Pain in the neck?
I’m sure at least one person thinks you are but I’m also sure you have some redeeming qualities.
But seriously, have you noticed some neck stiffness, decreased range of motion, or pain in one or both sides of your neck?
Do you have any difficulty reaching overhead as part of your daily activities or during your workouts?
What if you are getting a stiff neck on a frequent basis?
What if after work or a good workout your neck and/or shoulders start to hurt for no reason?
And by “no reason” I mean there was no incident that started the pain.
In my experience, when pain comes out of nowhere, there is a movement and/or positional component to your pain and you have unknowingly been working on this problem for quite some time.
And in many cases, your shoulder and/or neck pain may be symptoms and not the actual problem.
Yes, you read that right. The neck pain is not the problem. This means that if you only work on the neck, you will fail to get better.
This. Happens. Often.
Before we get into specifics, I have to mention something that should be part of every rehab/physical therapy journey but is often neglected.
Step number 1, which is the one people skip the most often, is to…
This includes your daily activities, exercise, sports/hobbies, and anything work-related.
For this article, I am going to focus on the exercise piece.
That being said, if you fail to address those other facets of your life then you render the exercise less effective.
There are general rules that I would recommend you follow. These are meant to help put out the fire, so to speak. You will be able to resume all of these at a later date.
The information here works best if you’re dealing with a chronic neck/shoulder issue.
They will also work best if you are not having any numbness, tingling or pain down one or both arms.
If you just hurt your neck or shoulder and/or are having any symptoms down your arm, go see a qualified clinician to get a proper evaluation. Don’t be a dumbass.
While these strategies can work for acute injuries, you need to know what you are rehabbing before you start following any plan.
The other nice thing about the info that I am going to share is that the strategies are conservative in nature. They are all relatively low-risk activities.
Worst case, these just don’t help but they rarely make things worse.
So let’s get into why you might be having pain in the first place and things you can do to get out of pain.
Yup, we have to get this out of the way first.
Posture has become quite the controversial topic. Some people blame it for everything. Others say it doesn’t contribute to anyone’s pain.
The truth lies somewhere in between.
The problem with this argument is that most people are not arguing about the same thing.
People throw out words like normal or optimal to make their point or to disprove someone else’s.
The Evidence-Based Practice (EBP) practice crowd will always point out that there’s no, or very little, research that connects posture and pain.
While I love EBP, some people take it too far and can’t make an educated decision unless research says it’s ok to do so.
Your posture, as I will describe, can be a contributing factor in why you have neck/shoulder pain.
To make sure we are arguing about the same thing, let’s lay out some basic terminology regarding posture.
The first thing we should discuss is neutral posture. What in the wide world of sports is that?
Now before anyone gets triggered, not getting into this position does not mean you currently have pain.
In my opinion, it means you’re heading in that direction. Posture is a slow-moving train and can be “abnormal” for a long time (years) before any pain starts to poke through.
This is another reason why people will argue that posture doesn’t cause pain or have any role in pain.
If you can’t get into this position it does mean that certain exercises are out for you at this point in time. More on that later.
Standing against the wall or a pole is great but this only looks at your static posture or what you do when you’re not moving.
Just because you can get against the wall does not mean you can effectively hold this position when you move around.
Once you start moving, there is a better-than-good chance that your static posture turns into a pile of hot garbage.
This is hard to quantify so it is another feather in the cap of the posture-doesn’t-cause-pain crowd.
If your posture is all jacked up that will seem like an impossible task. But this should be the expectation. And if you lose this position, your set should be finished.
If you struggle to maintain it further, your workout is done for the day.
Part of the issue is that perception and reality when it comes to posture are not aligned.
This is because posture is a learned behavior.
Your brain gets used to your posture, good or bad, normal or abnormal. If you’re rounded forward and have a hard time getting against the wall, your brain will tell you that you’re too far tipped back when you try to straighten up.
Your brain will also nudge you to get back into the rounded position because it is familiar. That is what your brain knows as “normal”.
Getting used to holding that neutral static posture will take some time to get used to.
Maintaining it while you move can take some people months of hard work before they truly own it.
You WILL NOT solve this riddle over the weekend. That much I can promise.
Be consistent and be patient.
Chances are, you’re going to have to spend some time addressing your overall posture.
Remember when I said that posture was a learned behavior? Man, those were good times.
Because of this, your perception and your reality when it comes to what your posture actually looks like are probably far off.
The way to start to change what “normal” is and what it feels like is pretty easy and we have already talked about it.
The wall is critical because it acts as your reference point. This, done repeatedly, is what’s going to change your awareness (perception) of your posture.
I also recommend doing this in your car. I know you probably don’t exercise in your car but this is an easy way to get in some postural re-ed time when you are driving around, especially if your commute is considerable. Here’s how you set that up.
Adjust your seat so the back is close to vertical with your head against the headrest and your hands on the wheel.
From this position, set your mirrors. This is your Reference Point for your car.
