Observation revealed a forward head posture and forward rounded shoulders. Examination revealed an Upper Crossed Pattern of muscle imbalance with trigger points in the neck and the upper trapezius muscles. Spinal joint fixation was noted in the upper neck and the upper and lower back. Muscle tightness was noted and tenderness was elicited with pressure over the area of complaint. Interestingly, the symptoms were most easily reproduced with left rotation and left lateral bending of Paul’s head. X-rays revealed a complete loss of the normal curve in the neck along with moderately to advanced disc degeneration at the C5 disc level.
Pauls’s pain was not directly caused by a local structure or tissue in his shoulder blade area. It was referred pain from the C5 disc in his neck. 70% of all pain felt in the scapular region, all the way down to the lower border of the scapula, is referred from the neck. Our medical team began corrective treatments including postural re-education, spinal rehabilitation, cervical spine decompression, muscle release techniques, and spinal manipulation (adjustments). Pain resolved quickly and has not returned. This is another example of how focusing on the area of complaint would be an ineffective course of action.