Well its a brisk Saturday morning on this March 19, and when I let our aged-but still very cute black lab “Karlee” out for her morning business this morning, a smile came to my face as I realized that the lingering of winter is still in the air, however our trip down to the Dominican KarleePoochChristmas2Republic in two days should provide an adequate remedy for that.

As my wife suddenly appeared downstairs after her well-deserved 10 hour “sleep-in” after our training session the day before, I asked her how her neck and shoulder muscles were feeling after the workout and manual treatment that I had done to help her chronic neck pain issues. My wife’s name is Jodie, and her morning report about her neck was a positive one this time. As a therapist, I guess I have been blessed with a life partner who not only provides me with her willingness, but also the body parts to practice my therapeutic treatments on. A husband and therapist can only get so lucky, right?
Our long-running conversation about her chronic neck and shoulder pain always seems to come back to this “rounded-shoulder” thing.
Ok, so what is this “rounded-shoulder” thing, why is it important, and how can it give you chronic neck and shoulder pain?
BadBettyPosture

As you can see from the image above, the forward or rounded shoulder(s) really re-configures the entire upper body and head position. The repositioning of the head is what can cause strain on the muscles that form a bridge between the neck (cervical spine) and the scapula (shoulder blade). The main muscles affected here are the Levator Scapulae and the Upper trapezius muscles. All you need to know is that if these muscles are bothering you and causing a dull aching pain in the corner of your neck and the top of your shoulder, this pain is really just symptomatic. Put another way, you’ve got a slightly bigger problem here.
In the image below, Jodie’s shoulder is rotated inwards (internally rotated) as a result of another tight muscle that connects from just under your collar bone to your second through fifth ribs. Your Pec muscles have two layers. The pec major layer is the outer layer, and if is tight and short, will pull the shoulder forward and rounded. The second and deeper layer is the pec minor muscle. This muscle is the “linch-pin” in the forward shoulder posture. If the pec minor is short and tight, the top end of your scapula (shoulder blade) will tilt forward and allow your shoulder joint to creep forward. Your pec muscles are your Peacock muscles that we work so hard to develop and show off. The Pec major is the muscle that is on display here in our other image and the ones that we like glistening in pictures on our trips to Mexico. What you can’t appreciate from the images is that the more you work, contract, develop,and tighten the pec major muscles, the more you shorten and tighteh up the undetected pec minor muscle..
PecsMinor

The problem with a tighter and shorter pec minor, is that it approximates (brings together) it’s two attachment points. What this means is that this tension reduces the already limited amount of space under your collar bone in a compartment called the “sub-acromial” space. Within this space there are a few very important structures such as nerves, blood vessels and the tendons of your rotator-cuff muscles. You may recall hearing that anatomical term “rotator-cuff”? Yes, the rotator-cuff muscles and their respective tendon attachments on the ball of your “ball and socket” joint which is named your gleno-humeral joint, is one of the few structures that can be negatively affected or injured while lifting the shoulder with an internally rotated shoulder position. Incidentally, the ball is actually called the ‘head of the humerus”. The humerus being your upper arm bone connecting to your shoulder joint. Sorry for the little digression into the anatomy lesson, hopefully that was brief and painless enough but educational as well? Aside from the strain on the rotator cuff tendons and muscles, the mal-alignment of the head forward beyond the shoulder will place your other neck muscles in a more strained position. In the forward head posture, these muscles are constantly being pulled and having to resist the weight of the forward head and the slumping nature of your upper torso. These muscles are the “levator scapulae” and the upper trapezius.
Hold up your hand if you’ve been or are in this leaky boat?
Ok, moving on then.

Now, you may be wondering which exercises develop your pec muscles (major and minor) and cause your shoulder to round or rotate in. Off the top of my head……the main ones that come to mind are bench pressing with a bar, doing an excessive amount of push-ups, or dumbbell flyes, etc. Now these exercises specifically aren’t at the root of the problem here. However, we know that the cause of a muscle imbalance is that muscles can fail to return to a lengthened state if not stretched properly after you exercise. Given enough time with this pattern of building tension and never stretching the tight muscles out can definitely lead to the rounded shoulder syndrome along with other complications. In addition to the exercise related causes, we also know that those people who sit for prolonged periods of time (we call you professional sitters 🙂 ) can also manifest the forward head and rounded shoulder position if their work station isn’t promoting good posture.
These people don’t need to be exercising either. Years of prolonged sitting will get your muscles to adaptively shorten to the chronic position you impose on it.
Leaning forward into your computer monitor to see more clearly as your eyes get tired is a very common moment our clients find themselves in.
So, if you find yourself with such a posture or shoulder position, or have been told by a healthcare professional that this muscle imbalance exists on your body, then fear not…. help is on the way!
To address the first layer of this muscle imbalance, here we check in on our unforgotten friend, the Pec major muscle:
I’ve already posted in my blog about the stretching out the pec major muscles. This is a good beginning!
See: http://blog.ancasterpersonaltraining.com/?p=48

So you can start with the Pec major stretching and then progress on to the Pec minor stretching protocol.

If you feel that you have a rounded shoulder posture and/or shoulder and neck issues, then this series of stretches will address all the strained and achy muscles involved. In order to properly “bullet-proof” your shoulders, you need to do this stretching, re-balance your shoulder(s) and put them back into good postural alignment. Now sometimes, despite your diligent effort of stretching, your pain or muscle imbalance is still present. In this case, if you live close by our clinic in Ancaster, then I would recommend a good manual treatment that will be likely improve your injury or condition substantially.

Here is an image of the stretch for the Pec minor to help you get your shoulders turned back out again.
PecMinorStretchJudie

The video below provides you a step by step approach to stretching out these muscles involved in the rounded shoulder and forward head syndromes.
In case you miss it in the video, your stretching protocol goes like this:
Neck muscles: Hold for 3-5 seconds and reset (head back to neutral)
Repeat this 10 to 15 times

Pec Minor muscle: Once in stretch position, inhale and then go into the stretch as demonstrated in video as you exhale. Hold each stretch for about 10 seconds. Go into each stretch as you exhale. Do this 5 to 6 times.
While your at it, I highly recommend that you also address the muscles between your neck and shoulder. As mentioned before, these muscles are your levator scapulae, and upper trapezius.

Here is a link to a video that will demonstrate the proper stretching for this levator scapulae muscle:

And here is a link for a video that will demonstrate the proper stretching for the upper trapezius muscle.

If you have any further questions about the stretching, or your own specific set of circumstances with neck or shoulder pain, you may contact me at: jean@ancasterpersonaltraining.com

Yours in health and fitness,

Jean LaFleur CAT(c), CSCS, NSCA-CPT, Pn1, FMS-1, B.HK, Dip SIM
Spectrum Therapy and Fitness

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