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Upper Crossed Syndrome
[email protected] www.grahamrehab.com 206-622-9001 Standing Sitting Standing with good intention Typical seated posture Sitting with good intention Postural Support Syndromes Upper Crossed Syndrome Scapular Destabilization Syndrome Lower Crossed Syndrome Posture affects the Body and the Brain The spine and musculature are affected Organs are affected Mood is affected Chronic pain syndrome (UCS) can result in the absence of other positive clinical findings Faulty Posture Muscles in slightly shortened positions tend to be stronger Muscles in slightly elongated positions tend to be weaker than their opposers If we can balance muscle groups there is a sense that posture can self-correct Patterns Postural or tonic muscles shorten while phasic muscles weaken Type 1 Postural fibers contract slowly Burn O2 more efficiently than phasic muscles Allows them to work slow and steady over time Shorten in response to stress and overuse Patterns Phasic or Type 2 fibers weaken and lengthen under prolonged stress Type 2a fast-twitch fibers Contract faster than type 1 Resist fatigue due to more mitochondria and myoglobin Walking and sprinting Type 2b fast-twitch glycolytic depend more on blood sugar for energy (strength training, weight lifting) Patterns Tonic or Postural Muscles tighten and shorten Pectoralis Major and Minor Upper trapezius Levator Scapulae Sternocleidomastoid Patterns Phasic muscles weaken Lower and Middle Trapezius Serratus Anterior Rhomboid Major and Minor Pain Symptoms are the product of too much strain and the physiological changes that happen to soft tissues over time Altered Posture Occ, C1 and C2 hyper extend Head translates anteriorly Lower cervicals and upper thoracic are now stressed Altered Posture Scapula rotates and abducts Due to the upper traps and levator scapula shortening and contracting This inhibits the lower traps and serratus anterior Scapula looses stability Excess demand now put on humerus and the levator scapulae, upper trapezius and supraspinatus are called to maintain functional efficiency Upper Crossed Posture Tight Trapezius Levator scapula Pectoralis major and minor Latissimus dorsi Weak Rhomboids Serratus anterior Deep neck flexors Motor control loss is a central issue here Upper Crossed Posture Eyes are looking forward Excess Arch in the neck (tight sub occipital) Levator scapula sign (prominent) Shoulders are rolled inward Thumbs point toward hips rather than forward Upper Crossed Posture As head migrates forward there is less ability to rotate For each inch forward it doubles in weight and applies more force to the cervical thoracic junction This causes increased potential for degenerative changes Upper Crossed Posture Headaches can appear due to upper cervical involvement and can refer to the frontal and temporal or vertex There are correlations with temporomandibular joint pain TOS becomes more likely due to structural tightening Upper Crossed Posture Shoulder impingement can become more likely as space under the acromial arch is decreased due to the forward tilt of the scapula Upper back and mid back pain increase due to chronic tension and overwheming tissue capacity Scapular Instability Downward rotation Inferior border closer to the spine May be depressed Weak Serratus anterior Musicians are at high risk Scapular Instability We want to stabilize the scapula not move it Wrap Decrease Upward rotation, posterior tilt, depression Lower crossed Posture Tonic or Postural muscles Iliopsoas, Rectus Femoris, Tensor fascia Latae and Erector Spinae All tighten and shorten Phasic muscles Abdominal, Gluteal and Quadratus Lumborum Weaken Lower Crossed Posture Pelvis is tilted forward Flexing hip and exaggerating lumbar lordosis L5-S1 Soft-tissue and joint distress Pain and irritation Lower Crossed Posture In the sagittal plane Quadratus Lumborum Shortens Glute Maximus and Medius Weaken Lower Crossed Posture Unstable lower cross leads to SI joint becomes unstable Piriformis syndrome Other Factors Congenital Misuse Immobilization Inappropriate breathing Chronic negative emotional Reflexive influences such as Trigger points and facilitated segments Other Factors Laxity of ligaments Fascial tightness Muscle tonus Pelvic angle Joint position and mobility Neurologic outflow and inflow Tissue distorters Tight and spasmed muscles Inflammation Scars Proprioceptive loss Ligament laxity Loss of coordination Muscle inhibition Poor locomotor recruitment Ideal tissue shape and tone are restored by removing distorters from the body Considerations beyond asymmetries or contracture The Autonomic Nervous System (ANS) Soft tissue has sympathetic innervations not parasympathetic These regulate neuromuscular and cardiovascular Sympathetic produces more waste and consumes more O2 Stress tightens soft tissue and causes General Adaptive Response (Selye 1984) Postural dysfunction results Habituation Adaptive demands on the musculoskeletal system are exceeded The capacity to absorb the load is overwhelmed Elastic limits are exceeded resulting in structural ad functional modifications Repeated postural and traumatic insults over a lifetime Somatic effect of emotional and psychological origin Confusing pattern of tense, short, fatigued then fibrous tissue. Sensory awareness and movement modalities It is a memory loss of how certain muscle groups feel and how to control them” Thomas Hanna Sensory motor-amnesia Red light reflex Green light reflex Trauma reflex Sensory awareness and movement modalities “On acting on