FAQ: Why is tension carried in the shoulders?

Many of us seem to carry tension in the shoulders as if the whole world rests on our shoulders.  That’s right.  We often feel like it, with so many responsibilities, urgent tasks, and uncertainty for the future.  But, why in the shoulders?

It seems the main cause is mechanical – poor posture.  Most of us spend too much time sitting with the head forward or down and the hunched back.  Since we keep the same position for a long time, the muscles in the upper back are stretched out while the chest and abdominal muscles are short and tight.  Both stretched-out and short muscles cause problems.

From the perspective of body-mind connection, muscle tension and nervous tension are hand in hand.  Mental stress triggers the muscle tension, and the muscle tension causes discomfort leading to stress.  It goes both ways and is a vicious cycle.  Some degree of muscle tension or nervous tension is normal and even necessary.  However, if it’s happening constantly and becoming a habit, it will do more harm than good. 

When we are anxious, worried, upset, or distressed, we experience faster and shallower breathing as well as other fight-and-flight responses.  We sometimes hold our breath.  Thus, the chest has to work rather than the diaphragm,  a large muscle below the lungs to control breathing (read more about the diaphragm in this post).  To move the chest up, the muscles attached between the neck and the ribs or shoulder blades have to do more work.  If the condition persists, the shoulders stay tensed up. 

A small step to reduce shoulder and neck tension is to catch ourselves in the poor posture and under stress/anxiety.   Do the exercise for upper body, and breathe slowly from your stomach (read the next post about breathing exercises).  And, get a massage to relax!  We deserve a break from carrying the world. 

That's Not Where It Hurts - Infraspinatus

When you get a massage, you probably have this experience: You didn’t realize some muscle was very tender until it was pressed on.  There are muscles that don’t hurt, but cause pain somewhere else, so you never suspect those muscles are involved.  The scalenes are one of them as introduced in “Pain Source in the Neck - Scalenes.”

Another example is infraspinatus (in-frah-spih-NAH-tus), which causes pain familiar to many people.  The muscle covers the major part of the shoulder blades.  It rotates the arm outwards and helps stabilize the upper arm bone (humerus) in the shoulder joint. 

PAIN PATTERN

If you feel pain in the FRONT of the shoulder, deep in the shoulder joint, or down the biceps, this muscle is in trouble.  Other areas you might feel pain are: the back of the neck, the inner border of the shoulder blade, the forearm, the thumb side of the hand.  And also, if you have weakness and stiffness in the shoulder and arm, restricted movement of the arm, or pain when sleeping on either side, bring your attention to this muscle in the back.  And also, if you are diagnosed with “frozen shoulder,” dysfunction of this muscle among other rotator cuff muscles may be the cause.

CAUSES

Anybody who keeps the arms up in front (driving, typing without elbow support, using the mouse) or overhead (painting, decorating) for long hours, or reaches back repeatedly, is likely to stress this muscle.  And also, many sports activities, accidents and falls may contribute to overload.

TREATMENT

To relieve the condition caused by infraspinatus, you can massage with a tennis ball as explained in “Tennis Ball Massage (1) - Back.”  You can start in the middle of the shoulder blade rolling the ball side to side against the wall.  You might feel the ropy thing and the referred pain in the front of the shoulder (or somewhere else).  If you don’t feel anything, press harder.  For some people, a firmer racquet ball is more effective than a tennis ball.

If you find the tenderness in the middle of infraspinatus, you can use this Ortho-Bionomy release technique.  The following “Release for Shoulder Point 4: Turkey Wing” is referred from “Ortho-Bionomy A Path to Self Care,” the book I introduced in “Look for Comfort –Ortho-Bionomy®.”

• Stand with your back to the wall, and bend your elbow back.  The position of your elbow should be slightly to the side rather than straight back.
• Lean your elbow slowly into the wall so that compression is applied from the elbow in toward the shoulder joint.  Relax all the muscles at the shoulder, neck and arm as you lean.  Focus on your sensation.
• Check the middle of infraspinatus for tenderness.  If it’s still tender, change the elbow position slightly.

