Massage for neck and shoulder pain

Why it happens

Your head weighs about as much as a bowling ball, and the muscles of the neck and upper back hold it up every waking hour. When the head sits directly over the shoulders, that job is easy. When it drifts forward, toward a screen, a steering wheel or a phone, the same muscles have to work much harder to stop it from dropping further.

The muscles that carry most of that load:

• The upper trapezius, the band of muscle from the neck to the top of the shoulder. It is where most people point when they say their shoulders are tight.
• The levator scapulae, which runs from the side of the neck to the top corner of the shoulder blade. When it is tight, turning your head to check a blind spot pulls or pinches.
• The small muscles at the base of the skull, which hold the head level. They are often behind the ache that climbs up the back of the head.
• The muscles between the shoulder blades, which are stretched and overworked when the shoulders round forward.

Stress adds to it. Many people lift their shoulders slightly and hold them there when they are under pressure, without noticing. Sleeping with the neck twisted, carrying a heavy bag on one side, or holding the phone between ear and shoulder all load one side more than the other.

Muscles that work without a break become tender and short. Tender spots within them, often called trigger points or knots, seem in many people to send pain elsewhere: up into the head, across the shoulder blade or down toward the elbow. That may be why neck tension can show up as a headache, and why the place that hurts is not always where the problem is.

The small joints of the neck and the discs between the vertebrae can be involved too. Even then, the muscles around them often tighten to protect the area, and that guarding can be part of the stiffness.

What massage can do about it

Muscle tension can be part of what you feel in neck and shoulder pain, and it often responds well to steady, well-placed pressure. On its own, that relief tends to be short-lived. It lasts longer when the habits and movement behind it change too.

A therapeutic massage session works on the neck and shoulders together with the chest, the upper back and the arms, because tight chest muscles and a stiff upper back keep pulling the shoulders forward. If the tightness has been there for years and sits deep, deep tissue massage gives more time to slow, sustained work on those layers.

What to expect:

• Many people turn their head more easily after the first session, and the ache across the shoulders often eases.
• If the pattern comes from eight hours a day at a desk, it will come back unless something about the day changes too. See desk-work posture.
• If the neck tension comes with headaches, easing it often eases them. More under tension headaches.
• Massage does not change the shape of a disc or the structure of the spine. It works on the muscles and soft tissue around them.

The neck is worked with care. The front and sides of the neck carry arteries and nerves close to the surface, so deep pressure there is never the goal. The deeper work goes to the back of the neck, the shoulders and the upper back.

What my physical-therapy training adds

My physical-therapy training from Ukraine taught me to look at the neck as part of a chain. A sore neck is often the end of the story, not the start.

I watch how you sit and stand, how far you can turn and tilt your head each way, and how your shoulder blades move when you lift your arms. If one shoulder blade lifts early or wings out, the neck muscles on that side are often doing work that belongs to the muscles lower down.

Then I explain what I see, in plain words: which muscles are overworking, what is pulling the head forward, and which habits keep feeding it.

Between sessions you get one or two simple exercises. Often something to open the chest, something to strengthen the muscles that pull the shoulder blades back and down, and a gentle way to bring the head back over the shoulders. Done for a few minutes a day, they are what keeps the neck from tightening up again the following week.

When to see a doctor first

See a doctor before booking a massage if your neck or shoulder pain:

• Started after a car accident, a fall or a blow to the head.
• Comes with numbness, tingling or weakness that spreads down the arm into the hand, or you keep dropping things.
• Comes with clumsy hands, trouble with balance or changes in walking.
• Comes with a fever and a stiff neck, especially if bending your chin to your chest hurts. Get emergency care now, or call 911.
• Comes with a fever, weight loss you cannot explain, or a history of cancer.
• Is constant and there at night, whatever position you lie in.
• Comes on suddenly with a severe headache, dizziness, double vision or trouble speaking. Call 911.
• Comes with chest pressure, shortness of breath, or pain into the jaw or left arm, especially with exertion. Call 911.

If a doctor has checked it and cleared you, massage can be a sensible next step.

Massage therapy is not medical care.