cases of upper trap pain, active trigger points in the muscle can refer pain into the neck and head and present as a headache. Your nervous system is a lot like a tree, with the ‘base’ of the tree near your neck and the ‘branches’ running through the rest of your body. Because of this, it’s possible to feel the effects of a pinched nerve in other parts of your body besides your neck. Understanding the root cause of your pain is fundamental approach to treating your pain in the long run & will decrease your dependence on painkillers or treatment that only address the symptoms.

Can upper trap pain be treated?

Yes, upper trap pain can be treated and with great results. Even better, many times it can be treated conservatively without needing injections, pain medications, or surgeries. The key to treatment is to solve the root cause of your pain so you can get the best results and a long term outcome.

Some root causes of upper trap pain can be:

• Forward head posture
• Rounded shoulders
• Weak mid back and shoulder blade muscles
• Overload to the upper trap muscles
• Tight neck and mid back

If you have failed multiple treatment approaches already, the clinician missed the real root cause of your pain and was just chasing the symptoms. The pain or symptom is the effect, not the cause. What do I mean by this? For example, say your fire alarm goes off in your house. Its purpose is to protect you and make you aware something is wrong and that there is a fire in the house. “The alarm” is like your pain (your body’s way of telling your something is wrong) and “the fire” is the root cause. When the fire alarm goes off you don’t run upstairs and just turn it off, right? You run through the house with the fire extinguisher, trying to find the room where the fire is at, to find out what caused it to go off, so you can put it out. Then once the fire is out, then the fire alarm can go off. Solve the “root” cause of your pain, and then the pain (“the effect”) eventually goes away.

Additionally, there is a common root cause that many clinicians misdiagnose. They treat the upper trap pain with a cookie cutter approach hoping it will work, thinking it is an actual simple muscle problem. They tend to rely on stretching, ultrasound, massage, and focus treatment directly on the upper trap muscle. However, often the root cause is missed and the symptoms return. So many healthcare clinicians do this and show poor treatment outcomes, resulting the pain coming back because they missed the root cause of your upper trap pain. This is also the case when patients turn to injections, nerve blocks, and other surgeries that end up still not working because the actual problem still is not solved and treatment was just chasing the pain

The first step in treatment is to identify the root cause of your pain. A specific and individualized treatment approach for your type of pain can lead to a successful outcome for you and resolve your symptoms. For the long term too! This is why you can’t rely on a standard cookie cutter approach and you need a customized and individualized treatment approach specifically for your type of upper trap pain.

“On my first visit with Ron, he did a thorough evaluation and identified the underlying issue with my shoulder. […] Within a week, the pain in my shoulder was significantly decreased. […] What’s been amazing is that I’m realizing how much I’d been accommodating a reduced range of motion and pain in my shoulder for who knows how long! Bottom line: I highly recommend Ron and Pursuit Physical Therapy.“

Anne E.
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What happens if it goes untreated?

Minor case – If it is a minor case of upper trap pain, research shows that many acute cases of pain may spontaneously go away in 4-8 weeks. But who wants to wait 8 weeks to get pain free? Let’s try to solve the root cause of you pain in 2-3 weeks and address all of the risk factors present (so it never returns!) and get you back to your favorite activities faster! We still recommend that you get it checked out by a one of our board certified physical therapists to ensure that it is just a minor case, to solve all risk factors, and to get the optimal outcome in the fewest visits needed. Most minor cases resolve on their own in time, or get better with some stretching and strengthening. But, the sooner you take action, the sooner you are pain free. (and research support this!)

Severe case – If it’s more of a severe and chronic case of upper trap pain, your pain will probably start to worsen and increase because the root cause of the pain is not being treated. Many people turn to pain medication at this time but this only blocks the pain for short term. You may not feel the pain when taking pain medications, but the underlying problem is still there. Many people say after the pain medication is stopped, then usually the pain returns and sometimes it returns even worse. This is when you may experience chronic muscle pain, radiating pain into you neck, shoulder blade, or shoulder. You may even begin to experience a headache. At this point the trigger points in the upper trap muscle become painful to touch and commonly cause increased neck pain and worsening headaches. Sometimes in severe cases, it can happen on both sides of the neck. Even though it’s more chronic now, we can still help. Once the root cause is addressed, then we can start decreasing your pain, regardless of how chronic and severe the pain is. This is the crucial first step. It just may take more time to recover from a chronic case. Usually with chronic and severe cases, the longer you have your pain and injury, the longer it takes to resolve.

What outcome can you expect from treatment?

As we’ve discussed, the first step is to solve the root cause of your upper trap pain. This is the most essential step to plan a treatment specialized for you and your unique type of pain. Your root cause will guide your treatment and dictate what is the best way to treat your pain. This, along with identifying risk factors that may be predisposing you to have your pain and injury, will allow you to start getting pain free again. The next step is to start decreasing pain, modifying activities, and start addressing all of the impairments causing your pain which we discovered during your evaluation. With each session, pain should start to decrease and you should start to regain range of motion with less pain and symptoms. Any radicular and referred pain should resolve fast as well. At this point, we begin light and basic strengthening only if it does not increase pain. Treatment will consist of a lot of manual therapy and light exercises.

