Nagging Neck Knots
I’ve had a knot in my upper back right above my scapula on the left side at least since I was a teenager. I remember sitting during piano lessons and massaging that spot near the top corner of my shoulder blade and even seeing a massage therapist to try and treat it. I was told to carry my backpack on both shoulders but that was really all the advice I got. Fast forward to me as an adult and that same knot was still there. I noticed during stressful times it would flare and really irritate me (like when studying for a big exam). I got to the point where I decided to try acupuncture simply because I wanted someone to stick a needle in it to break it up!
I have seen and felt that knot on others over and over again in the treatment room.
From a muscular point of view, the culprit is often the levator scapulae muscle. It attaches to the transverse processes of C1-C4 (the upper portion of the neck) and then to the medial (inner) aspect of the scapula from its superior (uppermost) angle to the root of the spine of the scapula. It plays an important role in raising the scapula, helping to rotate the neck to the same side, and supporting lateral flexion (side bending) of the neck.
(Image: Finando, D., & Finando, S. J. (2005). Trigger Point Therapy for Myofascial Pain: The Practice of Informed Touch. Healing Arts Press.)
This muscle is frequently afflicted by muscular constrictions and trigger point activity - in other words, the muscle is in a tight and shortened state, full of knots that cause referral pain patterns, and it’s not getting enough blood flow! You could have an issue with this muscle if you have pain in the red area pictured here. You may also have pain on the side of the neck and possibly the posterior (back) of the shoulder and midscapular area. You may feel discomfort or stiffness with bringing your ear towards your shoulder or rotating your neck to the same side of tightness or pain. You will likely have limited range of motion on that same side. It may be observed that your resting posture has your neck slightly bent with your ear leaning towards the side of pain and/or that the scapula is elevated on the side of pain.
(Image: Finando, D., & Finando, S. J. (2005). Trigger Point Therapy for Myofascial Pain: The Practice of Informed Touch. Healing Arts Press.)
What causes this muscle to get aggravated?
It could be poor posture, particularly with sustained head and neck rotation to one side. For example, you may be unconsciously tilting your head while working on your computer and that position may become your default posture.
What does Chinese Medicine say about this area?
Another reason for knots in this muscle could be because of emotional tension and difficulty with mental clarity. This is because the meridian that treats the levator scapulae muscle is the Small Intestine.
From a physiological perspective, the Small Intestine is an important organ that receives food and drink directly from the stomach and then separates out the nutrients we need from the components that can be eliminated through the Bladder as urine or through the Large Intestine as poop. Expanding on this idea of separation, the Small Intestine has a psychological role in helping us with mental clarity and judgement. The energy of the Small Intestine is about having the power of discernment; the ability to identify relevant issues and see them clearly before making a decision. When the Small Intestine Qi (energy) is deficient, decisions cannot be made because the various options can’t be differentiated.
I wonder about this area getting particularly tight for those dealing with mental fog post COVID infection or post concussion. It’s entirely possible that treating this muscle will help clear that brain haze.
Interestingly, if there are muscular symptoms along the Small Intestine muscle channel pathway, you may also experience tinnitus (ringing in the ears) or pain of the ear that may reach the submandibular region, which is the area below the corner of the jaw. The Small Intestine has multiple pathways that enter the ear, so if you are experiencing ear symptoms, it could be that the Small Intestine meridian is out of balance.
So what can you do?
Since this is a postural muscle to keep your head up, you most often do not need to strengthen it. Instead, stretch exercises can help lengthen this muscle. Give the following at try!
Bend the head toward the unaffected side, leaning the ear toward the shoulder on that same unaffected side. Rotate the face approximately 30 degrees to the unaffected side. Flex the neck slightly by looking down, directing the stretch forward and toward the unaffected side.
For a deeper stretch, while holding the above position, hold the wrist of the arm on the affected side behind the back and pull slightly.
(Image: Finando, D., & Finando, S. J. (2005). Trigger Point Therapy for Myofascial Pain: The Practice of Informed Touch. Healing Arts Press.)
If you frequently sit at a computer, I recommend addressing your work ergonomics with an in-person ergonomic professional.
To support mental clarity, you can meditate (even for 5 minutes!) or do a moving meditation like Qigong. I like Mimi Kuo-Deemer who has many Qigong videos. Since the Small Intestine is a fire element, you can try her 13-minute Qigong for the Fire Element. You’ll notice she also talks about the Heart meridian, which is the organ that is paired with the Small Intestine. We’ll explore more about the Heart, Small Intestine, and neck/shoulder pain in another blog post.
But will the knot ever resolve?
Resolving the trigger points in the levator scapulae is certainly possible! I definitely found relief with my chronic knot through acupuncture, better work ergonomics, and movement practices.
When I address the levator scapulae in the treatment room, I use a variety of methods including acupuncture on trigger and motor points, electroacupuncture, cupping and gua sha. Some people call this type of acupuncture dry needling or trigger point needling. When there is a tight overly contracted muscle like the levator scapulae, acupuncture needles precisely inserted into specific spots on the levator scapulae muscle helps reduce the local contraction of the muscle and reset the entire muscle to bring lasting pain relief and postural improvement. When I add electric current to the needles, the extra energy helps break up the tension, decrease inflammation, clear scar tissue and other debris, and improve the blood flow. Gua sha and cupping this area are fantastic modalities that increase blood flow to the area, break up fascial adhesions, and reduce inflammation.
So I believe resolving the knots for long-term relief requires both a practice at home and in-person treatments.
I would love to hear how your levator scapulae muscles are doing!
Book a free 15 minute consultation to see how acupuncture could support you.
Sources:
Deadman, P., Al-Khafaji, M., & Baker, K. (2016). A Manual of Acupuncture. Journal Of Chinese Medicine Publications; Vista, California.
Finando, D., & Finando, S. J. (2005). Trigger Point Therapy for Myofascial Pain: The Practice of Informed Touch. Healing Arts Press.
Maciocia, G. (2015). The Foundations of Chinese Medicine. Elsevier Churchill Livingstone.
Whitfield Reaves, & Bong, C. (2009). The Acupuncture Handbook of Sports Injuries & Pain: A Four Step Approach to Treatment. Hidden Needle Press.
Gabi Curbelo is a licensed acupuncturist in Albany, CA specializing in therapeutic and intuitive treatments for wellbeing, musculoskeletal pain management, and facial concerns.