the significant parts of the body such as the eyes, the neck, the breath, or the pelvis, it is easy to effect striking changes of mood on the spot” Moshe Feldenkrais Sensory awareness and movement modalities “There is no such thing as the right position, but there is such a thing as the right direction” “You come to learn to inhibit and direct your activity” F.M. Alexander The Cure Vitalism The historical concept of vitalism proposes the idea that our spirit animates and operates the body… If our mood is depressed we may slump…If we slump we may have a depressed mood Postural Spirit Put your Spirit up front rather than the ego If ego is up front in posture it can drive it down In our mind we have a body image of ourselves that is internal in orientation but we can get a sense of it when we look in the mirror. We are seeing our body image but it is better to look as if seeing someone behind the mirror. That is look for your image.” We need to rebuild where the wound is in the body image. Hubert Goodard Gravity There can be a change in hormone production due to the way that you hold your body against gravity “Balance reveals the flow of gravitational energy through the body” Rolf Gravity It is when the gravity-combating active subsystem of the huan organism becomes deficient or defective in some way that stress begins to be put on the joints and passive subsystems of the body. Most commonly, this takes the form of an upper or a lower crossed syndrome. Leon Chaitow Natural posture Learning to push away from our support pillars while sitting or standing Helps us feel more open and connected with our world Often we can let Nature determine our posture rather than dictate our posture to nature Pillars of structural support Feet Feel the contact points with the ground and push away Use a wall to measure HFP (head forward posture) Sitz bones Feel the contact on the ischium and push away If you arch your lower back a little it is harder to slump If uncorrected FHP will continue to decline It is very common to observe 2 inches of anterior head placement in my patients. Our heads weigh about 12 pounds. Would you be surprised that your neck, upper back or shoulders hurt if your neck had to hold up a 20-30 pound pumpkin all day ? Uncorrected, forward head posture will get worse and continue to decline. One study showed that the further a persons head is away from the wall the earlier they would die from any cause death In a nut shell this is a good reason to be looking for FHP in our patients For every inch your head moves forwards, it gains 10 pounds in weight, as far as the muscles in your upper back and neck are concerned, because they have to work that much harder to keep the head (chin) from dropping onto your chest. This also forces the suboccipital muscles (they raise the chin) to remain in constant contraction, putting pressure on the 3 Suboccipital nerves. This nerve compression may cause headaches at the base of the skull. Pressure on the suboccipital nerves can also mimic sinus (frontal) headaches. Kapandji (physiology of the Joints, Vol III). People with Asthma have decreased lung capacity “Head in forward posture can add up to thirty pounds of abnormal leverage on the cervical spine. This can pull the entire spine out of alignment. Forward head posture (FHP) may result in the loss of 30% 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 inferior hyoid responsible for helping lift the first rib during inhalation.” Rene Cailliet M.D., Persistent forward head posture also known as a hyperkyphotic posture puts compressive loads upon the upper thoracic vertebra, and is also associated with the development of Upper Thoracic Hump, which can evolve into Dowager Hump when the vertebra develop compression fractures (anterior wedging). A recent study found this hyperkyphotic posture was associated with a 1.44 rated of increased mortality. Parkinsons patients benefit neurologically from physical medicine, posture control and rehab therapy Implications for the spinal joints Phase 1 – Initial sprain. Phase 2 – Beginnings of fibrosis. Phase 3 - Complete fibrosis. Complete fibroses and the beginnings of fibrosis are not reversible, leading to permanent spinal biomechanical impairment. Implications for the spinal joints Hypomobility: Abnormal restriction of joint motion Hypermobility: Abnormal increase in joint motion Compensation reaction: Long term hypomobility causes the joint above the hypomobile area and occasionally the joint below to become hypermobile. Positional dyskinesia, dynamic misalignment: Joint misalignment throughout the entire range of motion of the involved joint Golf Posture One of the fundamentals of golf is posture. Many golfers have muscle imbalances which prevent them from physically getting into the posture and positions that their PGA or LPGA instructor is recommending. The two most common postural distortions are: Upper Cross Syndrome or C-Posture Lower Cross Syndrome or S-Posture The Upper Cross Syndrome is often developed by people who are used to sitting over a computer or desk. It is a forward shoulder posture where the pecs become over contracted and the muscles in your shoulder blades get weak. The C-Posture has an excessive rounded curvature in the back which limits ability to rotate in the back swing. The Lower Cross Syndrome is often the result of extensive sitting whereby the hip flexers are shortened. Since the brain thinks the hip flexers are contracted, the abdominals get relaxed. Often it causes a Reverse Spine angle swing fault and leads to back injury. The