Riding in a bumpy Jeep Wrangler, Bob's journey from Boston to Houston took him just under 26 hours. He was determined to make the trip without stopping since he would start his new job in just two days.
The day following his arrival in Houston, Bob's left shoulder hurt. It was an odd pain. Located around his shoulder blade, the pain was deep, dull, boring and aching. He tried moving his shoulder around and even had a friend massage the area but the pain remained. Bob searched his memory banks for what could have caused it. Could it have been the drive? How could driving injure my shoulder? Well, it'll go away. I probably just strained it.
A year later, Bob's shoulder still hurt. He had tried stretching his shoulder, applying heat and then when that didn't work he tried ice. He went to an acupuncturist then a massage therapist followed by his family doctor who diagnosed it as a shoulder muscle strain and prescribed muscle relaxers and a mild pain killer. He took the medication but it didn't help. He tried Aleve then Tylenol then Motrin. Nothing helped. Bob was now very concerned. The pain appeared almost as soon as he sat down. It was now bothering him nearly all day long. What is this? How can my shoulder hurt from just sitting?
When you hurt in or around your shoulder, most of us assume the problem is in the shoulder, which is a normal and reasonable conclusion. But nearly all musculoskeletal causes of shoulder pain have a clearly defined incident associated with them. You did something unusual (like hauling 40lb. bags of rock all afternoon) or did something too much (instead of playing tennis for three hours, you played all day) or you injured the shoulder (from a fall, accident or something striking you). When your shoulder hurts in the absence of one of these three instigators, one of the causes for pain in your shoulder may be a creeping neck.
Creep is a term used by engineers to describe how a substance changes shape in response to an applied force over a period of time. Silly Putty is very creepy. If you leave it on your kitchen table over night, the once round flesh colored ball will be a large, very flat flesh pancake. Overnight, the putty creeps or deforms just from the effect of gravity. When a substance is highly creepy, it deforms quickly.
The intervertebral disc, which resides between two intervertebral bones of your spine, is creepy. The disc, consisting of a tough outer ring called the annulus and a soft, jelly-like core called the nucleus, changes shape in response to upright body positions. The force due to gravity causes the disc to shift its shape and deform, much like Silly Putty does by spreading out, but much more slowly. A weak disc creeps more rapidly than a stronger, sturdier disc.
As the disc creeps, the annulus stretches bulging outside the edges of the bones above and below it tugging on the imbedded nerve fiber. The pain from the creeping annulus is a deep, dull, boring and aching quality. You feel it not in your neck or back but in other areas of your body like your shoulder blade. When you lie down, the pressure on the disc drops and it creeps back to its original shape reducing the stimulation of the nerve. The pain gradually goes away until you sit up again.
The longer the force is applied, the more the tissue creeps and the more it creeps the easier it becomes for it to creep again. Creep begets creep. So, Bob's ride was one, long creepy ride. The tissue slowly, insidiously oozed its way to the point of nerve deformation and then bingo his shoulder hurt.
All biologic tissues of the body, including your disc, need physical stress to maintain or improve their health. To make your disc sturdier and less creepy takes time since its blood supply is minimal much like cartilage. The disc gets its nutrition in part from a meager blood supply and the remainder from a diffusion process through the bone. It needs the very thing it cannot withstand: pressure. Pressure, on and off, forces an exchange of nutrients in and out of the disc and greatly improves its internal chemistry. But, if the pressure is too great, the diffusion exchange diminishes. It is similar to what happens when you press down on a water hose. At first, the rate of water flowing through the hose increases but if you continue to press on the hose, the flow will eventually stop.
For Bob to get control of his symptoms and head down the path of rebuilding the physical capacity of his disc, he must give up control. He will have to follow one simple rule. He must reduce the creep by decreasing the pressure in his disc. There is nothing anyone else can do to reduce the disc pressure. There is no magical manipulation nor is there a pressure reducing pill. The simplest way to do decrease disc pressure is to lie down in a comfortable, well supported position for five minutes every 1-2 hours throughout the day (the disc pressures while lying down are five times less than you experience in a sitting position). Once his symptoms subside, which typically takes about two weeks, he can then begin a rebuilding program to improve the sturdiness of his disc and the strength and endurance of his muscles.
Discs creep and when they creep too much, you will hurt. Your body is trying, in the only way it can, to tell you it is under too much strain. Remember, creep begets creep. The less the tissue creeps, the less it will creep in the future. To change the creep, change the pressure.
Make today count.
Author. Teacher. Therapist.