Upper Crossed Syndrome – A foundation for failure

Posture follows movement like a shadow

Are you being double crossed by your posture? There is a chronic condition called Upper Crossed Syndrome (USC) which is expressed by the rounding of shoulders, forward chin poke of the head.  Mostly seen with elderly, but with an accelerated escalation of sedentary lifestyles and work environments, it has become a common sight for all ages.

Upper Crossed Syndrome Anatomy

The position of your head and shoulder is orchestrated by various opposing forces. These muscle balance forces vary depending on the positions we regularly find ourselves in. With UCS there is usually a weakness of the deep neck flexors and overactive/tightness of the upper traps and levator scapulae. This causes a forward head position with a hinge point at the lower cervical spine.

Lower down with weakness of rhomboids and lower traps, matched with overactive/tight pectoralis major and minor causes a rounding of the shoulders.

The muscle imbalance can affect multiple joint levels of the spine, the glenohumeral joint, the acromioclavicular joint and scapulothoracic joint. These might all lead to dysfunctions and result in injury.

How does this impact me?

Well that depends on how you live your life. This is a chronic condition that affects multiple joints and progressively over years they become stiff or weak. This closes the window on living an active lifestyle and increases risk of injury.

With less mobility and stability, comes greater risk to injury. 

This is typical with most office workers, students or driver’s. Their neuromuscular system has adapted to the UCS shape for years. But the injury risk increases when activity and movement levels are pushed higher than normal, for example overhead lifting, throwing sports or freestyle swimming that requires a wider overhead range of movement and ends up putting undue stress on the upper body.

Have you got the following?

• Chin Poke: Is your head sticking so far out it’s at risk of falling off! Next time you stop at traffic lights take a look at the other drivers posture, it’s common to see the drivers head stuck at least 12 inches from the head rest.
• Rounding of the Shoulders: Due to a weakness of scapula retractors, the lower traps and rhomboids, the super tight Pec muscles draw the shoulders forwards. Look at overly developed bodybuilders for a great example of rounded shoulders.
• Winging scapula: When the scapula lifts away from the wall of the rib cage, it’s usually the result of a muscle imbalance. This might take a friend to spot this one for you.
• Creasing in the neck: It’s the last places you want to see a crease. At the base of the neck and accompanied by the start of a hump in the thoracic spine.

Change starts now – How do I get there?

Expecting to do an overhead squat or chest to bar pull up straight away might be unrealistic if you’ve spent years holding a UCS posture. But there are ways of getting there…

• Scaling the new movement that your practicing and working within the ranges that your body allows. Giving the joints time to adapt, without risking injury.
• Working on individual muscles that developed the weakness and tightness over the years. This requires specific strengthening and stretching exercises.
• Muscle tightness in your neck and chest may benefit from soft tissue work to release the muscle, like massage or dry needling.
• Correcting form, sometimes we don’t have the body awareness to identify poor technique. Having the coach or physio look at your movement to correct where it’s needed.
• Change can only be enforced through repetition and habit. The positions you’re in most of the day dictate your posture. At work, in the car, or at home, try to change your posture regularly.

Below are some basic examples of exercises to get you started with organising the shoulder and head. Try following them regularly to give your body the opportunity to change.

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What’s causing my muscle tightness?

One of the main issues patients struggle with is muscular tightness. They get a feeling of pain or tightness and an inability to relax the muscle.

What is tightness?

When looking at patients I need to find out if they have mechanical stiffness or the “feeling” of tightness or a combination of both, as this would direct my treatment plan.

Is the range of movement limited? does it have a soft or hard end feel? Are movements a struggle at end range, feeling heavy? What’s the rest feeling like, is it a constant tightness?

While we can have mechanical tightness of a joint or muscle, there are also the “feelings” of tightness. You might get your hands to the floor with your legs straight and feel the hamstrings tightening. While another person could do the same, get to their knees and not have tightness.

What causes the feeling of tightness?

Tightness is a sensation like many others, including pain. What we understand from pain is that this is not always brought on physically, but also by the perception of threat.

