Why is my shoulder such a pain in the neck? Part 2

Why is my shoulder such a pain in the neck?

Part 2 – Posture Edition

“Sit up tall, pull your shoulders back, no slouching! It’s not good for your health!”

How many times have you heard your mother, teacher, Pilates instructor, physical therapist, etc… remind you to fix your posture? Too many, right?! We’re all guilty of falling victim to gravity’s relentless pull forward. Good news is you don’t have to have perfect posture, nor does it have to be maintained one hundred percent of the time, in order to reap its many benefits. And trust me there are a lot of great benefits that come as a result of good posture: increased height, greater breathing efficiency and capacity, improved emotional health and self-esteem, and decreased risk of developing neck/shoulder/spine injuries, just to name a few [1-5].

Poor posture doesn’t develop overnight, and neither will good posture habits. Posture is a daily practice. It requires thoughtful consideration throughout your day, especially in the beginning, when you’re working towards undoing bad habits that have become your body’s default position. I encourage my patients not to look at their posture correction practice as an all or nothing, but rather to make an effort to spend a little more time each day with better posture than you did the previous day. With time, these conscious practices will become second nature, resulting in good posture habits becoming your new (subconscious) normal.

Now, when committing to improving your posture it’s important to set yourself up to be successful. The rest of this post serves as a guide to do just that. I’ve included alignment tips that you can implement for your sitting and standing positions, thus improving your chances of maintaining optimal alignment for longer periods of times. The longer your body can maintain proper alignment the more it becomes used to being in that position, and will more quickly become your default. As I mentioned in part 1 of this series, good posture allows the shared muscles of the neck and shoulder to work through their optimal range, thus decreasing your risk and/or helping to resolve current neck and shoulder issues. Let’s dive in!

  1. What’s the best position to be in while sitting? I get this question a lot from my patients. I encourage people to sit on the edge of their seat or all the way back in their chair with their spine supported on the backrest. Sitting in the middle of a seat is what I call the dead zone. The dead zone only encourages people to round their low back so that it eventually touches some part of the back rest while the remainder of your spine is all kinds of hunched over. When sitting correctly you should feel that you’re sitting on the apex of your sits bones with your ribcage stacked directly over your pelvis and your ears right in line with your shoulders [6-8]. This will allow the natural curves of the spine to support your body best. Both feet should be flat on the floor with your hips between 90-120deg of flexion (that’s when your hips and knees are parallel or the hips are slightly above knee height). If your hips are lower than your knees while sitting, find another chair. I also like to encourage my patients to place a small towel roll or rolled up jacket – no larger than the diameter of a tennis ball – behind their low back for lumbar support. Your lumbar support should encourage the natural curve of your lumbar spine, not exceed it. This type of support aides in helpful feedback for maintaining good posture over longer periods of time with low energy expenditure. Another option is to sit on a slightly inclined wedge, with the thickest section closest to the back of your chair, which will encourage you to sit on the apex of your sit bones naturally. Just be thoughtful that your low back it’s arched and your ribcage isn’t flaring outward. Apply these same principles when sitting on softer surfaces like couches as well.sittingposture
  2. How do I know if my computer is set up right? The alignment of your chair and position of your screen significantly impact sitting posture. You should sit in a chair that allows you to achieve the alignment I described in the previous paragraph. Most people work with screens too low for their height, which further perpetuates forward head posture. Your screen should be in the top half to top third of your visual field while your keyboard should be at the natural height of your forearms, with forearms and wrists supported by armrests or atop your desk [9]. If your forearms aren’t supported in this way, your neck and upper trapezius muscles will feel the need to support them, thus creating unnecessary tension in your neck. If you have a laptop, I recommend using an external keyboard so you can have your screen and keyboard at the appropriate heights, respectively, to achieve the most ideal posture for your body. Sometimes, in order for people to arrange your desk in a way that meets all these requirements, they may need to boost your screen up on books or a box, move your keyboard out from under the sliding tray of your desk, and/or use a foot stool to support the bottom of your feet. If you spend a lot of hours at a computer, I would highly recommend having an ergonomic specialist examine your workstation to make sure you’re properly aligned. It’s well worth the investment, and your employer might even pay for it.Ergo
  3. Driving really bothers my neck and shoulder. Why is that? Driving is another forward head posture culprit. I often recommend people adjust their seat so that it’s close to parallel with the floor (most default to a bucket-like seat which encourages a slouched position), raise the seat up so that you can get as close to 90deg at the hip as possible, and move the backrest forward so that it more closely reflects that of a regular chair [10]. I also find that placing a small towel roll behind your low back or sitting on a small wedge also encourages people to maintain better alignment (as mentioned above). Once you have all that dialed in, readjust your mirrors. That way if you start slouching, you’ll notice fairly quickly as it will be difficult to use your mirrors!Small figures
  4. My neck seems to bother me when I try to read. Why is that? Cell phone (or reading) neck is probably one of the worst irritants for neck and shoulder pain. Most people are staring at their hands or lap for extended periods of time during these activities. Your phone/book/tablet should follow the same rules as your computer screen – they should be near eye level! Now that doesn’t mean I want you actively holding your device up at eye level but rather set your self up in such a way that that this can be achieved without you actively straining your body to do so. Trust me, your neck and shoulders will thank you! Ps: Notice how the picture shows how much (unnecessary) added pressure we put on our necks as we look further downward towards our electronic devices – yikes!!Texting spine
  5. What’s the best way to stand? Standing correctly is a lot harder than it looks. When aligned properly, you should be able to drop a plumb line from your ear through your shoulder down to your hip, knee and ankle joint. You want your body weight to be equally distributed between both feet and your weight to be focused between your arch and heel, toes light [8]. When we’ve been standing for long periods of time, people start to lean back while shifting their weight to one leg or shifting both hips forward to counter their weight. Another common compensatory pattern starts to look more like the “poor posture” forward head example in the picture provided, causing people to translate their weight forward into their toes and round through their upper spine. Either way, their spine is unsupported since both positions turn off the gluts and core musculature, which are vital for maintaining good postural support. The ribcage needs to stay stacked over the pelvis with the ears in line with the shoulders and body weight evenly distributed in both feet while they’re approximately hip to shoulder width apart.standingposture
  6. Do you like standing desks? As far as standing desks go, I think they’re great for those who spend a lot of hours sitting for their work related tasks. However, they too need to be properly fitted and ergonomically constructed for each individual. I encourage my patients to get a standing desk that is convertible and/or has an option to sit with proper alignment (as I’ve mentioned above). Just like how sitting for too long isn’t good for our bodies, either is standing. With a standing desk, the same rules apply for where your computer screen and keyboard should be located and then apply the standing principles to the rest of your body [9].standing-desk-ergonomics