It doesn’t take more than a minute for most people to let their head fall forward away from the headrest.
With your head in this forward position, you can no longer see using your mirrors. DO NOT adjust your mirrors.
Sit your ass back where you belong.
This also doesn’t mean you cannot take your head off the headrest to look for traffic but when you can, sit with your head back.
If these strategies feel awkward and uncomfortable that just indicates you need this more than you know.
It also means you probably need some of the other strategies I am going to share.
Performing the postural re-education that I just mentioned might be challenging, especially if your thoracic spine doesn’t extend like it is supposed to.
While not every person has a tight thoracic spine, most people do have mobility issues here.
A common, yet horribly oversimplified, idea for fixing posture is just to sit or stand up taller. If it were that easy then most of us wouldn’t have this problem.
The thoracic spine curves forward naturally. We sit too much and we spend way too much time staring down at our phones, tablets, and laptops.
Even if you’re working on your t-spine mobility regularly it can still be tight. And if you’re never working on it then this could be the hub of your shoulder/neck pain.
If your thoracic spine lacks the ability to extend fully/normally/optimally (choose your favorite word to argue over) then many exercises that could ultimately help are going to irritate both the neck and the shoulders.
As I will mention in a bit, this has a potentially significant role in pressing overhead.
There is a difference between mobilizing your spine and manipulating the spine.
They both do the same thing. They improve mobility of the segments of the spine targeted.
The main difference is the presence of a pop. When things pop, you have manipulated the joint. Well done.
But, you do not need things to pop to effectively mobilize your spine. Not everyone enjoys their joints popping and that is fine.
Mobilizing techniques work even if things are not cracking and popping. And, if your spine is really tight, it isn’t going to crack or pop for a while anyway.
Thoracic mobility exercises are going to be something you should be doing on a regular basis anyway. Even after things feel better.
To get the most out of that improved mobility, you need to pair something with it to use the mobility you just obtained.
Performing your postural re-ed exercise after the thoracic mobility is a great way to get the most out of each.
What are some ways to improve thoracic mobility? Here are some do-it-yourself methods if you like to do it yourself.
Thoracic Mobility with Roller
Standing Thoracic Mobility
You can also use a mobilization wedge. I use this on clients/patients if they need some help getting their thoracic mobility going in the beginning.
You can also lay it on the floor and do a self mobilization, similar to the foam roller. Getting on the wedge and moving around can be challenging but the wedge allows you to mobilize specific vertebra more than the roller can.
Here is a useful nugget of info. Not all tight muscles need to be stretched.
Yup. I said what I said. Sit back and drink that one in for a moment.
Sometimes, and probably more often than people appreciate, muscles are “tight” because they are overstretched.
So, stretching them doesn’t help and can aggravate/irritate things more.
While this is not exactly how things work, this analogy can be helpful to visualize why stretching doesn’t always work.
Imagine, if you will, a piece of rope.
If you tie a knot in the rope, the ends of the rope move closer together. The rope is, in essence, shorter.
Good so far, right?
Now, imagine tying a knot in your muscle. Unlike the rope, muscles are attached to bones on both ends so the knot increases tension (stretch) in the muscle.
It feels tight but not because it is shortened.
Even when you are resting, your muscles are still overstretched and in need of a break.
And, these trigger points can refer pain to other parts of the body. See the image below.
So, even if they are not the primary cause of your pain, you still want to work to get rid of these in any way that you can.
Soft Tissue Mobilization (STM) is just a five-dollar word for massage but, as a physical therapist, I couldn’t massage a patient but I could provide soft tissue mobilization to a patient.
For the record, your muscles don’t know the difference.
STM can be done using a foam roller, Theracane, massage therapist or any number of devices. They all work in a similar manner.
They all work to remove the knot/trigger point/adhesion (whatever you want to call them) which reduces or removes the tension in the muscle(s).
There is one simple rule that I give to my clients/patients when it comes to STM.
The hypersensitivity to pressure you feel is not normal. It indicates something is up with those muscles and it needs to be dealt with.
Instead of destroying your muscles with epic STM sessions, focus on shorter durations and more frequency.
Foam rolling or working on your muscles for 30-60s at a clip is perfectly fine. Do that 2-3x/day instead of powering through 10 minutes of foam rolling.
One other bonus technique I want to share that not enough people know about is a first rib mobilization.
Your first rib is much higher in the body than most people appreciate. It runs right under your collarbone.
For different reasons, it can become elevated. This can be a source of both neck and shoulder pain.
The technique can really only be done at a gym unless you have a squat rack or smith machine at home.
First Rib Mobilization
Yes, exercise can be a problem.
If you have just one of the issues above, your normal workout routine or favorite class might be a nightmare situation for your body.
In reality, most people have all three going on simultaneously.
This is why everything hurts and why everything seems to make it worse.
While exercise is part of the treatment, the way you are currently exercising is probably part of the problem.
Sorry, I don’t mean to sound judgmental, but most people do not exercise with very good technique.
