A Common Complaint I See – Neck, Shoulder and Chest Pains – Related or 3 Different Problems?

I receive messages basically every day from people by locally and from afar asking for advice. I do my best to help everyone I come across but I thought I would answer this one in a blog post…well, because James suggested I could! Thank you James πŸ™‚

Read on after the break to see what he wrote to me and what my suggestions were…

Hi Antony,

I am a reader of your blog from the UK. I love the posts, so please keep up the good work, as I love in when a new post pops in my RSS reader!

I have a question about a pain/some pains I have been getting from weightlifting. Completely understand if you’re too busy, by the way.

I have developed a chronic pain in three areas. I have no idea if they’re related.

1. My neck feels sore at the base, in the center all day long. Very frustrating. As you said in one of your posts, massaging is a temporary fix only.

2. My left shoulder feels, just, wrong. I am not in agony, and can move in all the standard motions (as you describe in your shoulder video). I can mainly feel the pain when I hunch forward and pull my arm down, It radiates from my collar bone/upper pectoral, right through my delt and shoulder.

3. Right in the center of my chest, I get a painful tightness. When I stretch out very wide, the chest pops and I feel fine again.

My routine consists of heavy weightlifitng, four times per week (deadlifts, squats, bench, rows). However, I have now been out of the gym for 3 and a half weeks, with the pain not really subsiding.

I warmup with mobility exercises every single workout for 20 minutes. I’m so gutted this hasn’t seemed to prevent my injuries.

I have seen a doctor, and he shunned me away. I paid for one Physio and she really didn’t seem to help me out all that much. Put it this way, she was FAR less informative than your blog.

Can you offer any advice at all? Feel free to make this into a blog post also πŸ™‚

Thanks again for the great content,
James

You see, this James has described some of the most common symptoms I see – neck, shoulder and chest pains. Unfortunately, sometimes it is hard to see the forest from the trees.

Please also remember that this is general advice and guessing and should never take the place of a good assessment and treatment.

1. Neck pain. So common. We live in a society that encourages us to sit a lot. Sitting posture is poorly taught and difficult to maintain. The fact that massage only temporarily relieves the pain says to me that the muscles are tired from compensating for the problem…so it is likely that something needs to change in your posture or training to help the joints or ligaments or nerves that you may be straining.

2. Shoulder pain – I don’t know James’ age but he is probably under 65 so I am not thinking of a rotator cuff. Maybe some rotator cuff strain is there. Impingement doesn’t seem likely since he can move his arms through a full range of motion and his aggravating activity decompresses the shoulder joint. But why does hunching forward and pulling his arm down hurt?

3. Chest pain. Stretching often produces a pop or release and people feel better. I usually associate this with compression of the anterior thorax and will check to see if that is true.

So does James have 3 different problems or are they all related? Does his heavy weight lifting have anything to do with it? What about his work? He doesn’t mention what he does (in fact, at this point, I want to make it clear that I am only guessing about what might be wrong with James!)

I think his problems are related. He does heavy weightlifting. This to me means that he isn’t in a Pump class doing 100 reps at 20kg of deadlifts, squats, bench, rows (they do these in a Les Mills Pump Class!). No, he is likely to be on some form of strengthening program like 5 sets of 5 reps, 3×3, etc. A heavy deadlift with poor form will make you hunch over and will pull your arm down. Lots of Bench Press will “close” or “round” your shoulders. Getting a Ninja Turtle shell posture during a heavy squat will round your shoulders. It is very common to see these compensations when fatigue sets in. I know it happens because it happens to me all the time!

The neck posture is interesting because when we move heavy weights, we tend to focus on a point on the wall – it helps our balance. We strain and look up to the sky in an effort to activate every last Nm of torque from our back and neck extensors. Then we go and sit and peer into a computer screen all day. This kind of neck posture can pinch nerves in your lower neck – specifically from C5-T1…more on this soon…

The shoulder pain is brought on with a hunching forwards and pulling down of the arm. This kind of traction of the arm can produce painful shoulders and arm because your nerves can be irritated and if you add the forward head poking, you can see how easily it is to pinch a nerve.

Lastly, the chest pressure that doing lots of weight lifting does will lead to the joints of your anterior chest being compressed. This would lead to the pops and cracks that often make us feel good…for about 5mins. The secret to long-lasting relief is not to wait for the pain to arrive and then try to sort it out. The ideal situation would be to manage the pain, balance James’ training and integrate all this back into his everyday life.

My guesses as to what might help:

1. Neck posture – very difficult to describe how to do this well but basically your neck needs to sit on an upright torso as well as an upright pelvis. This can relieve the pressure on the base of the neck and the possible pressure on the joints and nerves that I think you might have

2. Technique. See the post where I look at Fiona’s Kettlebell swings before and after on this blog. This is important to test to see if this works for you. Also, you need to maintain a good deadlift posture when it is raining pain on you. If you can’t, the load is too heavy. Choose a load that is heavy enough but still be able to do well.

3. Breathing. As a heavy weight lifter, you are likely used to making your body rigid and stiff to maximise the efficiency in your lifts. I bet that your breathing is not spot on. Too much with your obliques and rounded shoulders. Practice wide grip pullups (palms facing away from you). Also get someone to teach you whole body breathing. You can spend time rolling out your ribs and thorax – the obliques, serratus anterior, pec minor, etc etc).

 

Summary:

Your neck posture when doing heavy weights can “pinch” or irritate your nerves and provide a sustained compression to the back of your neck. Adding length to the system via rounded shoulders and arms that lengthen can further irritate your nerves and stretch tender structures. Best to use video to see what you are doing and then I can provide better feedback.

See how you go with that…stay in touch πŸ˜‰

 

If you are interested in my opinion on your problems, please contact me at physiodetective[at]gmail.com (I will use a different email to reply – this will control the spam!)

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About Antony Lo
Antony Lo is an APA Musculoskeletal Physiotherapist based in Sydney. His website is www.MyPhysios.com.au. He specializes in the management, treatment and prevention of pain and dysfunction, particularly of the pelvis and ribcage. His sub-specialties include Crossfit and Exercise Performance Optimization, Ante-Natal and Post-Natal Care and difficult cases that have failed treatment elsewhere.

2 Responses to A Common Complaint I See – Neck, Shoulder and Chest Pains – Related or 3 Different Problems?

  1. Ruby Red says:

    I’m loving this post. I would love it if more therapists, trainers and weight-lifting experts would address posterior neck contraction/forward head position in lifts. I see it in everything from flys & curls, to the big lifts, like squats and deadlifts. Even burly bros with lifting videos on youtube jut their heads forward ad the top of the lift. I suspect they’re engaging the traps to get them through the effort, and just based on what good body position looks like (balanced & aesthetic) this bad habit is rarely identified, but probably causes a lot of down-stream problems.

    Like

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