Neck and Shoulder pain is very common. In my experience, there are plenty of fitness enthusiasts that have suffered, or continuously suffer with this problem. After a question from a reader that was along these lines, I was prompted to look into this and during my research, I found the “go to guy” who is far more qualified to help in this department than me. So I went ahead and asked him some questions and the owner of www.ThePhysicalTherapyAdvisor.com – Ben Shatto has very kindly offered to write a guest post. There is some great advice in this article that will really help anyone with neck and shoulder pain and I believe that if this information is practised in every day life, it will prevent neck and shoulder pain completely

So over to Ben Shatto of ThePhysicalTherapyAdvisor.com. (Ben has also supplied us with a PDF of his recommended exercises that are mentioned throughout the article. This can be found by CLICKING HERE )  –

back-and-neck-painImagine how much the average person actually slouches during a day.  Slouching during breakfast, then hunched over the kitchen sink to wash dishes, slouching while driving a car, and then slouching while sitting at work or at a school desk.  Don’t forget about slouching while texting, watching TV or using the computer.  When you are not slouching, you’re bending over to clean or pick up children and/or pets.  The list of slouching possibilities is endless!

Now envision your training posture.  Does it look any different?  What areas do you train most—your chest or back?  Push or pull?  Exercise enthusiasts experience many of the same aches and pains as their sedentary counter parts.  Shoulder, upper back, and neck pain is a common occurrence.  The most typical cause is almost always poor posture.  Poor posture leads to altered biomechanics and muscle imbalances that eventually lead to pain.  Poorly designed training routines only worsen muscle imbalances as many choose to emphasize the anterior (front) part of the body while neglecting the posterior (back) portion.

Our spines are designed to move many directions including both forward and backward.  The problem is that we spend most of our time in a slouched, hunched over (flexed) position.  Think of the amount of time you’re spending hunched over your electronic devices!  The rounded shoulders forward head posture tends to be even worse in people who are taller than average or in teenage girls and women (as many will slouch to modestly hide their chests).  Slouching is often associated with a posterior pelvic tilt, which causes a reduction in the normal lumbar curve that increases your risk of developing low back pain (LBP).  Over time, this constant flexed position causes excessive strain on the posterior muscles of the spine.  It begins to overload the vertebral discs and ligaments which can also lead to pain and injury.

Poor posture causes improper spinal positioning and affects the neck, shoulders, low back, mid back/thoracic, and ultimately, the entire body.  This flexed (slouched) posture leads to postural muscle weakness which causes us to slouch more as well as predisposing us to injury.  This position can also cause limitations in performance as rib and vertebral mobility worsen.  This can affect proper positioning of your neck, shoulders, and arms during certain lifts (particularly, overhead or when using a pull-up bar).  Strength imbalances between the anterior (front) and posterior (back) half of the body can lead to pain and dysfunction even in a “strong” person.  Most of us don’t adequately train the posterior half of the body.  This can lead to muscle imbalances and ultimately, pain.

How to improve posture and eliminate pain?  As simple as it sounds, first work on your posture!  Sit and stand up straight.  Initially, it may be difficult because the posterior chain (which includes the back extensors as well as the hamstrings and glutes) are weak in general or in relationship to the front part of your body.  Correcting your posture may actually cause some discomfort as the muscles will be utilized in a way that they aren’t used to.  If you’re already experiencing neck, upper back or shoulder pain, even small changes in posture can have big benefits.  Persistence is crucial if you want to eliminate pain and decrease your risk of injury.

By focusing on posture and biomechanics, you will reduce your risk of injury and pain.  Ultimately, you’ll be able to safely develop more strength.  Take the shoulder for example.  If you have normal thoracic mobility, the shoulder blade can freely rotate back and down as you push or lift overhead.  The shoulder blade, shoulder joint, and the shoulder musculature will allow for the arm to obtain a stable full range of motion (ROM).  The more stable the shoulder, the more weight the arm will be able to safely lift.  If your pecs are tight or over developed in relationship to the back half of your body, then the shoulder blades cannot fully rotate.  This will significantly increase your risk of developing a shoulder impingement and pain.  Nothing will derail your training faster than injury.

