Neck and Shoulder pain

Top tips to counter neck and shoulder pain at home.

Neck and shoulder pain is a subject close to my heart, as it is something that I had to deal with from a young age and most of my clients in my treatment clinic present with some type of neck discomfort. I have come to realise over the years that this issue is far more common than we think and that there is quite a lot that we can do to alleviate the symptoms and manage the condition. It is important to identify the triggers and understand that there will be ups and downs - but with the right approach, the ups can outweigh the downs. 

Dealing with Neck Pain

Before we proceed, it is important that one seeks medical advice before embarking upon any type of self-help measure. So, do go and see a physiotherapist or an osteopath for an assessment of your condition, or visit your doctor and see whether you need to be referred to an orthopaedic specialist. This will help ensure that you keep safe and ensure that you do not unwittingly aggravate a pre-existing condition. The neck is a delicate area of the body and due care and attention is required. 
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Neck pain can result from a number of different factors. Some of these factors could include a physical activity that is aggravating the neck, long-term stress, sleeping position, work posture, general posture, repeated asymmetrical movements of the head and certain sports. If you have experienced physical trauma via an accident, even after being cleared by a medical professional as being fit once again, some muscles can remain tight through a protective spasm.
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Let us look at some of these in a little more detail.  Activities that could be causing a problem could well include seemingly innocent things such as:

• Gardening and general outdoor chores
• DIY jobs including painting and decorating
• Cleaning and other general chores
• Moving furniture
• Shopping
• Sports
• Work
• Poor posture
• Sleeping position

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You may be thinking that we were made to move and so why could these innocent activities be causing an issue? Our muscle groups tend to work in pairs - with one muscle contracting/shortening and the opposite lengthening. This is a great arrangement, and is known as phasic or action muscles. It means  that these muscles have the ability to be used for a long period of time, as the two opposing pairs take it in turns to work. However, when we keep performing the same movement or holding the same position, the muscles become more rapidly fatigued and they are given less than the ideal opportunity to recover. The body also needs time to adapt and become accustomed to activity and the loading placed on it. When the average layperson embarks upon gardening, DIY (Do It Yourself) or painting property, their body does not tend to have the opportunity to adapt to this type of boom and bust activity. The position the arms, neck and shoulders are held in is highly relevant too. Imagine painting the ceiling of one of the rooms in your house and your arms being held up overhead for a lengthy period of time; this will place a huge amount of pressure on your neck and could well result in the neck muscles becoming overly fatigued and tight, and a headache ensuing. Whenever we are carrying something heavy,  there is often a huge loading on the shoulders and the chest muscles. Imagine carrying a heavy item, our arms are out in front of the body, the chest muscles actively engaged, as well as the shoulder muscles. When we load the chest muscles in this way,  we can be causing the shoulders to anteriorly rotate and come forward. This can tug at the delicate neck muscles and put loading on the cervical vertebrae (the neck vertebrae). Carrying unequal loads can also place added stress on the neck as the shoulder girdle rotates and one shoulder is held higher than the other. Even carrying a heavy handbag on one shoulder can become  problematic for the neck and shoulders over a period of time. It is important to evaluate our activities and be able to identify what might be triggering our pain. This can be harder to do than it seems - there is often a reluctance to to attribute our lifestyle to our pain, I guess we do not want to believe that our activity choices or that the general demands of life placed on us could be causing us pain.
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Long-term stress can be another trigger for neck and shoulder pain. When we are stressed, our body tends to go into a fetal position; the shoulders come forward and the hip flexors contract. Shoulders rise and become rigid - this in turn places a huge stress on the neck. One thing we have to be very aware of is that the position we hold our body in for a long period of time, can become a version of our posture that we carry throughout the day. Shoulders rolling forward can lead to the wrong tensioning between muscle groups; with some muscles such as the rhomboids and the mid-trapezius becoming long and tight, and pectoral (chest muscles) becoming tight and short/contracted. Also, when stressed over a long period of time, the body can get stuck in a heightened state of adrenaline. This is an automatic physiological response to an event that is perceived as being a danger. The muscles gain tonicity as they are preparing to work to lead us to safety - there is increased blood flow, the pupils dilate, the heart beats faster and so on. As humans, this response  can linger long after the danger has passed. In the animal kingdom, animals tend to recover faster once the perceived threat has passed. The stress hormones tend to remain in our systems for longer; our sleep can become compromised, our ability to rest is impaired and further anxiety ensues. It is important to adopt practises to help us relax mentally and physically. Meditation, easy gardening chores, spending time in nature, listening to music, focussing on song lyrics, participating in gentle sports and physical activity, can help us to stay in the moment and destress the body and mind. As a meditation practitioner, I was taught that stress can leave the mind during meditation, but linger in the body for longer. I see this when I am massaging my clients - their body always tells a story. 