Postural adjustments will feel strange, will be difficult to maintain, and will often feel tiring in the beginning. That is all normal. Remember, you’re relearning a new skill and the body needs time and practice to learn these new skills, build muscular strength and endurance, and erase your bad habits (which are currently your body’s default). Be kind with yourself and know that with daily practice these will become easier and eventually become your new normal, requiring less and less conscious thought to maintain. Your muscles will also being going through an adjustment as they relearn how to work and maintain adequate strength in their new positions.

I encourage my patients to set a timer on their phones every 30-45min as a friendly reminder to check in with their posture. Change positions, stretch, take a quick walk down the hall during this check-in, even if it’s only for a few minutes to help reset your body. I call this the control-alt-delete button for your posture. It helps the body reset your posture default plan much more quickly with these regular check-ins. Some of my patients also like to use posture devices like Lumo Lift to help coach them on their posture throughout the day and track their progress.

Try out these helpful tips in order to support you on your quest for improved postural alignment. They will also be the foundation from which we will build upon for my next post. Stay tuned for the third installment of this series (coming soon!). I’ll be talking about myofascial release, mobility and strengthening exercises you can incorporate into your daily routines to further improve your posture while simultaneously addressing neck and shoulder dysfunction. Get your foam rollers, tennis ball/lacrosse ball, and resistance bands ready!


  1. Koh, Eun-Kyung, and Do-Young Jung. “Effect of head posture and breathing pattern on muscle activities of sternocleidomastoid and scalene during inspiratory respiration.” Korean Journal of Sport Biomechanics3 (2013): 279-284.
  2. Oliveira, Ana Carolina, and Anabela G. Silva. “Neck muscle endurance and head posture: A comparison between adolescents with and without neck pain.” Manual therapy22 (2016): 62-67.
  3. Nair, Shwetha, et al. “Do slumped and upright postures affect stress responses? A randomized trial.” Health Psychology6 (2015): 632.
  4. Moustafa, Ibrahim M., and Aliaa A. Diab. “The effect of adding forward head posture corrective exercises in the management of lumbosacral radiculopathy: a randomized controlled study.” Journal of manipulative and physiological therapeutics3 (2015): 167-178.
  5. Kim, Tae-Woon, et al. “Effects of elastic band exercise on subjects with rounded shoulder posture and forward head posture.” Journal of Physical Therapy Science6 (2016): 1733-1737.
  6. O’Sullivan, Kieran, et al. “What do physiotherapists consider to be the best sitting spinal posture?.” Manual therapy5 (2012): 432-437.
  7. Korakakis, V., et al. “What do physiotherapists consider to be the optimal sitting and standing posture?.” Manual Therapy25 (2016): e111.
  8. Claus, Andrew P., et al. “Thoracic and lumbar posture behaviour in sitting tasks and standing: Progressing the biomechanics from observations to measurements.” Applied ergonomics53 (2016): 161-168.
  9. Mahmud, Norashikin, et al. “The Effects of Office Ergonomic Training on Musculoskeletal Complaints, Sickness Absence, and Psychological Well-Being A Cluster Randomized Control Trial.” Asia-Pacific Journal of Public Health 27.2 (2015): NP1652-NP1668.
  10. Schmidt, Susanne, et al. “A literature review on optimum and preferred joint angles in automotive sitting posture.” Applied ergonomics2 (2014): 247-260.