• Matthew Anstey MCSP HCPC

Nerve pain or muscular pain?


Sometimes it can be tricky to work out whether you have a trapped nerve or painful muscle. What makes it even more tricky is sometimes a trapped nerve in one place can cause pain in a different area altogether.

The most common example of this is pain at the medial border of the scapula (the shoulder blade region). This can be a muscular issue, but can also be something called cervical radiculopathy. This is when a nerve gets trapped in the neck, but pain is referred down the thoracic nerve and can transmit pain into the scapula region. The pain feels very much like it is in the muscles, and sometimes it is, but if a release of this region does not help then the neck needs to be investigated by a musculoskeletal specialist physiotherapist, as it is more than likely a nerve being pinched in the neck giving the symptoms.


If this is the case you may also get pins and needles or numbness down the arm, usually on the same side. An investigation into these areas should aim to identify the level from which the nerve is being irritated or pinched. A thorough neurological assessment should also be completed to identify the extent of the issue, and to make sure there is no nerve compression.

Once identified, treatment will consist of mobilisations to try and free the nerve, some tractions to open the region up. Then exercises are essential to improve biomechanics and prevent the nerve from being irritated/pinched again.

You should never have your spine manipulated when you present with these symptoms as one wrong move can cause a more severe compression of the nerve which can result in more permanent symptoms. Manipulation of the neck should rarely be done due to the number of highly sensitive structures around the neck. If any of these structures including the arteries/spinal cord are compromised, there are likely fatal consequences. Neck manipulation is rarely the best long term solution anyway, as the delicate structures of the neck are unlikely to have permanent relief from such aggressive forms of treatment.

Physiotherapy for cervical radiculopathy, pain down the arm, in the neck or in the shoulder blade regions can help give natural, effective and permanent resolution of radicular symptoms.


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