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Is Stress Causing Your Neck and Shoulder Pain?

Updated: Dec 11, 2023

At least 90% of my clients’ primary or secondary reason for seeking massage is for upper back, shoulder and neck pain.

When we are stressed or feel threatened, like other animals, we hunch our shoulders to make ourselves appear larger. In modern culture, the threat may be work-related or to the drive home. Nothing that in and of itself is life-threatening, but our bodies still respond the same. Whether it is stress, poor posture, or a less than ergonomic desk, habitual shrugging of the shoulders definitely affects the musculature of the area.

But I want to discuss another cause you may not be aware of. Very few of my clients knew when first coming to me how significant their sleeping position is to their back, shoulders, and neck.

The first rule, whether standing, sitting, exercising, or sleeping, is to keep the spine in a neutral position. And for this reason, the best position to sleep in, is on the back. It allows your spine and muscles to be in as close to a neutral position as possible while lying on a flat surface. If this doesn’t come easy to you, some simple techniques will be given, but first, let’s discuss structure.

The basic structure for vertebrates is our skeleton. It is comprised of the skull, spine, hips, and limbs. For this topic, the spine is most important. It begins at the base of the skull and ends at the tailbone. The first portion, which correlates to the neck, is called the cervical, the chest (rib cage) portion is called the thoracic, the lower back is the lumbar, the portion between the hips is the sacrum, and the tailbone is the coccyx. These bones protect the spinal cord. From the spinal cord emerges nerves that allow us to feel, see, and move. Nerves follow and lay between muscles. Muscles hold the spine and all other bones in place. The relationship between bones and muscles is much like a balancing act. Bones give us structure, but without balance, the structure falls apart. Nerves can be pinched between muscle and bone if the structure is misaligned. Later, we’ll discuss some causes of overextended and shortened muscles. Keep in mind that short muscles create a slack between two structures, such as the spine and shoulder. They are more likely to have knots, which are called adhesions. Overextended muscles feel tight, sometimes like bone instead of flesh, and can decrease the range of motion. Now, we’re ready to discuss why other positions can be harmful.


Sleeping on your stomach

This presents two major issues. The first is that the head is turned to a 90-degree angle. This means the vertebrae in the neck are twisted. The muscles from the skull to the shoulder on the side you are turned away from are overstretched, and the muscles on the side you are turned towards are shortened. Several muscles attach from the skull to the shoulder, others from the skull to the collar bone (clavicle), and several more run the entire length of the spine. Still more muscles attach from the spine to the shoulder. In other words, it’s all connected and this position is causing an imbalance and pain. The second issue is that the top (dorsum) of your foot is extended. This puts the feet in the same position as if wearing very high heels. The muscles in the front of the leg and foot are overextended, while the muscles on the back of the leg and bottom of the feet are shortened. Muscles attach to bones, so this will cause the bones in the feet and ankle to be misaligned. Sleeping on the stomach can agitate or be a compounding factor to plantar fasciitis and contribute to knee pain. This position is an example of what causes muscle imbalance.


Sleeping on your side

There are three major issues with sleeping in this position. First, when lying on the side of our bodies, the shoulder on the bottom is rolled forward. That arm comes forward as a balance and is bent so that either the hand is under or over the head. This overextends the muscles that connect between the spine and shoulder. It shortens the muscles that connect the shoulder and collarbone (clavicle). A compounding factor is that all the weight of the shoulders, rib cage, and upper organs is on a narrow surface. Do you have knots between your shoulder blade and spine (see image to the right or above for mobile)? If so, this position is likely the cause or a major contributing factor. If this arm is raised over the head, there will be a knot (adhesion) at the top of the shoulder which may cause a clicking sound when the shoulder is rotated backward (posteriorly). The opposite shoulder is most likely rolled forward so that the forearm and hand are on the bed. This will have the same over-extended and shortened muscle pattern as the lower arm but with fewer or no knots (adhesions) near the shoulder blade because it’s not withstanding the weight of the body. Second, additional muscles will be compromised unless your pillow is the correct size, meaning your neck is in alignment. If the pillow is low, the head will turn towards the lower shoulder, which shortens the neck-to-shoulder muscles and overextends the opposite side of the neck. If the pillow is too large, the pillow side of the neck is overextended, and the opposite side is shortened. This can lead to a decreased range of motion in turning the head from side to side. Third, even if the person is sleeping with a pillow between their legs, there is weight on the hip joint from the entire pelvis, the sacral portion of the spine, and the small and large intestines. This assumes the intestines are empty. Along with hip pain, this can cause a tight IT band and, of course, misalignment of the hips. If you are sleeping without a pillow between your legs, there will be additional hip misalignment because the top leg is turned inward towards the lower leg. If the top leg is bent more than the lower leg, then the misalignment is still more significant because it’s now on the bed instead of the lower leg. I’ve seen videos and articles that suggest sleeping on the side isn’t so bad, but it can cause misalignment at all major joints.


Sleeping on your back

If you don’t already sleep in this position, or even if you do, these tips can help you be more comfortable. Since the bed is flat and our bodies are not, one of the first challenges is comfort. People complain of low back pain and have the need to roll over. Putting a pillow under the knees repositions the glutes and alleviates the pressure. Your body size will determine how high of a pillow you require. Most people will need some support for their head, but those foam pillows with the increased neck support are too large for the normal curvature of the upper back to the head. If you have a relatively minor curvature of your upper back, a pillow under your head may not be needed, but your neck will need support. I suggest a cylinder-shaped pillow. These can be pricy, so start with a rolled-up towel. The towel should support the curvature of your neck. If it’s too large, it can push your chin towards your chest, causing the overstretched/short muscle dichotomy that can partially block your airway. The result can cause or increase snoring. With too little or no support, the same muscle dichotomy will occur in reverse when your chin is tilted too far up. This puts undue stress on the small vertebrae in the neck. Once you have the correct size, measure the width of the towel and start shopping. Also make sure the sheet in untucked to allow your feet to hopefully stay at a 90-degree angle to your leg but at least fall naturally instead of being forced into a greater angle by a tucked sheet.

Some nights, my head will roll to one side or the other. Those airport neck pillows have the correct design, but they are entirely too large. Someone should design a small, medium, and large version of that pillow. I don’t know how long it would take to catch on, but it would do wonders for the improved health of many people.

Editor D. Rein Nov. 28,2023

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