“I have something new for you to address, if you don’t mind,” Ms. S. said. “My neck is really becoming a problem. I can deal with it, but it has become something I am almost always aware of now. I have been having headaches and neck stiffness to a greater degree than at any time in recent memory. I don’t know if it is related, but I have been doing more weight training this winter instead of putting as many miles into running or riding my bike.”
“Do you notice any exercise that particularly aggravates your neck?” I asked.
“Not that I am aware of. My trainer seems very knowledgeable and keeps a close watch on my form. I don’t feel immediate discomfort at the time, but the more involved I have been with weight training, the more my neck hurts. This is really perplexing.”
I began by checking the anterior muscles of her neck, starting with the sternocleidomastoid and the scalenes. Nothing seemed remarkably tender, and the tissue texture seemed compliant and soft. The upper trapezius is often overloaded in weight training, and that might explain the headaches she was experiencing. Once again, the tissue was remarkably supple with very little tenderness.
I began to explore the semispinalis capitis with Ms. S. in the supine position. Here, I found quite a bit of tension, and palpation replicated both her neck discomfort and the headache symptoms. Reaching further down the paraspinal area while she was supine, I felt a significant restriction at the upper thoracic area. I intended to palpate the semispinalis capitis, but the restriction I felt was horizontally oriented. Having her retract her scapula revealed that the restricted muscle was the middle trapezius.
What would explain this? It would be difficult to make the case that the middle trapezius was the culprit, since it does not typically create headaches or restrict neck mobility. Yet, this muscle was very tender even if it didn’t recreate her symptoms. Then, what was its role?
I explained my dilemma to Ms. S. and why the tension in the middle trapezius didn’t make a lot of sense. “The main job of the middle trapezius is to bring your shoulder blades together,” I explained. “If you squeeze them together, you will feel this muscle contract.”
I placed one hand under her upper thoracic area to palpate the middle trapezius, giving her proprioceptive feedback. By chance, I left my other hand cradling her cervical area. When she brought her scapula into retraction, I felt her neck muscles, specifically the semispinalis capitis, tense.
“Can you pull your shoulder blades together without contracting your neck?” I asked.
“I’ll try,” she replied as we repeated the shoulder squeeze. “Wow, I can feel myself contracting my neck, pushing against your hand every time I contract my shoulders. I know I should be able to squeeze my shoulders together without tensing my neck, but one action seems linked to the other.”
There was a silence in the room as we processed the implications of this realization. Suddenly, Ms. S. jettisoned off the table in excitement.
“Wait, I think I might know how these actions got connected,” she said enthusiastically. “Would this make sense?”
Ms. S. then demonstrated an exercise where she bent at the waist and brought her outstretched arms into horizontal abduction. While this exercise is supposed to target her middle trapezius, it was clear that her cervical extensors were tightening with every movement of her arms.
“My trainer loves this exercise,” she said. “We do tons of them. He said it is really important to enforce good posture.”
“I think I understand the problem now,” I said. “There is a saying in neuroscience: that which fires together, wires together. Each time you contract your neck erectors while simultaneously firing your middle trapezius, your brain learns to link the two actions together. It becomes like flipping a light switch—both bulbs come on even if you only wanted to illuminate just one. We need to delink these actions in the same way you learned to link them.”
Ms. S. and I spent several minutes working on separating the two actions. I held my hand under her head and she tried time and time again to contract her middle trapezius without engaging her neck extensors. After many failures, she was able to successfully squeeze her shoulders together without tightening her neck. Once this relearning happened, both her shoulder and neck muscles softened substantially. We ended the session there.
I received a text from Ms. S. two days later saying how much better her neck felt. She realized it had been bothering her even more than she thought. Without the pain, she was able to sleep more soundly than she had for weeks. Her trainer sounded very conscientious, and I think he will also appreciate a deeper meaning of the word training.  

Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars, president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois, and a trustee for the Massage Therapy Foundation. His clinic, seminars, and research endeavors explore the science behind this work. Visit www.nmtmidwest.com, or email him at doug@nmtmidwest.com.