Chronic Neck & Shoulder Pain? Don’t Beat, Massage or Use Patches!

The other day, I came across a post online where a user mentioned that the muscles around their shoulder and neck area always hurt. They’ve tried foam rollers and massage devices, but nothing seems to work. The post resonated with many netizens, indicating that this issue is a common concern.

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When our shoulders and necks send out warnings of soreness, many people’s first instinct is to choose massage, pounding, or to apply a patch of plaster. The temporary relief feels good, but the pain returns in a few days. Why is that?

As a physical therapist, today I will take you deep into the root cause of neck and shoulder pain and provide you with scientific and effective recovery strategies.

Common Symptoms Not Addressing the Root Cause

Why do massages and plasters only provide temporary relief?

When soreness occurs near the trapezius muscle (the muscle we often refer to as the “top of the shoulder”), our most instinctive reaction is to rub, get a massage, or seek the help of a plaster. These methods can bring temporary relief because they:

However, this is like an alarm going off in your car, and you just turn off the alarm without checking why it went off. Pain is an alarm signal from the body, and muscle tension and soreness are often the “scapegoats”, while the real “culprit” may be joint dysfunction, poor posture, or incorrect exercise patterns. Not addressing the root cause and only dealing with surface symptoms will naturally lead to recurrent pain.

Where the Alarm Sounds
What are the Key Structures in the Neck and Shoulder Area?

To find the root cause, we must first understand the “residents” of this area. Your neck and shoulders are not a simple whole, but a complex entity composed of many precise structures working together. Any problem with one of them can cause pain:

👉Cervical Spine Joints: The seven cervical vertebrae, stacked like building blocks, are responsible for bearing weight and enabling flexible head movements. If a small joint is not moving smoothly or is misplaced, it will immediately cause protective spasms in the surrounding muscles;

👉Thoracic Spine Joints: The 12 thoracic vertebrae that connect the cervical and lumbar spines, whose mobility (especially extension and rotation) is crucial for the health of the neck. Stiffness in the thoracic spine can cause excessive compensation in the cervical spine and shoulders.

👉Muscle Groups: These are the most common “suspects”.

👉Ligaments: Like tough tape, they are responsible for stabilizing bones and joints.

Physical therapists will use professional clinical examinations, such as assessing the mobility of the cervical and thoracic spine, pressing specific trigger points, and performing special nerve tension tests, to identify which structure is problematic. This is crucial for subsequent correct treatment.

Two Major “Culprits”
The Difference Between Unilateral and Bilateral Pain

In clinical practice, we usually divide these issues into two major categories based on the main distribution area of symptoms, and their causes and solutions are completely different.

✅Characteristics

The soreness is mainly concentrated on one side of the body, sometimes extending from the neck to the same side of the shoulders, back, and even the temple.

✅Root Cause

This is usually due to long-term asymmetric body usage habits, causing excessive pressure on the joints and muscles on one side. It can be imagined as a slow, ongoing “chronic pillow neck” that lasts for weeks or even months.

✅Typical Habits

✅Result

The joints on one side of the body (especially the cervical and thoracic spine) gradually lose mobility, the muscles remain short and tense, while the muscles on the other side are overstretched and weak. This imbalance eventually manifests as soreness.

✅Characteristics

Pain and heaviness are felt simultaneously in the back of the neck and both shoulders, as if carrying an invisible weight.

✅Root Cause

This is the most common “archenemy” of modern people – poor posture, especially “head protrusion (Forward Head Posture)” and “rounded shoulders (Rounded Shoulders)”.

Adults’ head weight is about 4-5 kilograms, equivalent to a large watermelon. When your head is in a neutral position, this weight is fairly borne by your cervical vertebrae. But when the head protrudes forward, for every 2.5 centimeters the head moves forward, the burden on the cervical spine increases by nearly 5 kilograms!

To prevent your head from falling off, the muscles at the back of the neck (including the upper trapezius, levator scapulae, etc.) must tighten and exert force desperately, like a constantly taut rein. Over time, these hardworking muscles will become ischemic and hypoxic due to overwork, becoming stiff and sore.

✅Self-test method

First, make the typical “turtle neck” (head protruding forward), and pinch the hardness of your upper trapezius muscle;
Then, retract the head, align the ears with the shoulders, and the shoulders with the hip joints (cervical spine repositioning), and pinch the same muscle again.
You will find that the muscle becomes much softer in a good posture!

Precision Intervention

Rehabilitation Suggestions from Physical Therapists

Now that we understand the causes, we can prescribe the right treatment.

✅Pillow Assessment: If you always wake up with discomfort on one side, the pillow might be the culprit. An ideal pillow should fill the gap between the head and shoulders, keeping the cervical spine in a straight line when lying on your side.

✅Self-mobilization Exercises (for left-sided pain as an example):

Lateral Neck Stretch: For example, if the left side of the neck is stiff; sit straight, use your right hand to pull your head to the right side, and sink the left shoulder down to feel the stretch on the left side of the neck. Hold for 30 seconds and repeat 3 times.

Thoracic Spine Rotation Mobilization: On all fours, place your right hand behind your head. Inhale to prepare, and exhale as you open your right arm to the sky to the maximum, then slowly return, feeling the rotation of the thoracic spine. Repeat 10-15 times per set, do 2-3 sets.

✅Correct Rounded Shoulders and Hunchback: Make Space for the Cervical Spine

Thoracic Spine Extension: Lean against the back of a chair or use a foam roller, slowly extend the back (not the neck) and return, repeat 15-20 times, do 3 sets.

✅ Cervical Spine Repositioning + Endurance Exercise: Teach Muscles New Habits

Chin Tuck Exercise: On all fours, look at the bed surface, tuck the chin and move it horizontally backward, as if to create a double chin, feeling the back of the neck being elongated. Note that it’s not about lowering the head! Hold for 20-30 seconds, repeat 3-5 times. This movement is key to activating deep neck extensors and relaxing superficial neck flexors.

✅Environmental Modification

Immediately check your workstation! Adjust desks, chairs, computer screens, etc., to the right positions to delay the harm of poor posture and sedentary behavior.

Reconciling with Soreness,
Starting with Changing Habits

The soreness in the neck and shoulders is a direct way for our body to express its fatigue and protest. It is not an enemy that needs to be “eliminated,” but a signal that requires us to listen and understand. Saying goodbye to soreness is not something that can be achieved overnight; it means we need to incorporate some physical exercises into our daily routine and gradually get rid of bad habits.

The real cure is not in a single refreshing massage, but in every day, every hour, whether you consciously retract your head a little, open your shoulders a little, and straighten the screen a little. The best therapist is yourself, and the best time for treatment is now.

⚠️Attention: If your symptoms persist without relief or are accompanied by serious conditions such as arm numbness, dizziness, etc., please seek the help of a professional physical therapist or doctor for a systematic assessment and treatment.

May you have a relaxed and flexible neck and shoulders!