“Why am I getting treatment on my neck and back? when it is CLEARLY my shoulder that is in pain?!”

We understandably get this question a LOT….! And the answer hits the core of how neck and shoulder pain is treated and rehabbed so that it DOESN’T COME BACK!!   

In this blog, I will discuss why the neck and shoulder areas are so interconnected and how this will shape the assessment, treatment and rehab journey of people who experience neck and/or shoulder pain. I will also discuss common causes and contributing factors to developing pain in this area and some SIMPLE exercises to help prevent pain and injury in this region.

So Let’s DISCUSS how these areas are connected and UNDERSTAND this region further.

Neck and shoulder pain are two of the most common reasons people visit the physio.  

As physios, we will assess the neck and shoulder complex as a whole region and even the upper and middle back! However; people are often confused as to why this is. 

Anatomy

Before I get into discussing what a physio does with this type of presentation, we need to first look at WHY these three presumably distinct areas – the neck, shoulder and thoracic spine (upper/middle back) are just SO intertwined.

Let me start by asking a question:

The arm connects to the rest of the body at the scapula (shoulder blade), right?

But then which bone or joint connects the shoulder blade to the rest of the body?

The answer to this question is bloody complicated and is at the crux of why the shoulder, neck and thoracic spine are so interconnected!!

1) The shoulder blade connects to the sternum (chest bone) via the collar bone through 2 relatively small joints

2) The scapula makes a “pseudo” (kind of) joint with the rib cage

3) There are lots and lots of muscles, that when all working together in harmony will maintain the shoulder blade in position.

These muscles include many that attach to the neck and to the middle and upper backs.

So if:

• Any of these muscles get tight or weak,
• There is stiffness in the joints of the neck, shoulder or upper/middle back
• There is poor posture making some of these muscle work harder than they should
• Or there is an acute injury to the joints e.g. shoulder or muscles

The results can be development of pain and pathology in one or more of the; neck, shoulder and thoracic spine!

The Rehab Journey

When you visit the clinic with neck and/or shoulder pain, it is our job as physios to guide you on your rehab journey and this starts by first listening and asking the right questions to understand your story.

Some of the most common elements we hear in patient’s neck and/or shoulder pain stories are:

• I fell on my arm/shoulder a few weeks ago and the pain in my arm isn’t going away
• I work at a computer/desk or I am a student with exams coming up
• I have recently increased my workload
• Life has been stressful lately
• Since the weather has gotten colder, my neck has stiffened up
• I haven’t been exercising as much as usual

The Physical Assessment

After getting to know your presentation, we (your physio) will then physically assess you which may include but is not limited to:

• Movement quality and range in your neck.
• Movement quality of your shoulder blade and the range of your shoulder.
• Movement of your upper and middle back.
• Movement in the individual joints of your spine (discs and facets).
• Movement of the nerves from your neck to your arm
• Muscle length (tightness) and strength of the muscles connecting the shoulder blade to the neck and spine as well as the rotator cuff (shoulder stabilising muscles).
• Movement of the shoulder joint (glenohumeral) itself.

The Diagnosis

Following this assessment, we will likely reach an understanding of the problem and reach a diagnosis… For some people this is reassuring and why they came to a physio in the first place, but for others the “label” can be daunting and scary.

What’s important to understand and what will be carefully explained by your physio, is that labels are misleading!

People often report to us that they’ve been told in the past that they have;

• Facet degeneration
• Disc compression
• Muscle tightness
• Muscle strain
• Cervicogenic Headache
• Postural defects
• Rotator cuff tendinopathy
• Cervical spondylosis

But YOU now KNOW from the anatomy of the neck, shoulder and upper back – this area is complicated and interconnected so a two-word diagnosis doesn’t quite cut it and definitely doesn’t lead to understanding what the Rehab Journey should look like.

So be ready for a diagnosis more like this!

• Due to the long hours you’ve been spending at work lately in a sustained sitting position, the intervertebral discs at several levels of your neck have become compressed putting undue pressure on the facet joints. 
• The muscles that connect your shoulder to the neck have also become tight which puts further pressure on these particular facet joints.
• You have also developed upper and middle back stiffness – likely over many years, so that this area of your spine is not carrying the load of your head and neck as it should.
• Together, these factors are causing you neck (or shoulder or headache or upper back) pain.

