There are muscles encasing our heads and faces. I think people actually understand the concept of referred pain (or non-local pain) when it comes to headaches - they just don’t know they do. Put another way, I don’t hear much about people massaging their head (cranial) muscles, rolling them, stretching them, or otherwise treating those various muscles.
Of course muscles in general can be the producers of symptoms, but it’s rare. I write about this extensively. Everyone loves to name and treat muscles, but, while important, they’re rarely the problem when it comes to orthopedic disorders.
People seem to intuitively comprehend that head pain or headaches can come about for a lot of reasons. Stress, dehydration, allergies, hunger, concussions, and illness to name a few. There are indeed musculoskeletal causes as well - just rarely the muscles. The joints in the neck and mid-back can refer pain (or any symptom) to the head. In rarer cases, the jaw joint can create local symptoms.
If people can understand that their head can hurt not as a result of the muscles in the area and that their chests and arms can hurt due to a heart problem, then hopefully people can start to grasp that arm pain or leg pain is not necessarily due to arm or leg muscles. -- Laura
Differential orthopedic diagnoses for shoulder blade pain include a strain/pull/tear to any of the muscles in the area (there are many) and a shoulder joint disturbance. It’s very rare that you injure one of those muscles - and shoulder joint derangements only infrequently refer pain posteriorly to the shoulder blade. Can a frozen shoulder refer pain back there as well? Sure. But that’s not usually going to be the chief complaint of someone with a frozen shoulder.
The joints in the cervical spine and the thoracic spine can refer symptoms to many areas, and the shoulder blade is a big player. With altered electricity coming from irritated spinal nerves, it’s not uncommon to find spasms or trigger points in the shoulder blade muscles. Those findings are the symptoms, not the culprit. Local weakness can also be a finding due to spinal nerve irritation. I find that in nearly every case I’ve seen in which the person complains of shoulder blade pain (or ache or tightness), we can fix it with repeated or sustained movements of the spine - in the sagittal, frontal, or transverse plane. -- Laura
I always write about not basing orthopedic treatment on imaging findings. We should also not base our treatment on clinical findings that appear to be structural without repeatedly moving the spine and/or extremity. Clinical orthopedic tests for the shoulder have been proven to be unreliable (for example, tests for rotator cuff tears, labral tears, impingement, or tendinopathy). McKenzie clinicians move your spine and extremities, looking for immediate cause and effect. Here, while it looks like the patient has a shoulder problem, when the McKenzie clinician moves her thoracic spine, it resolves. -- Laura
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