So like pain, tightness is a protective mechanism from the central nervous system to avoid danger. On a number of levels it detects stressor’s that expose the whole body or specific region to threat.

Examples of this…..

• Prolonged sitting, without movement we often notice tightness in certain areas, possibly through reduced oxygen supply and increased metabolic toxicity.
• Stressful situations cause rising cortisol levels and increased activity of the Vagus nerve leading to muscular tightness.
• Repetitive movement over a period of time causes increased tension.
• Injury or pre-existing weakness can cause a guarding response from the nervous system.

Using tightness as a warning sign for these potential threats might allows us to acknowledge the situation and quickly act upon it.

What will help my tightness?

Like all movement patterns, we improve with practice. The same goes for muscle tightness. If we regularly bombard it with neural messages to remain tight we develop trigger points and chronic tightness through a process called central sensitisation. Which makes the tissues more sensitive to pain and tightness.

If we can regularly supply our nervous system with input that is non-threatening we can slowly help desensitise the muscle. But this takes time and regular repetition.

Stretching

Most people with tightness, especially after prolonged rest feel the need to stretch out. But depending on our intended goal there are different types of stretches.

• Static stretches
• Active stretches
• Dynamic stretches
• PNF (Contract-relax)

While these stretches will help, it might only be temporary without regular repetition and reinforcing the nervous system with good movement.

Strengthening

There is a misconception that resistance training causes our muscles to feel tighter. Mainly due to the effect of DOMS. That feeling of soreness you have the day after a hard workout. But some recent studies have shown that strengthening can be equally, if not more beneficial than stretching.

Improvements in flexibility coming from improved ability to handle higher levels of metabolic stress and lower levels of inflammation. By lowering the threat to the nervous system through increased strength, it allows you to work the muscle through a wider range, without getting a stretch reflex.

Massage and other soft tissue work

Another way to help desensitise these tight muscles is to apply pressure. This could be with the use of a foam roller/lacrosse ball or other manual therapy techniques like deep tissue massage, myofascial release, trigger point release, dry needling.

Relaxation techniques and breathing mechanics

Like in the previous blog, an overactive or dominant sympathetic nervous system can cause muscle tightness. Finding ways of breaking poor postures or shallow breathing using a range of methods like kapalbhati, wim-hof, meditation, yoga etc. Using these methods are just part of the process to lowering overall tightness.

Usually, just following one of these methods individually is not going to be as effective as combining them together. Try to deal with the tightness from all angles.

If guidance is required or manual therapy techniques feel free to call 09 5290990.

Coping with stress – Part 2

It’s not the Load that breaks you down, it’s the way you carry it.

Right, so we understand the main causes of stress, its impact on bodily functions and affect on pain sensitivity when we have an injury. How do we learn to cope with different types of stress? What can I do to make it easier? A “stress free zone” may be impossible but a “stress reduced zone” is better than nothing.

Recognising stress

You might notice your muscles getting tighter when training in the gym. To prevent a strain of the muscle and relieve the tightness, you would stretch or use a foam roller. The same applies to emotional stress. We all respond differently to stress and it sometimes can be the subtle changes that we need to recognise.

Changes like shallow breathing, palpitations, tense muscles, perspiring. If things like this start to happen it’s important to stop for a moment and consider “is this stress benefiting me or another person?”. Remember, stress is a system to save us or someone else from a life threatening situation.

Question your stress – is the feeling beneficial to me or someone else?

Stress is a great response to have, for example if someone was chasing after you with a knife or you needed to save someone from being run over. Consider the stress felt if you’re receiving more emails than normal, having relationship difficulties or have demanding kids. Is this stress response beneficial to anyone?

