• Poor posture and/or unnatural sleeping positions. Sleeping on a soft mattress can give you a stiff neck the next morning.
• Tension and stress. When you feel tense, the muscles around your neck can go into spasms.
• Tendinitis, inflammation of a tendon, the cord-like tissue that connects muscles to bone. Left untreated, tendinitis can turn into "frozen shoulder", a stiff, painful condition that may limit your ability to use your shoulder.
• Bursitis, an inflammation of the sac (bursa) that encases the shoulder joint. Bursitis can be caused by injury, infection, overuse, arthritis or gout.
• Osteoarthritis. Unlike rheumatoid arthritis, osteoarthritis develops from normal wear-and-tear of the joints as we age or from repeated injuries. Aging can cause the joints to wear out, producing bony spurs that can press on nerves and cause pain.
• Accidents and falls. Collarbones can break after falls or auto accidents.
• Motor vehicle accidents. You can develop a whiplash injury when your vehicle is hit from behind.
• Pinched nerve. Arthritis or an injury to your neck can pinch a nerve in your neck. Pain from a pinched nerve usually runs down the arm and one side only.

• Stretching and strengthening routines, especially before exercising, helps prevent tendinitis. So can using the right equipment and following the proper technique.
• Avoid injuries to the shoulder by wearing seat belts in cars and trucks and using protective gear during sporting events.
• Avoid vigorous exercise unless you are fit. If you are out of condition, start to strengthen your muscles gradually and slowly increase exercise intensity.
• Don't sleep on your stomach. You are likely to twist your neck in this position.
• Sleep on a firm mattress. Use a feather, polyester or special neck (cervical) pillow. Use a thinner pillow or none at all if you have pain when you wake up.

• Stretch the back of your shoulder by reaching with one arm under your chin and across the opposite shoulder, gently push the arm toward your collarbone with the other hand. Hold for 15 seconds. Repeat five times, then switch sides.
• Raise one arm and bend it behind your head to touch the opposite shoulder. Use the other hand to gently pull the elbow toward the opposite shoulder. Hold for 15 seconds. Repeat five times, then switch sides.
• Holding light weights, lift your arms out horizontally and slightly forward. Keeping your thumbs toward the floor, slowly lower your arms halfway, then return to shoulder level. Repeat ten times.
• Sit straight in a chair. Flex your neck slowly forward and try to touch your chin to your chest. Hold for 10 seconds and go back to the starting position. Repeat five times.
• Sit straight in a chair. Look straight ahead. Slowly tilt your head to the right, trying to touch your right ear to your right shoulder. Do not raise your shoulder to meet your ear. Hold for 10 seconds and straighten your head. Repeat five times on this side and then on your left side.

Put the arm with the injured shoulder in a sling when you take the person to the doctor.

Treating Tendinitis - Taking over-the-counter pain relievers such as aspirin, ibuprofen or naproxen sodium eases the pain and reduces inflammation. Acetaminophen eases muscle soreness but does not help with inflammation. [Note: Do not give aspirin or any medication containing salicylates to anyone 19 years of age or younger, unless directed by a physician, due to its association with Reye's Syndrome, a potentially fatal condition.]

R.I.C.E. - Rest, ice, compression and elevation, is the accepted treatment for tendinitis. While the pain could linger for weeks, with the proper and immediate treatment, it usually disappears in a few days.

R --- Rest the injured shoulder. Rest prevents further inflammation, giving the tendon a chance to heal. Resume your activities only after the pain is completely gone.

I --- Ice the injured area as soon as possible. Immediately putting ice on the injury helps to speed recovery because it not only relieves pain, but also slows blood flow, reducing internal bleeding and swelling.

• Put ice cubes or crushed ice in a heavy plastic bag with a little water. You can also use a bag of frozen vegetables. Wrap the ice pack in a towel before placing it on the injured areas.
• Apply the ice pack to the injured shoulder for 10 to 20 minutes. Reapply it every two hours and for the next 48 hours during the times you are not sleeping.

E --- Elevate the shoulder whenever possible to further reduce the swelling.

The swelling is usually eased within 48 hours. Once the swelling is gone, apply heat to speed up healing, help relieve pain, relax muscles and reduce joint stiffness.

• Use a heating pad set on low or medium or a heat lamp for dry heat. Or, use a hot-water bottle, heat pack or hot, damp towel wrapped around the injured area for moist heat. [Note: Damp heat should be no warmer than 105¡F.]
• Apply heat to the injured area for 20 to 30 minutes, two to three times a day.

Treating Bursitis - Prolonged use of a joint or arthritis can cause the pain and discomfort of bursitis. Fortunately, these flare-ups can be controlled by:

• Applying ice packs to the sore shoulders.
• Taking a hot shower, using a heat lamp, applying a hot compress or heating pad to the affected shoulder, or rubbing the area with a deep-heating liniment.

After first checking with your doctor, you can ease neck discomfort by:

• Resting as much as possible by lying on your back.
• Using cold and hot packs. See how to use them in the above section on treating tendinitis.
• Improving your posture. When sitting, select a chair with a straight back and push your buttocks into the chair's back. When standing, pull in your chin and stomach.
• Using a cervical (neck) pillow or roll a hand towel and place it under your neck.
• Avoiding activities that may aggravate your injuries.
• Covering your neck with a scarf in cold weather.
• Practicing some of the stretching and strengthening exercises listed under the section on prevention on page 106.

Along with the shoulder and neck pain are you: Feeling pressure in your chest, especially on the left side? Short of breath or having trouble breathing? Nauseous and/or vomiting? Sweating? Anxious? Having irregular heartbeats?
Did you experience a serious injury that caused shoulder and/or neck pain that is not going away and/or is getting worse?
Do you have a stiff neck along with a severe headache, fever, nausea and vomiting?
Do you have any of the following? Severe or persistent pain, swelling, spasms or a deformity in your shoulder? A shoulder that is painful and stiff with reduced ability to move it? Stabbing pain, numbness or tingling? Pain, tenderness and limited motion in the shoulder?
Is the shoulder pain severe or interfering with your sleep? Is the shoulder stiff in the morning, swollen, tender or hard to move?