The next step is to achieve full range of motion, (which should correlate to being pain free) and now we can start progressive strengthening. Strengthening the muscles is crucial and research shows that this gives you the best long-term outcome! As you start to get stronger and maintain your mobility, your pain will continue to decrease if it is not already gone. Your increased strength will allow you to perform more activities and prevent flare ups. This usually does take up to 4 weeks. As you clear our goals, then we can start easing you back into sport, golf, running, and whatever your favorite activities are. This is when we start winding down treatments and getting you back into functional strengthening, sport specific training, return to run programs, golfing, and whatever your goals are. At the end, we reassess everything, making sure we achieved all of our goals, your goals, that all risk factors are gone, and finalize your long-term home exercise program. There are many factors which can influence your outcome, but 85-90% of our patients respond well to our treatment approach and achieve a successful outcome when completing their plan of care.

How is it diagnosed?

When you seek the help of a physical therapist, the physical therapist performs a comprehensive evaluation and asks questions about your pain and your daily activities. These may include:

• How and when the pain started: Did the pain begin spontaneously or was there any trauma or popping experienced in the cervical region?
• Where are the symptoms located, and have they changed location or intensity since the onset?
• What makes the symptoms better or worse?
• What type of work do you perform?
• What hobbies or household activities do you regularly perform?

Your physical therapist will gently test the movement of your neck and arms. The therapist will check your tendon reflexes and strength, and conduct special tests on your neck and upper extremity to determine which spinal nerve root(s) may be involved, and to rule out other conditions. To provide a definitive diagnosis, your therapist may collaborate with an orthopedist or other health care provider. The orthopedist may order further tests, such as magnetic resonance imaging (MRI) or electromyography (EMG). An MRI can show soft tissues, including the spinal cord and nerve roots. This test can determine what is causing the compression on the nerves, including disc bulges or disc herniation. An EMG measures the nerve and muscle function. This test can tell how well your spinal nerves are communicating to your muscles.

Do you need an X-ray and MRI imaging for upper trap pain?

For most common orthopedic cases, imaging is not needed and the diagnosis can be made with a simple physical therapy evaluation. No need to waste thousands of dollars on unwarranted diagnostic imaging. We also have clinical tests which we can perform to help rule in and rule out pathologies that correlate to MRI findings (which is WAY cheaper than an MRI!). An expensive MRI may just tell us what we already know. Also, often times the positive findings found on x-rays, MRIs, and EMGs may not actually be the root cause of your pain. What does that mean? Many positive findings on an MRI are also found in asymptomatic (pain-free) individuals, so diagnostic imaging may not be able to tell us what is actually causing your pain. For example: many people have a herniated disc in their low back but do not have any low back pain. So if herniated discs can cause no pain, just because someone with low back pain has a herniated disc does not mean that is what’s causing their pain. The key is to find out if your clinical evaluation findings during your evaluation at Pursuit match the MRI findings. If so, then we can decide what is the best way to treat it.

How can a Physical Therapist treat it?

Physical therapy is an effective treatment for cervical radiculopathy, and in many cases, it completely resolves symptoms. Your physical therapist will develop an individual treatment plan based on the findings of your initial evaluation. The treatment plan may include:

Pain Management. The first goal is to reduce the pain and inflammation in the area. Ice packs applied to the neck and scapular (shoulder blade) region during the first 24 to 48 hours following the onset of pain, help reduce inflammation. Moist heat can be used after this time period to help the surrounding muscles relax. Your physical therapist may advise you to wear a soft cervical collar at times throughout the day, to allow the neck to relax. A cervical contoured pillow may be recommended to properly support the neck, and allow you to sleep more comfortably.

Manual Therapy. Your physical therapist may use manual therapy techniques, such as manual cervical traction, to relieve pressure in the cervical (neck) region. This procedure can provide immediate relief of pain and numbness radiating into the arm. Gentle massage may also be performed on the muscles of the cervical spine and scapular (shoulder blade) region. This technique helps the muscles relax and improves circulation to the area, promoting healing and pain relief.

Posture Education. Posture education is an important part of rehabilitation. Your physical therapist may suggest adjustments to your workstation and work habits, to promote good posture to protect your neck. In the early stages of recovery this may mean sitting only 15 to 20 minutes at a time. You will also receive instructions on how to bend, reach, and lift throughout the day in safe positions that place minimal pressure on your spinal discs.

Range-of-Motion Exercises. Your physical therapist will teach you gentle cervical mobility exercises to relieve your symptoms, and allow you to return to normal movement. In the beginning stages of recovery, it is important that none of these exercises increase the pain radiating down into your arm. It is important to communicate your symptoms accurately to your physical therapist. If you spend many hours sitting at a desk during your workday, your neck may become stiff. Your therapist will teach you neck stretches to take pressure off of your neck from extended periods of sitting, to help improve your mobility.

