Upper back and neck pain have become epidemic in our modern culture. Endless hours on computers and the stress of a go-go 24/7 work ethic and improper posture contribute to this painful condition. However, acupuncture and massage, with their ability to move qi and blood, are excellent treatment protocols to treat this pain syndrome, which if left untreated can frequently lead to occipital headaches and referred pain into arms and hands.

Interestingly, there are varying theories on what is happening physiologically within the soft tissues that create pain and stiffness. You would think in this day and age of MRI's, CAT scans, and advanced biological discoveries we would know exactly why muscles tighten up and cause us pain. That however, is not the case. In each muscle cell there are numerous chemical interactions that provide not only for our ability for movement, but create the energy we need to sustain life itself. It is the complexity of these chemical interactions that create conflicting views on the etiology of muscle tension. One theory proposes an accumulation of acids (acidosis) from ATP synthesis inhibits sensory nerves and motor point function, while another theorizes an imbalance of ions (calcium, magnesium, potassium) affects the sodium potassium pump that moves the muscle unit in its corkscrew-like motion. A new theory from advanced MRI analysis believes small tears of the muscle on the microscopic level bring inflammator y molecules to the area, creating chronic inflammation, nerve irritation, and reduction of blood flow.

In a Scandinavian study of the body's response to physical and mental stress it was clear that the trapezius not only contracted under low-level physical activity, but also was equally affected by sympathetic nervous system response (mental stress). There is no doubt that whatever the mechanism that contributes to muscle tension, it is universally accepted that the muscle itself has been shortened and its corresponding nerves agitated leading to pain.

In all of these theories, it is apparent that the accumulation of acids, inflammatory molecules, or ions creates local excess within the muscle cell itself. Redness, swelling, radiation of heat, or bruising is common outward manifestations of this process. It is easy to understand how ancient Chinese practitioners interpreted these signs and symptoms as a stagnation of Qi and blood. It is important to understand that the muscles of the upper back and neck perform two major functions. The first is movement, as with rotation of the cervical spine. The second is support of the upper body and head. Two different types of muscle fibers accomplish these actions. Phasic muscle fibers are skeletal muscles that perform what is called phasic contraction. This is the contraction that leads to major muscle movement and allows the body to be mobile. These muscles have fast twitch motor units and fatigue very easily. Tonic or postural muscle fibers are unusual, that part of the muscle is in a continuous state of contraction while a neighboring muscle unit will be relaxed. This is called "tonic contraction" and creates less fatigue and long lasting support within the muscle itself. The trapezius, being the largest muscle of the upper back and neck, actually has both of these types of fibers, probably contributing to it being the muscle most identified with upper back and neck pain.

Muscles that are primarily phasic are the rhomboids, mid-thoracic portion of the erector spinii, and lower and mid portion of the trapezius. The tonic or postural muscles of the upper back and neck are the levator scapula, sternoclidomastoid, scalenes, and upper portion of the trapezius. With a basic understanding of this muscle physiology, it is clear why excess computer work, postural bad habits, and stress are creating a situation in which upper back and neck pain contributes to a loss of billions of dollars in lost work hours. We are putting our muscles in unusual positions for long periods while under extreme stress, causing the body to defend itself. That is what pain is. The body is trying to tell us something is wrong, and if we don't listen the pain gets worse and worse until we finally get help.

From a Western medical perspective, treatment is usually focused on pharmacological intervention centered on muscle relaxers like Soma and Flexeril. In more chronic cases, physical therapy will be prescribed. However, patients are not happy with the side effects of lethargy, dizziness, and unfocused mental clarity that are common in these drugs and their perceived treatment on only the symptomatic level. Physical therapy, while helpful in many cases, has its limitations depending upon the treatment modality.

From an acupuncture perspective, there are, of course, numerous ways to treat this common problem. I jest with acupuncturists at times that a patient can go to five different acupuncturists and get five different treatments: micro systems, balance method, distal vs. local, scalp acupuncture, Japanese technique, Korean Hand. How amazing.they all work!

