That neck and shoulder pain has been with you for more than a year. Each time it flares up, you put on a medicated patch, take a few painkillers, once even went for a few sessions of acupuncture, and it eases. A few weeks later you wake up one morning with your neck as stiff as before, and turning your head to the left sends a sharp twinge. The report from your neck X-ray sums it up in one line: mild degeneration. You don’t know whether to feel reassured by the word “mild” or worried because the pain never quite goes away.
We hear this kind of story quite often, about the neck and shoulders, the lower back, the knees or the heels. Many treatments aim only at the spot that hurts, while the thing causing the pain may lie in the feet, in the jaw, or in a worry that has gone on for a long time.
Where it hurts and where the problem is can be different places
Every home has a bottle of medicated oil and a few pain-relief patches. Rubbing wherever it hurts is a natural reflex, and often it really does feel better. Traditional medicine has a classic saying, “where there is free flow there is no pain; where there is pain there is no free flow” (通则不痛，痛则不通 / 通則不痛，痛則不通, tōng zé bù tòng, tòng zé bù tōng): when qi and blood circulate freely there is no pain, and pain means something is blocked. The catch is that the blockage is not necessarily right under the hand doing the rubbing.
Why it can hurt in one place when the problem is somewhere else
Many areas of the body share nerve pathways back to the spinal cord. When one area has a problem, the brain sometimes reads the signal as pain in a different area. Medicine calls this referred pain. A few examples of pain that does not sit where the problem is:
- A problem in the hip joint, while the person, especially a child, complains of knee pain;
- A pinched nerve root in the lower back causing pain and numbness along the buttock and the back of the thigh, down to the calf;
- Small tight knots in the neck and shoulder muscles sending pain up to the temple, easily mistaken for a headache;
- A heart that is short of blood supply can show up as pain in the left shoulder and left arm, sometimes reaching the jaw.
The last example is why the doctor always asks carefully before thinking about muscles and joints.
Pain in the lower back, root in the feet
The body stays upright thanks to many muscle groups pulling against each other, like a tent held up by many guy ropes. If one rope goes slack at one corner, the rope at another corner has to pull harder to keep the tent from falling. Professionals call this a compensation chain. A foot with a fallen arch turns the knee inward, the pelvis tilts with it, and the back muscles on one side tense up more to keep balance. A few years later, the place that hurts is the lower back, while the shoes at home have long since worn down unevenly on one heel.
Compensation is what lets us keep walking and working. If treatment targets only the lower back that is doing the extra work, the pain eases for a while and then often comes back, because the arch of the foot is still fallen as before.
Three directions to look for the cause
When examining long-lasting pain, the doctor looks in turn at three directions: structure, chemistry and mind, which the clinic calls the health triangle. Some people are stuck in only one direction. In people who have had pain for many years, we often find two groups of causes layered on top of each other, sometimes all three.
Feet, jaw, eyes
The structural group includes joints, muscles, ligaments, the spine, and also the way you use your body every day. Besides the feet, two places that are often missed are the jaw and the eyes. People who grind their teeth in their sleep, or clench their jaw when stressed, make the chewing muscles and neck muscles work all night. Glasses with the wrong prescription, a screen set too low, and long hours holding a phone gradually push the head forward, and the muscles at the back of the neck have to hold up a head sitting off-balance all day.
Micronutrients, hormones and the medicines you take
The chemical group is whatever is circulating in your blood and in your cells, including micronutrients, hormones and the medicines you are taking.
A lack of magnesium can also make it hard for muscles to relax, and a blood test does not always pick it up (DiNicolantonio et al., 2018); this is covered on its own in our article Normal blood magnesium but still twitching, cramps and poor sleep.
Thyroid disorders or the changes around menopause can come with tired muscles and joint pain. The medicines you take also need to be asked about. Some cholesterol-lowering drugs in the statin group cause muscle pain in some people. If you suspect this, do not stop the medicine on your own; tell the doctor who prescribed it so you can review it together.
Worry makes muscles tense
Long-running worry leads many people to tense their neck and shoulder muscles all day without noticing, and even when they lie down at night the muscles have not let go. The pathways by which stress acts on the body are described in our article Tension, stress, sadness: when everyday emotions affect your health.
Your first visit to the clinic
For your first visit, plan on about 30 to 45 minutes. The doctor takes your history, does a clinical examination by modern medicine, the four examinations of traditional medicine (looking, listening, asking, taking the pulse) and a functional neurology examination, then does muscle testing following Applied Kinesiology (AK).
Muscle testing helps the doctor follow each direction of cause. You place your own hand on the area suspected of having a problem (therapy localization), or the doctor presses gently on a joint in a particular direction (challenge), then the same muscle is tested again to see how its response changes. To check the chemical group, you hold in your mouth, or sometimes just smell, a small amount of a mineral, an electrolyte or a medicinal substance before the doctor tests again (Walther, 1981, pp. 45–50). For the mind group, the doctor checks for stress in the frontal lobe, the limbic system and the cingulate gyrus. The mechanism is explained in our article Why the doctor tests muscles during the examination.
