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The Gist: What is neck and shoulder pain?

Also known as: neck spasm, throwing your neck out, or "I woke up and can't turn my head"

Neck and shoulder pain is the pain in your upper shoulders and neck that typically worsens with poor posture or body mechanics. It can be a broad, achy pain that spans the entire neck and shoulder girdle, or it can be one sided and pinpoint.

Because the pain typically arises from overactive muscles or restricted facet movement, the pain is typically achy but can become sharp with certain movements, like turning your head. You may feel stiffness in the upper back and neck, which can result in less motion and mobility. You may also feel like you can't relax your shoulders or that your posture is always slouched.

The anatomy of Neck and Shoulder Pain

The neck connects your head to your shoulders. Your neck consists of 7 vertebrae that articulate to form facet joints on the left and right side of your neck. You also have muscles that run along your neck, at the base of your skull, and the tops of your shoulders that all contribute to unimpaired and pain free neck movements. Your first rib also originates just below your neck at your first thoracic vertebrae.

Neck and shoulder pain is typically caused by stiffness in the facets or spasms in the muscles. These restrictions can decrease the mobility in your neck, which then lead to tighter muscles. In order to prevent the pain from getting worse you must break the cycle.

Who gets Neck and Shoulder Pain? When does it occur for women?

During pregnancy, the breasts grow and get heavier. As a result of this change, the center of mass shifts forward, which can promote slouching and rounding of the neck and shoulders. Because of this change, the muscles of the neck, shoulders, and upper back must work harder to maintain proper posture as well as head and neck alignment. When these postural muscles are weak, the body will compensate and utilize whichever muscles it has available, typically the upper trapezius muscles (UTs). When these muscles are overworked, they go into spasm causing neck and shoulder pain.

After delivery, new moms must immediately begin performing child care tasks that include, but are not limited to, lifting, holding, carrying, nursing, and feeding. They also look down at their adorable new baby, quite often! Between looking down, breastfeeding, carrying, and feeding, their head will start moving forward and their shoulders and mid back will begin to round. This slouched posture creates a significant amount of demand on the surrounding muscles. When these postural muscles are weak, the body will inevitably compensate with accessory muscles, like the UTs and paraspinals. As these muscles are overworked, they will go into spasm and become achy, inflamed, and painful.

Neck pain during pregnancy can arise at any time, but it typically comes about later in the pregnancy when sitting or finding a comfortable sleeping position becomes challenging. After delivery, neck pain may start fairly soon as you are performing novel movements and tasks that place a lot of demand on the neck and shoulders.

The Origin Way: Physical therapy for Neck and Shoulder Pain

When looking at the head, neck, and shoulders, we look at your posture and positioning in its entirety. How are you sleeping? What is your work set up? What does the curve in your low back look like? We address any movement, position, or body part that could be affecting how your neck and shoulder move.

Your neck pain and poor posture is treated with a combination of manual therapy techniques to your muscles and joints, postural exercises, and strategies to improve the way you sit, sleep, and move. One of the biggest drivers of neck and shoulder pain is the way we move and hold our head. By making meaningful, long term changes to your movement patterns, you can have long term success.

Your Physical Therapist will show you how to sit, sleep, drive, lift, and carry without overly stressing your neck and shoulders. They may also use certain taping techniques to improve your postural awareness as you get stronger.

How long does it take?

Changing the way you hold your head and move can take time because we are likely trying to break patterns that have been in place for years. Most patients feel some relief after a few visits, but long term change can take 2-3 months or longer.

What to expect in the future

Our goal for you is to make meaningful postural changes and change the way you move. We cannot guarantee that you won't wake up one day with a stiff neck, but we want to make sure we have given you the tools so you are not scared of your symptoms and can address them confidently and appropriately.

Additional Reading and Sources

Kesikburun, Serdar, et al. "Musculoskeletal Pain and Symptoms in Pregnancy: a Descriptive Study." Therapeutic Advances in Musculoskeletal Disease, SAGE Publications, 19 Nov. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6262502/

Hidalgo, Benjamin, et al. "The Efficacy of Manual Therapy and Exercise for Treating Non-Specific Neck Pain: A Systematic Review." Journal of Back and Musculoskeletal Rehabilitation, IOS Press, 6 Nov. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5814665/

Neck Pain: Revision 2017. Peter R. Blanpied, Anita R. Gross, James M. Elliott, Laurie Lee Devaney, Derek Clewley, David M. Walton, Cheryl Sparks, and Eric K. Robertson. Journal of Orthopaedic & Sports Physical Therapy 2017 47:7, A1-A83, https://www.jospt.org/doi/abs/10.2519/jospt.2017.0302

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