Neck Pain and the role of the Shoulder Blades - a PT's Perspective

Neck Pain and the role of the Shoulder Blades - a PT's Perspective

Shoulder Blade muscles and Neck Pain:

If your shoulder blade muscles, like the Upper Trapezius, aren't the cause of your neck pain, there's still a good chance they are contributing to your neck pain. As a Physical Therapist, the intimate relationship between the neck and shoulder blades is clear. Problems in one area can lead to problems in the other. In this post, I'll introduce all of the relevant shoulder blade, or scapular, muscles including the "Good Guys" and the "Bad Guys." You'll learn how to strengthen the right muscles and relax the problem muscles to get rid of your neck pain. We've made videos detailing each exercise that you'll need. Please enjoy! 

Anatomy: 

The shoulder blades, or scapulae, are a pair of large triangular-shaped bones on the back of your rib cage. They are extremely mobile, in that the shoulder blades can move in almost any direction on your rib cage. When you shrug your shoulders to show disinterest, that's all just motion of the shoulder blades moving on your rib cage. Oftentimes, the difference between good posture and bad posture is the position of your shoulder blades. Slumped posture, with shoulders forward, and chest in, is simply the shoulder blades moved toward your armpits. In contrast, having the shoulder blades squeezed back, with your chest out, represents good posture. Amazingly, the shoulder blades are suspended in the air by just shoulder blade muscles and a far-off connection to your sternum. Picture this bone, the scapula, as the center flag in a tug of war game. The flag has no control of where it goes, and is constantly being pulled in either direction by the opposing teams. The scapula is at the whim of the scapular muscles, which can move the scapula up, down, left, right, forward and backwards. 

The Good Guys

You’ve probably heard of the trapezius muscle in passing, but that is just one of the many scapular muscles. When we talk about good posture, with shoulders back, we are using the middle trapezius, and the other “Scapular Retractors” including the Rhomboid Major and Minor. Think of these muscles as the good guys. If the Scapular Retractors were competing in this tug of war game, you would want them to win. These muscles can be seen in the image below. Physical Therapists will often work to strengthen these muscles to improve posture and take stress off of the neck. I’ll show you the exact exercises I like to do with my patients to strengthen these important postural muscles later on. 

The Bad Guys

So if the Scapular Retractors, including the middle trapezius and rhomboids, are the good guys, who are the bad guys? In my world, that’s an easy one. The Upper Trapezius and the Pec Minor are the bad guys. Let’s zoom in on the Upper Trapezius first. This is the muscle that is strengthened when weightlifters do their shrugging exercises. It’s also a common pain source for people with neck pain. The prototypical patient with Upper Trapezius muscle pain would be a stressed out desk worker, who sits with hunched shoulders, and has pain at the base of their neck moving towards the shoulders. I’ve mentioned that the scapula is essentially suspended in the air by muscle and that muscle holding up the scapula is the Upper Trapezius. Imagine a string running from the base of your skull to the top of the scapula. Clearly, this muscle prevents the scapula from falling to the ground. Holding up the scapula is no easy task, and thus the upper trapezius is often overused, overactive and painful. The Upper Trap can also create neck stiffness, as it will limit how far you can turn your head if it is tight. Thus, a bad guy. I’ll talk about how we treat this muscle pain by strengthening the surrounding scapular muscles later on.


The other bad guy in the world of scapular muscles is the Pectoralis Minor. This muscle, which runs from the front of the scapula to attach on the front of the rib cage, pulls the shoulder blades forward, into “bad posture.” Basically everyone has tight Pec Minors, and this is because so many of us, including me, spend a lot of time sitting, slumped, with our shoulders forward. Tight Pec Minor muscles will pull on the other bad guy, the Upper Trapezius, which can result in neck pain. To improve our posture, we need to stretch and massage the Pec Minor. More to come on this. 

Strengthening the Good Guys

The benefits of strengthening the scapular retractors (Middle Trapezius, Rhomboids) are plenty. Firstly, having strong, endurant scapular retractors allows us to sit, stand, and live with good posture. Good posture takes stress off of the neck because that bad boy, the Upper Trapezius, will be relaxed and free of tension. Also, over time, strong good guys will lengthen the tight Pec Minors which will further improve posture and improve your shoulder and neck function. So, if my math is correct, strengthening the Good Guys will help relax the Bad Guys. That’s right, it’s the old killing two birds with one stone approach. So, how do we strengthen the Good Guys? Get yourself a light resistance if you don’t already have one, and follow along.

Relaxing the Bad Guys

Let’s treat ourselves. We’re going to do some feel-good treatment on those Bad Guys. First, we’ll massage the Pectoralis Minor to help it relax and improve your posture. There are many ways you can go about this and I’ll show you some of my favorites. After our massage, we stretch. Massage, then stretch. It's the classic one-two physical therapy combo! 

Summary

Treat your neck pain like Physical Therapists:

1. Strengthen the Good Guys - 2 sets of 10 repetitions per exercise:

  • "No Moneys"
  • Rows
  • Shoulder Extension

2. Relax the Bad Guys:

  • Massage the Pecs - 1-2 minutes
  • Stretch the Pecs - 2-3 minutes
  • Shoulder Rolls - 20 repetitions

 

What about the NecksLevel device?

With the NecksLevel device, you can strengthen the Good Guys, while strengthening your neck muscles....at the same time:

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