Shoulder and neck pain

Andrew O'Neill 

Pain in between your shoulder blades? Pain in the neck?

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This week I decided to tackle what is invariably the most complex joint in the human body, the shoulder. Why is it complicated? Well, for a start it is the only joint that can rotate through full 360 degrees of motion meaning there are many muscles to contend with. Secondly, chronic shoulder and neck pain (meaning pain that did not originate from an acute injury)  are commonly related dysfunctions somewhere else in the body. When assessing for these dysfunctions we need to look at the following:


  1. The opposite shoulder.

  2. The rib cage positioning.

  3. The diaphragm’s efficiency.

  4. The position of the neck.

  5. The position of the pelvis.

  6. Scapular (shoulder blade) movement and position.

  7. The position of the jaw.

  8. Fascial and skin irregularities.

  9. Your daily activities of life.


This is just the start ! and unfortunately, we do not have the space to delve into and discuss every one of these potential dysfunctions. But in general, if any one of these, or more than likely a combination of these are not functional and doing what they should be doing we can end up getting nasty shoulder and neck pain. I have decided to focus firstly on what we see in the clinic on a day to day basis most often and address the rest of in future articles.


So let’s first address your daily activities of life. What I mean by these are the things we do in our day to day life and specifically our jobs. For those of us that sit at a desk all day or drive a lot of you may relate to this even more than others. Unfortunately, sitting for long periods of time means your posture can become restricted in certain areas, for example, your upper back and buttocks get very little movement and can result in a flat looking spine. So why is this an issue? Well, it means your shoulder blade will not sit and slide effectively on the rib cage and we find when the shoulder blade doesn’t function properly we get shoulder pain. We often see this presented as shoulder blade winging where one or both shoulder blade stick out from the rib cage and don’t move in sync as we lift our arms up and down repeatedly. We also see the shoulder loses its ability to internally and externally rotate. What tends to happen then is other muscles around the shoulder and neck become overworked and cause pain. We tend to see people complaining of pain at the side of the shoulder and down the arm. Specific exercises and treatment are then required to released these overworked muscles and re-establish the shoulder blade control on the rib cage

Shoulder Blade - image on the right shows how the shoulder blade is rounded (C shape) and should sit on a rounded spine 

Shoulder Blade - image on the right shows how the shoulder blade is rounded (C shape) and should sit on a rounded spine 

This also requires working on the ribcage itself to achieve this, just solely working on particular muscles will not suffice. We do this by training our diaphragms. An inefficiently working diaphragm generally means our ribcage becomes elevated at the front and flat and extended at the back. Breathing exercises that encourage the ribcage to depress at the front and expand around the T-spine are very effective in getting the scapula to move efficiently, hence off-loading those overworked muscles and getting the ones that need to work, working.


Let’s now address how an elevated rib cage can cause neck pain. In simplest terms, if the ribcage is elevated this can shorten the muscles at the front of your neck, pulling your neck and head forward, this, in turn, lengthens all the muscles in the back of your neck. Muscles that are in a constant lengthened position will feel like you can barely keep your head up “heavy head”. Like any other muscle in the body, they have to be able to contract and lengthen, muscles that are stuck in either a ‘lengthened’ or ‘shortened’ position will eventually cause pain. These muscles that are lengthened in the back of your neck are also attached to your shoulder, if these don’t function properly you may see a shoulder that is up on one side and down on the other. For example, you may feel pain running down your neck to the top of the shoulder blade or the trap muscle that runs from the side of the neck to the top of the shoulder. Simply stretching these muscles may help in the short term but unless the root cause is addressed you will end up back in the same place you started.


So, in conclusion, you can have a number of different symptoms and a number of different causes. The key point is you are the environment you live in, think about when your pain starts? how long it lasts? And can you relieve it?. If you can answer these questions then it can make my job a lot easier to fix. Don't forget that pain that comes and goes’s is MUSCULAR not a bone and not a disc.


Tommy ConwayComment