Pain Points - Neck & Shoulders


Take a wild guess... what's THE MOST COMMON PAIN COMPLAINT I get from clients?


Probably not a shocker... The neck and shoulders!

(in fact, close your eyes right NOW and check in with YOUR neck & shoulders - how do they feel on a scale from 1-10? If 5 or above you need to come see me:) )


When clients come to me with pain my job is threefold: (1) address the symptom, (2) address the cause, and (3) teach them what to do on their own time feel better in the long-haul.


Muscles of the posterior shoulder girdle

1. Treat the symptom.

This part may come as a surprise... neck and shoulder pain is almost always the symptom of the problem, not the cause! This is great news.


First, understand that pain is actually a good thing at its core. It's your body's way of telling you that something is amiss that needs to be fixed. If you didn't have a pain response, you would be dead right now (think of all the times you've had a cut that bled a lot. Without pain to alert you to the danger, you'd bleed to death. Bummer.


Hooray! Thanks, pain.


In addressing neck & shoulder pain in an initial visit (the first time someone comes to see me) I do what you'd expect. I reach into my well-equipped toolbelt of bodywork modalities (deep tissue, trigger point, neuromuscular therapy, etc etc) and I go to work on the pain areas. I start with what clients clients want, then work on what they didn't know they need.


99% of the time I work the "knots", soothe the overly-tight muscles, and clients breathe a deep sigh of contented relief. Because now they CAN breathe - the muscles that were constricting their upper chest have been released so the rib cage is (mostly) free again.


"I'm free, as free as the wind blows... as free as the grass grows..."

THEN I do the unexpected....


2. Address the Cause


I work the muscles on the front of the shoulder/chest, focusing on the Pecs, the side of the rib cage, and the neck. Although the pain is felt on the back of the body, the major relief comes from releasing the front.


Muscles work in groups, and when fixing a structural problem you have to address the agonist (primary mover) and antagonist (opposing) groups.


In neck and shoulder pain, muscles of the chest are the agonists (primary) and the neck and the shoulders and back muscles are the antagonists (antagonists).


Pretty crazy when you first learn it, but when you think about the musculoskeletal system as a system of levers and pulleys, it starts to make sense! It makes even more sense when you understand biomechanics, physiology, and how modern life affects our bodies...


Spoiler alert.... modern life F*CKS US UP!

Nice spine, bro


Nearly everything we do, look at, and interact with happens in a 1.5-foot square, 6 inches from our face




This leads to literally all the problems you can think of, including Shoulder & Neck Protraction as this post's problem is called. "Protraction" is any time a structure is forward (anterior) from where it's supposed to be. As in the photo above, the gentleman's neck and shoulders are slumped forward from where they would be if he were standing straight and looking straight ahead.


So why does releasing the chest help the neck and shoulders?


Of course the specific muscles responsible for protraction are unique to each person, depending on the person's (in)activity. But in general the Pecs (agonists), especially Pectoralis Minor, are too short and keep the the shoulder stuck forward of center. As a result, the Trapezius & Rhomboids (antagonists) in the shoulders are constantly over-stretched, working to try and pull the shoulder joint back. Over time they get tired and worn out, leading to pain.


So the short answer to the problem is....


FREE THE CHEST TO FREE THE NECK & SHOULDERS


Well that's great. But now that you've given me a bomb massage and I'm feeling awesome, won't my shoulders hurt again tomorrow?


Not if you do something about it!



3. How to Keep Feeling Awesome


If you've ever been to a bodyworker, physical therapist, or in-the-know doctor you've probably been told that you need to stretch. And indeed you do! Stretching is one of the most important things you can do for self care!

more on that later!


Your nerves actually tell your muscles how tight to be! Stretching tells your nerves to tell your muscles to chill out.... more or less. Stretching increases muscle length, making your muscles spry and increasing blood flow to your tissues. All good things.


But if stretching has an evil (or angelic) twin, it's strengthening! I can't tell you how many clients I've worked on and nearly begged them to strengthen their muscles. When muscles are in pain because of under-use no amount of stretching will help. In fact, it will probably exacerbate the problem.


For shoulder & neck pain it's equally important to stretch the pecs and strengthen the shoulders.


My favorite Pec stretch is in a doorway









or in yoga poses like wheel, camel, and dancer.

And whatever one this is:











Stretching pro tip: you MUST STRETCH AT LEAST 30 seconds per side! Anything less doesn't stimulate the nerves properly to instruct muscles to lengthen.


To properly strengthen your Trapezius and Rhomboids, simply do free-standing handstand push-ups:




Or, if you're a real human, simple weight lifting is great. Ask your neighborhood personal trainer for more ideas.


Workout Bod not required.








And that, dear readers is my simple and brief explanation of how to address shoulder and neck pain.


I sincerely hope you have enjoyed this first installment of Pain Points. I've willingly sacrificed 2.5 hours of my life on the altar of your wellbeing.


I would all the more love to find out what unique things are going on in YOUR neck and shoulders, and create a personalized care plan with you in person! Come see me and get yourself some bodywork!


With much love,

Eli McCutchen, LMT




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