The above is an illustration I found on an internet search for "scalene trigger points." Such diagrams were constructed based on the work of massage therapists, among other allied health providers, but I believe they have inadvertently mapped out common symptom distributions for neuroplastic pain/TMS. Such diagrams exist for multiple body regions, and while neuroplastic pain can cause a wide variety of symptoms, I do believe that certain patterns are more frequent.
A few years ago, I had pain, tingling/numbness, muscle spasm, and weakness in these exact areas. As a formerly avid surfer and rock climber, my quality of life went down the drain as I had lost the ability to participate in these activities. I couldn't even lift my arms in front of me without significant discomfort. Carrying my daughter was torture, and I could barely sleep at night.
Several months before these symptoms took over my life, I had undergone shoulder surgery for instability and labral tears. My shoulder was stiff and frozen after the surgery, and extensive efforts to regain mobility had chronically strained the muscles in the side of my neck. My neck was literally so tight that its range of motion was cut in half.
I had symptoms in both arms at that point, and I feared that I had either bilaterally injured the brachial plexus nerves (which pass from the neck underneath the collar bone to the arm), or I had nerve compression in my cervical spinal cord and/or cervical instability. Talk about pain/fear cycle! Despite a normal MRI of my cervical spine, normal flexion/extension x-rays of my neck, and inconsistent/shifting symptoms (one of the hallmarks of neuroplastic pain), I had significant trouble convincing myself that the problem wasn't dangerous.
Below, I'll list in no particular order, the inter-related steps that I used to overcome the problem. This was over a year before I took the Pain Reprocessing Therapy (PRT) certification course, and interestingly many of the steps are similar:
Establishing confidence in the neuroplastic diagnosis:
I kept a mental checklist of the inconsistencies of the symptoms: times when they randomly felt better, or how they would move around in ways that didn't make sense anatomically, and how stress would make them worse, and being around friends made them magically seem better. When I was having a flareup of symptoms, I would remind myself of these inconsistencies.
To understand this next point, take another look at the rightmost illustration above. These are the common locations for trigger points in the scalene muscles. When I would lightly palpate these areas on myself, it would reproduce symptoms in the shoulder, arm or hand. I was careful to be gentle enough so as to not compress my brachial plexus, this was very light pressure over the muscle only. I realized this referred pain had no anatomic basis in the peripheral nerves and could only be explained as a neuroplastic, or mind-body syndrome.
Emotional processing:
I developed these problems at a time in my life when multiple chronic stressors had accumulated, and were in fact acutely exacerbated. When it rains it pours. What I didn't realize was that I was also chronically repressing emotions, in an attempt to "be tough" and to keep up with my responsibilities in life.
The work of Dr. John Sarno, as well as Dr. Howard Schubiner's book "Unlearn Your Pain" were both instrumental in realizing how my personality traits and chronic stressors were associated with my chronic pain. With this newfound realization, I was finally motivated to confront multiple personal and interpersonal issues which had been smoldering just beneath the surface. Releasing emotional tension and developing self-compassion were both important steps: "You have to feel to heal."
Mindfulness:
Learning how to view the symptoms with a sense of neutrality or indifference was important. I again turned to Dr. Schubiner's materials, in this case guided meditations.
This was essentially the same thing as somatic tracking, and I was teaching my unconscious mind that the symptoms were not dangerous. I eventually developed a greater sense of somatic awareness, realizing that my symptoms were correlated with tightness in the scalene muscles.
Addressing the psychophysiologic connection with anxiety:
At one point, I couldn't even think about the symptoms without feeling basically what felt like a really unpleasant mini adrenaline rush. This was invariably accompanied by an exacerbation of the symptoms themselves.
I learned to check in with my breathing when this was happening. Low and behold, it was rapid and shallow, and my scalenes (which are accessory muscle of respiration) were tense and painful.
I learned breathing techniques which stimulate the vagus nerve, and which reverse many of the physical symptoms of anxiety.
I learned how to voluntarily relax skeletal muscle groups, starting in my face and working down my neck to the rest of the body. Relaxed body, relaxed mind. Self-regulation provided an amazing sense of control, which counteracted anxiety.
Physical work
Stretching out my neck muscles not only helped me restore normal range of motion, but also would temporarily relieve the symptoms to some extent. This also helped me realize that my neck wasn't unstable, since the symptoms got better not worse when things were "looser."
Strengthening my scapular stabilizer muscles improved my posture and took the strain off of my neck.
Resuming activities despite the presence of symptoms restored my abilities and my quality of life. It was important for me to progress slowly, especially at first. My motto at the time was that as long as I could tolerate the symptoms despite a higher workload, I would continue progressing. Eventually the symptoms subsided despite an increased workload.
Other cognitive/behavioral work
At one point, automatic negative thoughts dominated my psyche. These were mostly about the pain and it's effects on my life, but also about other stressors and problems. I eventually realized these thoughts were occurring involuntarily, were largely based on cognitive distortions, and were uneccesarily causing physical as well as mental suffering.
I learned how to "let go" of these thoughts, and shift my attention elsewhere. It was hard at first but over time became much easier.
I realize that the above is quite long-winded and may be an overshare. However, if my story can help anyone else recover I feel obligated to share it. Hopefully, it serves to emphasize the mind-body connection in chronic pain, and how a multifaceted problem often requires an equally multifaceted solution. The good news is that this can all be individualized and furthermore that the results are cumulative. It certainly doesn't need to be done all at once, and is best approached in a relaxed manner depending on what you feel like working on in any given day. Or better yet, forgetting about "treating" or "curing" the problem and just resume your activities and live your life!
In my case, the story has a good ending. I'm back to a high level in all my desired physical activities, and while I still have occasional symptoms they are minor and have no impact on my quality of life. Furthermore, my personal experiences have inspired me to start this consulting project so I can help other people overcome similar hardship. I'm accepting new clients and have a passion for this work, so feel free to contact me at any time!
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