BW: Neck Pain with Bilateral Shoulder and Low Back Pain: Week 4

This week is focused on addressing the mobility limitations that are continuing to contribute to excessive strain on the neck and progress strengthening into lateral and overhead motions
The program is going to grow considerably this week and if there was ever a time that you could take a nose dive in your progress…this is it
The trick with this part of the program is that everyone is different in how much time it takes them to progress through these activities. It is up to you to maintain the awareness of…does it feel like my body is ready for this or not.
- I encourage you this wee to email me throughout the week as needed with any questions or concerns and I highly emphasize to do all of the new movements very light, well short of pain
- If something doesn’t feel right, or you have the suspicion that a movement will cause pain later…STOP DOING IT
- I use the example…we wouldn’t work out if the outcome was we got weaker and more over weight…we want the positive results. If you are doing a movement and it pinches or causes pain after, you need to use the parameters below to adjust that movement, or get rid of it temporarily and try it after you have done the other stuff for another week
Addressing your concerns
- The most difficult motion seems to be reaching behind the back, which specifically requires good mobility of pec and posterior capsule/rotator cuff
- Let’s include some self myofascial release followed by you light movement into a stretch prior to moving into the behind the back direction
- Continue with the neck tension checks
  - One option is to pause in the tense position of each rep and turn your head side to side
    - If your neck is relaxed you should be able to turn your head the same amount during the exercise that you can turn it while at rest
- As we progress the program, the challenge/threat to your body increases
  - The parameters that I adjust to increase the challenge to the body are
    - Motion
      - Isometric=No motion
      - Start mid range or least painful range
      - The more motion your shoulder moves through, the more challenge to all the tissues that are attempting to support it
      - The amount of motion can be increased too quickly resulting in repetitive pressure on that sore injured part of the bodu
    - Resistance
      - The most obvious, but external load/resistance can come from adding weight/tension or making the movement more unstable by training on uneven surfaces that challenge balance and trunk control working with the shoulder and neck
    - Speed
      - The faster you move, the more subconscious the pattern has to be
      - Initially when you learn some of these movements, it is a little redundant and basic….which can be a little boring
      - You are trying to teach your body a very different way of doing things, and to get that new pattern to stick, you have to do it alot very slow and deliberate for it to become second nature
      - By doing everything slow initially, you can really focus on what parts of your body are active
      - If you move into increasing speed too fast, you will likely fall back into your old pattern which is usually related to why you have pain.
- Another difficulty is the capacity to isolate certain muscles while keeping others relaxed
  - It is alright for some of these movements to feel almost too easy at first as you try to correct the pattern of activating certain muscles while keeping others relaxed
  - It is really important to establish the good pattern prior to increasing the challenge
    - Many people in their desire to get better faster rush into pushing themselves too hard too fast and they fall right back into that old compensatory pattern and they irritate their symptoms again
    - Cementing that new pattern does take time so don’t rush it
Goals:
- Update strength circuits to be more activity specific and mobility circuits to focus on the pec and posterior capsule
  - Mobility circuits will focus on body awareness and mobility with the goal of establishing a multi-planar warm up or cool down pre/post activity
    - This may be utilized on a daily basis
    - 5-20 reps
  - Strength Circuits
    - Begin to progress in overhead and lateral motions
    - Will include 3-4 movements that challenge the body in opposing motions
    - Each circuit will attempt to pair less threatening more comfortable movements with more threatening/challenging movements
    - As the list of strength circuits grows, they will continue to increase in difficulty with a progression towards desired activities
Ice should be used 10-15min following if any pain or soreness is felt
5-20 reps of each exercise or 30sec to 2 min
Mobility/Body Awareness
- 1 set through the circuit 5-20 reps or 30sec to 2 min
Strength Circuits
- 5-20 reps or 30sec to 2 min, go through circuit a second time but complete 1/2 as many reps or time as first set
Day 1
- Mobility/Body Awareness
  - Goal: These movements are meant to pull and be utilized as a warm up/ cool down or as a light sequence on a daily basis
    - Narrow the list below down to 4-5 movements that feel like they accomplish stretching and tightness without pain
  - Scapula and Cervical Positioning Drill VIDEO
    - If this position bothers the shoulder, take hands further apart and put a small towel under forehead
  - Self Myofascial Release Posterior Shoulder VIDEO
    - spend 45sec to 60sec in each aspect of the shoulder hitting 3-4 points
  - Posterior Shoulder Stretch Door Pull VIDEO
  - Tall Kneel with Scapular Depression/Retraction VIDEO
    - Progress to the following, especially second option in the video below
      - Sleeper Stretch->Behind Back with Towel->Reach Opposite Arm VIDEO
        
