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"Boulders in the Shoulders": Chronic Neck and Shoulder Pain

December 13th, 2013

A lot of people carry pain and tension in their neck and shoulders. The classic symptom is what massage therapists sometimes refer to as "Boulders in the Shoulders": large, painful knots in the neck, upper back, and shoulders.

Mind-body massage therapy offers a fascinating explanation of this phenomenon, which goes something like this: The body comes equipped with built-in automatic reflexes so if a tiger attacks you in the jungle, you don't have to think about what to do because by the time you're done thinking it would be too late. So you're born with certain reflexes designed to save your life in an emergency. One of the strongest protective reflexes in the body is the urge to protect the neck, which reflexively involves hiking the shoulders up while pulling the head down.

Unfortunately for people living in stressful environments, these reflexes can be inadvertently stimulated by any situation that feels unsafe or otherwise stressful. According to neurological trigger-point theory, repeated stimulation of specific neurological pathways (such as these reflexes) eventually leads to the physical creation of "shortcuts": new, hardwired neural pathways that maintain or perform an action automatically, without thought or conscious input. The nice thing about this short-wiring is that the practice and repetition of a movement that we once had to concentrate and focus on to perform successfully (such as running, jumping, riding a bike, or playing piano) eventually becomes so easy we don't need to think about it, we can just do it.

Unfortunately, when a neurological shortcut is forged over a defensive reflex (such as the instinct to protect the neck), a "holding pattern" frequently develops. We call it a "holding pattern" once the short-wiring has set in and the reflex "holds" / no longer releases even when the causative stressor abates. This soon creates chronic pain and tension in the particular muscles responsible for the defensive reflex. Once this occurs, the person may have difficulty relaxing the affected muscles even when no stressor is present and even if they try.

Shoulders are particularly vulnerable to developing this type of holding pattern because of the strong reflex to protect the neck. Over time, repetition of this defensive reflex causes it to become physically entrained until it is difficult to relax your shoulders even when there is no threat or stressor present. Over time, the holding pattern can result in pain and misalignment as the body physically grows into it.

So how does one deal with this situation? Certainly, a good massage therapist can help by relaxing and stretching the affected muscles. And many techniques, including trigger-point therapy, heat, warmth, and good old TLC are very useful for immediate relaxation of tension. At a deeper level though, neurological rewiring (and, preferably, removing the chronic stressor if it is still present) is generally desirable to assist in effecting long-term improvement.

A massage therapist trained in mind-body techniques can assist by bringing the client's awareness to the affected area while lengthening, stretching, and differentiating the affected muscles. Conscious awareness is a very effective tool for discovering the source of the holding pattern and deciding whether to preserve or release it. Directed breathwork during massage can also accellerate and assist the relaxation of holding patterns.

An expert therapist trained in mind-body techniques can sometimes even assist the client (through guided meditation and presence-centered inquiry) to discover for themselves the source of the triggers causing the holding pattern in the first place. Through guided questioning, the client can personally assess how those life factors are benefitting or impairing them, and even take the opportunity to personally decide for themselves what / whether they want to change anything.

From this crucial awareness, long-term improvement can grow, in addition to the immediate relief offered by a really good massage. For more information, please see Aloha Massage.