Background
A 42-year-old banker and mother presented with a six month history of persistent neck and shoulder pain, along with intermittent headaches. The pain fluctuated, often worsening during high-stress workweeks and feeling better during weekends. She had no clear history of injury.
She tried stretching routines she found on social media and then a couple of massage sessions. She felt better a little while, but the headaches and neck pain kept returning. The pain cycle started to interfere with work demands and being a mother.
Why Stress Can Drive Pain
Chronic stress is a commonly underappreciated driver of neck and back pain, though many patients expect a “structural” explanation for pain. Our biomedical culture circles around a structural cause most of the time with scans and exams.
However research shows that stress can amplify pain through several ways. Upper trapezius or shoulder muscle tension arises from chronic sympathetic nervous system activation resulting in a sustained muscle contraction. The pain cycle gets reinforced with worrying about the pain and how it is interfering with quality of life. This also can heighten muscle tone and pain sensitivity [1,2,3,4,5]. A forward head posture during work tasks feeds into the tense muscles and contribute to headache onset [6]
Examination Findings
During her assessment, several important findings emerged:
- Movement and posture assessment revealed forward head posture and rounded shoulders, contributing to cervical extension strain.
- Stress and anxiety screening revealed high work-related stress, poor sleep, and frequent muscle tension during heavy work weeks.
- Pain patterns showed symptoms worsened when her frustration grew with the pain and its unpredictable nature indicating an emotional component to her pain.
- Upper cervical spine exam revealed hypomobile segments and significant tenderness in the upper trapezius and suboccipital tenderness.
Treatment
Her care plan targeted both the physical and cognitive aspects of pain that included manual therapy, specific postural exercises, pain reprocessing coaching, electro-dry needling to break the chronic muscle tension, pain science education and stress management strategies such as breathing strategies and organizing her day better.
Outcome
By six weeks, she was able to work full days without flare-ups. She modified her work station to reduce postural strain as well as take more frequent breaks. She modified her day to get up before the kids so she’s not waking up in a reactive mode but rather in a proactive mode. When she did begin to experience tension rising, she was able use her new stress management strategies from developing into a full flare up.
Key Takeaways
Stress and anxiety can be powerful but overlooked drivers of musculoskeletal pain that is missed as a contributor to pain in the medical system. Postural strain adds another level of load onto a stress-induced muscle tension that then creates an upper cervical mobility dysfunction. In this case, addressing both the body and mind was the best approach in resolving her pain.
References
- Tavakkoli, Maryam, and Fatemeh Bahrpeyma. “Elastic Modulus of Suboccipital Muscles, Cervical Range of Motion, and Forward Head Posture in Cervicogenic Headache.” Archives of Bone and Joint Surgery, vol. 11, no. 10, 2023, pp. 589-596
- Weatherall, Mark W. “Muscle Contraction Tension Headache.” StatPearls, StatPearls Publishing, Dec. 2024,
- Hassinger, H., et al. “EHMTI-0360. Chronic Sympathetic Activation in Migraine Headache: Unique to Migraine or Common to Sympathetic Nervous System Disorders?” The Journal of Headache and Pain, vol. 15, suppl. 1, 2014, article C39
- Weston, Eric B., et al. “Cognitive dissonance increases spine loading in the neck and low back.” Ergonomics 66.12 (2023): 2133-2147.
- Wiech K, Tracey I. The influence of negative emotions on pain: behavioral effects and neural mechanisms. Neuroimage. 2009;47(3):987-994.
- Fernández-de-Las-Peñas, C., Cuadrado, M. L., & Pareja, J. A. (2007). Myofascial trigger points, neck mobility, and forward head posture in tension-type headache patients. Cephalalgia, 27(5), 445–450.
