Hello All!

We just got lucky.

Dr. James Warson, neurosurgeon and the only physician in the world exclusively specializing in equestrian health, is launching a new column just for our community called "Ask the Doctor".

Dr. Warson is a renowned physician and writer. He is a distinguished military surgeon who served in Viet Nam. He is also an avid horseman and previous owner of J&J Farms training and show barn which produced 23 national and world champion Morgan horses. He has generously offered to share his vast medical knowledge with our community.

Dr. Warson invites all our members to ask him any questions at all about injuries, aches and pains, or any other issue that is affective your health and well-being.  Just post your questions in the comment box below!

Question:

  I have had chronic neck pain for several years. It comes and goes and is most pronounced when I wake up in the morning. It seems to be located on the left side of my neck. I also notice that when it is really bad, I also have a headache. Both seem to feel better as the morning progresses.

A bit of background: I am left-handed and years ago, I had surgery to correct a dislocating left shoulder. My last two horses both have both been stronger in the left rein and I have been told that I ride with my left shoulder somewhat higher and in front of my right shoulder.

Help!

Answer:

I'd love to see you actually ride, or else a video, but here goes.

Dressage riders who are middle aged or older and have ridden for a while commonly suffer with neck pain. It starts like this; as we age, we tend to use the muscles of back extension less. This tends to result in the forward thrusted position of a middle aged riders' pelvis during dressage rides. When this happens, the neck becomes flexed forward during the ride in order to balance the head. This chronically stresses the muscles of neck extension and makes them irritable. Irritable muscles often tighten up during sleep. Once you're up and using the neck muscles, you stretch them and stretched muscles become less irritable.

  Shoulder surgery is the extra here. Most shoulder dislocations are anterior, and the surgical repair results in tightening ligaments anteriorly. This may produce stress on the neck through chronic elevation of the shoulder also.

You have a really fascinating complex of problems, but here's the bottom line - It sounds like the shoulder either wasn't rehabilitated fully after surgery, or the muscles have tightened perhaps due to discomfort. I would suggest a 3 way approach:

1. Shoulder examination for strength and range of motion.If there are deficits they can be addressed.

2. Appropriate nonsteroidal antiinflammatory medications combined with heat, not ice, to the shoulder and neck. The heat should be moderate, not high, so that it can be applied for a longer period of time once or twice a day.

3. An Xray of the neck would be good to see if there are potential problems there. If no problems are evident, you might benefit from a single course of cervical traction in a seated position for 15 minutes with a 12 to 15 pound weight twice a day for only about 30 days. Consult your physician to see if this is safe and appropriate for you.

After all this if effective, you don't want the pain to return. Lumbar spine extension muscles that are strengthened will hold you in a more vertical frame when you ride and will equalize your forward and backward pelvic movements, resulting in a more natural,fluid moving ride. Look at the gold medal rides on youtube. Those riders are beautifully balance in their forward and backward movements in the saddle.