Text Neck

Unfortunately, modern technology is not necessarily doing good for our bodies.  I wrote about a “Forward Head Posture” and “Texting Thumb” a while back.  There is an increasing problem we can’t overlook.

“Text Neck” is happening more to younger people, even small children.  It’s not caused by just texting, but using any types of handheld mobile devices including tablets for long periods of time.  Looking down at a device causes the back of the neck overstretched and inflamed.  The common symptoms are headaches, pain in the shoulders, neck, back, arms, elbows, and wrists, and even numbness and tingling of the arms and hands.  Dr. Dean Fishman, who coined the term “Text Neck,” calls this condition “a harmful and dangerous physical condition on the human body.”  The long term risks can be flattening or reversing the natural spinal curve, early onset of arthritis, spinal degeneration, disc herniations and etc.  This poor posture decreases the lung capacity leading to vascular disease, and puts pressure on the organs causing gastrointestinal problems.  It sounds pretty serious, doesn’t it?

How do we avoid “Text Neck”?  Old habits die hard, but think seriously about the long term consequences especially if you are still young.  Here are suggestions.  

Tablet stands / docking stations:

Use a stand or a docking station to put your device closer to your eye level.

“Text Neck Indicator” (for Android):

This app alerts you when you tilt a smartphone too low and are at risk for Text Neck.  Unfortunately, I haven’t yet found an app for iPhone.

Look up!

Look up and turn your head left and right 10 times whenever possible.

Do exercises:

Try these exercises I posted at “Stretching and Strengthening Exercises at Your Desk (1) and (2).”       

Pain Source in the Neck (2) – How to Massage Scalenes

It is important to know how to massage these key muscles for many problems as mentioned in the last post.  Don’t be afraid of touching your neck.  You may want to lie down while massaging so that your neck gets relaxed.   

Scalenes are behind the sternocleidomastoid (SCM).

To reach the anterior scalene, with your opposite hand, you have to push the sternocleidomastoid aside toward your throat to locate it between the sternocleidomastoid and the neck vertebrae.  

© Clair Davies

Get your fingertips in front of the vertebrae and push the anterior scalene against the vertebrae up behind your ear and down to the collarbone (clavicle).  If you feel the pulse, just get out of the way.  You will feel tenderness if trigger points are active.  You might find the worst one behind the collarbone.  It is normal to feel a referred sensation somewhere else or mild nervy sensation.  Stroke on each trigger point side to side up to six times.

To locate the middle scalene is easier.  Get your fingertips on the side of the neck vertebrae.

The posterior scalene is buried almost behind the collarbone and tricky to find.  Find where your collarbone meets the top ridge of the shoulder, and move toward the throat along the collarbone. 

© Clair Davies

When you press downward toward the collarbone, you feel a bony structure underneath.  The posterior scalene is around there, and it feels ropy and moves around.  It brings to me a mild nervy sensation, not tenderness, and sends a referred sensation to my back at the inner edge of the shoulder blade.  It may not be comfortable first, but if you don’t find trigger points in the anterior and middle scalenes, this posterior scalene is the key, so don’t be discouraged.  

Pain Source in the Neck (1) - Scalenes

It seems that these particular muscles in the neck is the solution to many problems in the upper body.  It’s called scalenes (SKAY-leenz) and located in each side of the neck, next to the vertebrae.  I never forget to work on these hidden muscles in the neck. 

Many people avoid touching the neck or don’t want it touched.  However, working on these muscles solves so many pain problems in the upper body.

© Clair Davies

• Upper back pain (the inner edge of the shoulder blade)
• Mid back pain
• Chest pain
• Front, side and back of shoulder pain
• Front and back of arm pain/numbness
• Pain, numbness, tingling, swelling in the arm and hand; symptoms of thoracic outlet syndrome 

Scalenes consist of three muscles (anterior, middle, and posterior), and attach to the sides of neck vertebrae and to the first and the second ribs. 