Technique should be the most important variable and nothing should ever jump ahead of it.
Most people are too busy chasing a certain number or reps or pushing a certain amount of weight and technique gets left way far behind.
This works for a while…until it doesn’t.
Even if you work on your posture, thoracic mobility and any soft tissue restrictions your exercise habits/technique can still jack you up and leave you feeling more broken down than when you started.
I mentioned in the beginning that you should hold all overhead pressing for now. (And frankly, as discussed in this article, pressing is overrated.)
Here’s the reason why.
When your thoracic spine is tight, it rounds forward more than normal.
All of your ribs come off of the thoracic spine so there is a shift in your rib position.
Your shoulder blade sits on your ribs so its position is impacted.
The socket of the shoulder is at the end of the shoulder blade and the collar bone meets up with the end of the shoulder blade.
So, both the acromioclavicular (AC) and the glenohumeral (GH) joints are impacted.
If there are postural issues, thoracic mobility issues and/or soft tissue problems then your overhead press is going to be a dumpster fire and will definitely increase your symptoms.
Your feet do not have to be against the wall, but you should be able to keep your hips, shoulders and head against the wall while getting your forearms against the wall.
I understand that you could press with the elbows pointing forward to circumvent this position.
This is more an issue of could vs should. You could but you shouldn’t. It’sin your best interest to hold off on pressing until you get some of the other things in order.
And, if you cannot get into the 90-90 position, you shouldn’t be squatting with a straight bar either. This is where a yoke bar or switching to front squats may be in order.
The good news is that working on the things I am talking about can help you get into this position.
One of the hardest parts of getting out of pain is changing your mindset. If what you are doing was working, you wouldn’t be in pain. Right?
Exercise was not at the top of the list of things to work on. This was not an accident.
Exercise is a part of the plan to get you back on track but failing to address the other things renders the exercises less effective and, in some cases, a major contributor to your pain and dysfunction.
Throwing more exercise at neck and shoulder pain rarely makes the problem go away.
Early on when trying to get rid of your shoulder/neck pain, using supported exercises is a great place to start.
Supported exercises, which is also known as a supine position, also help to reinforce the neutral posture we discussed in the beginning. But, because you are supported, it’s much easier for the body to stay in this position.
Try performing your flyers, pullovers, pullaparts or skull crushers while lying on the floor.
Sure, your range of motion might be limited by the floor but this is actually ok at this juncture.
Skip benching with a bar and move to the floor for a 1 DB floor press.
(Thanks David for the demo. This is also a great exercise to build your inner chest.)
Once you get used to this, try performing a 1 KB bottom’s up floor press.
The head and neck get support from the floor and the floor can also help to limit your range of motion which is often helpful at the beginning stages of this process.
Bent-over rows are not a bad exercise but shouldn’t be a part of your routine until your neck/shoulder feels better.
Limit prone exercises. This is going to put the neck in a tough position. Hold off on planks and plank variations for now and anything that has you in this position, especially if you are struggling to maintain the position.
Time for celebration, right? You just got a hall pass from doing planks for now.
You can also do supine rows. This would require you to lay on the floor near a pulley or set up a bench under a pulley.
Grab the handle and lay down and perform the row from the supine position. This also helps people feel their shoulder blades moving.
Your shoulder blades should initiate all of your pulling movements (more on this in a minute).
The tactile feedback from the floor or bench can be instrumental in helping you get the most out of your pulling exercises.
Most people demonstrate terrible technique when they perform pulling movements.
Generally speaking, you should be initiating the movement with the shoulder blade. And the shoulder blade should dictate when the movement stops.
If you hold a DB, a band or something attached to a pulley, you should be able to leave your elbow straight and create some movement by squeezing your shoulder blade back.
You can perform this quick self-check in the middle of your set to see if you are still pulling with your shoulder blade or if you are just yanking with your arm.
Judge me for my cargo shorts, I dare you.
Not only does the shoulder blade not guide the movement, your head and neck shoot forward and the shoulder rolls forward and gets closer to your arm which is also not helping.
If you are dealing with neck and/or shoulder pain, you will need to change your mindset as it pertains to your exercise and all of your daily activities.
Trying to power through and continuing to do what you have been doing isn’t going to change anything about where you currently are.
I have used the above strategies with countless patients and clients to not just manage their pain but resolve it completely.
Consistency is the key with the strategies I have listed above. If you are sporadic with your approach you will make it difficult to truly resolve the issue(s).
The people that have the best outcomes are the ones that are most consistent with the plan.
Keep in mind that chronic neck and shoulder pain has components that have been in place long before your pain first made an appearance.
You’re probably working against years of mobility issues, soft tissue restrictions, postural abnormalities and abnormal movement patterns.
You are not going to fix these issues permanently after a week.
Modify your workouts, change your mindset and give yourself at least 3 months of consistent work to give these things a chance to work. Then, make addressing these issues a regular part of your program, whether in your warm-up or your actual training.