When you sit at work all day and your shoulders feel heavy every afternoon

What follows combines several people's visits into one reconstructed account. It is not any one person's story, and anything that could identify someone has been removed.

How do people describe it when they come in?

As they sit and work, the back of the neck gets as hard as stone, and by the afternoon the whole upper body feels heavy and drooping.

Many also say that the exercise they started for their health made their knees ache, and now they're afraid of exercising at all. They think of the shoulders and knees as separate, but when we ask, both often started around the same time.

Why is it heavier in the afternoon?

If you sit for a long time with your body's center collapsed, only the neck and shoulder muscles are left holding you up. The longer they hold, the heavier it gets.

That's why it's bearable in the morning and worse in the afternoon. It's not that the muscles are damaged — it's closer to them working nonstop.

What do we look at?

We check whether your neck juts forward, whether your shoulders roll in, and whether your shoulders sit at different heights. From the side, we also check whether your back is rounded and your pelvis tilts forward.

We don't look only at how you sit. We have you raise your arms and stand up from a seated position. If you can't use your buttocks and hip joints and your knees move first, your knees are taking on all the load.

We also check whether your core has lost strength. When the middle of the trunk can't support you, somewhere above or below has to hold on instead.

How do we treat it?

We go in this order: first get the stiff areas moving, then build the strength to hold you up, and finally relearn how to move.

If you do only strength training from the start, your shoulders can actually hurt more. Getting the sides of the neck and the middle of the back moving comes first.

Next, we do exercises that stabilize the trunk and the shoulder blades. Finally, we guide you to relearn the feeling of using your buttocks and hip joints, not your knees, when standing up from sitting.

How did people do?

First, you get less tired even sitting in the same position. Next, the stiffness that used to build in the afternoon eases.

For the knees, we check by how they feel during exercise. "Where the effort goes" changes before how much it hurts.

What are the limits of this approach?

Neck and shoulder stiffness has other causes too, such as a herniated disc in the neck. What we look at is one path that involves posture and movement.

If your arm goes numb, your hand gets weak, or sensation changes, we check that first. If your knee swells and feels hot, orthopedic tests come first.

If you have the same symptoms

1. It gets worse in the afternoon because only the neck and shoulder muscles keep holding you up.
2. We don't look only at how you sit; we also watch you stand up from sitting.
3. If your knees move first, they're taking on all the load.
4. We go in this order: get things moving → build strength to hold → relearn how to use it.
5. If your arm goes numb or your hand gets weak, we check that first.

We start by measuring how far your arm can be raised. Our first goal is for you to be able to turn over in bed at night.

If shoulder pain keeps you from turning over at night, come and see us. That night pain is the first thing we work on. Recovery begins once you can sleep.

Because there are many possible causes, progress differs from person to person, even with the same care.