Hi,
I understand your frustration and need to address the problem via safe and skilled assessment / treatment.
It is difficult for me to find therapists when I need to refer, let alone patients finding someone. As you have experienced, trial and error is not
always successful. Theoretically we have the training as therapists to treat most problems or refer to those that do. In practise the system
can fail due to clinic marketing, poor networking or lack of experience. Therapists tend to have different levels of experience due to chance dependent
upon who walks in the door over many years. I have worked in closed head injury neuro, multi orthopaedic trauma, community health, nursing homes,
District hospital as head physio and private practice (over 19 years). All therapists with experience tend to have strong opinions regarding their areas
of interest and it can be difficult to refer and have the therapist treat as recommended. As I am in Australia and you are in England the difficulty is magnified.

I believe that you would benefit from a very deep tissue massage to the Right Levator scapulae muscle trigger points (where the muscle joins onto the scapula).
This is different to usual massage and only takes two to three seconds. Warning: it hurts! I use my index finger middle joint. Then the scalene muscle attachments onto
the Right Wikipedia reference-linkfacet joints of the neck are given deep tissue massage at C5,6,and 7. Levatore scapulae stretches are taught. C6 and 7 facet joint mobilisation is given.
If you have a therapist that has been trained with the (Australian) Maitland method they would use a fact joint glide twice per level at a grade 4 plus. Don't worry
about the jargon, it is just a rating system that helps communicate what we do, like music notation speaks to a musician.
Regarding Wikipedia reference-linkMRI etc, you may not require this type of scan for your level of problem in the neck. I treat this regularly without need for scans. Scans are more relevant for
more serious referral with other presentations. The shoulder Wikipedia reference-linkrotator cuff may benefit from an ultrasound scan to check the bursa and supraspinatus tendon. If you have an acromial spur (smal bony spur underneath the bony shoulder overhang near your AC joint) a specific x-ray view can confirm.

The shoulder alignment exercise follows. You could try this, but it may be better to have the neck treated first. If you have a sub deltoid bursitis it can be eased by a specific deep tissue technique
where pressure is applied at a 45 degree angle underneath the acromian and above the arm bone where it fits into the socket. There is a small gap there that occurs with the arm hanging by the side. You cannot easily do this to yourself. If that doesn't work a cortisone injection can help. Try Voltaren or Feldene non steroidal gel if you wish to avoid an injection.

Give the neck and shouldr time to recover. Imagine the nerve root in the neck like a garden hose. If you park you car tyre on the hose then drive off the next morning, the hose will have
a kink in it even though there is no compression anymore. The water will not flow at full pressure until the kink is reduced. The nerve impulse acts the same way. Give it time. All the muscles will require strengthening and need to learn how to act in the proper synergy before full symptom reduction occurs. By the way, you can have a painfree C7 yet still have referred pain.

Let me know any urther thoughts you may have.


There is a procedure for the sciatica as well, also involved, if self treating.

Shoulder retraining and strengthening
1. In sitting - Place your fists on the seat at each side of your hips, and
slightly behind you.
2. Look forward keeping the chin level.
3. Lift your shoulders toward your ears, and roll them back and down
feeling your shoulder blades pinch together.
4. Keeping the shoulder blades pinched back, push down onto your
fists gently as if you are to lift your bottom off the seat.
5. Hold the position for 10 seconds, repeat 10 times at the first session,
and do 2 sessions per day.
6. Progress each day by increasing the number seconds held or the
number of holds per session on alternate days. For example: Day one
10 secs/10 times; Day two 11 secs/10 times; Day three 11secs/11
times; 12/11;12/12 etc
Over 3 weeks gradually build up your tolerance to eventually achieve
20 second hold and 20 repeats, twice daily.
Once you have achieved this level reduce to 20 seconds 20 repeats
once a day for a week.
Congratulations, you have corrected the problem by improving muscle
strength endurance & length as well improving posture. The next step is
to maintain the good work by doing the exercise occasionally.
Hints
Be certain that the shoulder blade pinch is maintained when pushing
down with your fists. Use a rolled towel each side of your hips if the
surface is soft eg a padded couch or bed.
If you feel muscle tightness across the abdomen you are leaning back
too far.
If soreness is felt through the neck you may be pushing down too hard
with your hands or not keeping the head level.
It is normal to feel exercise muscle soreness, especially when beginning
this exercise. If you are concerned regarding any symptom change,
please phone your therapist for advice.

Write the procedure onto a calendar AM & PM then tick off as you proceed.
MrPhysio+