Persistent Trapezius and Occipital pain post C-4/5 Discectomy

Try a physical therapist who does massage, manual vestibular retraining it's called and gentle manipulation of the surrounding tissues and muscles first. Ask for heat and manual myofacial release. Massage, dry needling and those other techniques helped me a ton too. Similar problem as you, but different surgery. I can't take pain meds, so I opted for the PT and was sooooooo glad I did.

I'd try an occipital nerve block.
I'd also want reimaging of the C4-5 to ascertain that everything is as it should be.
If you see a pain speciality, they should be able to do the block and order MRI imaging. If you are anywhere near a university pain clinic, you might try there. Some orthopedic surgeons also perform the blocks.
https://www.cedars-sinai.org/programs/pain-medicine/specialties/head-neck/occipital-nerve-block.html#:~:text=During%20an%20occipital%20nerve%20block,used%20for%20the%20nerve%20block.
Hoping you get relief.

@ajames5 First, let me welcome you to Connect. I am a cervical fusion patient. I see that you are about 2 months past your surgery. I know for me, that period was when the surgical scar tissue started to tighten up. I also have thoracic outlet syndrome or TOS, and this exists right next to the spine where the nerves travel from the spine under the collar bone and down the arm. Those are very small spaces and muscle and facsia tightness will compress the nerves there for me. Adding some inflammation from a surgical procedure next to it, did increase the TOS arm pain for me. Many spine patients also have TOS because it can be caused by an accident, whiplash or repetitive stress type injury or even poor posture.

The remedy was physical therapy to loosen up the tight tissue with myofascial release. That may be an answer and definitely worth a try so it's worth asking your surgeon for some physical therapy. Even though you have moved, you are still a patient under the surgeon's care. Is there a plan to follow up remotely with X-rays to check for fusion status? You may also be having muscle spasms. That happens to me because of the TOS which makes one side of my neck to be tighter than the other, and when it gets kicked up, it starts rotating my vertebrae, mostly C1 & C2, but it has rotated them all down to my fusion level at C5/C6. That causes pain at the occipital area on the back of the skull because of muscles that attach there that are getting pulled.

I think you will get past all of this as you heal, but it helps to learn some self treatment stretches from a myofascial release therapist so you can self treat at home to maintain your condition. Muscle spasms can cause so much pain, and if you can work out the knots in the muscles and release the tightness in the fascia, it allows the body to function and move better, except for the fusion area of course. You do need your surgeon's permission and a script for therapy. I had to wait about 4 to 5 months for that, but I also had a fusion done without hardware and they wanted to make sure it was stable.

I do sometimes get a tight trapezius knot like you described, and I did some deep tissue massage on it with a Theracane to work out the knot, and also plenty of MFR stretching which helped a lot. I have been doing MFR work for at least a dozen years because of TOS and it has helped me a lot, and also helped me have a better result with my spine surgery because the tissue was easier to retract during surgery because it was looser, and after, it helped in my recovery after the scar tissue from the incision had healed.

Here is our discussion about MFR (Myofascial Release) where you can learn more.

Neuropathy - "Myofascial Release Therapy (MFR) for treating compression and pain"
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/
There is a provider search at this link. https://www.mfrtherapists.com/

Has your surgeon suggested any physical therapy?

So I'm not sure if I had a fusion? I had the two titanium cages so maybe the fusion is part & parcel of the work?
I did a little PT after two months but it was very rudimentary. The pain wasn't there again yet.
I'll try the myofacial release and with a new doctor at The Center for Pain Institute, if they will do a nerve block, great. This is not getting better. I have that theracane and have been just hooking it over my shoulder and pressing hard with the ball part on the trapezoid knot. It happens to be in the same trouble spot massage therapists seem to want to break up but it never has. Maybe a natural place for it to occur?
I did have two follow up x-rays-one after a bad bicycle accident I landed on my chin requiring stitches there and kneee. It was all still in place!
Thanks for advice. I have a starting place.

@ajames5 Typically cages are inserted when a disc is removed and that is a fusion when it all heals and bone grows into the cage. The abbreviation is ACDF for Anterior Cervical Discectomy and Fusion. The surgical scar tissue does periodically tighten up, and I have to work on mine. I also use a red (softer) "Davinci tool" which I can hold in my hands and press with a sideways shearing motion on a tight spot and hold it or put it up against a wall and push into it. That is how myofascial release works, and you just wait for it to untangle itself. It's kind of like pressing in to knead bread dough except you push and hold it against the pressure. You can lay on small firm balls where it is tender to use your body weight to stretch the fascia. It may help to use a heat wrap before you try to stretching to help it relax and soaking in epsom salts in a bath may help because magnesium helps muscles relax and you'll absorb it through your skin. You can also use webbing straps and foam rollers to help stretch or even your hands if you can get them in position to press in and have a sideways shearing motion. I'm guessing from your response that perhaps your surgery wasn't recent. It wouldn't matter what doctor refers you to physical therapy as long as you find a really good therapist. In the MFR discussion, there are a few videos that you may want to watch that explain how it works.

Good luck in your quest.
Jennifer

Hope you have found relief. If not ask for a trigger point injection. They are very helpful to me

I’ll add dry needling in the trapezius as an alternative to trigger point injections. It can break up knots as well.
PTs trained in dry needling can do it so it could be easier to access than injections done by docs.
Insurance may not cover dry needling as part of PT but usually the extra charge for dry needling is not too much.