It is also possible to get stuck in a pain cycle when pain is not dealt with in a timely manner. There is scientific evidence to back this theory up. A delay in dealing with pain can make us more likely to have pain for a longer period of time. There is also the possibility that the pain alters the way we move, or limits our movement; which can have a multitude of consequences - including causing problems with our movement patterns and our posture, as well potentially leading to depression, sexual issues and a general reduction in wellbeing. Healthy movement is so important for us. 
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Many of my clients are desk workers; they often sit for over 8 hours a day. Even when we seem to be inactive in a sitting position, we still have muscles that are firing to help us keep in that position. The hip flexors are working alongside the extensors of the back, the pectorals, the trapezius and the sternocleidomastoids. In a poor desk sitting position, the weight of the head places pressure on the delicate neck vertebrae - in fact, the loading on the neck increases the lower the head is held. This can get even more challenging when two computer screens are used - especially when one screen is looked at more than the other. It is important to have the main screen positioned centrally ahead of you. Repeatedly turning your head to one side can create an imbalance in neck muscle tightness. I often get my clients to think about how their television viewing station is set up, as well as the dining area and the socialisation area - looking straight ahead when there is neck pain is key, especially in the recovery phase. We want the neck muscles to fire evenly between the left and right sides, and the front and back of the neck. Think about your posture throughout the day. Are there any activities that leave you with one-sided neck pain? Is your television screen straight ahead? How about your dining table seating arrangements - is the company you keep sitting next to you or opposite you? At work, do you have your colleagues always approaching you from the one same side because of your desk set-up? Do you balance your phone against your ear and shoulder? Start to be aware of your body throughout the day. Take note if anything that you are doing is having some kind of negative impact on your body. Sometimes the effect of a repetitive or one-sided movement can take a bit of time to show - if there is neck pain, look back over the last couple of days to see what could have been a triggering factor.

How about looking at our sleep posture? Is your pillow right for you and your personal anatomy? Is the pillow thick enough for the width of your shoulders? Your neck and your vertebrae should be in a straight line as you are sleeping - get someone to check this for you. Some people enjoy using anatomic pillows as it helps support the neck alongside the head - these can take a bit of getting used to. Memory foam pillows of varying firmness can also be popular. People tend to need to go through a few before they find the one that suits them best. 

Tummy sleepers sometimes fare worse than back and side-laying sleepers, as their heads rest sideways to their prone body - which invariably puts a strain on the neck. It could be worth experimenting with having a pillow under the chest, or even a bolster under one of the arms. In an ideal world, one might try to change their sleeping position if tummy sleeping is leading to a lingering amount of soreness during the night or the following morning. 
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On the topic of sleep, check that your mattress is not too firm or too soft, or too old and worn. A saggy mattress will encourage the hips to sink too far, altering the straight line we wish to achieve from the neck along the length of the spine. A worn out base could also have a negative effect by robbing the mattress of effective support. 
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Are you warm enough when you are sleeping? During sleep our body temperature drops. In the colder weather it is important to make sure that you have a reasonable temperature in the bedroom and ample bedding that covers the vulnerable parts of the neck. Use a small soft blanket or a snuggly throw on the bed to bridge any small gaps between the bedding, your shoulders and your neck. 
Also watch out for draughts from open windows, fans blowing on the neck and air conditioning units blasting out cold air directly on to you, as these can upset the nerves and the muscles. Muscles that get cold whilst you are sleeping can go into a type of spasm. I see this regularly in my Sports Massage Clinic. Change the direction of airflow where possible and keep a light sheet over your shoulders. In Cyprus, I notice an increase in neck and shoulder related problems when the weather changes as fans and air conditioning units are used in the bedroom and at the workplace.
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What about our sporting activities? Is there anything that we do in the gym or during our workouts that can aggravate the neck and shoulders? There can be sports related triggers to our workouts. Some of these could be due to poor technique - consult with a properly qualified and experienced coach to have your technique checked and corrected, or even adapted where necessary.  Some movement patterns might need to be retaught to use the correct muscles in the right order - especially if movement patterns have become altered. Sometimes, the volume of training might need to be reduced for a period of time until pain is under control. Once pain is under control, training can be gradually increased within the remit of pain and discomfort.

When we are in the middle of a severe neck/shoulder pain cycle, it might not be a good idea to train muscles that affect the this area. There are a large number of muscles that support and help create movement in the shoulder and some of these can directly impact the neck. Overly tight and spasmed muscles can result in impaired and limited movement patterns. Tight muscles are more easily upset and can become upset further, or even damaged if a large load is placed on them whilst they are in a vulnerable state. It is good to move within the remit of pain, but not to overly challenge tight muscles during a pain crisis. Once again, get pain under control first. 

