Neck and Shoulder Pain – Movement Considerations

In the past I have talked about the positive influence correct breathing (diaphragmatic) has on posture, as well as the relationship between neck position and spinal curvatures. Additionally, I wrote an article in which I attempted to explain the relationship between trunk rigidity/stabilization and increased efficiency and cleanliness of movement.

Along with these points, I want to address a point at which “over-bracing” can become problematic. Specifically relating to the shoulders, the desire to create more stability can be pathologically satsified with creating more tension. Not just tension in supporting musculature, but tension in ALL musculature, supporting and otherwise. We can sometimes be led to believe that this is the way to create more stability, and has actually been explored in a couple of really good books. The “suit of armor” concept as it pertains to restricting movement is explored in Joanne Elphinston’s Book Stability Sport and Performance Movement, as well as the concepts of foot-fixing, facial-fixing, and butt-gripping. All of these are nervous system attempts to source stability from the wrong places. With respect to the upper extremity, today I want to talk about trying to source stability from the neck. 

coremusculature

When describing the CORE, we typically refer to abdominals, paraspinals, and hip flexors and extensors. All of these have profound qualification as “core” muscle, but why? Because, their role in attaining and maintaining posture is defined by their size, proximity to the spine, and function as it relates to stabilizing the trunk. What else is close to the spine and is sometimes looked to for stability? The neck.

Importance of sourcing stability from the trunk:

Without a stable trunk, it is likely that some sort of dysfunction will develop and begin to radiate outward. If there is dysfunction (weakness or poor coordination) in the core, and/or misalignment, you can expect that those problems will manifest in a ripple effect downward to the hips, knees, and feet. Or upward to the neck, shoulders, elbows, and hands – or anywhere else in between.

For example, when we squat with the bar on our back, we will brace ourselves by drawing a breath in and contracting our abdominals to achieve and maintain a rigid (but neutral) spinal position. By doing this, we have done our best to ensure that the downward force of the bar acts as directly as possible through a rigid segment (our trunk) and is moved more or less exclusively by the legs.

In the above case of squatting with the bar on our backs, trunk rigidity and leg strength are important. But what about the muscles that are involved at the hip joint which control some of the finer points of our leg movements. We know, for example, that weak or inactive glutes and femoral external rotators can lead to valgus collapse of the knees. We also know that this is usually facilitated by inability to maintain pelvic position and therefore dissociate the hip from the tunk. Since ugly hip mobility combined with posterior tilt in a flexed hip manifests as femoral internal rotation (A on F, not F on A.) This is an example of that ripple effect, a dysfunction close to the core having negative influence on the adjacent extremity. 

knee-collapse

Ow.

So bracing strategies obviously allow for more efficient movement, but what about when it comes to movements involving the upper body? There are a lot of points of consideration, and the one I want to hit on today is with respect to using the neck as an “anchor” point when we use our arms to interact with our environments. Yes, it’s still important to brace ourselves and seek optimal alignments, but one of the first things we can be aware of in this case is the position and function of our scapulothoracic joint.

First, neutral alignment should look something like this:

neautral-scap

If you don’t know where T2 is, feel for the most prominent bone on the back of your neck while looking down. That is C7. 2 bones “south” of there is T2. From there, you should be able to figure out the rest.

From this “neutral” position with your arms hanging by your sides, your scapulae have to move in ways that accommodate everything else you may want to do with your arms. This is called scapulohumeral rhythm. The scapulothoracic “joint” really just refers to the relationship between your scapulae and thorax. Essentially, the scapula slides along the rib cage in harmony with the movements of the humerus (bone between shoulder and elbow) in order to support it in various positions.

There are a few muscles that have direct attachment between the scapulae and the trunk. They are:

scapular-muscles

In Vladimir Janda’s Upper Crossed Syndrome, one of the most common dysfunction patterns is actually detailed relating to inability to correctly control the scapula as it moves inefficiently to accomodate humeral excursion. Upper Crossed Syndrome is detailed below:

ucs

And this is the point I want to make today. Janda posited a long time ago that postural issues have negative influence on the balance and ability of muscles to do their respective jobs. In the case of Upper Crossed, we see (on the back side) over reliance on the upper traps and levator scapula, two of the muscles named in the other picture of those which determine scapular control. These two muscles are heavily used in most people with what is now common posture. Remember, common does not mean “normal.” With that said, this nature of this postural dysfunction also inhibits the rhomboids, serratus anterior, and mid to lower traps. While it seems the jury is still somewhat “out” on the exact function of mid and lower traps, we do know that inhibiting the other two (rhomboids and serratus) which control scapular movement in the transverse and frontal planes is pure bad news.

So with the upper trap and levator doing most of the work, inhibited serratus and rhomboids, you will commonly see scapular winging and a neutral scapular position that is further from the midline than the previously proposed ideal of 2.5-3 inches. It is also easy to observe people who use these muscles preferentially in movement patterns which involve the upper extremity. Because of preferential (incorrect) recruitment of the two overused muscles, and consequent postural malalignment, people will use the NECK as an anchor for upper body movements.

Dissociation of the neck from movements involving the shoulder, and cooperative scapulohumeral rhythm then becomes an alluring prospect. Of course, like many other things involving “rehabilitation” there is a period of re-learning. In other words, you may need to consider how to regain or establish control of your scapular control muscles, and this may be embarrassingly necessary without weight. I have made a short video in which I try to demonstrate a few scapular movements while dissociating my neck.

You may notice I’m pretty asymmetrical in terms of movement control. I’m actually currently experimenting with these movements in parts of my warmups and training. I’ve been having some pain in the right wrist, as well as left shoulder, that I assume are a function of compensatory shoulder movements (weakness) in the left, and inadequate shoulder mobility in the right.

The bottom line is, unless you are able to establish or regain control of your scapulae then you open your doors wide to opportunities for pain. Poor scapular control and postural incorrectness can lead to a pathological situation which nurtures poor joint centration, impingement syndromes/other tendinopathies, and overuse injuries like strains and labral tears. So next time you are doing any sort of upper body movements (preferably without the support of a bench – which will further limit your scapular movement), try some neck dissociation and test yourself. It may also be worthwhile for you to take note of any times you regularly have your arm “forced” into a shrugged position. Are your office chair arms too high? Do you rest your elbow in the console when you drive? Check on some of the things around you that could be insidiously feeding your over-reliance on the upper traps and levators.

Further material of interest: