Neck pain in the gym is a common complaint, and as a strength coach I’m often cautious about diagnosing or treating it directly. If a client comes in with noticeable neck discomfort, I usually step back and refer out to a clinician with more diagnostic and manual-therapy skills. That said, there are constructive steps you can take if you’re a trainer or coach. In this guest post, physical therapist Dr. Michael Infantino goes into practical considerations for what to do when neck pain shows up in the gym.
The gym isn’t the sole culprit, but neck pain from lifting and upper-body work is often linked to a few key issues. Pain blamed on form is common, but to fix it we need to ask: why is the form off? In many cases, neck pain comes down to one or more of these factors:
– Mobility limitations that affect posture in certain positions
– Skill limitations required to perform a movement
– Capacity limitations (strength and endurance) for that movement
– Human factors (hydration and fluid balance, self-care, rest, sleep, breathing, posture, fear)
Limitations in Mobility: Two Movements to Address Them All
Two main mobility limitations can contribute to neck pain during upper-body work. If you struggle with one exercise, you’re likely dealing with similar issues in another.
Position #1: Shoulder Extension Test
Movements that involve pushing, pulling, rowing, dipping, or even jumping rope can reveal this pattern. The idea is to retract the neck and extend the shoulders just beyond the trunk without:
– Moving the head forward
– Letting the shoulders translate forward
– Shrugging the shoulders
If you can’t perform this movement without strain or load, you probably have a mobility problem. If you can do it unloaded but struggle under load, mobility is part of the issue.
Target areas for mobility work:
– Soft-tissue mobility: pecs, serratus anterior, upper traps
– Stretches and joint mobilization: chin retractions, thoracic extension with arms overhead, open-book stretch
After addressing these, re-check the test position. Is it better? If not, you’ll need to keep working on mobility.
Assuming mobility is sufficient, you also need the skill to perform the movement with good form:
– Push-ups, pull-ups, rows, dips, and other loaded upper-body moves require strength, stability, and coordination.
– Can you maintain a good position at the bottom of a push-up, in a row, at the top of a pull-up, at the bottom of a dip, and during jump-roping?
Follow this sequence:
1) Build the mobility to perform the pattern in its basic form (Position #1 and Position #2).
2) Ensure the necessary skill for your chosen movement.
3) Build capacity (endurance and strength) for that movement.
If you lack the baseline strength for a good push-up, pull-up, dip, or row, here are gentle regressions to maintain form while you regain proficiency:
– Push-up: incline version (against a bench or counter), knee push-ups
– Pull-up: assisted with a band, inverted row
– Dip: assisted with a band, bench dip
– Row: start with a body-weight-friendly option (or use a TRX/inverted row and adjust the angle)
The goal is to demonstrate the ability to maintain proper form, using an appropriate regression.
Position #2: Overhead Test
Movements that involve an overhead press, bottom-position pull-up, or snatch can reveal another mobility pattern. Lie on your back with knees bent, tuck the chin, and start from a press position with arms on the ground. Move the arms overhead by sliding them along the ground.
Common faults:
– One or both arms lift off the floor
– Forward head posture or an extended neck to keep the arms on the floor
– Arching the spine to keep the arms on the floor
If you repeatedly can’t replicate this position, you likely have another mobility issue.
Target areas for mobility work:
– Soft tissue: pecs, lats, rhomboids
– Stretches and mobilizations: chin retractions, thoracic spine extension (or drop-ins), open-book stretch (with external rotation at the shoulder), first rib and scalene mobility
After addressing the weak link, re-check. If the position improves, move on. If not, continue working on mobility before adding heavier loads.
Skill, Strength, and Regression
Once mobility improves, assess whether you can maintain control during the overhead movements you want to perform (overhead press, snatch, hangs, or kipping variations). If control is lacking, regress the movement by reducing weight or practicing simpler, single-arm variants. Common regressions include:
– Overhead press: landmine press
– Snatch: cleans, single-arm overhead kettlebell squat, single-arm overhead lunge
– Pull-up (bottom position): use a resistance band for support, or inverted row
Human Error
After you’ve established basic mobility and control, minimize human error. It helps to have an extra set of eyes—someone to give you feedback can be invaluable. It’s easy to blame a workout for neck pain, but the smaller factors matter more than you think: diet, hydration, sleep, rest, breathing, posture, and general self-care.
Hydration and Electrolyte Balance
What you eat and drink around workouts matters. Proper fluids and electrolytes before exercise can delay fatigue and cramping. If you’re dealing with neck pain, do your best to optimize hydration:
– About four hours before exercise, drink roughly 5–7 mL per kg of body weight (2–3 mL per lb) of water or a sports drink. This helps hydration status and clearance of any excess fluid.
Warm-Up and Recovery
A smart warm-up gradually raises heart rate and increases muscle readiness. It should prepare you for the movements you’ll perform (squats, push-ups, deadlifts, cleans, etc.) and set the stage for better performance. A good warm-up reduces abrupt spikes in blood pressure and helps prevent exertion headaches.
Recovery matters too. After training, spend time on light stretching and soft-tissue work to reduce soreness and improve muscle extensibility. Adequate rest is essential for recovery; poor sleep can blunt recovery, weaken the immune system, and affect mood and pain perception. Don’t overdo the “grind”—respect your body’s need for rest and repair.
Breathing and Posture
Breathing matters more than many realize. Holding your breath or clenching the jaw during effort can increase neck tension and even trigger headaches. Many people breathe shallowly, which can tighten the neck muscles and raise anxiety. Practice relaxed diaphragmatic breathing to reduce neck tension. Prolonged poor postures, especially with a forward head, can worsen neck pain and headaches.
If you find yourself stressed or anxious, consider the broader picture. Stress and pain are connected, and addressing breathing and posture can help.
The Advil Fix
Avoid regular use of over-the-counter anti-inflammatories to mask pain. Long-term NSAID use can carry risks for the GI tract and other tissues. Use medications judiciously and seek safer, non-pharmacological strategies first.
Fear and the Internet
Many neck-pain stories online are well-intentioned but not well suited to you. Red flags for serious pathology are relatively rare in typical gym-related neck pain. Focus on practical steps—mobility, skill, capacity, and healthy habits—and seek medical advice if relief isn’t achieved.
Overview and Big Takeaways
In most gym-related neck pain cases, the root causes fall into:
– Mobility limitations that affect movement
– Skill limitations needed for the movement
– Capacity limitations (strength and endurance)
– Human error (hydration, sleep, breathing, posture, self-care, and fear)
A small modification can often eliminate neck pain. Start with building mobility to support your movement patterns, then ensure the necessary skill, then increase capacity. Look at your overall health and life—if injury worries rise or relief isn’t achieved, consult a medical professional. Being proactive and willing to learn and adapt makes a big difference.
About the author
Dr. Michael Infantino is a physical therapist who works with active military members in the DMV region. You can find more articles by Michael at RehabRenegade.com.