Imaging and lab tests remain the main basis, and muscle-testing results are read together with them. When needed, the doctor will suggest an X-ray, an ultrasound or a blood test before treatment, or refer you to the appropriate specialist.
Treatment based on the causes found
Acupuncture and moxibustion
Osteoarthritis and shoulder pain are among the types of chronic pain examined in the pooled analysis by Vickers et al. (2018); the figures are in our article Acupuncture. Points are chosen according to the causes found during the examination, and the doctor personally performs the moxibustion (warming points with burning mugwort).
Herbal decoctions
The herbal decoction is modified to fit each person’s pattern. People with long-standing pain are often already taking painkillers, and some are also on blood thinners. Herbs can interact with the painkillers and blood thinners you are taking, so you need to give the doctor a list of your medicines; read more in our article Herbal decoctions.
Meals and micronutrients
When the examination finds a problem in the chemical group, the doctor gives guidance on adjusting your meals and, if needed, on taking micronutrients such as magnesium at a specific dose and for a specific length of time; sometimes the doctor suggests a lab test first. Micronutrients also have doses and interactions, so taking them as directed is safer than buying a few more bottles because of an advertisement.
Changing habits and exercising at home
The doctor shows you a few exercises within your ability to do at home. Alongside them come small changes such as raising your screen, changing your shoes, rethinking your pillow and having your eyes rechecked for glasses.
When to see a doctor or go to hospital right away
Most musculoskeletal pain is not dangerous. With the signs below, you need emergency care or a hospital visit before thinking about acupuncture or herbal decoctions:
- Pain after an accident, a fall or a heavy injury;
- Fever together with one joint that is swollen, hot, red and painful;
- Weakness or paralysis in the arms or legs, or numbness and loss of sensation spreading widely;
- Being unable to pass urine, leaking urine, or losing control of your bowels, especially together with back pain;
- Unexplained weight loss together with bone or joint pain;
- Pain at night that does not ease with rest;
- Pain in the left shoulder, left arm or jaw together with chest tightness, shortness of breath or breaking out in a sweat; call emergency services at 115.
Frequently asked questions
I’ve already had an X-ray. Do I need another one?
Bring your images and all your earlier results, including normal ones. The doctor reviews them together with the examination; if the information is enough, there is no need for new imaging. More imaging or tests are done only when the examination raises a question the old images cannot answer, or when you have any of the signs in the section above.
My X-ray says degeneration. Does that mean nothing can be done?
Degeneration is the change a joint goes through over the years, and what shows on the image does not always match how much it hurts. Some people have clear degeneration on their X-ray but little pain; others have mild changes but a lot of pain. That gap often comes from muscles, posture, micronutrients and sleep, things an X-ray cannot capture. A joint that has changed rarely goes back to how it was, but the pain and how well you can move usually still have room to improve.
How long before it gets better?
Everyone is different, so the clinic does not promise a timeline in advance. Recent pain with a clear cause usually changes faster; pain that has lasted many years, with several causes layered together, takes longer. After the examination, you will know the treatment plan and the date for your follow-up review. If the pain has not shifted by then, the doctor will review the diagnosis and talk it through clearly with you.
Worth keeping
- Write down your pain score each day on a scale of 0 to 10, along with what makes the pain worse or better;
- Turn over the shoes you wear most and see whether one heel is worn down unevenly;
- Raise your computer screen to eye level, and every 30 minutes get up and walk around for a few minutes;
- Ask the person who sleeps beside you whether you grind your teeth in your sleep;
- Write down every medicine, supplement and micronutrient you are taking to give to the doctor;
- Bring your old X-rays, ultrasounds and lab results when you come for your visit;
- Go to hospital right away if you have any of the signs in the section above.
If your pain keeps going while your X-ray only says mild degeneration, bring your images to your visit; how the clinic combines its methods is described on our Treatment methods page.
Dr. Dinh Ngoc Duc (MD, MSc in Traditional Medicine) is responsible for the medical content of this article.
References
- Vickers AJ, Vertosick EA, Lewith G, MacPherson H, Foster NE, Sherman KJ, Irnich D, Witt CM, Linde K. Acupuncture for chronic pain: update of an individual patient data meta-analysis. J Pain. 2018;19(5):455-474. https://doi.org/10.1016/j.jpain.2017.11.005
- DiNicolantonio JJ, O’Keefe JH, Wilson W. Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis. Open Heart. 2018;5(1):e000668. https://doi.org/10.1136/openhrt-2017-000668
- Walther DS. Applied Kinesiology, Volume I: Basic Procedures and Muscle Testing. Pueblo: Systems DC; 1981. Chapter “Chemical and Nutrition Testing”, pp. 45–50.
