Shoulder and neck pain is one of the most common complaints I come across in clinic. Often, there is no acute “injury”, as such, rather it is reported as a long, gradual onset to the point where people will feel as though their shoulders are creeping further and further upwards, towards their ears, often at times of stress or tiredness.
I often hear them explaining how they can feel – or that they have been told previously – that these muscles are knotted or tight, and they will explain how it needs to be released, loosened or stretched.
But the structures test very differently to these descriptions in clinic.
And most painful upper traps/shoulders I see are not ‘tight’.
Yeah, I said it.
The sensation of tightness or stiffness felt is because they are constantly being overloaded in a position of stress, and the muscles simply do not have the capability to endure. As we looked at in my blog about posture, muscles are designed to move, and being placed in this position for prolonged periods of time can, and often will, lead to a level of discomfort.
And this is where I see a lot of treatment falling down, focusing too much on trying to lengthen a muscle that is merely screaming to be moved.
The pain itself can be blamed on Ischemia. Ischemia is a lack of blood flow. And so a lack of oxygen to the muscle. And no nutrients. No ‘waste’ removal.
A simple *haha!* evolutionary reporting system produces ischemia, and so discomfort, to encourage us to move!
Try sitting COMPLETEY STILL for 10 minutes – I would bet that you feel quite some discomfort. Its why stress positions are so, well, stressful (and why we should have a new found respect for ‘Human Statues’!)
WHAT CAN YOU DO?
Move more. Thanks for reading.
To be a bit more precise…
Anatomically, the Trapezius muscle is a large diamond-shaped muscle, described as lower-, mid-, and upper- portions, that is found down the side of your neck and top of your shoulders – if you colored in your painful area on a Pain Map, I am sure you would colour in your Traps.
Its the most superficial muscle of the upper back and runs from the base of your skull, along to the tips of your shoulders, and down to the middle of your back, as seen in the image above.
It is generally (a word we try to avoid, of course) considered to be the traps that hurt. Ergo, strengthen the traps!
So far so good.
The complication comes from the commonly held belief of the actions of the 3 parts of the trapezius muscles. It was commonly thought that the lower-, mid- and upper-traps all had isolated functions and nerve innovation, but we now know that to not be the case. For example, we know that the actions of the trapezius muscle is insufficient to rotate or elevate the Scapula (shoulder blade) alone, instead it is its combined action with the Serratus Anterior that does this job. The action of the Serratus Anterior pulling the shoulder blade outward around the back, at about 30° of arm elevation, is ultimately when the upper trapezius muscle assist in its upward rotation and elevation.
So what does this mean?
First and foremost it means that anyone in the gym doing “shrugs”, are not really hitting the upper traps, if you are not incorporating that 30° of arm elevation. There is a muscle underneath the upper-traps called the Levator Scapula, which – brilliantly – does exactly what is says on the tin; elevates the scapula (shoulder blade) – the shrug movement. So what are we strengthening exactly?
A better option are Monkey Shrugs. Please do film yourself and send them to me for my own amusement 🙂
The majority of the Upper Trapezius muscle fibres attach to the end of the collarbone; when they contract they rotate the collarbone inward. This causes compression of the sternoclavicular (collarbone-sternum) joint, and allows forces and loads from the arm and shoulder to be transferred away from the neck – a pretty amazing system to protect the neck, and a system we would like to be strong and robust.
So, most painful upper traps/shoulders I see are weak, not ‘tight’ or ‘short’.
Soft tissue therapy, massage, joint mobilisation, and taping can be a hugely effective, if somewhat transient, component of treatment for your recurring shoulder issues – hence the monthly visit to your massage therapist.
But the key word in all of this is “recurrent”.
Why is it coming back?
Why isn’t it being “fixed”?
What can you do??
There is a way to build a sustainable treatment plan, achieving long term benefit, whilst empowering you to self manage.
To find out how, contact Dan@DC-InjuryClinic.co.uk
N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work.