As a therapist, one of the most common symptoms I hear my clients mention is pain or tension in the upper back and neck. They describe it as a knot, pain or tension between the shoulder blades or from the shoulder running up to the base of the skull. In all of these cases, though, one of the first places I evaluate for treatment is actually the front of the body – the abdomen, upper chest, and front of the neck. I know what you are going to ask, “Why would you look at the front when my pain is in the back?”

Many of these clients have a forward posture, whether it’s the whole upper body leaning forward, the shoulders rolling inwards, or the head pulling in front of the rest of the body. These signs are especially common with people who spend a lot of time in a forward posture, often in the form of long hours at a desk or leaning over a keyboard. This produces shortened and taut muscles in the front of the body. Secondarily, the upper back and neck muscles strain to support the weight of the head, which weighs 10-12 pounds. The problem is that those muscles in the back are not very effective at doing so, and over time, the overworked muscles in the back begin to fatigue and go into spasm. This is why you develop those tight and painful trigger points and knots. No matter how much treatment we provide to the back, we will not have lasting results, because we’re treating a secondary issue. The moment you stand up the tight musculature in the front pulls you into the same repetitive pattern (shortening in the front, overworking in the back leading to knots and trigger points).

By helping the front of the body to open up, reversing that forward pull, we ease the strain on the back muscles, allowing them to return to a neutral position and significantly reducing pain and other symptoms. Once the front of the body has opened we can directly treat the back itself, assessing the movement of the shoulder blades and the soft tissue around the spine. Sometimes, I may spend an entire session without directly working on the back, although the whole session is focused on easing the back pain symptoms. There’s no line in our bodies dividing front from back – releasing the pull of the fascia from the front will ease the symptoms in the back.

Fortunately, there are also easy self-treatments you can do to help open the front of the body and ease that strain pattern in the upper back. These simple techniques use just a pillow, pool noodle, foam roller or a bath towel as a prop. If you’re experiencing that strain and pain in the upper back, click the self-treatment links below for more information.

Although we can manually pull our shoulders back in an effort to correct our posture on a temporary basis, as soon as we release the effort, our bodies will be drawn forward once more by the taut muscles. Using one or both of these simple stretches is a great way to support your therapist’s efforts to help the front of your upper body to open up, relieving the pain in the back. We have to remember to treat the front of the back.

For more information or clarification on any of the self-treatment exercises ask one of the NBT therapists.

Self-Treatment Ideas:
Anterior chest release with pillow – click here
Anterior chest release with pool noodle – click here
Anterior chest release with foam roller – click here
Neck stretch – click here