For the last twenty years and 15,000 upper back and neck treatments, I've used a combination of channel pathology and ah-shi points to help at least 95 percent of my patients with a very simple local, distal, and adjacent needle technique used bilaterally. Classically the local, distal, and adjacent technique is defined as needling into the ah-shi point. This is done by picking a point adjacent or close to the ahshi point and adding a distal point on the meridian the ah-shi point corresponds to

It is my experience that most minor upper back and neck pain comes from the interplay of four muscle groups, the trapezius, upper or lower rhomboid, levator scapula, and the sub-occipitals (splenius capitus, splenius cervicis, semispinalis capitis and cervicis). Upon examination, patients will show you where their pain emanates from, or using orthopedic examination, the offending muscle group can be identified. For example, if a patient's pain is in the lower cervical area usually lateral to C-5, 6, and 7, I needle this ah-shi point along with GB20. Palpating along the upper medial scapula there is usually an ah-shi point in the upper rhomboid (close to SI13) and along the upper trapezius there will be an ah-shi point close to or on GB21. These points seem to work in conjunction to relieve all four muscle groups. I then either moxa these points or use low frequency electro stimulation to move Qi and blood. Distal point choice is usually along the afflicted meridian. (SI, GB, SJ, UB) There is no right o r wrong here, use the knowledge you've gained mixed with a little intuition and you can't go wrong. Tui-na, cross friction massage, and cupping are also very effective when combined with this treatment. If you do not get the results you want, try adding Huatuojiaji points level with the area of pain to your treatment.

When using e-stim, I couple the cervical points together, then connect GB21 to the upper rhomboid ah-shi point (SI13) with a lowlevel frequency. Needle depth is a personal choice for each practitioner. I use a very moderate needle depth and very little needle manipulation as I try to get Qi with my initial incersion. You have to understand the use of electro stimulation moves a lot of Qi. If it is uncomfortable to the patient, switch to moxa or try cupping these points. There are times your needle may be inserted into a motor point, e-stem will] then create a major contraction of the muscle and this can make the patient anxious. Slight re-incersion of the needle usually remedies this situation, although needling the motor point without e-stim can be an excellent treatment.

This grouping of points also works well for occipital headaches and in a modified form, referred pain into the arms and hands, commonly called Brachial Plexus Syndrome. For occipital headaches the addition of BL10 is sometimes helpful as it also relieves tightness in the sub-occipitals, which is usually the leading cause of these headaches on a physical level. Classically, calming liver qi stagnation should always be used in conjunction to alleviate stress, which, as we talked about above, can be a leading cause of tightening of the upper back and neck muscles

When upper back and neck pain is neglected, referred pain into the arms and hands can sometimes occur. This problem is often confused with degenerative disc disease, as the symptoms are very similar. However, unlike disc disease, which will always be dermatome specific in its referred pain pattern, brachial plexus syndrome will cause pain and weakness in varied parts of the arm and hand. This is because the brachial plexus is a group of nerves that originates from C-5,6,7, and T-1. The patient will generally complain about non-specific pain in the shoulder, elbow area, or even the hand. Orthopedic testing using compression or distraction of the cervical spine will usually help in differentiating between disc disease and brachial plexus syndrome.

Treatment of this problem is again quite simple with a slight variation of the four-point needle technique described above. Primary needling will be lateral to C-7. Feel for tight muscle bands or ah-shi pain in this area. Couple this point with GB21 if you choose to use e-stim, along with a coupling of the upper rhomboid ah-shi point and SI12. Although anatomically the brachial plexus passes under the scalenes, use of this four-point technique will usually alleviate the situation. Again, cross fiber massage, tui-na, or cupping of the levator scapula and upper trapezius is an excellent adjunct to quell this radiculopathy. Using a distal point in the referred pain area of the arm or hand can also be added.

In conclusion, I always try to teach my patients a little office yoga. As we stated above, prolonged sitting, computer work, and mental stress is usually the root cause of these conditions. Teaching the patient to take a one-minute break every hour to stretch their upper back and neck cannot be understated. Neck and shoulder rolls, while pushing their scapulas together with a few deep breaths will help move blood into these postural muscles and go a long way in helping them from getting tight. Last, but not least, I try to educate my patients on the benefits of acupuncture's ability to prevent upper back and neck pain if they commit to a maintenance program of at least one or two treatments a month OM