Don’t worry, we’ll have models and pictures to make this a little easier to understand!!

Sounds like a lot, right??!

Let me assure you that by understanding the CUMULATIVE factors that have led to your presentation, you will be able to TAKE CHARGE of your rehab and know not only how to treat this pain and restriction now, but how to prevent pain from coming back!

The Treatment!

The bit you’ve really come to the physio for in the first place!

After your diagnosis and further education about your presentation, your treatment will be specifically shaped on the various factors contributing to your pain:

• Hands-on physio – dry needling, joint mobilisations, soft-tissue massage (to help loosen up the joints, muscles and improve movement) 
• Heat (hot pack, hot water bottle, wheat bag) (to help improve blood circulation, speed up recovery and relieve soreness)  
• Work-station adjustments (To address any previous or current ongoing biomechanical issues) 
• Postural adjustments (Very Important to correct imbalances and prevent future issues from rising) 
• Supplements especially natural anti-inflammatories and muscle relaxants such as magnesium or turmeric. (To help reduce soreness, muscle tightness and promote muscle recovery and relaxation) 

And most importantly, EXERCISE! For LONG TERM RECOVERY!

Part 1: Simple Stretches for the neck, shoulder and thoracic spine.  

1. Neck Flexibility:

a) Start in a kneeling position (or sitting or standing) with the spine comfortably lengthened.

> Exhale while gently lowering the chin to the chest, rounding in the back of the neck.

> Inhale to raise the gaze up to the ceiling, consciously extending through all vertebrae neck (avoiding hinging).

> Exhale back to a neutral neck position

b) Inhale to prepare

> Exhale turn the gaze over the right shoulder. Inhale.

> Exhale turn the gaze over the left shoulder. Inhale.

> Exhale back to neutral.

c) Exhale to lower the right ear to the right shoulder while keeping the shoulder stable. Inhale.

> Exhale to raise the head back to neutral and lower the left ear to the left shoulder. Inhale.

> Exhale back to neutral.

> Gently bring the chin to chest to roll the neck forward, to the right, upwards from the right, back and to the right, back and to the left, to the left, forwards to the left and back to chin to chest.

> Reverse direction without the nose crossing the midline with the chest/sternum.

2. Single Shoulder Roll:

Start in standing (or sitting or kneeling) with the spine comfortably lengthened.

a) Begin by elevating the right shoulder towards the ear.

> While keeping the shoulder elevated, draw the shoulder blade towards the spine.

> Maintain the shoulder blade towards the spine, drawing the shoulder downwards towards the back pocket.

> Maintain the downward draw of the shoulder while rolling the shoulder blade away from the spine.

> Return the shoulder to its resting position.

> Repeat this shoulder rolling action 10 time.

Focusing particularly on drawing the shoulder blade back and down as this opposes the hitched and forward shoulder posture many of us adopt while sitting at a computer or desk.

b) Repeat 10 more times but in the opposite direction.

c) Repeat 10 times, each direction on the left shoulder.

Gently maintain an open chest posture (tips of the shoulders drawn apart) after completing the exercise.

3. Thoracic Foam Roller:

Start by sitting with the knees bent and knees and ankles together, foam roller placed at the base of the pelvis ACROSS the mat.  

> Roll the foam roller away from your pelvis so that when you lie on the roller, it is ABOVE the lower back (lumbar spine).

> Interlace your fingers and place your hands behind the head to support the head and neck.

> Gently raise the bottom off of the mat and allow the chest, head and neck to lower back towards the mat. The spine is now in alignment.

> Roll the foam roller up and down the thoracic (middle and upper) back by bending and extending the knees.

> To progress the exercise on the middle and upper back, hug the arms around each shoulder to draw the shoulder blades apart.

Tuck the chin to keep the head and neck in alignment with the spine.

> Repeat for 2 minutes.

Disclaimer

If you are experiencing neck/shoulder pain or have experienced lower back pain in the past it is highly advised that you see your physio before starting any specific form of exercise to treat the symptoms.

The exercises listed above are an indication of what a neck/shoulder exercise program would involve and are not recommended for anyone experiencing symptoms without first being assessed or speaking with their/a physio.