Neck tension doesn’t always come from the neck. When a neck feels tight, stiff, and achy, that doesn’t always mean that the neck muscles are the culprits. On the contrary. Clients frequently present with neck pain and are totally confused as to why they have it. I mean, it’s not like sitting at a computer all day or sleeping peacefully at night requires neck reps and loaded mobility exercises. The shoulder and the arm, on the other hand, move all day. Not even when working out necessarily, but opening doors, brushing teeth, picking up your cat when it’s time to snuggle. And this is where it gets tricky.
Think about the spine and the shoulder like a crane. The spine is the vertical tower (on a crane it’s called the mast), and the arm is the horizontal component (on a crane it’s called the jib). The biceps, running along the jib, contract and relax all day long. Many days, weeks, months, and years of repeated movement can take a toll on the ligaments at the shoulder. Like the lever-and-pulley system in the crane, the joint shifts in its efficacy and eventually becomes unstable.
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While biceps work is more commonly thought of in conjunction with elbow dysfunction, both the long head and the short head at the proximal end of this muscle attach to the scapula. Which means the shoulder isn’t not affected. Commonly, as the biceps become chronically shortened, the scapulae subtly shift forward, and the upper back and neck begin to feel not happy.
Levers at Work
Try this: With your client supine, stand at the side of the table and bring their arm into about 90 degrees of abduction. Start working into the biceps from the elbow and glide up toward the shoulder. This can be done by grasping the muscle tissue away from the humerus or by using a flat palm, finger pads, or a soft fist to compress into the biceps and drag along the fiber direction. Or, try both! Often this will reveal what feels better for the client and helps you to fully understand what kind of work will be more effective.
Next, take that same approach but add some passive movement to the mix. Lever the client’s lower arm so the elbow is flexed, shortening the biceps. Repeat the first techniques as you simultaneously bring the forearm down, extending the elbow and lengthening the biceps. This is a great pin-and-stretch. It’s also an amazing way to introduce length into a tight upper arm while bringing slack to the tendons of the biceps at the shoulder. It’s a sleight of hand, so to speak.
Once you’ve decreased the tension in the muscle bellies, the tendons have some breathing room. With a specific point of contact—I tend to be thumb-heavy, but this can easily work with a finger or a tool—sink through the anterior deltoids into the long head of the biceps tendon. Use that passive range of motion with their elbow again to palpate how the bicep tendons react to mobility. This may be enough, and slow, intentional work here will reveal some hidden truths about a client’s upper back and neck pain.
The next step, then, is to break the pattern. If there isn’t a pain response with this pressure, bring the elbow back into flexion, and, as you hold that pressure, have your client engage their biceps against your resistance. Do this by using your other hand to create light resistance against their wrist as they try to bring their wrist toward their shoulder. Friendly reminder that this does not have to be a battle. Creating activation will highlight the neuromuscular component, or, as I like to say, wake up some good communication.
The final step will be to draw this work into the neck itself. After you have touched base with the belly of the biceps, be sure to follow through with your work. Don’t stop short at the top of the arm. Slide over the anterior deltoids, keeping a gentle traction on the arm itself with your other hand, and connect the biceps to the glenohumeral joint, under the deltoids, and into the pec major. Repeat this approach through the back of the shoulder—reintroducing the posterior deltoids to the trapezius, the rhomboids, and the levator scapulae. This is where sweeping, effleurage strokes shine.
Make Your Clients Aware
This pattern of working distal to proximal, broad to specific, or outward to inward, can be repeated with your client in the prone and sidelying positions, too.
Pain isn’t always easy to pinpoint. But bringing attention to the tension pain patterns will create more awareness for both you and the anatomical crane you are working on. It might be easy to isolate the pieces, but connecting the dots is everything when it comes to good bodywork.
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