        You can go to the last part of the video if it feels better to not pull with the strap
        
        A regression from this movement comes out of a research article I found on frozen shoulder
        
        Try the movement below as a substitution option for the behind back stretch
        
        Side lying Low Load Long Duration Behind the Back Stretch VIDEO
        
        Hold very light tension for 30sec-90sec
  - Puppy Pose Progression VIDEO
    - Be careful to stay short of pain
  - Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
    - Option number 2 keeps the lower body stationary while the upper torso moves
      - Sidelying Thoracolumbar Rotation Stretch VIDEO
  - Deep Neck Flexor with Thoracic Extension Seated and Foam Roll VIDEO
    - You mentioned this one has been a problem
      - Couple changes
        
        Lets focus on progressing thoracic ext with overhead shoulder motion
        
        This will set us up for overhead pressing and pulling
      - Shoulder Flexion Laying->Wall Sit->Seated Against Wall VIDEO
        
        Start lying on your back, if that goes well…prior to progressing to second part of video which is a wall sit, may want to try the video below that progresses to sitting and back against counter prior to going into wall sit
        
        Shoulder Flexion Seated->Standing VIDEO
    - So in summary
      - 1st-Do it lying on your back
      - 2nd-Try seated in a reclined position
      - 3rd- Back to counter
      - 4th Wall sit position
Day 2
- Mobility/Body Awareness
  - Goal: These movements are meant to pull and be utilized as a warm up/ cool down or as a light sequence on a daily basis
    - Narrow the list below down to 4-5 movements that feel like they accomplish stretching and tightness without pain
  - Scapula and Cervical Positioning Drill VIDEO
    - If this position bothers the shoulder, take hands further apart and put a small towel under forehead
  - Self Myofascial Release Posterior Shoulder VIDEO
    - spend 45sec to 60sec in each aspect of the shoulder hitting 3-4 points
  - Posterior Shoulder Stretch Door Pull VIDEO
  - Tall Kneel with Scapular Depression/Retraction VIDEO
    - Progress to the following, especially second option in the video below
      - Sleeper Stretch->Behind Back with Towel->Reach Opposite Arm VIDEO
        
        You can go to the last part of the video if it feels better to not pull with the strap
        
        A regression from this movement comes out of a research article I found on frozen shoulder
        
        Try the movement below as a substitution option for the behind back stretch
        
        Side lying Low Load Long Duration Behind the Back Stretch VIDEO
        
        Hold very light tension for 30sec-90sec
  - Puppy Pose Progression VIDEO
    - Be careful to stay short of pain
  - Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
    - Option number 2 keeps the lower body stationary while the upper torso moves
      - Sidelying Thoracolumbar Rotation Stretch VIDEO
  - Deep Neck Flexor with Thoracic Extension Seated and Foam Roll VIDEO
    - You mentioned this one has been a problem
      - Couple changes
        
        Lets focus on progressing thoracic ext with overhead shoulder motion
        
        This will set us up for overhead pressing and pulling
      - Shoulder Flexion Laying->Wall Sit->Seated Against Wall VIDEO
        
        Start lying on your back, if that goes well…prior to progressing to second part of video which is a wall sit, may want to try the video below that progresses to sitting and back against counter prior to going into wall sit
        