Managing stress

Look at the following strategies, some may be easier said than done but if it helps alleviate a small amount of stress it’s a start:

• Take charge of the situation, make changes where possible, including the way you react to it
• Tune out negative thoughts, adapt to more moderate/positive views
• Step back from the situation to gain perspective
• Take regular breaks – diffuse your brain from constant activity
• Set realistic Goals
• Keep hydrated, healthy eating and sleeping
• Find a healthy outsource to down regulate, exercise, deep breathing, meditation

Strategies for dealing with stress

Breathing

Focusing on something as simple as breathing is a way to off load demand on our nervous system. Allowing full expansion of the lungs changes the flow of blood through the body and the stretch response on the lung tissue decreases the sympathetic nervous system allowing stress factors to be relieved (1).

Sitting down, place a towel around the ribs and hold it tight at the front. Breath down to the lower ribs to get them to expand. Take in a slow but normal deep breath and exhale at the same speed.

Sleeping

We’ve heard 8 hours of sleep is good for us. How many of you stick to that practice? Sleep deprivation impacts our hormones that regulate stress levels (2) and can have many other health implications (i.e. diabetes, obesity).

Structure your sleep, be consistent with when you go to bed, try not to eat 2 hours before hand, avoid staring at a screen 1 hour before.

*There should be no guilt with napping. Your body clock (circadian clock), follows a rhythm through the day and twice our body temperature drops slightly to prepare us for sleep. Once in the evening and 8-10 hours after we wake up (mid-day slump). Our busy lives during a working week restrict us from napping. But at weekends a siesta can be of benefit (3,4).

Hydration

Cortisol is a stress regulating hormone in the body and has been found to increase when poorly hydrated (5). Trying to maintain 2 liters of water a day, obviously more if you have been training.

Meditation

Giving your self time to step back from your busy life and switch off can be hard. Meditation has been shown to reduce stress and anxiety levels (6). Meditation can come in a number of forms; from formal classes, youtube videos, even to walking or running in the park. The idea remains the same, to switch off your overactive brain.

 Exercise

Exercise comes in all types and it’s been well published to help not only with physical but also mental health (7). Find a way of fitting in some exercise each day whether it be high intensity, a team sport or just getting out for a run.

Many of the suggested strategies are essential to our own existence. But how often do we think about full diaphragmatic breathing, prioritising sleep and hydration? These are suggestions to reduce stress levels, the causes of stress will continue to be demanding if not changed.

1. Eckberg, D. L. (2003). The human respiratory gate. The J of Physiology
2. Spiegel (1999) Impact of sleep debt on metabolic and endocrine function. Lancet
3. Murphy (1997) Night time drop in body temperature: a physiological trigger for sleep onset? Sleep J
4. Monk et al, (1996) Circadian determinants of the post-lunch dip in performance. Chronobiol Int
5. Maresh Et al (2006) Effect of hydration state on testosterone and cortisol responses to training-intensity exercise in collegiate runners. Int J Sports Med
6. Schmidtman et al, (2006) Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders The J Neuropsychiatry and Clinical Neurosciences

7. Anderson et al, (2013) Effects of Exercise and Physical Activity on Anxiety Front Psychiatry

Trigger points – what are they?

I’m going to put a wild bet out there that everyone has a trigger point in at least one muscle of their body. Some have more than others. Who of you are regularly rubbing their shoulders or elbows? More and more we are sitting at the computer or looking down at our phones (sorry for writing this blog) causing prolonged tension on muscles around the neck and shoulder, resulting in the development of trigger points.

What is a Trigger point?

It is defined as a hypersensitive palpable nodule in taut bands of muscle fibers. Meaning very small bundles of muscle fiber have become contracted/”knotted” due to a chemical imbalance within the tissue.  The area is very painful and can cause you to jump or cramp on palpation. It can cause referred pain, weakness and restriction through movement. Which makes doing normal activities and training difficult.

Diagram of trigger points within a muscle

Trigger points of individual muscles have a very specific referred pain pattern and can mimic other problems. For example pain in the forearm and wrist can be referred from Infraspinatus, a shoulder muscle. Without a detailed assessment and clearing other areas this could be misconceived as a tennis elbow.

What causes a trigger point?

​A TP can be brought on in a number of ways. 

