Fix Neck, Upper Back, and Shoulder Pain

Bad Cervical (Neck) Discs, Nerve Impingement, Round Shoulders, Upper Crossed Syndrome, Muscular Pain, Rotator Cuff, Numb Fingers, and "Stress" Pain


© Jolie Bookspan, MEd, PhD FAWM
Director, Neck and Back Pain Sports Medicine, Philadelphia
www.DrBookspan.com

Clinicians at the Harvard School of Medicine named Dr. Bookspan, "The St. Jude of the Joints."


This article will show you how toquickly stop the source of upper body pain. Then you no longer will get the pain and your neck, shoulder, and upper back can heal.

Neck Pain and Upper Back Pain – Why?
Neck and upper back pain are not difficult to prevent or fix. People do an astonishing number of things every day to strain, weaken, and pressure their necks. They stand, bend, sit, and let their head slouch forward all day and shoulders round, all day, every day, then compound the problem with inactivity, holding muscles tightly, and bad exercises that only round the upper back further. They may do physical therapy or exercises, but not be aware that strong muscles will not automatically give you good posture, make you stand and move properly, or make up for all the things you do the rest of the day to hurt your neck. It is no wonder why they still get pain even though they "do their exercises." Many wind up in surgery, taking pain pills, or long term or recurring pain, not understanding why their physical therapy or exercise program, or pills, or yoga "didn't work." Luckily, neck pain is usually easy to understand and fix yourself. Here is how:

 

1. Bad Discs
The pressure of your own body weight on your neck muscles and discs over years of poor sitting, standing, and bending habits is enough to injure your neck as badly as a single accident.



This is a side view of your spine. Left - normal disc between two vertebrae. Right - disc pushed out (herniated) from bad bending habits.
Chronic forward bending gradually pushes discs out to the back. Lift and bend properly to avoid damaging your discs.

Sitting, standing, and living with your neck and head forward
can eventually push cervical (neck) discs out

 

2. The Forward Head
A "forward head" is the source of much neck and shoulder pain.
The neck should be on a straight vertical line. Check to see if you let your head and neck tilt forward. This is called a "Forward Head."


Are you too tight in the upper chest and shoulder to stand properly?
The forward head (left) commonly results in sore shoulder, neck, and upper back.
Such pain is easily fixed.

A forward head can eventually damage neck and upper back structures, as they bend and rub at angles they were not built for. Chronically holding neck muscles in an overstretched position weakens them. The forward head creates shortened, contracted muscles in front, and a stretched, weakened back. Cervical (neck) discs are pressured posteriorly. This creates a cycle of forward positioning that herniates discs and makes sore aching muscles, and the tightness and habits that keep you tilting forward. The result is that the average person has upper body pain from the poor positioning and at the same time, the chronic poor positioning makes them too tight to stand up straight.

Check yourself - you may be surprised to find that you do much of your standing, sitting, activity, and exercise with a forward head. No wonder you have pain. Look in any fitness magazine and see all the photos of people doing exercise with their neck tilted forward and chin jutting forward. Look at how people (or stand) when they eat. Look at how they carry backpacks and bags - neck tilting forward against the load instead of using muscles to hold the spine in healthy position. Then they do shoulder stands in yoga, which simultaneously overstretches the ligament, pressures discs outward, and creates forces that generate bone spurs. The average person overstretches and unequally stretches their neck and upper body so much, it is no mystery that they hurt - it is a mystery that they don’t hurt more.

The pain and other problems of the forward head are sometimes referred collectively as "Upper Crossed Syndrome." Upper Crossed Syndrome is not a disease, or "condition," or structural problem, or something to live with. It is pain from slouching. It is easily fixed. Stop holding your neck and head forward. Don't "do exercises" for your pain then go back to the forward head. It is simple. Methods follow below.

Muscular Pain from The Forward Head
Poor standing and sitting ergonomics are a common cause of numb shoulder, upper back pain, and headache. It makes a classic "tension" pain across the shoulders, in a diamond pattern down the middle of the upper back, in the neck, up the neck to the head, and sometimes down the arm. Forward head is a common source of headache. Yet, after mechanically pressuring their neck all day, people call it stress and do not fix the very forward posture that would give them relief and stop the injury process.

