Knots in upper back & trapezius

July 2, 2019

I’ve been suffering with tight upper back/ shoulders for the past few years with recurrent knots in these areas. For the past 18 months or so the knots have localised to my Right upper back mid clavicular and medial scapula region.

I’m actually a GP, and I’m sure my pains are triggered by work- doing a stressful desk job.

However I have tried a number of things – workplace adaptations/ exercises but have had no success. I’m only 30 years old and am worried this isn’t getting any better.

I’ve seen a few physios already, who have diagnosed a forward head posture, mild R scapula winging, and slightly exaggerated lumbar curve. I’m Right handed and use the mouse in my Right hand.

I’ve also had some acupuncture in this area which helps but only temporarily.

Please help!!!

July 2, 2019

Hi Laura

This, as I’m sure you realise, is pretty common – and what you feel has little relevance to what’s wrong.

The pain you feel and all those wannabe knots are all referred from your cervical spine – have a look at C4/5 referral patterns. This area of your neck is where the pain is coming from but not the cause.

The why is more important than the what.

You’ve got a forward head posture (ignore the other stuff, it’s all probably quite normal) because you’ve got a flexed and relatively stiff thoracic spine. This, if you don’t move your head, makes you look down. To stop doing this you can’t simply lift your chest (you’ve got a stiff thoracic spine) so you poke your chin and keep your poor neck over extended in your mid cervical spine….C4/5. You also cheat further by leaning backwards when your stand to decrease the overload on your neck. This is why sitting is worse – you’ve lots a compensation.

Think of it like a “bruise” in your neck – you keep poking because you don’t have the ability to move any better, and you need to move better in your thoracic spine to take the pressure off your mid cervical spine. You then need to control this movement and why rehab, rather than passive treatments (massage, acupuncture etc) is absolutely key.

Try doing these for the next 10 days or so and then slowly start a really simple strength program





The Guru

Thank you for such a fast and helpful response:

I will try those in the next 10 days.

I meant to say I’m Left handed (not R). Also I’ve been told I don’t have much mid back strength and need to build this up to try and take the pressure of my overactive traps. After I’ve done 10 days of what you suggested how would you recommend doing the simple strength program?

Thank you very much,


The Guru responded:

Don’t worry about strength, yet.

You need to get control first so you can have better form when getting stronger.

Get back in touch in 10days – 2 weeks and I’ll give you some simple stuff to get on with.

Laura got back in touch after 10 days:

I’ve been doing the stretches that you recommended previously. They are definitely helpful but I still have lots of tension in my upper back/shoulder area.

I would be grateful if you can give me the next steps as you had mentioned before.

Thank you

These are the next steps:

If they seem to be working (and I think it sounds as if they are) then I’d keep going with them but slowly start to add in some 2-5kgs free weights.

Doing simple things like biceps curls, overhead lifts, bench press plus these, slowly progressing the reps and resistance.



Another 2 weeks and let me know – you should be able to then do what you want to do as long as you’ve got better control and greater postural endurance.

The Guru


Guru Responded

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