Shoulder Pain Relief: Posture

Shoulder pain, neck pain, and upper back pain are common symptoms too many of us suffer through without effective pain relief. Many times pain in these areas stems from poor posture and ergonomics throughout our everyday lives. Think of the busy office worker slouched over their desk or the doctor leaning over patients all day long. The chronic stress placed on your shoulders and spine by poor posture can be reversed by knowing what good posture looks like and how to maintain it.

Good posture and its effect on upper back pain and neck pain is a topic I discuss a lot when educating clients in person and during telehealth sessions. Whether clients are coming to me for injury rehabilitation, sports massage therapy, or personal training, their everyday posture will impact their course of treatment or training in significant ways. When good upper body posture is [combined with proper belly breathing and low back stabilization], you have a great program for preventing back pain and neck pain.

Breathe into Your Belly

Referencing an earlier video I made about the importance of proper breathing mechanics for low back health-youtube video, the simple act of breathing isn’t so simple for most of us. After being locked into a slouched, seated posture since the first grade, the majority of Americans breathe using accessory respiratory muscles in our chest and neck. These muscles ideally are only used for posture, but may also be used for breathing during times of extreme stress like flight or fight scenarios (think of being chased by a lion on the Sarengetti). 

An easy drill to fix this is to breathe using your diaphragm. Place one hand on your stomach and the other on the center of your chest, then take slow, shallow belly breaths by pressing your bottom hand forward without letting your chest move (use the top hand as a sensor to detect any unwanted breathing from the chest).

This drill should feel very strange for anyone not familiar with belly breathing. Don’t expect it to feel natural for several weeks. The goal is to gradually transition from chest breathing to belly breathing for all activities. Consistency is key here.

Lengthen Your Spine and Hold Your Shoulders Down and Back

Slouching Posture
Slouching posture is one of the most common causes of low back pain and neck pain.
Tall Posture
Maintaining a tall posture vertically aligns the head, shoulders, hips, and ankles for ideal movement.

While it seems fairly straightforward, most of us need to be told to stand tall. Once we’re used to slouching (see the photo on the left), the act of standing tall feels awkward. While standing or sitting, imagine a chain is attached to your skull and is pulling straight up to pull the rest of your spine straight (see the photo on the right). This one change will do more than you think for changing your posture and how you move. The hardest part is doing all day, every day.

Like standing tall, this seems simple but may feel strange to many people when initially trying it. Keeping your shoulders pulled down towards your hips (don’t let them shrug up towards your ears) and held in towards your spine.

Maintain a Neutral Pelvic Alignment

Your pelvis is the foundation for your spinal column. If your pelvis is tilted the wrong way, every structure up the chain is compromised: the low back becomes destabilized, your shoulders slouch forward, and your head shoots forward are just a few posture faults linked to a fault pelvic alignment.

Anterior Pelvic Tilt
Anterior Pelvic Tilt: the pelvis is tilting forward while the low back arches.
Posterior Pelvic Tilt
Posterior Pelvic Tilt: the pelvis is tilting back while the low back is rounding.
Tall Posture
Maintaining a tall posture vertically aligns the head, shoulders, hips, and ankles for ideal movement.

Most people with a dysfunctional pelvic alignment tend to have an anterior pelvic tilt (see left picture). If you think of the pelvis as a bowl holding water, an anterior pelvic tilt means water will spill from the front. However, your pelvis can also go too far the other way and your pelvis becomes posteriorly tilted (see center picture). Again, think of water in a bowl, this time spilling backwards. You can think of a neutral pelvic alignment as a pelvis not spilling water from the front or back. (see right picture).

To set you pelvis in a neutral alignment practice this drill. Stand tall, squeeze your butt, then inhale and increase tension in your midsection like you’re bracing for a gut punch. Holding the midsection tension tight, slowly let the glutes relax. Hold the tension in your midsection for 3-5 seconds, then repeat this process 5-10 times.

Increase Your Upper Back Flexibility

Assuming the pelvis is neutrally aligned and belly breathing is regularly occurring, the upper back region (thoracic spine) can now be examined. If you upper back is rounded forward, the shoulders won’t have a stable foundation for movement and the neck will become tight from chronically being held in extension. The thoracic spine is one of the most difficult areas to mobilize, so consistent work is key.

The key with this drills is isolating the upper back movement. Make sure your stomach never leaves your thighs and your motion originates from your upper back, not by moving your back up and down.

Because spine rotation causes extension on one side of the vertebrae and flexion on the other, upper back rotation drills are one of the most consistently effective ways to increase your thoracic flexibility.

Bottom Line

While this seems like a lot of things to think about, consistent practice makes it automatic. For people looking to improve their posture in daily life and their upper body health during exercise, try thinking about creating a tall spine while holding your shoulders down and back throughout the day, and do 3 sets of 10 reps of the midsection bracing drills, child’s pose t-spine rotation, and belly breathing. Practice with intention makes progress.

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