Some examples of physical activity that might impact the neck include overhead cardio-inspired punching drills. Sit-ups - there are many kinds and various ways to adapt them to make them more user-friendly. Back extensions from a bent over flexed position. There are more - you need to explore to find your own triggers. 

Whatever happens, you are the first person to gauge whether something is causing you pain and if the adaptation is suitable for you. That inner voice inside you, that you learn to block out, can be the warning that you need to take heed from. Be brave enough to speak out and ask for an alternative exercise or to just skip certain exercises for the meantime - until things are back to normal for you again. 

Can clothing have an impact? Yes, in the summer, there are many garments that can upset the neck around the C7 area (where the vertebrae sticks out at the base of the neck). Halter neck bikini tops, casual tops and sports bras with high up racer backs can put pressure on the delicate neck vertebrae.
 

When should you get help? If there is any pain that lingers, gets worse or disrupts your daily life, it should be investigated. Types of pain/symptoms  to look out for include intense migraine like headaches, neck pain, shoulder pain, blurred vision, nausea, stiffness in the neck and upper spine, neck muscle spasms and restricted movement of the head.  If there is any numbness in the fingers or thumbs one should seek help as this may be indicative of a nerve related issue. Look for postural imbalances - are the shoulders at an even height, is the chin jutting forward, are the shoulders rounded and coming forward? It is always best to see a medical professional in the first instance anyhow - whether that is a Physiotherapist, an Osteopath or an Orthopaedic Specialist. Seeing a medical professional on the first instance also allow Sports Massage to be performed in a targeted and safe manner. Pain should be addressed as it can be an indicator of a medical issue or a sign that we need to make adjustments in our life - especially in our daily self-care and in the general balance of our lives.
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The concept of The Three T's is close to my heart. When muscles become unhappy, it is often because we have done Too Much, Too Soon and Too Fast. People do not tend to like this when I tell them - especially when it is related to their sporting activity. The body always has a story to tell and it does not lie. When we train or do any physical activity, if we do more than our body is accustomed to, our muscles can become super tight and loose some of their flexibility therefore putting added stress on to the tendons - resulting in inflammation of the tendons. Joints can in turn become affected and also inflamed. Movement patterns and chains can become compromised and more issues can entail. We need to gradually build up the stresses and loads placed on the body - adding incrementally increasing physical stress, but also allowing time for the body to adapt, recover and gain strength. The best example of this is in the case of a runner who might run too many times a week before their body has become adequately conditioned and at a pace that is too fast. The Three T's can be applied to any physical activity. 

What you can do? - Basically you have three options. 

1. Avoid the activity that is aggravating your neck (not always appropriate or fun).

2. Adapt the activity in some way to have a less harsh impact on the body.

3. Do damage control to offset the impact of the activity on your body. 

Keep a journal to help you become aware of what your triggers might be - briefly note down what your activity was along with a morning and evening pain scale rating from 0-10 (0 = no pain and 10 = extreme pain). Seeing an overview of how are you doing may help you to find triggers that you may have otherwise not taken much notice of. 

Get a massage from a professional with specific training such as a Sports Massage Therapist or a Rehabilitation Therapist. They can help identify any muscular imbalances and give you a stretching programme to help address postural related issues. They can also advise as to whether any muscle groups need to be strengthened. Specialist massage is great for helping to address the balance between muscle groups and help the joints move a little more freely. You may also consider carefully using a massage tool - always avoid too high an intensity, working over any bones, and using it for too long or too frequently. A tennis ball in a long sock can also be used for trigger point work - stand against a wall and lean on the ball in the area of any tight muscles on the back of the shoulder blades, or in-between the shoulder blades. 

Stretching and mobilising the neck and shoulders can also be useful in reducing pain symptoms. Gently turn your head to the left and the right - try to increase your range of movement. Try taking your ear to your shoulder laterally - do you see a difference in movement capability between the left and right sides? Stand with your back against a wall and lengthen your neck by taking your chin back - enjoy the stretch along the base of the neck. Squeeze the shoulder blades together using about 20% effort - this will help open out the chest and re-educate the muscles in-between the scapula to give you better postural support. Stretch out the pectoral muscles of the chest with a door frame chest stretch - stand in the doorway and hold the door frame with both hands whilst you gently allow the body to fall forward. Hold stretches for the neck for 10 seconds and the chest for 20 seconds - 20 is the ideal time, but I find it can be a bit harsh on the delicate neck area. Experiment with laying back on an arched back stretcher or a yoga bolster - this is great to counteract poor posture, decompress the spine, relax the muscles and to open out the chest. If symptoms increase stop performing or modify these tips. 
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Author

Eva Evangelou is a Sports Massage Therapist with over 18 years of bodywork experience. Her private practice is in sunny Limassol, Cyprus. This Blog is based on her findings in her Massage Clinic and through her own experiences with battling chronic pain and various sports injuries.Write something about yourself. No need to be fancy, just an overview.