Problem: The client complained of a nagging left shoulder pain and burning pain in the back of the neck which increased during and after playing the violin. The pain was so intense other job options were being considered. Driving was also causing pain especially when reversing and having to turn the head.
Assessment: After undertaking a visual examination of posture and joint mobility I observed the following:
- Elevated left shoulder
- An imbalance in the neck and shoulder muscles
- Both shoulders were forward (rounded)
- On elevation of the left arm, movement was restricted with pain in the lower left shoulder (lower Trapizus muscle)
- On moving the head to the right side there was discomfort
- On palpation scar tissue was found in the shoulder and neck muscles.
Treatment: The effects on certain groups of muscles used and the posture held whilst playing the violin were discussed to provide the client with an understanding of why the pain was occurring. The following course of treatment was then undertaken:
- Deep tissue massage was applied to the muscles of the shoulder and neck to release muscle tightness and remove adhesions.
- Gentle soft tissue mobilisation (massage) to the muscles of the shoulder.
- The trigger points causing the pain were found and treated.
- Gentle stretching exercises were given to help mobilise and strengthen the shoulder.
Results: After the 1st treatment the client reported initial discomfort in his shoulder and neck, but increased mobility. Only upon rehearsing for a concert two days later did he experience burning in the back of the neck. After the 2nd and 3rd treatments the client reported the same initial discomfort, but after a couple of days the pain had gone. He found the exercises given to help relieve the tension were working well. He still felt a burning sensation in the back of his neck after playing the violin. We agreed that treatment would be required more frequently to reduce the build up of scar tissue in the back of the neck. The client now feels that the burning sensation is bearable and he is able to continue with his musical career.