We might be inclined to think the solution to neck and arm pain is in the neck or arm, but in many cases, we would be wrong. Sometimes a wider perspective is just what the doctor ordered.  We’ve consulted an acupuncturist, a chiropractor, and a pain clinic physician to get their approaches to this problem.

    Michael Max, the director and an acupuncturist for Yong Kang Chinese Medical Clinic, says he sees many people with neck and shoulder pain that radiates down the arm. “I often find that the shoulders and upper back are the problem, but not always. Sometimes the source of the pain can be a long way from where it is felt, like in the feet.”

    Chinese medicine assesses blockages in ‘the flow of chi,’ using the meridians, or pathways, that chi follows. Because those meridians have branches, a problem with the feet, through those branching channels, can cause pain in the upper body. “I use acupressure on different points of the meridians to see if it has an effect on the pain,” Max explains. “The flow of chi can get interrupted and clogged, like plumbing, and cause a backup (pain) in one area, and a deficiency (weakness and tingling) in another. Acupuncture restores the flow through the body, like using a snake for your clogged plumbing.”

    Besides reducing pain, acupuncture on the meridian points of influence also helps the person reach a relaxed state where the body can release tension and recalibrate itself, helping the muscles to stop working against each other.

    Robert Elder, a chiropractor with Metro Chiropractic and Nutritional Wellness Center, uses standard chiropractic adjustments to restore spinal alignment and alleviate neck and shoulder pain. Part of his workup with a new patient includes traditional X-rays and muscle-testing to identify the source of the pain. He sometimes finds that the problem relates to gait or foot-ankle imbalances, so he also may adjust feet, ankles and knees.

    “Chiropractic uses many tools,” Elder says. “In addition to X-ray, we apply math, engineering and physics to the spine and its natural curvature, and on down the body. We aim to fix the problem, not the symptoms. I’m seeing more chronic subluxations (misalignment of vertebrae). If I adjust someone who repeats with the same problem, I know there is more going on.”         Sometimes patients have pain without any misalignment, Elder notes. “More and more, I’m finding pain to be a nutritional issue. Sometimes, the pain is coming from an organ that is missing key nutrients, causing repeated skeletal problems,” he says. That’s where his nutritional testing comes in. He assesses the organs that may be involved, like the thyroid, determines which nutrients are missing and works on adding dosages of that nutrient. Elder reports that his nutritional response testing and treatment have been so successful, other chiropractors are referring patients to him.

    Dr. Rachel Feinberg, medical director for Injury Specialists pain clinic, says she sees patients with chronic pain who have been everywhere else. “They can have pain and still have a negative MRI,” she says. “Only 2 percent have an identified problem, such as a herniated disk. The other 98 percent need careful assessment. Often missed are the biomechanics: a leg that’s too short, misalignment in the thoracic spine, or a locked-up rib cage. The biggest mistake we make in pain treatment is not integrating the biomechanics. Medicine today has become so specialized, we forget how to look at the whole person.”

    Feinberg says, “There’s an art to the exam, and an art to really listening to the patient, not just looking at the neck and arm, if we are to find the real problem.” She explains that a bone spur, for example, pressing on nerves in the neck, can form because one leg is too short. It would cause rotation in the lumbar spine, and a counter-rotation in the thoracic spine that compresses neck muscles.  That pain can stay in the neck or radiate down the entire arm.

    “This type of pain is very treatable with body work to mobilize the thoracic spine and rib cage,” she says. “Massage is not invasive, but if the pain is long-standing, the muscle work by itself won’t necessarily relieve the pain. If the massage can’t get the muscle entrapment to release, then I use a very fine needle right over the problem area and inject a tiny amount of local anesthetic and a little cortisone to reset the nervous system and relax the muscles so we can manipulate the spine. It makes a huge difference.”