To complement the MASSAGE Magazine article, “Massage Strategies for Upper Crossed Syndrome,” by Nicole Nelson, in the November 2011 issue. Article summary: Musculoskeletal clinicians are as divided in their treatment approaches as the Tea party and Democrats are in political ideology. The structural approach vs. functional approach. According to the structuralists, treatment is guided by specific static structures, such as, “The MRI has discovered a tear in your supraspinatus tendon, so let’s cut you open and repair it.” Functionalists recognize pathology as a culmination of all processes, systems and movement, such as, “Your shoulder hurts, let’s examine your posture, how you move, the stability and mobility of the shoulder and the surrounding structures.”

by Nicole Nelson

Homework is absolutely essential if you expect to help clients garner change in their bodies.

Shirley Sahrmann, P.T., Ph.D., author of Diagnosis and Treatment of Movement Impairment Syndromes, suggests that everyday activities are the cause of movement impairment syndromes. I don’t believe I would be taking a huge leap in suggesting that this notion carries over to posture.

Let us assume your client is on your table for two hours per week—and left to his own devices, the remaining 166 hours, that is a lot of time for things to go sideways. Clients need to be active participants in this process.

One of the first things I address when I work with any client with an elevated shoulder girdle is breathing habits. Rene Calliet, M.D., a prominent musculoskeletal physician, suggests in his book, Rejuvenation Strategy, that forward-head posture resultant to upper crossed syndrome may result in the loss of 30 percent of vital lung capacity. These breath-related effects are primarily due to the loss of the cervical lordosis, which blocks the action of the hyoid muscles, especially the infra hyoid responsible for helping lift the first rib during inhalation.

Retraining the diaphragm muscle to do its job is critical in establishing good core function and core stability. What you will discover in practice is that a client may successfully diaphragmatically breath in a supine position, yet have difficulty doing so when challenging the stability of the spine, such as in birddog or plank positions.

Mastery of diaphragmatic breathing in a supine position must come before clients perform gravity-defying core exercises. As with any exercise, it should be directed with a progressive approach.

For example: supine-seated-standing-supine with arm, leg movement-bird dog-plank. Master one position before moving to the next.

Planks are amazing; however, they are high in the progressive food chain. Corrective exercise such as this takes time for motor re-patterning to occur; therefore, should be repeated for 30 to 60 seconds every hour throughout the day. When trying to re-pattern bad habits, the brain not only needs practice, but perfect practice; advise your clients that more is not better, don’t work to exhaustion.

The next step is helping the client understand what good posture looks and feels like. Nobody likes to hear that his head is 3 inches in front of his body or his shoulders are slumped forward. Don’t tell him, show him. My iPhone postural alignment app removes me from being the bearer of bad postural news. When clients can see their own postural distortions, they will be more accepting of the work that will need to be done in order to restore good alignment.

One of my favorite corrective strategies for upper crossed syndrome is packing the neck, also referred to as chin tucking:

1. Have your client stand with her backside against a wall, with the longest spine she can create

2. Instruct her to gently tighten her abdominal wall, rotate her hands so the palms are facing forward, draw her shoulder blades down and back toward her back pants pockets

3. Have her retract her chin, holding for the time it takes to take a nice diaphragmatic breath, and then relax, although not to the point where she surrenders her tall spine.

I have discovered that clients will be more compliant with homework if specific numbers of repetitions and sets are given. I feel 10 reps repeated four times throughout the day works well.

Here is one final suggestion for your clients: I first came across this idea while reading Paul Chek’s book, Assessing Core Function. Chek posits that by placing your tongue on the roof of your mouth, directly behind your teeth, it effectively closes the anterior cervical kinetic chain, thereby permitting a better opportunity for the deep cervical flexors (supra and infa hyoids) to be turned on.

In forward-head postures, the sternocleidomastoid generally overpowers the hyoids, and in doing so can create some nasty shear forces to the spine. Who knew that proper tongue positioning could save your clients some undue cervical stress?

Nicole Nelson holds a master’s degree in health science from the University of North Florida. In addition to being a licensed massage therapist, she is also certified as an Advanced Health and Fitness Specialist through ACE. She has a full-time massage and training practice in Ponte Vedra Beach, Florida.

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