© Clair Davies

They help support the weight of the head, and flex and turn the neck, but the main job is to lift the ribs when you inhale, so it has to do with breathing.  Breathing shallowly with the chest because of emotional tension or respiratory problems stress the scalenes.  However, daily activities like working with arms out in front of the body, pulling, lifting, and carrying a heavy back pack, and sports activities also easily overtax the muscles.

If you have one (or more) problems above, let’s focus on your neck first.  In the next post, I will show you how to massage the scalenes.      

Tennis Ball Massage (1) - Upper Back

I always recommend my clients massage themselves with a tennis ball as well as using a heat pack.  I would like everybody to get a massage as often as possible, but I know the limitation.  Massaging yourself every day would help you more than completely being dependent on massage sessions.  I would also like you to be in charge of taking care of yourself, so don’t be lazy and ask your family members to do it. 

I have introduced a few self-massage tools, but a tennis ball is actually versatile and inexpensive. It is good for massaging trigger points in your back, hip and buttocks. Although many instructions tell you to lie down on it, I would lean on a ball against a wall so that you have a complete control over the amount of pressure. If you lie on it, it’s difficult to roll the ball around, and it could be too painful for your condition. I also would put a ball in a sock so that you don’t have to pick it up every time the ball falls on the floor. It’s like scratching your back on the wall.  Here is how it looks like. 

If a tennis ball doesn’t give you enough pressure you want, you can try a smaller and firmer racquet ball.  It has a grip, so you could use it without a sock.  Or, if a tennis ball is too firm, you can try a softer squash ball. You might want to try with whatever ball you have at home first. 

GUIDELINES

• Pressure: The sensation should be what we call “good pain” and NOT exceed a pain level of 7 on a scale of 1-10.  If you can’t breath normally, you need to lighten up the pressure.  
• Relax the whole body as much as possible and wait for the sensation to fade. 
• Don’t overwork too long: Work on one spot only up to 12 strokes at a time. If you get sore or bruised next day, you work on it too much.
• Massage as often as possible (6-12 times a day)

The common trigger points in the back are located: 

• Between the spine and the inner shoulder blade: trapezius, rhomboids, thoracic erectors
• In the middle of your shoulder blades: infraspinatus
• The outer edge of the shoulder blades close to the armpit: teres minor/major, lattisimus dorsi

I will show you more common trigger points in the hips and buttocks for lower back pain in the next post.

Stretching and Strengthening Exercises at Your Desk (2) - Upper Body Strengthening

When you feel tension or pain, you can’t always think that stretching will help.  In the forward head posture discussed in the last post, while the chest muscles are short, the muscles located the other side in the back are overstretched and weak.  It’s likely you feel tension or pain in the back between the shoulder blades.  You don’t want to stretch already overstretched muscles.  Muscles coordinate with opposing muscles by contracting and relaxing to make every movement.  It is helpful to check your habitual posture to see which muscles are shortened or overstretched.  

Strengthening

While stretching helps shortened muscles, “strengthening” exercises help overstretched, weakened muscles increase muscle tone so that you can restore proper posture.  Here are easy exercises you can do at a desk. 

Upper back: When chest muscles are short, the muscles in the upper back are overstretched.

• Relax the shoulders.  Squeeze the shoulder blades together without using arms or any muscles other than the ones between the shoulder blades.  Hold each squeeze for 5-10 seconds with 3-5 seconds of rest between squeezes. Repeat 10 times or until you feel fatigue.

Mid-back: The muscles along the spine in the mid back are overstretched.

 
• Rest your hands behind your head, and lean backwards (extend the spine) within your comfort level.

Front of your neck: As the back of the neck is short and tight, the deep muscles of the front neck are weak.

• Pull your chin inward and head straight back. Hold it for 5-10 seconds with 3-5 seconds of the rest in between.  Repeat 10 times or until you feel fatigue in the neck.