Katakori: why stiff shoulders are Japan's signature complaint

Ask a room of office workers in Japan whether they have katakori and most of the hands go up, usually followed by the same little routine: fingers digging into the top of one shoulder, head tilted, a sigh. Katakori (stiff shoulders) is the dull, heavy, knotted feeling that sits across the top of the shoulders and up the back of the neck. It is so ordinary here that nobody treats it as news. Colleagues trade it the way people in Yorkshire trade remarks about the rain.

I did sports massage in England for years before moving to Kitakyushu, and the first thing I noticed was the vocabulary. At home people said their shoulders were "in knots". Here there is one tidy word, and nearly everyone uses it. Having a name for something makes it easier to notice, and possibly easier to complain about. I say that with affection.

How common is it?

Japan's Ministry of Health, Labour and Welfare runs a large national household survey every few years, the Comprehensive Survey of Living Conditions, which asks people which symptoms they have noticed in themselves. Stiff shoulders consistently land at or near the top of that list. In recent rounds they have usually been the symptom women report most often, and for men they come second only to lower back pain. The ministry publishes the results on its website, mostly in Japanese.

None of this means Japanese shoulders are made of weaker stuff. Neck aches are common wherever people sit at screens. Part of the story is that the word exists, so people recognise the feeling and report it. The rest is long hours at a desk, long commutes looking at a phone, and houses that get properly cold in winter.

The muscles doing the complaining

When someone points to their katakori, they are nearly always pointing at the upper part of the trapezius. This is a large, flat, kite-shaped muscle that starts at the base of the skull, runs down the back of the neck, fans out to the tips of the shoulders and reaches down to the middle of the back. Its upper fibres lift and steady the shoulder blades and help hold the head up.

Underneath it sits the levator scapulae, a strap of muscle running from the bones at the top of the neck down to the upper inner corner of the shoulder blade. If you press just above that corner and find a spot that makes you wince, that is probably it. Deeper still are the small muscles at the base of the skull that keep the head balanced, and between the shoulder blades are the rhomboids, which often ache along with the rest.

These muscles cope well with movement and poorly with holding still. A muscle that works at a low, steady level for hours without a break gets tired and sore, much like your arm would if you held a cup of tea out in front of you for the length of a meeting. An adult head weighs roughly as much as a 5 kilogram bag of rice. The further forward it drifts from its balance point over the shoulders, the harder the back of the neck has to work to stop it nodding onto your chest.

Why it builds up

Desk work

Screen work tends to pull the head forward, round the upper back and lift the shoulders a little towards the ears, especially if the keyboard is too high or the screen too low. Laptops are the worst offenders: screen and keyboard are joined, so one of them is always in the wrong place. Add long hours and skipped breaks, and the upper trapezius never gets a rest.

Phones

Look around any train carriage and you will see rows of people with their chins on their chests. The term "text neck" has caught on, but the research is more mixed than the headlines: studies have not shown a simple, direct link between phone posture and neck pain. What seems to matter more is how long you stay in one position without moving. A ten-minute scroll is not a problem. Two hours without lifting your head might be.

Stress

Watch your shoulders the next time a difficult email arrives. They creep upwards. Stress makes many people brace their neck and shoulders, clench their jaw and breathe higher in the chest, which leans on the neck muscles. Stress also changes how strongly pain is felt, so the same stiffness can seem worse in a bad week.

Cold

Many Japanese homes are heated room by room, so corridors, bathrooms and bedrooms can be chilly in winter. People hunch against the cold with their shoulders up. Summer brings the opposite problem: an air-conditioning vent blowing straight onto the back of your neck all afternoon is one of the classic office complaints here.

Eyesight

Eyes and neck work as a team. If you cannot see the screen clearly, you lean in and push your chin forward. People who wear varifocal (progressive) lenses often tilt their head back to read the screen through the lower part of the lens, which squashes the back of the neck for hours. Close focus also gets harder for almost everyone from their mid-forties. Eye strain and shoulder ache turn up together so often that an eye test is worth having if your last one was a couple of years ago.

What helps

There is no single fix. What works is a handful of small habits repeated often.

Move more often

The best thing for a muscle that hates holding still is to stop holding still. Stand up, roll your shoulders and walk somewhere every 30 to 60 minutes, even briefly. Plenty of people in Japan learned rajio taiso (the radio exercise routine) at school, and a few minutes of it at the office does more good than its reputation suggests.

Stretches you can do at a desk

Do these slowly. You should feel a mild, comfortable pull, never pain. Hold each stretch for 20 to 30 seconds without bouncing. Stop if a stretch causes tingling or numbness down an arm.