Surprising Source of Shoulder Pain
The forward head is a surprising hidden source of shoulder pain and impingement. With the head held forward, it rotates the upper shoulder forward (round shouldered) which gets in the way of normal motion when you raise your arm. The upper arm bone squashes the soft structures of the shoulder capsule against the shoulder bone (where the scapula meets the clavicle). This can cause pain, squashing (impingement) and rotator cuff injury. How often does this happen? Every time you wash and comb your hair, pull off a shirt, put away groceries, scratch your head, brush your teeth, and reach for anything - in short, a forward head can cause shoulder and upper back and neck pain many dozens of times a day. The injury adds up over time.

 

3. Making It Worse When Trying to Stand Straight
Check yourself - when you try to stand straight or "pull back your shoulders" do you do it by arching your lower back, or craning your neck, or both? "Craning" the neck means "pinching" it back, with the chin and face lifted. Craning the neck is surprisingly common and a big source of neck and shoulder pain. Check to see if you crane your neck to look up, to drink water, to reach overhead areas, even to eat. Check yourself to see if you jut your chin forward or hunch your shoulders up.


Are you so tight that you crane your neck to look up, or to try to stand straight?
Use the two stretches below to relieve this, then stop craning all the time.

 

Try This Wall Test To See If You Need to Fix Upper Back Pain and Poor Positioning

  1. Stand near a wall, with your back to it, but not touching the wall.
  2. Back up until something touches. Did your behind touch first, as in the first figure in the drawing below? You may stand "booty out," flexed at the hip.
  3. Did your upper back touch first (second figure in the drawing below)? You may stand slouched backward.


Do this wall stand test, described above,
to see if you have the healthy positioning needed to avoid neck and upper back pain.

 

Now try to stand with your heels, hips, upper back, and the back of your head against a wall. Bring the back of your head against the wall without raising or dropping your chin, or arching your back. If you can't keep your heels, hips, upper back, and the back of your head comfortably against the wall (third figure in the drawing above), or if you have to crane your neck, you are too tight to stand up straight. Pain results from the resulting bad positioning and slouching your tightness creates all day, every day. This is common. Here is what to do about it:


Two Easy Stretches
Tight pectoral (chest and front of shoulder) muscles rotate your arms inward. To see if you do this, put your arms at your sides, look in the mirror and note direction of your thumbs. Do they face inward – toward each other? To restore this muscle group to functional resting length do these two stretches, then *use* the new straight positioning for all you do. It is not the stretches that fix the problem, but the purpose of the stretches - to allow you to hold healthy position the rest of the day:

1. "Pec" Stretch (For pectoral muscles in front of your chest)

 

Keep good positioning - avoid the three mistakes pictured next.


First model on left is demonstrating flexed hip (behind out), middle has forward head, third (r) is arching backward. Avoid bad positioning when stretching

 

 

2. Next, stretch the top of your shoulder (Trapezius stretch)

- Stand against the wall, with your back and the back of your head against the wall, gently.
- Put one hand behind you, as if in an opposite pocket, as in the photo at right.
- Breathe in, then while breathing out, slide your other hand down the side of your body toward your knee, as in the photo at right.
- Tilt your head downward to that same side, gently, but keep it as much against the wall as you comfortably can.
- Don't round or hunch forward, or drop or raise your chin.
- Feel a nice stretch along your entire side.
- Hold a second or two while breathing. Switch sides.
- If your lower back hurts to do this trapezius stretch, you may be increasing the arch in your lower back. See the free article on hyperlordosis to fix this.
- Try the wall stand again and note that it is now easier to stand straight. If not, then you may have not done these two stretches as intended. Repeat correctly until your wall stand shows you have fixed the problem. Your wall stand should become straight starting the first day you start using this two-stretch method correctly.

Model on right is demonstrating bad forward head position. Instead, keep back of head against wall.

