Neck pain can be…well, a pain in the neck. Neck and upper back pain is easily one of the most common reasons that people present to our offices. There are a lot of possible causes for neck and back pain, so getting a good evaluation is essential to uncovering the underlying reason for the problem. One of the more common underlying contributors to neck and upper back pain is posture related muscle imbalances.
Whether it’s sitting at a desk reading or working on a computer, texting or driving (and not at the same time people!), most things we do are out in front of us. For short periods, this may not be a problem. For hours on end, day in and day out it will lead to muscle imbalances that can result in pain and dysfunction.
Upper Crossed Syndrome
If our head is allowed to come forward and our shoulders protract (droop forward), we put a great deal of stress on the musculature at the back of the neck. As the head drops forward, we do not look at the ground, we look out in front of us and the skull extends where it meets the neck. This engages the muscles just below the skull (the suboccipital musculature), which become overactive. The deep neck flexors weaken and destabilize the neck.
As the shoulders protract, our shoulder blade stabilizers (scapular stabilizers) become inhibited and weak. Muscles that are normally quiet are recruited to help stabilize the shoulder girdle. The pectoralis minor, upper trapezius and levator scapulae muscles all become overactive. Rehabilitation pioneer, Vladimir Janda, called this collection of imbalances an “Upper Crossed Syndrome”.
These imbalances often lead to neck and middle back pain, but the change in the upper extremity mechanics also makes shoulder impingement, and thoracic outlet syndrome (a common reason for hand and finger numbness) more likely.
Prevention:
The first step in prevention and treatment is identifying there is a problem. If you work on a computer, drive a car or watch TV, chances are good you need to think about preventing upper crossed syndrome. Better ergonomic setup is important if long hours are spent in front of the computer. Preventative stretching and exercise to offset the postural stresses will be especially important in preventing symptoms from occurring.
Treatment:
If the imbalances have already set in and simple self care exercises are not helping, or symptoms are progressing and getting more severe, then evaluation and treatment by a professional is certainly warranted. There are many different treatments for neck and middle back pain. What treatment is most appropriate and effective depends on the diagnosis, presentation of the problem and the particular patient. If the underlying cause is related to posture and upper crossed syndrome, then conservative treatment with chiropractic and physical therapy and soft tissue work can be very effective.
Spinal manipulative therapy or joint mobilization at the thoracic spine can decrease the middle back discomfort and increase the available range of motion. With increased range of motion, thoracic spine self mobilization exercises on and off the foam roller will be more effective. Spinal manipulative therapy may also be used at the cervical spine to address specific joint restrictions, but typically an overall increase in stability will be needed in the cervical spine. Active Release Technique® and facilitated stretching to tight or overactive trapezius, levator scapulae and pectoral muscles is often performed in the office. Stretching for these muscles will also be taught and part of a home exercise program.
It should however be remembered that these overactive muscles are overactive for a reason and may be contributing (albeit poorly) to stability because the prime stabilizers are not. Stretching without strengthening the neck and scapula stabilizers will offer temporary relief. Strengthening exercises and drills to improve scapular control will also be an important component to that home exercise program.
Like with many problems we see, neck pain associated with poor posture is not simply a muscle problem, or a joint problem, or a ligament problem. It’s how those different tissues interact, how we move and the compensation patterns that develop that shapes the symptoms we see. Addressing all those components - the muscle and tissue quality, joint mobility and the movement patterns with a balanced approach to care will yield the best results.