1. Shoulder rolls: lift both shoulders towards your ears, squeeze them back, then let them drop down. Do this 5 to 10 times, slowly.
2. Side neck stretch: sit tall and hold the edge of your seat with your right hand. Tip your left ear towards your left shoulder until you feel a stretch along the right side of the neck. Swap sides.
3. The armpit look: turn your head about halfway to the left, then nod your nose down towards your left armpit. You should feel the stretch at the back of the neck on the right, where the levator scapulae lives. A light hand on the back of the head is plenty. Swap sides.
4. Chin tucks: looking straight ahead, slide your chin straight back as if making a double chin. Hold for a few seconds and release. Repeat 5 to 10 times.
5. Doorway chest stretch: rest your forearms on either side of a door frame at shoulder height and step one foot through until you feel a stretch across the front of the chest. Tight chest muscles pull the shoulders forward, so this one helps the others.

For aches that keep coming back, research on long-running neck pain gives the most support to regular exercise, particularly strengthening the muscles of the shoulders and upper back. Slow shrugs or rows with a resistance band or two full water bottles, two or three times a week, are a sensible start.

Warmth

Heat eases tense muscles. A long soak in the evening bath is the traditional Japanese answer, and a warm towel over the shoulders does a similar job. If you use disposable heat packs (kairo), stick them to clothing rather than skin and never sleep with one on. Low-temperature burns can develop at heat that only feels pleasantly warm if contact lasts for hours.

Medicated shoulder patches are sold everywhere in Japan. Some contain anti-inflammatory drugs that are not right for everyone, and ketoprofen patches can make the skin react to sunlight, so their labels tell you to keep the area covered for a while after you stop. Ask a pharmacist before using them regularly.

Your sleep set-up

The aim with a pillow is to keep your neck roughly in line with the rest of your spine. Side sleepers usually need a higher pillow than back sleepers, to fill the gap between ear and mattress. Buckwheat husk pillows (sobagara), common in Japan, can be adjusted by adding or removing husks. Sleeping on your front twists the neck for hours and is worth trying to drop. The research on special pillows is thin, so there is no need to spend a fortune.

Massage and acupuncture: what the research shows

I have a soft spot for massage, for obvious reasons. Reviews of the research suggest that massage can ease neck and shoulder pain in the short term, but the studies are mostly small, of low quality, and the relief tends not to last unless the cause changes. My view from the other side of the table: it feels good, and that is not nothing, but it wears off if you go straight back to the same chair and the same hunched commute. Very heavy pressure can leave you sorer the next day, a reaction Japanese has a word for, momikaeshi. Firm is fine. Bruising is not the goal.

Acupuncture is widely used for katakori in Japan, often alongside other Eastern approaches such as kampo (if you are curious, see what kampo is and how it is used). Reviews have found that it may give short-term relief from neck pain compared with sham treatment or no treatment, but the quality of the evidence is mixed and the longer-term picture is unclear. The US National Center for Complementary and Integrative Health keeps plain summaries of this research on its site.

Serious side effects are rare when a trained practitioner uses sterile single-use needles. Needling around the upper back and shoulders does carry a small risk of puncturing a lung, which is one good reason to choose a properly qualified practitioner. In Japan, acupuncturists, moxibustion practitioners and massage and shiatsu practitioners hold national licences. Relaxation shops are a different thing, and their staff may not.

When it is not ordinary katakori

Most stiff shoulders are just that. Occasionally, though, shoulder and neck pain point to something else.

• Numbness, pins and needles or weakness in an arm or hand. This can mean a nerve is being pressed on in the neck. See a doctor soon.
• Shoulder, arm or jaw pain with chest pain or tightness, breathlessness, sweating or nausea. Heart trouble can show up as pain in the shoulder, arm or jaw, often on the left. Call an ambulance (119 in Japan) rather than waiting to see if it passes.
• Fever, especially with a stiff neck, a bad headache or feeling generally very unwell. Get medical help the same day.
• Pain after an injury, such as a fall, a sports collision or a car accident.
• Pain at night that wakes you, or pain that does not ease at all with rest or a change of position, particularly with unexplained weight loss or a history of cancer.
• A shoulder you cannot lift. If the joint itself hurts and you struggle to raise your arm or reach behind your back, that is more likely a frozen shoulder (known in Japan as gojukata, "fifty-year-old shoulder") or a rotator cuff problem than katakori, and worth having examined.

Outside those signs, see a doctor if the stiffness has not improved after a few weeks of sensible changes, or if it keeps getting worse. In Japan you can usually go straight to an orthopaedic clinic without a referral.

Five things to try this week

• Raise your screen so the top is around eye level, with a stack of books if needed.
• Set a timer to get up at least once an hour.
• Pick one stretch from the list above and actually do it, twice a day.
• Move the air-conditioning vent, or move yourself.
• Book an eye test if your glasses are more than a couple of years old.

More on looking after your neck, back and shoulders is in the posture and body care section.