Strengthening Exercises. Your physical therapist will help you determine which muscle groups need to be strengthened based on which spinal nerves are involved in your particular case. When pain no longer radiates down your arm, you may begin more aggressive strengthening exercises. Neck stability (strengthening) exercises will also be performed. You will receive a home-exercise program to continue strengthening your neck, shoulder, arm, and upper back long after your formal physical therapy has ended.

Functional Training. As your symptoms improve, your physical therapist will work on functional exercises to help you return to your job, sport, or other daily activities. For example, if your job duties require overhead reaching, pushing, pulling, and long periods of sitting, you will be taught ways to perform these tasks to reduce undue stress to the neck.

“After at least three years of doctor-hopping […] looking for someone to alleviate my constant dizziness and neck pain, I finally found Dr. Miller. I have more energy and less pain, and have halved my dependence on painkillers. He shouldn’t be the last stop on your road to recovery, he should be the first.”

Lisa B.
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How long does it take for recovery?

Recovery time for upper trap pain in the neck depends on multiple factors:

• The severity and chronicity of your pain
• Whether your pain is an easy or complex case
• If the root cause of your pain was solved or if it was missed (this is the key to getting a great recovery!)
• How long you have been in pain for and when you need to be pain-free by
• Other therapies and treatments you have tried
• Which medical professional(s) you saw prior to seeing us
• How active you are in trying to resolve your pain
• Which treatment approach is chosen and if it is proven to work for your pain

There are many factors that influence your recovery time and every patient’s recovery time is different. If you do nothing and don’t pursue treatment, it could gradually get better on its own, you could continue to have the same pain persist, or it could continue to get worse. As stated earlier, most acute cases may or may not resolve in 4-8 weeks. If you get expert treatment that solves the root cause of your pain, some cases resolve in 1-3 weeks! Then you can get back to sports, exercise, and your favorite activities without flare-ups and recurrences. Some of our patients are pain-free in 1-3 visits and back to 100% in 2 weeks!

If it is a complex case with chronic pain, your recovery may take longer, but you can still get a good outcome. Some chronic cases can resolve as fast as 2 months but can take as long as 4-6 months. It varies with every patient because every case of neck pain or of upper trap pain is different. Every patient’s recovery varies depending on the factors listed above. After a thorough evaluation here at Pursuit Physical Therapy, you will know your exact timeline of recovery, your prognosis, and when you should reach your goals.

How much does it cost?

The average cost of care for a case of spine pain in the US is $1800-$6600. This high price is due to many factors: the over-inflated cost of healthcare, the over expensive cost of unwarranted imaging (x-rays, CT scans, and MRIs) that is not needed, over-utilization of care (which increases the number of visits needed to be treated, requiring multiple visits to different doctors and physical therapists for the same diagnosis), and getting billed for unnecessary and unproven treatments that you don’t even need. All of these factors increase cost and this is why healthcare is so expensive. We strive to end that unnecessary, expensive cycle. In fact, we are currently publishing our first-year data with the University of Central Florida that shows the cost-effectiveness of our treatment approach.

This year, the average cost of our care was shown to be $814-$1141. Some of our patients get even as low as $315 for the full treatment! So if you have a deductible of $3,000-$10,000 and you have to pay out of pocket for your treatment, we can save you lots of money.

Remember, every case of upper trap pain is different and not all neck pain is the same. It is hard to predict exactly how much your treatment pain is going to cost you. But after a thorough evaluation, we can tell you exactly what is causing your pain, how long it is going to take, what the best way to treat it will be, and exactly how much it is going to cost. We have no hidden fees, no co-pays, and no miscellaneous bills that you will be surprised by 3 months after you receive treatment. Your pain, your diagnosis, your goals, and what is best for you dictate your treatment and how much it will cost, and while it varies for every patient, treatment at Pursuit is still much more affordable than standard healthcare.

How long are sessions?

Our evaluations are always one-on-one with one of our board-certified specialists and 60-90 minutes long. We like to perform thorough evaluations so we can solve the root cause of your pain, identify all risk factors, and make sure that we do it right. After the evaluation, you will know your diagnosis, the root cause of why you have your pain and symptoms, your prognosis, an expected timeline of when you should see results, what the best way to treat your pain is, how much it will cost, and your expected recovery outcome. We want you to fully understand everything about your pain and injury. What is best for you and will get you the best outcome is what will dictate your care and treatment. There will be plenty of time for you to ask questions so we can make sure you fully understand why you have your pain and what the best way to treat it will be. After the evaluation is completed, all treatment sessions are 60 minutes going forward and still one-on-one with your physical therapist. You and your physical therapist will design a customized treatment plan that works for you and that will achieve your goals.

What are the next steps?

Getting started is simple. The first step, and the key to getting you pain free again, is to solve the root cause or your case of pain. Remember, not all pain is the same. Your pain is different than someone else’s pain, even though it may be in the same area. If you’re ready to get pain free, give us a call at (407) 494-8835 or fill out the form below. The next step is to schedule your evaluation so we can solve the root cause for you. We’re happy to answer any questions you may have and we would love the opportunity to help you.