Neck Shoulder Exercise

Shoulder and neck problems often continue even after a reasonable period of rest, physical therapy, medication, injections and even surgery. Neck and shoulder pain is often attributed to some injury or structural pathology seen on an MRI or X-Ray. However, we often see pain problems are becoming more persistent and chronic.

Recently a more functional approach has come into play and the focus of neck and shoulder pain assessment has shifted from diagnosis of structural pathology found on MRI’s and x-rays to one based more on functional pathology. This dysfunction may be the missing link in the management of persistent neck and shoulder pain. This includes the assessment and correction of faulty movement patterns which can often be the source of biomechanical overload.

It is possible to have shoulder or neck pain without any relevant structural pathology on an MRI or X-Ray or to mistakingly attribute structural problems found on imaging studies to be directly related to neck and shoulder pain. Many people have also been shown to have arthritis, or other structural problems such as a rotator cuff tear without having any symptoms at all.

Functional pathology of the motor system is basically, dysfunctional movement and the most important type of dysfunction is a faulty movement pattern. In the upper back, shoulder girdle or neck area the key faulty movement pattern is an abnormal scapulohumeral rhythm. This causes the shoulder girdle to shrug up towards the ear(s) and results in increased neck and shoulder muscle tension, rounded shoulders, and forward head posture. This dysfunction can cause pain or loss of performance.

Neck Shoulder Pulldown
Overhead Pull Down (a) normal (b) abnormal (shrugged).

Once identified by a healthcare professional, this faulty scapulo-humeral movement pattern or shrugged shoulder(s) should be the first goal of treatment for pain or training to build physical capacity for better performance. A simple training method called the Y exercise can be used to both identify and correct such a dysfunctional neck and shoulder movement pattern.

The Y exercise involves testing and training with the arms in an overhead position making a letter Y shape. Some clinicians or trainers will also use the T or W position.

The Y exercise to restore shoulder and neck function utilizes an important method called shoulder packing or scapular setting. The key to the exercise is to pack the shoulder down and back. Imagine standing with one arm extended in front of you with your palm facing down. Now, push down as if pushing down on the top of a stick that is at chest height. Feel how your shoulder & shoulder blade muscles – in particular your latissimus dorsi – tighten as you push down on the stick. This feeling is the key to stabilizing or setting the scapulae (shoulder blade).

Packing the Shoulder Down & Back

The Y Exercise – Shoulder Packing (scapular setting) for neck and shoulder pain

– Stand facing a wall (about 1-2 inches away)
– Place palms on the wall
– Raise arms up in a Y position
– REACH up & shrug – Pack up. Shrug shoulders upwards ears until neck shortens
– ROLL back & down – Pack down (set scapulae)
– Roll (turn) hands out
– Bring shoulders back & down until neck lengthens
– RAISE Arms Off Wall
– Tighten core
– Lift arms off the wall
– Feel mid-back – just below the shoulder blades working
– Note: Avoid lifting arms off wall by arching lower back into sway back
– Perform 10-12 slow repetitions

The Y Exercise – Shoulder Packing

(a) start position

(b) Pack up (reach up)

(c) Pack down (roll back & down)

(d) Lift off (raise off wall)

(e) Incorrect lift off with sway back.

The exercise should be evaluated and instructed by a health care professional. It can help with some neck and shoulder pain problems by helping to restore normal function to the neck and shoulder muscles. This can potentially benefit those who suffer from neck and shoulder pain due to overuse from work or athletics.