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Muscle Imbalances in the Head, Neck, and Shoulders

Reading Time: 5 minutes 20 seconds


Date: 2022-05-26

This is the second installment of a three-part series on muscular imbalance. In part one, you learned why muscle balance is important. We also covered how to test muscle balance by looking at your client’s posture. 

This article begins a deeper dive into imbalance issues in specific areas of the body. As such, it will focus on the head, neck, and shoulder complex. 

First, we will discuss why it’s important to recognize muscle imbalance in these areas. Then we’ll go into common causes of balance issues. This is followed by ways to restore muscle balance in the head, neck, and shoulder regions.

Importance of Recognizing Muscle Imbalances in the Head, Neck, and Shoulders

When there is an imbalance in the muscles surrounding the head, neck, and shoulders, it affects your posture. Weakened muscles allow your shoulders to round forward, for instance. Rounded shoulders is known as shoulder girdle protraction. 

Protraction of the shoulder girdle decreases respiratory volume. It also overloads the secondary muscles of inspiration. This includes the pec minor, omohyoid, upper traps, and scalenes. Rounded shoulders lead to painful myofascial trigger points. It creates ischemia in the tissues. This causes neuromuscular inhibition of the antagonists and faulty biomechanics in the joints.

Imbalance in the neck muscle may also lead to a forward head posture. When you have poor posture, this leads to pain in the neck and shoulders. Improper posture can also aggravate chronic pain conditions. 

Misalignment of the head and neck places increased stress on the neck musculature. It adds pressure on the jaw complex and myofascial trigger points. The result is headaches and migraines. 

Postural Imbalance and Upper Crossed Syndrome

A common imbalance of the head, neck, and shoulder complex is called Upper Crossed Syndrome or UCS. It is a combination of weak muscles and some muscles being too tight. This creates a sort of X in the head and neck area. Hence the name “upper crossed.”

Upper Crossed Syndrome involves a few distinct features. One is a forward head posture. This involves the zygomatic arch under the eye gravitating more than 3cm forward of the sternoclavicular joint. 

The second feature is the position of the shoulders. In UCS, the shoulders appear slumped or rounded forward. There is also a noticeable rounded appearance of the thoracic spine. 

The third visual assessment is from the posterior view. From this position, the scapula appears to be winged and abducted. The normal position of the scapula is about 2-4 inches from the spine.

The notion of UCS was created by Vladimir Janda. Through his research, Janda found that certain muscles in the body tend to be prone to becoming tight (facilitated) or weak (inhibited or long). This is the reason why certain muscle imbalance syndromes tend to be so common. 

The muscles that tend to become short and hypertonic are the:

  • suboccipitals

  • upper trapezius

  • sternocleidomastoid

  • levator scapulae

  • pec minor

  • lats

  • pec major

The muscles that tend to be inhibited or weak include the:

  • rhomboids

  • lower trapezius

  • serratus anterior

  • posterior deltoid

  • external rotator cuff

  • deep cervical flexors 

Causes of Head, Neck, and Shoulder Muscle Imbalance

Imbalance in the head, neck, and shoulder area has many potential causes. One is gender. Research indicates that females have approximately 59% less muscle in the neck than males. Yet, their heads still weigh about 8% of their body weight. 

This could be a reason why many women seem to suffer from headaches, migraines, and general neck pain. If you have fewer neck muscles, yet they must support the weight of a bowling ball, it won't take long before they become overloaded.

Other causes of imbalance include:

  • Sitting in front of the computer for long periods

  • Muscle imbalances due to a specific sport

  • An excessive amount of volume performed in a workout program (such as too much bench pressing without an equal amount of pulling exercises) 

Signs of a Muscle Imbalance in the Upper Body

Assessing a client’s posture can help identify muscle imbalance. Look for a forward head posture or a rounded shoulder. It can also be helpful to ask the client if they are experiencing any physical symptoms.

Faulty positioning of the shoulder girdle can cause many orthopedic and neurological symptoms. One is numbness and tingling in the hands. This is caused by compression in the neck area. In the medical world, this is known as thoracic outlet syndrome. 

If there is impingement in the shoulder joint, this can also be a sign of muscle imbalance. In this case, the shoulder blade rubs against the rotator cuff. This leads to pain and irritation in the shoulder area. Ask the client if they have pain in the shoulder not due to injury. If their answer is yes, imbalance in the muscle may be an issue.

Muscle imbalance may even appear as shoulder instability. This makes it easier for the shoulder to become dislocated. Should this occur, it can create severe shoulder pain. So, ask about any shoulder dislocation issues as well.

First Step to Correcting Muscle Balance (And Posture) Issues

How do we start to correct an imbalance in the head, neck, or shoulders? First, we must remind our clients to maintain proper posture as often as possible. Cues such as “pull your shoulders back” and “tuck your chin” are a good place to start. Have your client perform these corrections to avoid chronic pain issues. 

In addition to providing guidance while they are in the gym with you, also encourage clients to pay attention to their posture when outside the gym. Have them use a mirror when exercising at home, for instance. Watching themselves work out allows them to correct posture issues before they can lead to pain.

If the client works from home, have them set up their desk for good posture. Also suggest that they put a mirror by their desk. Every hour, have them ask themselves these questions:

  • Is my head posture straight up or tilted forward?

  • Do I have rounded shoulders?

  • Am I feeling neck pain?

  • Is there pain in my shoulders or upper back?

A “yes” answer to any of these should instigate a posture shift. Have them change position so their cervical spine is tilted forward. Pulling their shoulder blades back and down can help relieve muscle tension in the upper back and shoulders.

Restoring Balance Through Corrective Exercise

Imbalance in the head, neck, and shoulder muscles can also be corrected with exercise. Corrective exercises aimed at posture can help reduce neck pain or pain in other upper body areas. They also work to reduce movement limitations. 

Doing stretches before the exercise session can help release tight muscles. If the trapezius muscle is tight, gently pull the ear to the shoulder. If the tightness is in the deltoid, you can stretch this muscle by doing cross-body reaches.

Do three sets of these stretches, holding each for 30 seconds. This helps to decrease neural impulses sent to the muscles. It also prevents overactive muscles during exercise. 

Exercises can also be added at the end of their routine to assist in strengthening each muscle group. Three to consider are:

  • Prone Cobra

  • Floor chin tucks

  • Standing cable rows (with emphasis on scapular retraction and depression)

For the Prone Cobra and floor chin tucks, the goal is to eventually work clients up to 3-5 minute straight holds. But to start, hold each for 30 seconds, then rest for 15 seconds. Continue in this manner until the client cannot hold for a full 30 seconds. Other variations can be used for weaker or stronger clients. 

Rows should use a slow tempo and high reps if postural endurance is the goal. Use a 3-second lift and a 3-second negative for 15-20 reps. Remember to keep rest times under 1 minute to emphasize endurance.

Learn more exercise options by becoming a Corrective Exercise Specialist. This ISSA certification course teaches you how to help clients with muscle pain issues. You also learn how to correct common movement limitations.

Related Articles:

Part 1: Muscle Balance Tests

Part 3: Pelvic Imbalances


Zheng, L., Siegmund, G., Ozyigit, G., & Vasavada, A. (2013). Sex-specific prediction of neck muscle volumes. Journal of biomechanics, 46(5), 899–904.

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