Stop Scrolling and Read This for your Neck and Shoulders
We all know that sitting up straight is “the right thing to do,” but did you know that your posture could be leading to shoulder pain, neck pain, or chronic headaches? As a PT, I’m used to backs straightening when I walk into the room. As soon as I say what I do for a living, people will cover their faces and say “I have the worst posture, don’t look at me!” It may or may not be true, but I would never say anything because I, too, am guilty of a slouch now and again.
It’s hard being a human being. Stress, anxiety, and the general effects of gravity can be draining. Add to that the typical desk setup and childcare techniques, and it’s a recipe for disaster for neck and shoulder pain. We tend to sit with our shoulders rounded and arms forward, whether they’re holding a phone, child, or sitting on a keyboard at work.
So, if we’re fighting a losing battle against stress and gravity — is there anything we can even do?
The most important thing is to understand how we would function in an ideal world so that we can strive for it when possible. Our spine works best with it’s aligned in a neutral position.
It’s not always as simple as just pulling your shoulders back. Posture starts from the very top — the way your head sits on your spine. There are little muscles on the front of your neck that get weak from being in a stretched position when we slouch - these are called deep neck flexors. When we engage these muscles, it creates a “double chin” position.
Poor posture tends to involve tightness in the muscles attaching on the front of your body - pectorals, lats, upper trapezius, and deltoids. It also results in weakness in the muscles on the back of your body - rhomboids, middle traps, lower traps, and the posterior rotator cuff to name just a few. This presents in reverse in the upper neck. The muscles just below your skull become tight from the slight lean of the head, and the deep neck flexors lengthen and weaken from the lifted chin positioning.
It gets really interesting in the shoulders.
The ball of the shoulder joint sits on the socket in a kind of precarious way - much like a golf ball sitting on a tee. In its proper position, there isn’t much space above the joint for the rotator cuff, ligaments, bursa, and biceps tendon to pass through. When you slouch forward, it takes that already small space and smooshes it. If you’ve ever heard of impingement, this is how it happens.
As you can see, when many structures pass through an already tight space, posture needs to remain excellent to maintain the maximal amount of space for them.
Who knew that a slouched posture could contribute sharp pain in the front of your shoulders?! Now, how is it causing headaches?
We’ve talked about triggerpoints here in the blog before when we discussed dry needling. Quick description: triggerpoints are taut bands of muscle (or knots) that cause a pain referral pattern. The upper trapezius pattern refers to the shoulders and midback, but also refers up into the back of the head and wraps around the ears in a “rams horn” pattern. The suboccipital muscles (those tight ones behind the base of the skull from your tipped back head) refer the the side of your head over your ears and just above your eyebrows.
See above: triggerpoint referral pattern for several muscles of the neck
If you’ve ever done a group fitness class, you may have heard the instructor tell you to release your shoulders from up by your ears. We tend to hold stress and tension in the upper trapezius muscle and that causes an exaggerated and long-term shrug position that we stop noticing after awhile. As you read this, take a deep breath and relax your shoulders down — were you doing it? Me, too! Sheesh.
We tend to form triggerpoints in muscles that are weak, used improperly, or overused. As you improve your posture, those muscles will lengthen and triggerpoints will be less likely to develop. You can undergo dry needling if you’re having a hard time getting control of your symptoms, but you can also start with a home regimen.
So how do you get rid of your symptoms?
Step 1: reminders.
I usually tell my patients to set timers or reminders on their phone or put a post-it on their monitors that say “sit up straight” or “tuck your chin!” because all the best laid plans to be more aware of your positioning will be set aside when you’re really on a roll at work. Sometimes a physical reminder can get you back on track.
Step 2: mobility.
I love this postural progression for mobility and refreshing stiff muscles. It’s a movement-based series. You’ll move through each position for 60-90 seconds for a total of about 6-8 minutes on the foam roller. If you can keep one by your desk, this can be a great break at work!
Start by laying with a foam roller along your spine, preferably a firm 36” roller positioned from your head to your tailbone. The first move is alternating reaching your fingertips towards your heels. Reach for a few seconds, then switch. Your head will stay put, this is a dynamic stretch for your neck.
Alternating arms, reach your fingertips to the ceiling. Hold for a second or two, then switch sides.
Pulling both arms back at once, make a rowing or bench press motion emphasizing the stretch as your elbows come towards the ground.
Reach one arm up overhead and one arm down by your hip (like a go-go dancer or a swimmer). Move arms slowly back and forth.
Take your arms out to the side like goal posts with your fists level with your ears and your elbows level with your shoulders, then bring them smoothly up towards midline bringing your wrists and elbows together.
HOLD YOUR HAIR OUT OF THE WAY! Cradling the back of your head in your hands, extend your back over the foam roller moving up and down to about the level of your shoulderblades.
Step 3: soft tissue work.
Not to sound like a broken record, but I LOVE dry needling to release tension in the upper trapezius. Short of this, the best way to make a change to your own tissues at home is rolling on a ball or foam roller or using a theracane. You can also use a massage gun to help work triggerpoints out of your muscles (more on which devices I like best in a later blog!).
Step 4: exercises and stretching.
These muscles are for endurance and can, therefore, be worked every day or close to it! The focus is both on strength and on muscle memory. Give these exercises a try:
Chin tucks — you can do this sitting upright, laying on your back, or sitting in your car by pressing up against the headrest behind you. Engage the deep muscles in the front of your neck, making a “double chin” motion. Hold for 10 seconds and complete 10 repetitions.
Scapular retraction — sitting upright, put your hands on your hips. Drawing your elbows back, engage the muscles of your mid-back and knit your shoulderblades together. Hold for 10 seconds and complete 10 repetitions.
Prone arm extension and scapular retraction — lying on your stomach, tuck your chin in and knit your shoulderblades together. Next, raise your hands a few inches and hold for 3-5 seconds. Complete 2 sets of 10.
Upper trapezius stretch — sitting upright, grip the side of your chair. Take your hand to the top of your head and gently pull your ear towards your shoulder until you feel a stretch on the side of your neck. Hold this position for 30 seconds, 3 rounds.
Cervical extensor stretch — sitting upright, interlace your fingers behind your head and gently pull your head forward into a stretch of the muscles that attach to the base of your skull. Hold this position for 30 seconds, 3 rounds.
Pectoralis major stretch — stand either in a doorway or a corner, place your arms on the doorway or wall, then lean forward until you feel a strong stretch sensation in your chest. Hold this position for 30 seconds, 3 rounds.
So — now you have the tools to manage your symptoms at home! If you have a hard time getting started or getting your symptoms under control, reach out to your trusted physical therapist to get your program started!
