Shoulder and neck pain can result from traumatic events such as a car crash, but one of the most common causes for non-traumatic shoulder and neck pain is a head-forward posture many people adopt in their workstations, says Phillip Hughes, a physiotherapist and president of Musculoskeletal Physiotherapy Australia.
Athletes whose sport involve throwing and tradies whose jobs require them to hold their hands over their head for a long time are also at risk of neck and shoulder pain, he says. “Excessive overhead activities can cause what we call a tendinopathy of the rotator cuff tendons, and that can lead to tearing of those tendons and significant pain.”
Pain can be a barrier to exercises, says Prof Michele Sterling, a physiotherapist and researcher at the University of Queensland. “But often, once people get moving – it can be quite a low-level or low-load type of exercise – their pain feels better.”
She says people’s natural inclination when something is sore is to rest but avoiding movement can often be counterproductive.
Sterling says there is no robust evidence that one form of exercise is better than another but research shows that exercise – as part of physiotherapy treatment – should be the first treatment approach.
There is no fixed recipe for shoulder and neck pain treatment, and every person has to be assessed and prescribed exercise therapy by a physiotherapist, but here are some tips that can help you get moving.
The class: yoga, pilates and tai chi
In a 2020 systematic review published in the British Medical Journal of Sports Medicine, Sterling and her colleagues compared the effectiveness of different physical exercises for chronic neck pain.
The review included 40 randomised controlled trials. “We found that low-load motor control exercises and classes like yoga, pilates and tai chi are somewhat more effective than things such as stretching exercises,” Sterling says.
Classes that have a strong focus on improving head, neck and shoulder posture can be highly beneficial in relieving neck and shoulder pain, agrees Hughes.
If you have never tried these classes before, Sterling suggests to approach them with caution. “Listen to your body,” she says. “Start at a lower load, with pain-free movement. Then gradually work up to higher loads and stronger exercises, and as in the case of yoga, pushing more into the range of movements.”
The move: the chin nod
Lie down with a soft pillow under your neck. Flatten the back of the neck against the pillow very gently, nodding your head forward as if to say yes.
You might feel the muscles at the back of your neck slowly extending but stop before you feel the front muscles hardening.
Hold the nod position for five seconds, then return your head to the start position.
“[The chin nod exercise] is really important for giving stability to the neck and supporting the neck by strengthening the muscles very close to the spine, at the front of the spine,” Hughes says.
He says building up strength and endurance in this exercise is crucial, and the final goal should be 10 holds of 10 seconds.
“Everybody could benefit from strengthening those muscles, but especially those who spend a fair amount of time on the computer.”
The activity: swimming
Swimming is a great activity to promote stability and strengthen the neck and shoulders, says Hughes. But he warns that it might not be for everyone. “Swimming is certainly not for people with more severe or acute conditions.”
Sitting and spending many hours in front of a computer are significant contributors to neck and shoulder pain. “Even just getting out of that position – walking, swimming, cycling or anything that gets you moving – can be enough to relieve the pain,” Sterling says. “It’s important the person enjoys it.”
The hard pass: lying on your stomach
Hughes says lying on your stomach with your head twisted to one side can harm the neck. He also suggests choosing the right pillow for your sleeping habits.
“If you lie on your back, you need a flatter pillow,” he says. “If you lie on your side, you need a higher pillow.” The focus remains a correct posture of the head, maintaining the back of the neck in line with the rest of the spine.