• Poor postures held for a prolonged period, causing certain muscles to work harder while trying to support structures like the head, eventually causing TP’s.
• Repetitive strain on muscles from overuse over multiple days, weeks and months. How many clicks of the mouse or typing are your doing? How much swiping of the smartphone? These repetitive movements take their toll.
• Emotional stress and poor sleep can cause muscle tension. Particularly the neck and shoulder muscles.
• A lack of movement will develop TP’s when sitting or on bed rest for a prolonged time.
• Heavy lifting can cause the development of TP’s when the muscle is placed under excessive loads which it is not familiar with.
• Trauma to a muscle, either as a reflex to pain or overcompensating for the weak and injured structure. This is quite common with car accidents or sports injuries.

Our muscles sit within a biochemical “soup” of  hormones, nerve transmitters and chemicals, all affecting the PH and Oxygen levels of the tissue. Your body knows the perfect recipe to keep everything balanced, but when we overload it with one or more of the above, it causes changes to the recipe, resulting in a drop in PH (becoming more acidic) and reduces the oxygen supply. This leads to the development of TP’s.

How do we treat a trigger point?

Your desire to change must be greater than your desire to stay the same. 

The following treatments for trigger points will help settle them down, but if we provide the same environment they will return.

• Trigger point release – sustained manual pressure applied to the trigger point causes increased blood flow to remove toxins from the area, interrupts the pattern of pain and spasm and encourages the production of natural pain relieving endorphin’s.
• Trigger point dry needling – There is a growing evidence base for trigger point dry needling. The needling causes local twitch responses which are a central nervous system reflex. This helps disrupt the pain feedback loop but also reset the acidic biochemical “soup” the muscle is sitting in, back to its normal levels.
• Myofascial release – the surrounding tight myofascial tissue that feeds into and over the trigger points could also be restricted, causing further exacerbation of the area. Using this technique will give some length back to these structures and can alleviate the trigger point.

Once the hands on therapy has been applied it is not the end of treatment. The muscles with the TP’s will need to be stretched to help prevent their return. Postural correction and stability exercises for surrounding muscles may need to be followed. Changes ergonomically may need to be enforced to prevent falling back into poor habits. Also looking at ways of alleviating stress through improved sleep, meditation, breathing techniques and increase of general exercise.

All of these factors will need to be considered to provide long lasting benefit and avoid their return.

1. Travell & Simon (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual
2. Shah et al (2008) Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome. Journal of Bodywork and Movement Therapies
3. Simons, (2008), New Views of Myofascial Trigger Points: Etiology and Diagnosis, Archives of Physical Medicine and Rehabilitation

Back Pain Myth Busting Part 5

And the final part of this Lower back pain blog is regarding factors in our life that we wouldn’t think influence our pain. Also, there is hope for people dealing with persistent back pain.

 

9 Sleep deprivation, stress, low mood and worry influence back pain

Some people feel that pain can only be mechanical, but there are a few other factors that affect our pain perception when we have lower back pain. Life events that cause increased levels of stress or depression can enhance the pain we feel. Understanding these factors and trying to take control of them will help. Studies have shown that with a cognitive approach dealing with stress’, fears relating to the injury and of movement will help lower pain scores and result in good outcomes (1)

 

10 Persistent back pain can get better

As previously noted in the last point and the other parts of this blog, there are many factors influencing back pain and not every individual is the same, requiring a tailored treatment plan to match their needs. Most people with persistent back pain will likely need to address non-physical factors as mentioned in the last point (2).

It is very common as most treatments only address one factor, if someone goes for a massage for their sore muscles, but fails to address their stress at work or fitness levels. You can understand why problems likes this become an “on + off” issue throughout life.

Identifying the different contributing factors for each individual and trying to address them, pain can be greatly reduced and people can live a happier and healthier life.

 

1.     O’Keeffe et al, (2015) Individualised cognitive functional therapy compared with a combined exercise and pain education class for patients with non-specific chronic low back pain: study protocol for a multicentre randomised controlled trial, BMJ Open

2.     O’Sullivan, P. (2012) ‘It’s time for change with the management of non-specific chronic low back pain‘, British Journal of Sports Medicine, 46(4), 224-227.