        Shoulder Flexion Seated->Standing VIDEO
- Strength Circuit #1
  - Prone Shoulder Extension Off Edge of Bed VIDEO
    - Focus on scapula position
  - Downward Dog Progression From Higher Level to Floor VIDEO
  - Table Top Progression VIDEO
- Strength Circuit #4
  - Laying on Back Weighted Pull Over VIDEO
    - Wider grip will likely be less pressure on the shoulder using a weighted EZ curl bar over a dumbbell if available
    - Can progress weight with less neck tension because neck is in a supported position
  - Full Can/Scaption Supraspinatus VIDEO
  - Prone I to T Progression VIDEO
Day 3
- Mobility/Body Awareness
  - Goal: These movements are meant to pull and be utilized as a warm up/ cool down or as a light sequence on a daily basis
    - Narrow the list below down to 4-5 movements that feel like they accomplish stretching and tightness without pain
  - Scapula and Cervical Positioning Drill VIDEO
    - If this position bothers the shoulder, take hands further apart and put a small towel under forehead
  - Self Myofascial Release Posterior Shoulder VIDEO
    - spend 45sec to 60sec in each aspect of the shoulder hitting 3-4 points
  - Posterior Shoulder Stretch Door Pull VIDEO
  - Tall Kneel with Scapular Depression/Retraction VIDEO
    - Progress to the following, especially second option in the video below
      - Sleeper Stretch->Behind Back with Towel->Reach Opposite Arm VIDEO
        
        You can go to the last part of the video if it feels better to not pull with the strap
        
        A regression from this movement comes out of a research article I found on frozen shoulder
        
        Try the movement below as a substitution option for the behind back stretch
        
        Side lying Low Load Long Duration Behind the Back Stretch VIDEO
        
        Hold very light tension for 30sec-90sec
  - Puppy Pose Progression VIDEO
    - Be careful to stay short of pain
  - Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
    - Option number 2 keeps the lower body stationary while the upper torso moves
      - Sidelying Thoracolumbar Rotation Stretch VIDEO
  - Deep Neck Flexor with Thoracic Extension Seated and Foam Roll VIDEO
    - You mentioned this one has been a problem
      - Couple changes
        
        Lets focus on progressing thoracic ext with overhead shoulder motion
        
        This will set us up for overhead pressing and pulling
      - Shoulder Flexion Laying->Wall Sit->Seated Against Wall VIDEO
        
        Start lying on your back, if that goes well…prior to progressing to second part of video which is a wall sit, may want to try the video below that progresses to sitting and back against counter prior to going into wall sit
        
        Shoulder Flexion Seated->Standing VIDEO
Day 4
- Mobility/Body Awareness
  - Goal: These movements are meant to pull and be utilized as a warm up/ cool down or as a light sequence on a daily basis
    - Narrow the list below down to 4-5 movements that feel like they accomplish stretching and tightness without pain
  - Scapula and Cervical Positioning Drill VIDEO
    - If this position bothers the shoulder, take hands further apart and put a small towel under forehead
  - Self Myofascial Release Posterior Shoulder VIDEO
    - spend 45sec to 60sec in each aspect of the shoulder hitting 3-4 points
  - Posterior Shoulder Stretch Door Pull VIDEO
  - Tall Kneel with Scapular Depression/Retraction VIDEO
    - Progress to the following, especially second option in the video below
      - Sleeper Stretch->Behind Back with Towel->Reach Opposite Arm VIDEO
        
        You can go to the last part of the video if it feels better to not pull with the strap
        
        A regression from this movement comes out of a research article I found on frozen shoulder
        
        Try the movement below as a substitution option for the behind back stretch
        
        Side lying Low Load Long Duration Behind the Back Stretch VIDEO
        
        Hold very light tension for 30sec-90sec
  - Puppy Pose Progression VIDEO
    - Be careful to stay short of pain
  - Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
    - Option number 2 keeps the lower body stationary while the upper torso moves
      - Sidelying Thoracolumbar Rotation Stretch VIDEO
  - Deep Neck Flexor with Thoracic Extension Seated and Foam Roll VIDEO
    - You mentioned this one has been a problem
      - Couple changes
        
        Lets focus on progressing thoracic ext with overhead shoulder motion
        
        This will set us up for overhead pressing and pulling
      - Shoulder Flexion Laying->Wall Sit->Seated Against Wall VIDEO
        
        Start lying on your back, if that goes well…prior to progressing to second part of video which is a wall sit, may want to try the video below that progresses to sitting and back against counter prior to going into wall sit
        
