Imagine how much the average person actually slouches during a day.

Slouching during breakfast, then hunched over the kitchen sink to wash dishes, slouching while driving a car, and then slouching while sitting at work or at a school desk.

Don’t forget about slouching while texting, watching TV or using the computer. When you are not slouching, you’re bending over to clean or pick up children and/or pets. The list of slouching possibilities is endless!

Now envision your running posture. Does it look any different? Many of us run in a forward head and rounded shoulders position–a slouched posture! Runners experience many of the same aches and pains as their sedentary counter parts. Upper back and neck pain is a common occurrence. The most typical cause is almost always poor posture.

How to Avoid Upper Back Pain When Running

Our spines are designed to move many directions including both forward and backward. The problem is that we spend most of our times in a slouched, hunched over (flexed) position. Slouching is often associated with a posterior pelvic tilt, which causes a reduction in the normal lumbar curve that increases your risk of developing low back pain (LBP). The rounded shoulders forward head posture tends to be even worse in people who are taller than average or in teenage girls and women (as many will slouch to modestly hide their chests).

Over time, this constant flexed position causes excessive strain on the posterior muscles of the spine. It begins to overload the vertebral discs and ligaments which can also lead to pain and injury. As runners pound out mile over mile, this creates even more pain and dysfunction.

Poor posture causes improper spinal positioning and affects the neck, shoulders, low back, mid back/thoracic, and ultimately, the entire body. This flexed (slouched) posture leads to postural muscle weakness which causes us to slouch more as well as predisposing us to injury. This position (specifically for runners) can also cause limitations in performance as rib and vertebral mobility worsen. This reduces your ability to utilize your full lung capacity and to adequately transmit forces up and down the spine.

Runners often experience increased neck and upper back pain when running a longer distance and particularly, when running on a harder surface. Symptoms typically begin as an achy feeling in your neck, shoulder or upper back. This achiness can quickly become a sharp and piercing pain. This may cause you to lose focus and running form. Often, you must end a poor training run or worse yet; lose some of your training days.

Treatment Strategies

How can we eliminate upper back pain (particularly, pain when running)? As simple as it sounds, first work on your posture!  Sit and stand up straight.  Be very critical of your running posture. Don’t allow your head to jut out too far from your body. Some degree of forward head posture is expected as this allows for an easier passage of air (when mouth breathing) down the trachea and into the lungs.

Even small changes in posture can have big benefits. Initially, it may be difficult because the posterior back muscles, which are responsible for maintaining an upright posture, are weak. Correcting your posture initially may actually cause some pain as the muscles will be utilized in a way that they aren’t used to. Persistence is crucial if you want to eliminate pain permanently and decrease your risk of future or further injury and pain.

Sitting

Sitting is not only a major risk factor for low back pain, but it is also a major risk factor for neck, upper back and shoulder pain because most of us tend to sit in a slouched posture.

• Limit your sitting. Limit the amount of sitting that you spend at one time. Move from your sitting position every hour, and ideally, walk. If you aren’t able to walk, then try to shift your position at least once every twenty minutes in order to regain a more erect posture. Frequent position changes can help you to avoid prolonged static postures that cause excessive strain on tissues and muscles resulting in pain. Avoid a long car trip directly before or after a long run or a race. For destination races, it’s best to arrive at least a day or two early and wait a day prior to returning home.
• Sit with correct posture. Whenever possible, make sure that your knees stay below your hip level and that you are able to maintain your natural lumbar curve. A McKenzie Lumbar Roll is a great tool to help you maintain correct posture.

Trail Packs and/or Hydration Packs

• Loads and compression forces add up. Limit the amount of time that you are wearing the pack. Take it off unless you are actually walking or running. If you’re standing to visit for a while or rest, then take it off.
• Use larger shoulder straps and a waist strap. Properly fitting straps can help distribute the load more evenly.
• Only carry what you have to. Many times, we carry more items than we really need to. Carry only what you need, and be efficient in the way you pack items. Don’t over pack! If you are participating in a long distance event, rely on your team to carry items for you.

Postural (Extensor) Muscle Strength

I prefer to utilize a combination of standing and prone (face down) exercises. Please refer to Exercises for Scapulothoracic and Postural Muscle Strength for instructions and photos of exercises that you can perform in order to strengthen the scapular (shoulder blade) and postural muscles.

Foam Roller (or Towel Roll) Stretches

A foam roller is the best option, but you could substitute one by tightly rolling up a beach towel or by rolling a beach towel over a water noodle. Make sure to keep your knees bent and your head supported. Subscribe to my e-mail list to gain immediate access to My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain for step by step exercise instructions and photos.

Activation of the Nervous System

In the case of poor posture, it’s common that the upper trapezius muscles become over active (which causes pain and muscle spasms) while the lower portion of the trapezius muscles become weak and disengaged. This is partially due to the nervous system. The nervous system often works like a dimmer switch for lights. It can cause certain muscle groups to become over active while dimming the involvement of other groups.

The trapezius muscle is an important postural muscle. The more you slouch and hold a forward head and rounded shoulders posture, the more signals the nervous system will send to the upper portion of the trapezius. This causes pain and spasms.

Work to improve your posture by keeping your shoulder blades back and downward while engaging your lower trapezius. When this occurs, the nervous system will automatically send increased signals to the lower trapezius in order to help the muscle hold the posture. Meantime, the signal to the upper portion is reduced. This combined with improved thoracic mobility (through foam roll use) should immediately reduce muscle spasms and pain.

Topical Agents

For immediate and short term pain relief, you may want to try a topical agent. Many topical agents can help to decrease and eliminate muscle spasms. The method of action varies greatly according to the product used. You may find that one product works better than another. Some of my favorite products in my medicine cabinet include: Biofreeze Pain Relieving Gel; Arnica Rub (Arnica Montana, an herbal rub); and topical magnesium.

Another option is oral magnesium. You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates. Taking additional magnesium (particularly at night) can help to reduce muscle cramps and spasming. It is also very helpful in reducing overall muscle soreness and aiding in a better night’s rest. Most people are deficient in the amount of magnesium they consume on a regular basis. I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose as needed. I would caution you that taking too much magnesium can lead to diarrhea. Mag Glycinate in its oral form is the most highly absorbable. Although not as absorbable, Thorne Research Magnesium Citrate and magnesium oxide can also be beneficial.

Kinesiological Tape

Utilizing Kinesiological tape can be particularly effective when treating upper back pain. It provides additional support, and more importantly, a mechanical reminder to maintain proper posture. I have had luck using Kinesio Tape, Rock Tape, and Mummy Tape brands. You could also utilize Spider tape or KT TAPE.

Many of the techniques are easy to apply by nearly anyone, but you will need assistance from a spouse or friend. To visually learn how to apply the tape, please refer to these two simple, yet effective, techniques: How To Tape for Upper to Mid Back Support Using X Technique and KT Tape: Middle Back. For application and removal tips, please refer to Skin Care with Taping.pdf.

Physical Therapy

Upper back pain, neck pain, and/or shoulder pain is a common complaint among runners. However, the reasons for developing the pain are typically no different than those of the general population. The key to a long term treatment and recovery is to improve your posture, thoracic (upper back) mobility, and your upper back postural muscle strength.

If you continue to experience pain and discomfort after implementing these treatment strategies, please seek additional assistance from a physical therapist. The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

For additional information on common running injuries and how to self-treat, please visit www.thePhysicalTherapyAdvisor.com.