What exercises can help alleviate neck and shoulder pain?

Exercise Recommendations for Neck and Shoulder Pain

For chronic neck and shoulder pain, perform progressive resistance strengthening exercises targeting the cervico-scapulothoracic muscles and upper extremities, combined with gentle stretching focusing on external rotation and abduction, for at least 2 minutes daily, 5 times per week. 1, 2

Core Exercise Components

Strengthening Exercises (Primary Intervention)

• Cervico-scapulothoracic strengthening is the most effective intervention, producing moderate to large pain reduction immediately post-treatment and at short-term follow-up 1
• Progressive resistance training with elastic tubing for as little as 2 minutes daily, 5 times per week, produces clinically relevant pain reduction (1.4-1.9 points on 0-10 scale) and decreased muscle tenderness (4.2-4.4 points) within 10 weeks 2
• Isometric neck exercises combined with dynamic upper extremity exercises achieve the greatest strength gains and pain reduction, with improvements continuing up to 12 months 3
• Cranio-cervical flexion exercises combined with progressive resistance training significantly improve both deep and superficial cervical muscle function (56.48 point improvement in performance index, 1.71 kg improvement in flexor strength, 2.52 kg improvement in extensor strength) 4

Stretching and Mobilization

• Gentle stretching and mobilization techniques should focus specifically on increasing external rotation and abduction to prevent frozen shoulder and shoulder-hand syndrome 5
• Active range of motion should be increased gradually while simultaneously restoring alignment and strengthening weak muscles in the shoulder girdle 5
• Neck and shoulder stretching exercises performed twice daily, 5 days per week for 4 weeks, produce significant pain reduction (-1.4 points on VAS) and improved neck function (-4.8 points on Northwick Park Questionnaire) 6
• Performing stretching exercises at least 3 times per week yields significantly greater improvement in neck function and quality of life compared to less frequent exercise 6

Exercise Frequency and Duration

• Minimum effective dose: 2 minutes of progressive resistance training daily, 5 times per week 2
• Optimal duration: 6-12 weeks for initial improvements, with continued benefits up to 12 months with ongoing training 4, 3
• The greatest gains in strength and pain reduction occur during the first 2 months, but improvements continue with long-term adherence 3

Critical Exercises to AVOID

• Overhead pulley exercises should be avoided as they encourage uncontrolled abduction and have the highest incidence of developing hemiplegic shoulder pain 5

Adjunctive Interventions

Physical Modalities

• Local heat application before exercise is beneficial and has higher strength of recommendation compared to ultrasound 7
• Ice, heat, and soft tissue massage can be used as adjunctive modalities to reduce pain/swelling and improve tissue elasticity 5

Electrical Stimulation

• Functional electrical stimulation (FES) may improve shoulder lateral rotation and reduce pain, though evidence shows no significant change in overall pain intensity 5
• Neuromuscular electrical stimulation (NMES) can be considered as an adjunct, though efficacy data remain limited 5, 8

Positioning and Support

• Proper shoulder positioning and protection from trauma reduces the frequency of shoulder-hand syndrome 5
• Shoulder strapping may be considered during ambulation to protect from traction injury, though evidence for pain prevention is insufficient 5
• For wheelchair users, lap trays and arm troughs may reduce shoulder pain and subluxation 5

Exercise Progression Algorithm

1. Begin with gentle range of motion exercises (active, active-assisted, or passive) to prevent complex regional pain syndrome and maintain joint mobility 5

2. Add progressive resistance training starting with 2 minutes daily using elastic tubing, targeting cervical, scapular, and upper extremity muscles 2

3. Incorporate stretching twice daily focusing on external rotation and abduction 5, 6

4. Progress to higher intensity strengthening (6-12 minutes daily) as tolerated, with isometric neck exercises and dynamic upper extremity work 3, 2

5. Continue long-term maintenance at least 3 times weekly to sustain improvements 3, 6

Important Clinical Caveats

• Aggressive passive range-of-motion exercises performed improperly can cause more harm than good; exercises should be performed within the patient's visual field in safe, appropriate positions 5, 8
• Correlation between strength gains and pain reduction exists (r = -0.22 to -0.36), supporting the mechanism that strengthening directly impacts pain outcomes 3
• Stretching alone without strengthening shows no beneficial effects and should not be used as monotherapy 1
• Pain reduction and functional improvement correlate with exercise adherence; those exercising ≥3 times weekly achieve significantly better outcomes 6