S-Posture has excessive curvature which looks like a sway back or S shape. UCS Evaluation Stand next to a wall Sit in a chair Watch them as you are doing their first interview • Take a photo Phone or computer apps Computer Physical Performance testing Hands on Evaluate ROM Palpation Evaluate tightened and shortened muscles weakened and lengthened muscles Strength testing Computerized Physical Performance Testing ROM Testing Extension strength Flexion strength Strength ratio Cervical extension strength should be stronger than flexion strength Stretch flexors prior to working with strengthening extensors When treating patients with UCS, Sherrington's Law proposes that the shortened muscles must be restored before embarking on training of the weakened muscles. The basis for this is reciprocal inhibition… when one muscle is shortened or tightened its opposite muscle relaxes. Treatment Goals Restoring energy-efficient and strain-free movement Ideal body movement and fitness are the end points of care. The quality of movement produces the actions that make our dreams real and give life value. It has been said that : The better you can move the better your life will be Remove the obstacles to cure 2 very important interferences to remove Postural Distortion Loss of movement control Treatments General Wellness Neuro approach versus simple structural changes Postural, functional and sensorimotor training ROM exercises Naturopathic spinal manipulation can be very corrective Reverse joint fixations Reinvigorate the muscles that retract the head Stretch the muscles that pull the head forward General Wellness for the Body Cardio Training Strength training Nutrition Lifestyle Cleanse Diet Creates homeostasis and a new relationship with food 3 weeks Weight Loss Hormones Men convert testosterone into estrogen Get the right and enough dietary fat to provide hormone precursers Eat cruciferous vegetables to remove estrogen at the level of the liver Cardio Interval running or spinning Walk or cycle slowly for 2 minutes to warm up 20 seconds on at medium fast speed (8mph at 10% incline)and 10 seconds off. Repeat 5 x This is a time efficient work out that takes less than 10 minutes and compares to about 2 hours of jogging Build up intensity appropriately over time Strengthening Creates Improvement in Function Causes a faster metabolism Added power to movement Enhanced flexibility Aging well Nutrition ‘Cleanse Diet’ for inflammation reduction Healthy and sane diet that is learned over time Add in healthy goals once about every 2 weeks Eat more slowly and stop at 80% full Change focus to good Protein, Vegetables, Good Oils Avoid simple Carbs, processed and GMO Avoid high carb and additive Beverages Grass fed organic meat Seafood Olive oil Fish oil Grape seed oil Nuts and seeds Filtered Water, Green tea, Coffee Drink the weight of your brain (2L) in water every day to improve memory Nutritional Treatment The model of inflammation Fish oils EPA and DHA versus Parent Omega 3’s How are GMO foods affecting our bodies and our environment Lifestyle Standing correctly Sitting correctly Breathe into abdomen Sleep Create a bedtime ritual Turn off lights and TV 30 minutes prior to bed Have a therapeutic bath, Peat and epsom salts Mg, Zn Phosphatidylserine serine to decrease night cortisol & support brain health Wait for about 30 minutes in the morning before exercise loading to preserve disc health Physical Medicine Treatments Balance Manual Therapy Stretching, Myofascial release, active release Strengthening Spinal Adjustments Neuromuscular Re-education Hydrotherapy Modalities Cold Laser Stim Ultrasound Balance Stability (Swiss ball) Pulse Flex Wobble boards Foam Roller Squat test Bird dogs Superwoman pose Pelvic bridge Letting gravity help Alternating arm flexions Field goal on foam roller Wobble board Manual Therapy Stretching Muscle energy stretching Myofascial release Active release of musculature Post isometric resistance Stretching PIR or MES Sub occipital SCMs Upper traps Levator Scapula Pectoralis minor Pectoralis major Upper rectus abdominus Strengthening Deep cervical flexors Supra and infra hyoid Middle and lower traps Rhomboids Serratus anterior Thoracic errectors Scapular stability Strengthening Exercises Birddogs Neck extension machine Use thoracic extension with cervical extension Inverted row with TRX straps • Swiss ball crunch for abdominals Reach Roll and Lift Bent over row with dumbells • when your posture starts to fail you are done Strengthening Exercises Static wall lean Neck rotations Cable reverse flys Barbell upright rows Foam roller Wall stretches upright diamond Wall angels Wall Angels Lat Test Note arching of mid back Strengthening Exercises Scapular stabilization exercises Single arm pull backs with opposite scap stabilized Double arm alternating pullbacks Wrap Taffy pulls Stabilized scapula opposite arm row Strengthening Exercises Swimming Naturopathic Spinal Manipulation Improvement in hypomobile joints Imrovement in neurological compression Neuromuscular Re-education Establish correct patterns of muscle movement Kinesio-tape methods The Nervous system is the conductor Retraining proper neural patterns in conjunction with organic healing of the tssues In neuromusculskeletal medicine there are interference patterns that can be removed Hydrotherapy Hot bath Contrast hydrotherapy Balneotherapy Peloid packs Additive bath Low Level Laser Myofascial release Muscle stretching Scar sensory imput Architecture faults Facilitation of locomotor patterning with therapeutic exercise Brain balancing
