As the image above shows so well, pain in the neck and shoulders can be closely related, so we’ve grouped them together for this post. There are many muscle, nerve and fascial connections between neck and shoulder, so pain in one can easily lead to pain in the other. In addition, as we will see, Pilates exercises tend to be focused on the mobility, conditioning and alignment of both together, because anatomy-wise, it is very difficult to make a change to one part without influencing the other.
The neck consists of seven vertebrae, with joints between the bodies of the vertebrae (through discs) and between the outer points of the vertebae as well. The spinal cord runs through the middle and nerve branch out to supply the shoulders and arms and also affect the head.
There is also an artery running up each side of the spinal column in the neck (marked in red on the diagram) which supplies blood to the brain. Problems within the joints, caused by wear and tear, posture, prolonged static positions or muscle imbalances, can cause pain around the neck area but also refer pain to other parts of the body. This is usually due to the distribution of the nerves as the run from the neck.
So pain arising in the neck can be manifested in different places, lower and middle neck problems can cause hand and shoulder pain, while upper neck pain can cause jaw pain and also headaches. This can be difficult to make sense of but we can get great results when we identify that the problem has arisen from the neck and treat the cause.
Problems with neck and shoulder posture are frequently seen together. People who work at computer screens or spend a lot of time sitting will tend to have a bit of a forward head posture, compressing the back of the neck, and the shoulders will begin to round forwards. This is called upper crossed syndrome and causes tightness in the front of the chest and back of the neck, and weakness in the upper back and front of the neck:
Look around you, does the posture above look familiar?! It can be the source of a lot of discomfort.
The shoulder and shoulderblade form a very mobile and complex joint system. The only joint connection to the rest of the skeleton is where the collarbone meets the sternum (the sternoclavicular joint below). The remainder of the shoulder relies on the support of the muscles around the shoulderblade and around the shoulder (glenohumeral) joint itself to remain in good shape and continue to provide the mobility that a shoulder is capable of. Take a moment to reach overhead, to the side, behind you – if you have no shoulder problems you should be able to get an incredible range of moments from your shoulder, all of these supplied by groups of muscles working in combination. Sorry to get a bit geeky about this, but I think it’s a pretty incredible feat of engineering!
Shoulder problems can arise when an imbalance occurs in these complex relationships between muscles, with dysfunction of a nerve or if there is a problem within the joint itself – tightening of the capsule that surrounds the shoulder joint for example. Anyone who does repetitive tasks or sits in sustained postures can be affected by shoulder problems. Within sport, swimmers and cricketers are a couple of examples where shoulder injuries can occur.
Pilates exercises work to balance the muscles around the shoulders, but also work the shoulders in different positions to achieve the dynamic stability the shoulders need to support them through the full range of movement they can achieve. The shoulders and neck are encouraged to work together to achieve improved posture throughout the upper body. This is great for preventing as well as treating neck and shoulder problems.
Some Pilates exercises use body weight to encourage correct control around the shoulders whilst maintaining good neck alignment. Specific movements encourage good coordination between muscles and allow muscles to switch on in the correct sequence which is vital for good shoulder function.
A Pilates client of ours had struggled with neck and shoulder pain for years and been to various Physios, chiropractors and osteopaths before giving Pilates a go. We have given her a programme of one-to-one Pilates sessions twice weekly as well as a few key exercises to work on at home. In the one-to-one sessions she has very close supervision of her positioning to ensure she gets the best out of the exercises. She has found that each session’s effects are lasting longer as she continues working with us, and we have been able to progress her to challenging exercises. Her posture has improved, pain reduced and movement in her neck and shoulder is now much better. She reports that Pilates has been much more beneficial than any previous treatment.
So, what can you do to help prevent neck and shoulder pain? Move, little and often. If you have to sit in a static position for a period, sit well supported with good neck and shoulder alignment (chin tucked in, length in the back of the neck and shoulderblades slid back and down into your mid-back) and take frequent rest breaks. During a rest-break you could try a couple of simple exercises to improve the mobility and dynamic stability of the neck and shoulders:
The V-W. Lying on your front with a cushion underneath your forehead, your chin tucked in and you belly button drawn up and away from the floor/mat. Start with the arms beside your shoulders in a W shape, then hover the arms a couple of inches and exhale sliding them overhead into a ‘V’ shape. Inhale and return to the start. Repeat 10 times. To make this exercise more challenging, lift the forehead a couple of inches, keeping the chin tucked in and continuing to look down.
Upper back extensions: with your hands either on the chair behind you or on your low back, keep the chin tucked in and length through your neck, feel for the stretch between your shoulderblades, not in your low back. Hold for a breath and release. Repeat 5 times.
Spine twist exercise (which can be done with or without a band or towel). Inhale, lenthen through the spine and exhale, rotate to the side, inhale hold and rotate a little deeper, exhale release back to the centre. Repeat 5 times each way.
Please see your instructor if you have any questions about the exercises described here.
Enjoy the benefits!