Thank you to participants of the Snowmass 2004 Wilderness Medical Society Stretch Workshop
for being in the two photos above

 


Do not do these two stretches "as stretches." Do them many times a day to allow you to stand and move the rest of the day without the forward position that injures and brings on pain. Use the wall stand as a test to check if you are straight. If not, do the two stretches above (pectoral and trapezius) again, then check yourself with the wall test again until you have corrected the problem right then and there Do not walk away with a tight, forward neck.

 

Exercises to Strengthen and Retrain Muscles
 Neck pain exercises are misunderstood. Do you injure your neck all day then hope to fix it with a few exercises? It will not work if you "do exercises" then walk away with no use of the positioning or strength you just practiced. It is like eating butter and sugar all day, then doing 10 minutes of exercises and wondering why it doesn't "work." When you stop sitting, standing, and bending wrong and injuring your upper back and neck many dozens of times each day, it can heal.

The key is what you do all day. Try these retraining drills slowly. See how you feel the next day, then increase. Use these movements, not as exercises to do 10 times, but to retrain how to stand, sit and move with straighter healthier positioning all day.

- Upper Back Extension. Many people chronically over-stretch their back with forward rounding, but never strengthen the muscles that hold the back and neck upright. Upper back extension is an important exercise to strengthen at the same time that you practice moving your back in the other direction. Lie face down on the floor, hands and arms off the floor. Gently lift upper body without hands. Don't force. Don't crane your neck, keep it straight, just lift using upper body muscles.


Upper back extension

 
- The "Double Chin" Exercise (also called "dorsal glide"). It is often misused and misunderstood. In this not-so-helpful exercise, people are told to pull the chin in 10 times. Then they go back to their "real life" and walk around all day with their head forward, wondering why their neck still hurts. Or they force their head back, causing more pain. Don't do that.

- Instead, understand that "the double chin" exercise is not something you "do 10 times" then stop. It is something you do one time to learn the concept of not holding a forward head, and then use it to keep healthful head position all the time.
- Keep chin in, not stiffly or so tightly that it hurts, but easily so that your ear and back of your jaw is above your shoulder, not forward of it.
- Move your head and chin back from the upper back and shoulders, not by arching your lower back.
- Test your position with your back against a wall often during the day, to see if the back of your head touches, without craning your neck or arching your lower back (described previously). If not, do the two easy stretches (described previously) to restore ability to stand upright, then use that ability all the time on your own, in comfortable fashion.
 

 

What To Do Every Day To Prevent Neck Pain. To restore proper muscle length to allow healthy posture:

 


Stretch your upper back "the other way" to counter rounding. When you look upward or reach up for all your daily activities, don't do it by craning your neck and arching your back. Instead, stretch your upper body back, which is a great stretch that you need anyway.


Don’t Exercise in Ways that Damage Your Neck, Shoulder, and Upper Back
If you hurt from excessive forward bending all day over their desk, steering wheel, work, and TV, the last thing you need is more upper back and shoulder rounding. Many exercises, ironically even those commonly (but mistakenly) prescribed for back and neck pain, involve more forward bending - toe touches, knee to chest, crunches, and shoulder stands like "the plow" and "The Frog" (lying backward, raising legs over head so that all weight is on your upper back and neck).

.
Don't pull your arm across their body in front to stretch. You already are good at rounding your shoulders.
Don't add to your round shoulders with more stretching in back. Round shoulders are part of the problem in the first place.
Instead, stretch the front, as taught earlier in this article.

 


Don't add to a forward head with these.
Adding body weight to a stretched-forward neck can also accelerate disc degeneration and gradually push discs outward to the back (herniate). Pressure on the back of the neck bones also can eventually make the bone protect itself by growing a bone spur.


The Point of Neck and Back Exercises
Strengthening and stretching are important, but alone will not change posture or lifting habits, and so cannot “cure” neck pain or posture problems. Many exercises contribute to the original problem of over rounding and bad posture. Neck and upper back exercises are supposed to be used to retrain you how you hold your body all the time. Doing exercises for pain is not like getting a shot of penicillin or going to confession. It does not “fix” unhealthful habits the rest of the time. For example, doing a "dorsal glide" for the neck (double chin exercise), then standing up and letting your neck tilt forward again, instead of keeping the proper chin-in position you just practiced. In the Dr. Jolie Bookspan method, exercise is used to retrain your thinking and habits *all the time* not just while you do 10 repetitions. Strengthening has no effect on posture if you don’t apply the strength to control joint angles for all activities. When you bend over things during the day, don't droop your head forward.

