I've been having some neck pain, and I can't turn my head all the way to the left to match how far I can go on the right. My physical therapist assures me that this will all clear up with a few treatments. I'm worried there's more to it than that. What if there's a tumor on one side or some kind of blockage?

It's a well-known fact that the cervical spine (neck) and the scapulae (shoulder blades) are linked or connected by nothing more than muscles. Specifically, the upper trapezius and the levator scapulae muscles. These are referred to as the cervicoscapular muscles.

Anything that affects one affects the other. So the fact that you can't turn your head as far in one direction as the other could easily be as a result of the tension in the cervicoscapular muscles. The therapist can do (and your therapist has probably done) some tests to help sort this out.

For example, neck motion is increased when the upper arms are supported or lifted up. This can be done by having the patient sit with the forearms supported on the chair's armrests. Testing neck motion in a neutral position (arms down at the sides) and comparing it to motion with the arms supported gives the therapist a good idea of the influence of the upper arms on neck motion.

Exercise programs to help restore full neck motion will take this information into consideration. Some of your exercises will be done with the arms in neutral. The same exercises may be repeated with the arms supported. By practicing normal alignment and motion, you can retrain your neck and muscles to move normally and thereby reduce pain messages that tell you something is wrong (or at least something isn't quite right).

Today's therapists are trained to look for causes of neck and back pain that could be something serious requiring medical attention. They know when to refer the patient to the physician for evaluation of infection, tumors, or fracture (the most common problems requiring medical treatment).

Let your therapist know your concerns and questions. If you are not experiencing an improvement in your symptoms after two or three treatments, bring this up with your therapist. Anytime you have serious misgivings, you should always check with your physician. It's wise to listen to your inner intuition. Patients are often encouraged to follow this advice: when in doubt, check it out.

Reference: 

Guilherme Trivellato Andrade, PT, et al. Influence of Scapular Position on Cervical Rotation Range of Motion. In Journal of Orthopaedic & Sports Physical Therapy. November 2008. Vol. 38. No. 11. Pp. 668-673.

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