Treatment Strategies

Sitting

Sitting is not only a major risk factor for low back pain, but it is also a major risk factor for neck, upper back and shoulder pain because most of us tend to sit in a slouched posture.

  • Limit your sitting. Limit the amount of sitting that you spend at one time.  Move from your sitting position every hour, and ideally, walk.  If you aren’t able to walk, then try to shift your position at least once every twenty minutes in order to regain a more erect posture.  Frequent position changes can help you to avoid prolonged static postures that cause excessive strain on tissues and muscles that can result in pain.
  • Sit with correct posture. Whenever possible, make sure that your knees stay below your hip level and that you are able to maintain your natural lumbar curve.  A McKenzie Lumbar Roll is a great tool to help you maintain correct posture.  Your shoulder blades should be positioned slightly backwards and down while you’re sitting in a tall position.

Activation of the Nervous System

In the case of poor posture, it’s common that the upper trapezius muscles become over active (which causes pain and muscle spasms) while the lower portion of the trapezius muscles become weak and disengaged.  This is partially due to the nervous system.  The nervous system often works like a dimmer switch for lights.  It can cause certain muscle groups to become over active while dimming the involvement of other groups.

The trapezius muscle is an important postural muscle.  The more you slouch and hold a forward head and rounded shoulders posture, the more signals the nervous system will send to the upper portion of the trapezius.  This causes pain and spasms.

A standing slouched posture is not much better than a sitting one.  Try to keep proper postural alignment with your shoulders under your ears and the shoulder blades set in a back and down position.  This is particularly important when performing any activity while using your shoulder.  On average, most of us need more activation of our lower and mid trapezius muscles and less activation of the upper trapezius.

Work to improve your posture by keeping your shoulder blades back and downward while engaging your lower trapezius.  When this occurs, the nervous system will automatically send increased signals to the lower trapezius in order to help the muscle hold the posture.  Meantime, the signal to the upper portion is reduced.  This combined with improved thoracic mobility (through foam roll use) should immediately reduce muscle spasms and pain.

Thoracic Mobility

Maintaining normal thoracic (upper back) mobility is critical for proper neck and shoulder function.  The more mobility your upper back has, the less likely your shoulder will impinge while moving.  Your upper back, shoulder blade, and arm must work together when moving.  Tightness in the upper back will prohibit this.  My favourite way to insure proper thoracic mobility is to utilize the foam roller as a self-stretching and self-mobilization tool.

Postural (Extensor) Muscle Strength

To improve postural muscle strength, I prefer to utilize a combination of standing and prone (face down) exercises.  Please refer to Exercises for Postural Muscle Strength.pdf for instructions and photos of exercises that you can perform in order to strengthen the scapular (shoulder blade) and postural muscles.  The purpose of these exercises is to improve your back extensor strength, so it will be easier to maintain proper posture.  You can increase the length of time you hold each exercise as you gain in strength.  In general, spend more time training the posterior half of your body versus the front half.

Upper back pain, neck pain, and shoulder pain is a common complaint.  The key to a long term recovery is to improve your posture, thoracic (upper back) mobility, and your upper back postural muscle strength.  If you continue to experience pain and discomfort after implementing these treatment strategies, please seek additional assistance from a physical/physio therapist.

 Ben Shatto, PT, DPT, OCS, CSCS is a doctor of physical therapy in the United States.  He is a board certified Orthopaedic Specialist as well as a Certified Strength and Conditioning Specialist.  His website, www.ThePhysicalTherapyAdvisor.com, is dedicated to helping proactive adults of all ages to understand how to safely self-treat and manage common musculoskeletal, neurological, and mobility related conditions in a timely manner so they can reach their optimal health.