Is Strength Training Effective for Stiff Shoulders? Reading the Differences from Stretching and the Barrier of ‘Can I Keep It Up?’

Speaking from the perspective of someone who has suffered from stiff shoulders, when it comes to countermeasures for stiff shoulders, stretching is the first thing that comes to mind. Speaking from the perspective of someone who likes strength training, I want to think here, “Wouldn’t strength training also be effective?” (Both are the author’s personal impressions, not the results of research).

To give the conclusion first, there is research showing that strength training around the neck and shoulders has a certain effect on neck pain. However, it is not research that specifically investigated “stiff shoulders” itself, and there are also studies where no effect was found. Furthermore, whether the pain is sufficiently reduced depended on “whether it could be continued.”

The author is a medical student, not a doctor.

First, stiff shoulders are a familiar symptom

In the 2010 Comprehensive Survey of Living Conditions by the Ministry of Health, Labour and Welfare, among people with subjective symptoms due to illness or injury, stiff shoulders were the most common among women, and the second most common among men after lower back pain.

Since it is an old survey, it is not necessarily the current ranking. Even so, it can be confirmed from this result that stiff shoulders are a familiar symptom.

Is stretching alone enough: What do the reviews say?

Gross et al. (2015) analyzed 27 trials in a Cochrane review of exercise therapy for neck pain.

For chronic neck pain, strength training around the neck, shoulder blades, and upper limbs is considered to have moderate evidence for reducing pain. Exercise that combines strength training and stretching has also been reported to be potentially useful.

On the other hand, stretching alone, general physical fitness building, and breathing exercises were found to have small changes in pain and low evidence.

However, there is no high-quality evidence, and no evidence was found for acute neck pain. The optimal values for the amount of exercise (number of repetitions and frequency) are also unknown in this review.

In other words, it is not that “stretching is meaningless,” but rather that “the evidence that stretching alone reduces pain was weak within the scope confirmed.”

12-month trial: Pain reduced in the group that added strength training

Ylinen et al. (2003) compared 180 female office workers aged 25-53 with chronic neck pain by dividing them into three groups: a strength training group, an endurance training group, and a control group. Everyone was recommended to do aerobic exercise and stretching three times a week.

After 12 months, the strength training group and the endurance training group had improved pain compared to the control group. The authors concluded that it is difficult to expect the same effect from stretching and aerobic exercise alone as from strength training.

This is a result showing that “the group that added strength training to stretching did better.” It is not a story that you should stop stretching.

Before whether it works, can you keep it up?

Dalager et al. (2023) analyzed data from a trial in which office workers performed five exercises to strengthen the neck, shoulders, and upper back at the workplace for 12 weeks from a different angle. 269 people kept records of their training.

Pain was reduced, especially in women and those who had pain to begin with. However, whether the pain was reduced to a “clinically meaningful” degree (30% or more) depended on how much it could be continued and how much the load could be increased.

30% of participants missed two or more consecutive weeks of exercise during the 12-week period. The median time to start missing sessions was around the 6th to 8th week. The authors state that some ingenuity is needed to maintain motivation once you pass the 6-week mark.

It is a result that makes one want to call it a ‘six-week quitter’ rather than a ‘three-day quitter’ (a play on words by the author, not a research term). It is the same as saying that just having a gym membership does not build muscle (this is an analogy).

The effectiveness of strength training seems to depend not only on ‘what you do’ but also on ‘whether you can make it sustainable’.

Things that cannot be determined from this research alone

• The subjects are mainly female office workers. It has not been confirmed here whether the same applies to men or people in other professions.

• What is being investigated is mostly ‘neck pain’ or ‘neck and shoulder pain,’ not ‘stiff shoulders’ themselves. It does not necessarily apply to stiff shoulders.

• The Cochrane review covers studies up to 2014. Subsequent research is not included.

• There are also studies where no effect was found. Saeterbakken et al. (2017) divided 34 female office workers with mild neck and shoulder pain into a strength training group, a Nordic walking group, and a control group for 10 weeks (this is a preliminary small-scale trial). Both exercise groups saw a reduction in pain within their groups, but no difference was seen compared to the control group.

• These studies alone cannot determine whether the reason for the reduction in pain was an increase in muscle mass or a change in mood from exercising.

• What the author was able to confirm is limited to the abstracts of the papers. I have not read the full text of the papers.

Three perspectives to reconsider (the author’s summary)

From here on, these are not procedures whose effectiveness has been verified by research, but rather perspectives for reconsideration that the author has thought of based on the content above.

1. If you are only waiting to see how things go with stretching, know that there is also the option of adding strength training (from the Cochrane review and the Ylinen et al. trial).

2. Before starting, think about whether it is in a form you can keep up (from the analysis by Dalager et al.; for example, taking a pause around the 6th week).

3. If you have severe pain, numbness, or difficulty putting strength into your arms or hands, do not exercise based on your own judgment; consult a medical institution.

Guidelines for the type of exercise, frequency, and weight cannot be indicated within the scope of the research, so they are not proposed here.

Addressing the question, ‘So, should I stop stretching?’

I cannot say that. The Cochrane review states that exercise combining strength training and stretching may also be useful. In the Ylinen et al. trial, everyone was also recommended to do stretching and aerobic exercise.

What I was able to confirm is that ‘the evidence for stretching alone is weak, and there are studies where pain was reduced by adding strength training.’ I cannot decide here which one is superior in a single word.

Summary: ‘Does it work?’ and ‘Can I keep it up?’ are separate questions

• A Cochrane review found moderate evidence for strength training in treating chronic neck pain, while evidence for stretching alone was considered low.

• In a 12-month study, female office workers who added strength training experienced improvements in pain.

• Whether pain was reduced sufficiently depended on whether the participants could maintain the routine. The median time for when people began to take breaks was around the 6th to 8th week.

• Some studies showed no effect, and the subjects were primarily female office workers; furthermore, the evaluation was for ‘neck pain’ rather than ‘stiff shoulders’ itself.

• These three perspectives are the author’s own synthesis and not a verified procedure for achieving results.

If you are interested in strength training, why not consider whether your approach is sustainable beyond the 6th week before worrying about ‘how hard to push yourself’?

References

• Gross, A., et al. (2015). Exercises for mechanical neck disorders. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD004250.pub5

• Ylinen, J., et al. (2003). Effect of neck exercises on chronic neck pain in women. JAMA, 289(19), 2509–2516. https://doi.org/10.1001/jama.289.19.2509

• Dalager, T., et al. (2023). Clinically relevant decreases in neck/shoulder pain among office workers are associated with strength training adherence and exercise compliance. Physical Therapy, 103(2). https://doi.org/10.1093/ptj/pzac166

• Saeterbakken, A. H., et al. (2017). Nordic walking and specific strength training for neck- and shoulder pain in office workers: a pilot-study. European Journal of Physical and Rehabilitation Medicine, 53(6), 928–935. https://doi.org/10.23736/S1973-9087.17.04623-8

• Ministry of Health, Labour and Welfare. 2010 Comprehensive Survey of Living Conditions. https://www.mhlw.go.jp/toukei/saikin/hw/k-tyosa/k-tyosa10/3-1.html

Disclaimer (Regarding Medical Information)

This article introduces general health and medical information as well as the author’s personal experience,

and does not constitute a diagnosis, treatment, or individual medical advice for specific symptoms.

If you have symptoms or concerns, please consult an appropriate medical institution or a qualified professional.