        Shoulder Flexion Seated->Standing VIDEO
- Strength Circuit #2
  - Shoulder Wall Ball Multiple Positions VIDEO
    - Start with first position only
    - Let’s try this as a substitute for bicep loading
  - Prone Shoulder Extension Off Edge of Bed VIDEO
  - Band Pull Down 3 Planes VIDEO
    - Start with one plane of motion focusing on the one that is most comfortable
- Strength Circuit #5
  - Bicep Loading Progression VIDEO
    - Try to load bicep in a neck supported position
    - Start on incline bench, may even put a small towel behind head if needed
    - Try a very light curl with thumbs up in hammer curl position
    - The incline bench will allow you to drop into a greater degree of shoulder ext
  - Arm Bar VIDEO
    - Start with light weight
    - This video is of my partner in the creation of the website
    - This option may work better the the plank/push up position against the wall
  - Row Band in Lunge/Half Kneel VIDEO
    - Light cable/band
Day 5
- Mobility/Body Awareness
  - Goal: These movements are meant to pull and be utilized as a warm up/ cool down or as a light sequence on a daily basis
    - Narrow the list below down to 4-5 movements that feel like they accomplish stretching and tightness without pain
  - Scapula and Cervical Positioning Drill VIDEO
    - If this position bothers the shoulder, take hands further apart and put a small towel under forehead
  - Self Myofascial Release Posterior Shoulder VIDEO
    - spend 45sec to 60sec in each aspect of the shoulder hitting 3-4 points
  - Posterior Shoulder Stretch Door Pull VIDEO
  - Tall Kneel with Scapular Depression/Retraction VIDEO
    - Progress to the following, especially second option in the video below
      - Sleeper Stretch->Behind Back with Towel->Reach Opposite Arm VIDEO
        
        You can go to the last part of the video if it feels better to not pull with the strap
        
        A regression from this movement comes out of a research article I found on frozen shoulder
        
        Try the movement below as a substitution option for the behind back stretch
        
        Side lying Low Load Long Duration Behind the Back Stretch VIDEO
        
        Hold very light tension for 30sec-90sec
  - Puppy Pose Progression VIDEO
    - Be careful to stay short of pain
  - Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
    - Option number 2 keeps the lower body stationary while the upper torso moves
      - Sidelying Thoracolumbar Rotation Stretch VIDEO
  - Deep Neck Flexor with Thoracic Extension Seated and Foam Roll VIDEO
    - You mentioned this one has been a problem
      - Couple changes
        
        Lets focus on progressing thoracic ext with overhead shoulder motion
        
        This will set us up for overhead pressing and pulling
      - Shoulder Flexion Laying->Wall Sit->Seated Against Wall VIDEO
        
        Start lying on your back, if that goes well…prior to progressing to second part of video which is a wall sit, may want to try the video below that progresses to sitting and back against counter prior to going into wall sit
        
        Shoulder Flexion Seated->Standing VIDEO
Day 6
- Mobility/Body Awareness
  - Goal: These movements are meant to pull and be utilized as a warm up/ cool down or as a light sequence on a daily basis
    - Narrow the list below down to 4-5 movements that feel like they accomplish stretching and tightness without pain
  - Scapula and Cervical Positioning Drill VIDEO
    - If this position bothers the shoulder, take hands further apart and put a small towel under forehead
  - Self Myofascial Release Posterior Shoulder VIDEO
    - spend 45sec to 60sec in each aspect of the shoulder hitting 3-4 points
  - Posterior Shoulder Stretch Door Pull VIDEO
  - Tall Kneel with Scapular Depression/Retraction VIDEO
    - Progress to the following, especially second option in the video below
      - Sleeper Stretch->Behind Back with Towel->Reach Opposite Arm VIDEO
        
        You can go to the last part of the video if it feels better to not pull with the strap
        
        A regression from this movement comes out of a research article I found on frozen shoulder
        
        Try the movement below as a substitution option for the behind back stretch
        
        Side lying Low Load Long Duration Behind the Back Stretch VIDEO
        
        Hold very light tension for 30sec-90sec
  - Puppy Pose Progression VIDEO
    - Be careful to stay short of pain
  - Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
    - Option number 2 keeps the lower body stationary while the upper torso moves
      - Sidelying Thoracolumbar Rotation Stretch VIDEO
  - Deep Neck Flexor with Thoracic Extension Seated and Foam Roll VIDEO
    - You mentioned this one has been a problem
      - Couple changes
        
