Dynamic Chiropractic
Upper Crossed Syndrome and Should Pain
Based off an article by Perry Nickelston, DC, FMS, SFMA
Edits and Commentary by Darren Chase, DC
Shoulder pain is an overwhelming issues among many athletes. No matter the athletic level or experience, no one is immune to injury.
Few Athletes understand what happens in an acute shoulder injury that leads to chronic issues. The majority of shoulder problems develop from micro-traumatic events occurring due to poor joint biomechanics and muscular movement imbalances. It is important for everyone involved to be aware that shoulder pain is usually a symptom of deeper problems that, unless corrected, may lead to total functional impairment.
Clinical Perspective
Micro-traumatic shoulder injuries happen in a predictable pattern: muscle imbalance>impingment>tendonitis>bursitits>rotator cuff injury. This leads us to the upper crossed syndrome (UCS). This syndrome is based on research and the understanding of predictable pattern of muscular compensation and postural imbalances in the body. It is postulated that faulty movement patterns on a poor postural base contribute to habitual overuse in isolated joints, while they minimize normal movement in others, thus creating a self-perpetuating cycle of dysfunction and eventual injury.
UCS leads to a forward head posture causing strain to the muscular attachments of the shoulder and shoulder blade. An anterior tilt and abduction ("flaring out") of the shoulder blades occurs, producing a rounded shoulder appearance. Due to the rounded shoulder posture, the mechanical axis of rotation of the glenoid fossa (shoulder socket) becomes altered. The humerus (arm) now requires additional stabilization from muscles that typically are quiet: the levator scapulae, upper trapezius, subscapularis, pectoralis minor and supraspinatus muscles. Postural overdevelopment of these muscles creates a deltoid shear (crossing of rotator cuff under AC joint), leading to shoulder impingement, tendonitis and bursitis syndromes.
Proper rehabilitation of the shoulder must include protocol for reversing the upper crossed syndrome.
Treatment Protocol
Due to chronic shortening, tightness and weakness in the primary stabilizers of the shoulder, muscular adhesions and trigger points develop that must be removed before active/passive stretching. Failure to do so will result in stretch-reflex reciprocal inhibition and increased loss of muscle tone. Performing of myofascial release and trigger-point therapy usually is needed. The most commonly affected muscles that become tight are the scalenes, pectoralis minor, infraspinatus and subscapularis.
Here are other aspects of this treatment protocol.
▪ Shoulder-blade retraction exercises
▪ Rotator cuff protocol
▪ Manipulation of the 5th and 6th cervical vertebrae and upper thoracics
▪ At-home treatment consists of rest and TENS to control pain. The tennis ball massage technique on the trapezius and infraspinatus (five to seven times per day) is extremely beneficial for breaking up active/latent trigger points. Self myofascial release with foam rollers on the upper back, lower latissimus dorsi, teres major/minor and infraspinatus will accelerate healing.
Most patients will be asymptomatic by the sixth visit and will demonstrate significant improvement in functional performance. The length of time it took to develop the problem is an indicator of how long you will need to work on correcting the faults before results will be felt. Keep in mind, pain is often only the tip of the iceberg, directing you to the real underlying problem: upper crossed syndrome.
