Sore Shoulders and What to Do About It
Hands down the number one issue I see in my massage practice is clients complaining of pain in their shoulders and upper back. You know the feeling, that tight, achy, burning feeling right between your shoulder blades. Sometimes it moves up into the top of your shoulders and up into your neck. It comes on in the middle of a long day at work, when you’ve been sitting at your desk too long, or when your feeling super stressed. You try to massage your own shoulders, bribe your partner or a friend to massage them for you or take a hot bath or shower to relieve some of the pain. It feels ok for a bit but doesn’t really fix the problem.
The clinical term for this condition is called hyperkyphosis. Wait, hyper-what? Speak English please! Ok, ok, it’s a fancy medical term for rounded shoulders sometimes accompanied by a head-forward posture. Your spine naturally has some normal curves in it. The normal curve in your lower back is called a lordotic curve and the normal curve in your upper back is called a kyphotic curve. Hyper means too much. So hyperkyphosis is too much curvature in your upper back.
So what causes this and why is it the most common condition I see in my clinic? While there are some pathologies that can cause permanent structural hyperkyphosis, what I see most often is functional hyperkyphosis which is caused by an imbalance in the muscles. These days most of us spend a lot of time on our computers or looking down at our phones, driving our cars, or other activities that put us in a position where our arms are held out in front of us, possibly with our heads down as well. Maybe you slouch a lot or sleep curled up on your side. Spending extended time in these postures causes our chest muscles, the pecs, to shorten. The short, tight pecs then pull our shoulders forward and cause the muscles in our upper back (the mid-traps and rhomboids) to be constantly pulled. It’s this constant pulling and strain that causes the pain we experience.
If left untreated hyperkyphosis can lead to even more problems than just sore shoulders. Over the long term, it can lead to breathing problems, numbness, tingling and pain in your hands and arms called thoracic outlet syndrome, frozen shoulder, and TMJ disorder.
Our instinct is usually that we need to treat the area that hurts. Your upper back hurts so you try massaging it or putting heat on it, but it doesn’t fix the problem. The root of the problem is the short, tight chest muscles. When clients come to see me for pain in their upper back they are often surprised that I actually start their massage face-up. A lot of them say they’ve only ever had a massage starting with them lying face-down. But once you understand that the root cause of the issue is actually the chest, it makes sense that you need to start by relaxing and lengthening the short, tight pecs.
So is there anything you can do yourself besides going for a professional massage? Of course, there is! While going to a trained massage therapist will definitely speed along the process of correcting hyperkyphosis, postural issues like this actually benefit the most from things you can do daily at home.
The number one thing you can do at home is stretching your pecs. The best way I find to do this is with a doorway stretch. Find a doorway in your home or workplace. Place your hands on either side of the doorway at shoulder height. Lean into the doorway until you feel a stretch in your chest. You can play around a bit with the height of your hands on the doorway, putting your hands higher and lower will target different areas of your pecs. Hold this stretch for 30 to 60 seconds. It is important to hold the stretch for at least 30 seconds as this is the amount of time it takes for your muscles to relax into the stretch. Try to do this stretch a few times throughout the day.
Once you’ve spent a few weeks stretching and you’ve got the pecs relaxed and lengthened it’s time to start strengthening the mid traps and rhomboids in order to keep your shoulders back where they belong. My favorite exercise for strengthening the mid-back is rowing. There are a few variations of rowing exercises. You can use a rowing machine, free weights, or do some actual paddling in a kayak, canoe, rowboat, or paddleboard. To use free weights you can do bent-over rows either one side at a time or both simultaneously. Whichever method you choose, make sure you are actually contracting your shoulder blades together and not just pulling with your arms.
Your posture is the main reason why you developed hyperkyphosis in the first place so it makes sense that you need to correct the problem that started it all if you want to keep sore shoulders at bay. Look at yourself standing sideways in a mirror. The outer edge of your shoulder should line up with your hips and the center of your ear should line up over the edge of your shoulder. Try to identify which activities contribute to your poor posture and then find ways to correct them.
If you spend a lot of time on a computer, make sure that your office space is set up as ergonomically as possible. Your screen should be at eye height, not below. Having your screen too low causes you to spend a lot of time looking down which contributes to the head forward posture that is often associated with hyperkyphosis. Your keyboard should be at a comfortable height that allows you to keep your elbows at your side, bent at 90 degrees. Your arms should not be held out far in front of you. Your chair should have good back support and the height should be adjusted so that your feet are flat on the ground, knees bent at 90 degrees.
If you spend a lot of time driving, take some time to set up your seat and steering wheel in a way that will help your posture. You should be able to hold the steering wheel at 4 and 8 and keep your elbows by your side. Avoid spending a lot of time driving with your arms held way out in front of you or held up high on the steering wheel. Also, avoid resting one arm way up on the side of the door or window while the other is down by the gear shift as this can lead to further problems of one shoulder staying higher than the other and causing neck pain.
Other activities that can cause problems with your posture include looking down at your phone or a book, looking down at the ground when you walk, slouching, or any other activity that causes you to have your arms out in front of you and your head down for extended periods of time. Try to make an effort to notice your posture throughout the day and correct it as needed, shoulders back and head up!
The last point to look at, and the one that is overlooked the most, is your body positioning while you sleep. Depending on your sleep patterns, you spend 6 – 10 hours every day sleeping. That is a long time to spend in one position, even if you toss and turn a bit or change positions throughout the night. Paying attention to your sleep position and using the proper pillows can make a world of difference in postural issues like hyperkyphosis.
No matter which position you like to sleep in, the goal should always be to keep your spine neutral. This means no exaggerated forward, backward, or side bends. The best way to ensure this is to select the proper pillows for your preferred sleep postition.
Sleeping on your back is the best position for keeping your shoulders in line. If you sleep on your back, you need a pillow that provides some support for your neck and the sides of your head, but not one that is so lofty that it pushes your head forward and causes your chin to tuck towards your chest. If your lower back gets sore from sleeping on your back, try putting a pillow under your knees as well.
The sleep position that I see most often in clients with hyperkyphosis is side sleeping. This position causes the shoulders to curl forward and often the head to fall to one side. In order to keep the spine and shoulders better aligned you will need three pillows for this position. First, you need a lofty pillow for your head that has enough height to keep your head in line with the rest of your spine but not so high that it bends it to the other side. Next, you need a pillow in front of you to hug. This pillow will stop your top shoulder from falling forward. Lastly, you need a pillow between your knees in order to keep your hips properly aligned.
Sleeping on your stomach seems to be the least favored position, at least for most of my clients, and causes more problems with the mid to low back than with the shoulders and causes different problems with the neck. That being said, if this is your position of choice try sleeping with a very flat pillow or no pillow at all in order to avoid putting too much lordotic curvature on the low back and neck.
Relief from sore shoulders is possible!
A lot of people think that sore shoulders are just something they have to live with, that it’s just stress or part of “getting old”. But relief from sore shoulders is possible! Following these steps at home in addition to working with a good massage therapist can make your sore shoulders a thing of the past.