Massage Case Study- Back Pain Worse with Breathing

James (not his real name) was suffering with a dull pain and persistent tightness under and between both of his shoulder blades. This tightness would ‘catch’ and feel significantly worse with breathing in. Sometimes the tight feeling would go up into his neck, or his arms would get achy and feel heavy, with the left arm being much worse than his right.

There are a variety of different causes for some of these symptoms, so an Orthopaedic Assessment was conducted, including posture and range of motion tests. However the ‘catching’ with breathing is typically due to a problem with the ribs, and the arms feeling heavy is usually due to compression of the Brachial Nerves. (These nerves run from the spine at the back of the neck to the front of the neck and then into the arms.)

The Orthopaedic Assessment confirmed there was restriction in the movement of some of his ribs, as well as significant compression of some of his Brachial Nerves. The Posture and Range of Motion testing also indicated specific muscles that also needed treatment.

So there were several parts to James’s first treatment.

• The first part focussed on releasing his muscle tightness and joint restrictions in his neck (cervical spine area), mid back (thoracic spine area) and rib cage (costal) area.
• Then (with James’s permission), mobilisation of his thoracic spine and ribs was performed.
• Next, the Strain Counter Strain Positional Release technique (SCS) was used to significantly reduce the muscle tightness and restriction in the muscles between his shoulder blades (rhomboid muscles).
• While his rhomboid muscles were being treated, James advised that he was experiencing the heavy feeling in his arms. As there are no nerves that go from this area into the arms, this suggested that the heavy arm feeling was a referred sensation rather than from compression of his Brachial Nerves. So we did not treat these nerves at that time.
• Finally, the SCS technique was used to release his tight chest (pectoral) muscles, as tightness here often causes tension in the rhomboid muscles.

James had a second appointment a week later, and he reported that the pain between his shoulder blades was fully resolved and that his left arm was feeling significantly lighter. After further Orthopaedic Assessment we found that there was still compression of the Brachial Nerves for his arm. As the problem with the rhomboid muscles was resolved but the arm heaviness was only reduced, it seemed that the heaviness was a combination of referred sensation and nerve compression. So we treated James’ neck and the pathway for the Brachial Nerves (Thoracic Outlet) in order to relieve the compression on the nerves.         

At his next appointment a week later, James reported that all of the issues had been resolved. He received the occasional massage treatment since then if his arm heaviness started to return. Now, 3 months down the track, he gets the occasional mild sensation and that is all.

As this Case Study illustrates, careful assessment and diagnosis is the key to getting great results for any condition.

Our expert remedial massage therapists average over 20 years experience, so if you have a back, neck, shoulder, hip or other muscle or joint problem, feel free to book in with one of them.