First published in What Doctor’s Don’t Tell You Magazine.
There are pros and cons to standing upright, yes our arms and hands are free to use as tools and to help us communicate with others, but the pay-off for bipedal living is inherent weakness in the lower back and neck. This often means that holding ourselves up from gravity translates into tension into the upper back, shoulders, neck and jaw.
When we get locked into work or stress postures (or even feeling protection in cold weather), our natural range of motion through the shoulders and neck can become compromised. Lack of flexibility in the neck region is associated with pain (BMC Musculoskelet Disord. 2015; 16: 56) and the more we can simply move, the less tension has a chance to build up.
The effects of stress on the shoulders, neck and jaw
Stress is expressed in body tissues as tightness, holding and viscosity. We can feel its physical, emotional and psychological effects most keenly through the state of our breath, the clearest signal of our mind-body state at any given time and which changes the how we hold our shoulders:
- Diaphragmatic breathing – This uses the primary breathing muscles, the large upside-down-bowl-shaped diaphragm muscles at the bottom of your ribs. With an easy exchange of filling and emptying the lungs, the chest expands and diaphragm moves downwards to inhale, rising back up as the chest drops to exhale. This is energy-efficient, oxygenating breath where the shoulders do not need to become involved.
- Thoracic (chest) breathing – When we’re stressed or the diaphragm cannot move fully, breath moves to the upper chest and shoulders, called secondary breathing. During the fight-or-flight stress response, this creates the quicker, shallow breaths we need for a full physical survival reaction, but can create agitation and habitual tightness when we don’t play out these physical responses.
Many people get stuck in the stress pattern, using up precious energy and creating Sensory Motor Amnesia, where feelings of tension in the neck and shoulders aren’t available to us anymore as this holding pattern is the new ‘normal’.
Looking out for tight, fast and shallow breath can help us identify when some deep exhalations can help us drop breathing down into the belly and start to release the shoulders not just by pushing them down, but from engaging the calming parasympathetic nervous that allows muscle release. Walking in nature helps this happen naturally; we breathe more deeply in the countryside and so relax our face, shoulders and minds, whereas in the face of pollution we protect ourselves with more shallow breathing and upper body tension. The motion of walking creates elasticity in body tissues and allows us to organise up from the ground with most ease.
Modern postural issues
It is not unusual for the majority of a modern day to be spent hunched over a keyboard (the left example in figure 1), if this is not with conscious, supported upright posture (the right-hand side example), it can quickly descend into a hunched that can contribute to a collapsed standing posture, where we lift up from the ground ‘up the back and down the front’ rather than the more open, grounding and supportive ‘up the front and down the back’.
If hunched, to look forward we need to tilt the chin up away from the throat. This creates compression in the base of the skull; another source of neck and shoulder pain. Moving the eyes, not the head, to look down and/or forward can help to avoid this.
This is the term used to describe neck pain and damage from the head-down posture used to look at a smartphone or other device, too often and for too long. Whilst lower back issues from sedentary desk habits have stayed quite stable, when compared to neck issues in a sample of Finnish teenagers aged 11-18 years old, neck pain has consistently increased over the time period studied, from 1991 to 2011 (BMC Musculoskelet Disord. 2014; 15: 296), concurrent with the rise of phone use in the population.
An average adult head can weigh 10lbs and our skeleton has evolved to perch this above our feet to be able to stand upright with cleverly calibrated design. Our s-shaped spine allows a vertically positioned neck that is designed to balance this weight without strain, roughly ears lifting above the shoulders. Habitually looking down at a device reconfigures the head forward of the shoulders, meaning the neck must lift its weight up from gravity at an angle. You can see from figure 2 that the force this creates can be the equivalent of pressing down as much as 60lbs down onto the spine.
This can create posture that is often referred to as ‘chicken head’ that forms as shown in figure 3.. With a 2011 study showing that 79% of the US population between the ages 18 and 44 have their smartphones with them almost all the time and spend only 2 hours of their waking day without their device on hand (IDC Research survey 2011), this is a cultural shift that needs conscious attention to prevent severe postural effects. Losing this natural inward curve of the neck creates compression that is a causative factor for arthritis as well as pain. Lifting your phone to your natural eye level, rather than looking down, can help prevent deeper issues. You can see how this neck position needs the chin lifted to see forward, creating tension where the neck inserts into the skull.
Lifting up from the hips
When standing or sitting, lifting up through the font of the spine and lifting up from the back of the skull (to lightly draw chin in towards the throat) can help unravel unhealthy neck patterns and therefore allow the shoulders to naturally release. This can be seen in fig 4 where habits of desk sitting are taking into a cross-legged seated position. Lifting the hips (sitting on a block) allows lift up from the natural curve of the lower spine, to stack the spine up from gravity and open the front body enough to easily lift the arms (fig 5). In the way, the head is supported by the front neck muscles, which are postural and designed for long-term support (sternocleidomastoid) rather than the back neck muscles (eg scalenes) which are for movement and create upper back and neck tension if relied on to lift the heavy weight of the head.
Freeing the jaw
Clenching the jaw is part of the self-protection response to increase blood flow to the brain, human’s most important organ of survival. The frowning and pursing lips that can accompany the seriousness and concentration when we go into survival mode can get stuck, telling the whole body to keep in constant alert mode. Face and jaw release at the beginning of any exercise or yoga session can allow all muscles to get the signal that it is safe to release. We often hold our habitual expressions – setting the jaw, frowning, even a forced smile – as our expression to the world and a coping strategy, so noticing this stress manifestation and recognising that we don’t need to be expressing anything during our practice, helps us both notice these habits and drop away from them.
