A pain in the neck

We’re excited about our recent announcement to transition our subscription model to a web-based publication! This offers our readers the opportunity to access our content from any smart device. The downside of mobile reading is a phenomenon called ‘text neck’.

Paralympic skiers of the U.S. team Stephen Lawler (R) and Stephanie Jallen look at a mobile phone, 2018. REUTERS/Paul Hanna


Rest assured that the cervical spine is made to endure flexed positions for prolonged periods of time – as evidenced by the many craftsmen throughout the centuries who sat hunched over their work. The problem for the modern person, however, is that the muscles of the thoracic spine may not be conditioned for the load. Even fairly fit athletes may ignore upper back muscles in their training routines leading to thoracic dysfunction from time spent on mobile devices. Trevor Langford reviewed the tests to diagnose thoracic limitations and exercises to strengthen the thoracic musculature in a recent article. 

The upper back muscles play a role not only in neck pain, but also in shoulder movements, as Chris Mallac explains in this week’s feature article on the upper trapezius. Pain and weakness in the upper traps affects the scapulohumeral rhythm, possibly limiting shoulder range and smoothness of movement. Limited scapular rotation most significantly impacts shoulder elevation in the arc of movement beyond 90°, as the scapula contributes over 50% of the motion in this range (see figure 1)1. Upper trap health, therefore, impacts overhead athletes, including swimmers and golfers.

Figure 1: Scapulohumeral rhythm muscle coupling

Sometimes, neck pain isn’t coming from the neck at all, as in a case study presented by Chris Mallac. The cause of this dysfunction came from an unusual source: the pec minor. Malloc explains his detective work and offers treatment strategies for managing this unlikely culprit (see figure 2). This case study, where the subject is a physiotherapist, is a great reminder to practice what we preach while reading on the go!

Figure 2: Pec minor release; under the pec major (direct)

Pec minor release; under the pec major (direct)


  1. World J Orthop. 2012 Jun 18; 3(6): 87–94.




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