Check to see if you tilt or hang or round your neck forward when doing other stretches. Most people round their back and neck all day. It only adds to the problem to do exercises like this too. Even sillier, by doing the stretch by rounding your neck and back, you lose the stretch on your leg, which was the whole point of doing the stretch in the first place.


Discs Can Heal
Disc injury is not a life sentence. Disc degeneration or slippage (herniation) can heal - if you let it, no differently than a sprained ankle. Stop damaging your discs with bad bending, standing, and sitting habits and the discs can heal. It takes years to herniate a disc, and only days to weeks to heal it by stopping bad habits.

Muscles Can Heal
When you over-tighten muscles with hunching and bad habits, they can remain too shortened to let you stand properly. Or they stay tightened in “knots” or spasm. This changes their muscle chemistry. When you slouch, you keep muscles overly stretched, which weakens and strains them. Stop straining your muscles and they can heal.


Do You Let Your Body Slump?
Are you letting your weight rest on the joints and discs of your neck by hanging it forward, instead of holding body weight up on muscles with straight positioning? Using muscles to hold healthful straight positioning would stop the pain at the same time that you burn calories, strengthen, and be a free workout.

 

Pain When Your X-Ray is Normal
You may be in great pain from simple damaging mechanics. Your X-rays and scans are normal. You may be told nothing is wrong, or that it is "stress" or to give up favorite activities. Your pain persists from bad postural habits. This is no mystery. Change the bad habits to change the pain.


When Pain Is Not From What's On Your X-Ray
Other times, the scans show some minor problem like arthritis, herniated disc, or degenerating structures. Just like car tires that are mid-life, but perfectly good, some wear may show on exam – but this is unrelated to performance or pain. Pain is falsely ascribed to the arthritis or to the disc. Patients feel doomed, and are often told to give up activities. Pain (even the herniation itself) may mostly result from poor mechanics. This is no mystery. Change the bad habits to change the pain.

Sometimes, the scans show some major problem, and major surgery is performed to correct it. When the original problem was from the bad positioning, often pain persists or returns because you never corrected the mechanics that caused it. The defect itself may return from uncorrected mechanics. Surgery can be avoided. Fix the source of the problem and the results of the problem can heal, usually without surgery.

How Long Does It Take To Fix Pain?
Using everything presented above, you should feel the difference as soon as you try the two easy stretches and reposition your head and neck during all you do. If you're not feeling better right away, check what you are doing compared to what you have learned above and in the other free articles, for example, are you still sitting badly at your desk or right now reading this?

It takes years to hurt a disc or neck muscles, and only days for it to start healing once you no longer are injuring it. Make sure there is not something else contributing to your pain. It is almost always quick and easy to start getting your life back and start feeling better right now. Don't wait.

 

Summary
Neck, upper body and much shoulder pain is not a mysterious "condition." People spend their day sitting, working, walking, and driving in terrible posture, hunching over the computer, lifting and bending wrong all day, walking heavily, and slouching all day, and then exercise in ways that strain and pressure discs and muscles. They do yoga and Pilates moves with their head forward, then do shoulder stands that forcibly pressure the discs in their neck. They take anti-inflammatory medications for mechanical pain that is not inflammatory in nature, try remedies that do not address the cause of the problem, do physical therapy in ways that exacerbates the original problem, give up favorite activities, have surgery then return to previous injurious habits, then everyone is astonished that they "tried everything and nothing seemed to work." It's like eating butter and sugar all day, then waving your hands in the air for five minutes and saying "I don't understands why I don't lose weight, I do my exercises."

How is your body positioning right now? The whole point of exercise and therapy is missed when you don’t learn to consciously use your muscles the rest of the day for standing, sitting, bending, and shock absorption. Use your muscles to stand and bend properly for all daily tasks. Bonus: It burns calories, strengthens, and is a free workout.

You Don’t Have To Live With Pain

 

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