        Lets focus on progressing thoracic ext with overhead shoulder motion
        
        This will set us up for overhead pressing and pulling
      - Shoulder Flexion Laying->Wall Sit->Seated Against Wall VIDEO
        
        Start lying on your back, if that goes well…prior to progressing to second part of video which is a wall sit, may want to try the video below that progresses to sitting and back against counter prior to going into wall sit
        
        Shoulder Flexion Seated->Standing VIDEO
- Strength #3
  - Band Extension Deadlift VIDEO OR Shoulder Flexion & Forward Reach Towel Slide to Ball Roll Out VIDEO
    - Both of these are meant to improve forward reaching while maintaining humeral head depression
      - They are similar motions, pick the one you feel you are best able to control
      - Try to turn head with each rep when you feel your neck tensing up and see if you can maintain the same mobility during the exercise that you have at rest
  - Laying on Back External Rotation Phase 1 VIDEO
    - Try to keep the feeling in the back of the shoulder/armpit
    - Standing Band External Rotation Phase 2 VIDEO
      - Don’t progress to standing too quickly
      - This movement should be very slow
  - Supine Rolling With Activation of Posterior Shoulder and Scapular Stability VIDEO
    - Coordinate posterior shoulder stability with rolling pattern
    - You can do this with your head supported on a pillow so there is less tension in the neck with the rolling
- Strength #6
  - Basics of Bear with Leg Lift VIDEO
    - Start with all the pieces of the movement without actually lifting knees up off the ground
    - We will use the bear to progress towards the overhead press
    - Only lift knees when able to without shoulder pinching
      - It way take a few couple weeks but you will get there
  - Wall Sit Active/Band Abduction VIDEO
    - There is a wide variety of bands out there, make sure the ones you start with are light
    - progress to the movement below as able for a more challenging version in that it adds more rotation through the trunk
      - Band Horizontal Abduction VIDEO
  - Band Horizontal Adduction VIDEO
    - Be very careful with this one
    - If painful, email me and we can discuss
Day 7
- Mobility/Body Awareness
  - Goal: These movements are meant to pull and be utilized as a warm up/ cool down or as a light sequence on a daily basis
    - Narrow the list below down to 4-5 movements that feel like they accomplish stretching and tightness without pain
  - Scapula and Cervical Positioning Drill VIDEO
    - If this position bothers the shoulder, take hands further apart and put a small towel under forehead
  - Self Myofascial Release Posterior Shoulder VIDEO
    - spend 45sec to 60sec in each aspect of the shoulder hitting 3-4 points
  - Posterior Shoulder Stretch Door Pull VIDEO
  - Tall Kneel with Scapular Depression/Retraction VIDEO
    - Progress to the following, especially second option in the video below
      - Sleeper Stretch->Behind Back with Towel->Reach Opposite Arm VIDEO
        
        You can go to the last part of the video if it feels better to not pull with the strap
        
        A regression from this movement comes out of a research article I found on frozen shoulder
        
        Try the movement below as a substitution option for the behind back stretch
        
        Side lying Low Load Long Duration Behind the Back Stretch VIDEO
        
        Hold very light tension for 30sec-90sec
  - Puppy Pose Progression VIDEO
    - Be careful to stay short of pain
  - Laying Down Humeral Depression with Progression to Pec Stretch VIDEO
    - Option number 2 keeps the lower body stationary while the upper torso moves
      - Sidelying Thoracolumbar Rotation Stretch VIDEO
  - Deep Neck Flexor with Thoracic Extension Seated and Foam Roll VIDEO
    - You mentioned this one has been a problem
      - Couple changes
        
        Lets focus on progressing thoracic ext with overhead shoulder motion
        
        This will set us up for overhead pressing and pulling
      - Shoulder Flexion Laying->Wall Sit->Seated Against Wall VIDEO
        
        Start lying on your back, if that goes well…prior to progressing to second part of video which is a wall sit, may want to try the video below that progresses to sitting and back against counter prior to going into wall sit
        
        Shoulder Flexion Seated->Standing VIDEO