- Gurning – aka facial distortion – gives tense muscles a well-needed inner massage, makes us feel carefree and may even create the whole body (including diaphragm) release of laughter.
Get as ugly as you can and squeeze into areas that resist release, so just like massage, giving muscles the job they are designed to do (ie contracting) helps remind them they can go full circle and acquiesce.
- Stretching the top lip over the top teeth releases an area where tension at the base of the skull is commonly expressed.
- Sighing out an ‘ahhh’ sound opens up space between the back teeth, the palette and the throat.
Face, neck and shoulder self-massage
Gently massaging the muscles and joints of the face can create a softening effect down into the neck and shoulders, especially if you move naturally into them afterwards. This can be done as a stress-reliever any time or pre-workout.
Gently circle the temples with the second finger, massaging into the joint of the upper and lower jaw (temperomandibular joint or TMJ) where much tension can be held. Then using the fingertips or the palms of the hands, stroke across the forehead, wiping away any tension, worries or concerns. While doing this they can say something along the lines of “I release all tension and relax into this moment” or “I let go of all my worries just for this breath” etc.
You can continue by creating a pinching motion across the eyebrows, out to the temples, around the backs of the ears, down the side-back lines of the neck and onto the upper middle back – the trapezius (aka ‘swimmer’s’) muscle and out across the shoulders, exploring into any areas that respond well.
Simple seated or standing exercises
Releasing the shoulders ripples de-stress through the whole body:
- Inhale the shoulders right up to the ears and let drop fully with the exhalation, allowing the full range through the shoulder girdle and reminding us where lifted is and where not lifted also is.
- Inhale the shoulders forward and up (figure 6), then exhale back and down (figure 7) to create full circles with the breath, making lots of space through the shoulders.
- With spine lifted throughout, bring your chin to one shoulder (figure 8), inhale here and then exhale a semi-circle with the chin down past the breastbone and up to the other shoulder (figure 9). Inhale here and the repeat from side-to-side, allowing a full release through the exhalation that opens the back of the neck and skull. Watch the shoulders don’t creep up to the ears, particularly as we can meet lots of tension in the upper back (trapezius) here.
Taking a break from sitting
When sitting for long periods of time, it is wise to stand up and release the shoulders whilst opening the chest to counter any habits of collapsing and tension.
- As in figure 10, interlink your fingers together behind your back and draw your arms down and away from the body to squeeze the area between the shoulder blades and open the chest. This can feel strong as nerves fire off in the upper back, but this is safe opening, so breathe softness into the shoulders to meet it with ease.
- Lift each arm at a time (figure 11) to take hold of the opposite elbow and draw it towards the midline, whilst lifting it towards the ceiling. This both lengthens the spine up through the arm lines and opens the chest. Keep the chin lightly tucked in to open up space between the base of the skull and the upper back.
Exaggerating the natural movement of the spine as we breathe creates a wave-like motion through the spine that helps to regain fluidity through the shoulders and neck. Paying mindful attention to the motion of the neck and the rest of the spine can help us to address the separation between head and the rest of the body – neck down – that occur as thoughts dominate and we feel we live ‘up in our heads’. These movements help us reconnect with our whole physical self and the integrated movement that helps us live with more body awareness.
Arching the back and opening the chest as the lungs fill to inhale, and rounding it as they empty on exhale, can be done in any plane and from many positions, here shown:
- Seated, either on a chair or on the ground (figures 12 and 13) we lift up the spine from the ground, which has a strengthening effect through postural muscles. On the exhale, fully rounding the back means drawing the belly right in, drawing the tailbone under and drawing the chin right into the chest; opening the whole back body. The inhale opens the front body as the lungs fill and the back arches. Be mindful here not to just lift the chin (hinging up the head) but rather keep the back and sides of the neck long to avoid compression at the base of the skull.
- The best known spine undulation cat-cow pose (figures 14 and 15) suspends this movement between the shoulder and hip joints, allowing free movement up the whole spine. Again avoid jutting the chin up, rather open across the collarbones. It is also very freeing to simply move from all-fours in any way that simply feels good in the shoulders.
Space into the shoulders out from the chest
Opening the shoulders lying on the ground removes the tension from lifting up from the ground. Lay on one side, thighs perpendicular to the torso so the legs drop and all motion is through the shoulders and not the hips. Support the head so that both sides of the neck feel even.
- Figure 16: settle into the shoulders here and reach the top arm forward
- Figure 17: inhale to reach the arm directly above the top shoulder, lifting up through the shoulder and keeping the gaze on the fingers
- Figure 18: exhale to reach the arm back, focus continually on the fingers means the shoulder and neck can move in tandem, as designed
- Inhale back up to the figure 17 position and exhale back to the beginning
- Continue the movement, letting the breath guide the rhythm and pace for full body release
Rotation through the shoulder girdle
From the same starting place as before, you may or may not need a head support here (figure 19) – see which feels allows most free movement through the neck. Simply let the breathe flow in an easy and spacious way:
- Figure 20: draw the top arm in a quarter-circle (fingers along the ground) to reach the arm up by the top ear or wherever your comfortable range of motion goes. Spend some time just moving between these two positions to feel out how the head turns comfortably as the shoulder rotates.
- Figure 21: if there is more room without force, you can start to open up the continual movement to reach further round, maybe even to arms opening out from the chest, as long as your gaze can track the position of the arm so it feels like your neck moves freely.