Here is some of the information I recently shared in a November newsletter. Each newsletter has a specific focus.  This newsletter is focused on upper crossed syndrome, text neck, and neck pain. If you would be interested in receiving my newsletters, please head over to my contact page and sign up.

TABLE OF CONTENTS

  1. Effect of dynamic cupping on mechanical neck pain
  2. Comparison of the effect of 3 different sloping seats on cervical muscle activity
  3. Effect of forward head and rounded shoulder posture on grip strength
  4. Efficacy of Kinesio taping and postural correction exercise on levator scapula
  5. Motor control training of deep neck flexors with pressure biofeedback
  6. Effectiveness of scapular retraction exercises on forward head posture
  7. Article & video on occipital neuralgia headaches by Erik Dalton
  8. Short video on why sitting causes upper back and shoulder pain
  9. Video by David Lauterstein with a review of anatomy and kinesiology of the suboccipital muscles
  10. Short video explains type of pain triggered by nerve irritation in the neck

STUDIES and ARTICLES

I receive a weekly update on anything published on the internet that includes information about upper crossed syndrome, whiplash, neck pain, and text neck.  I try to glean the best of the information and provide a brief synopsis of the information. If you come across any information that you think would be good to share, please also feel free to pass that information along to: info@holistichealingarts.net


1. A study titled Immediate effect of dynamic cupping on pain in teachers with mechanical neck pain: An experimental study, published in Indian Journal of Physiotherapy and Occupation Therapy Apr 2020 beginning on page 154, concludes there is a significant reduction in pain after the treatment with dynamic cupping (massage cupping) in teachers with mechanical neck pain, so dynamic cupping can be used clinically in patients with mechanical neck pain.

2.  A study titled Comparison of cervical muscle activity and spinal curvatures in the sitting position with 3 different sloping seats published in Medicine in Jul 2020, concluded:  a forward sloping seat surface was effective in maintaining a neutral alignment of the spine, and this decreased the cervical spine erector muscle activity. Based on this result, equipment and chair development of incline seats forward may improve posture and health, and prevent chronic pain.

3. A study, titled  Effect of forward head and rounded shoulder posture on hand grip strength in asymptomatic young adults: a cross-sectional study, published in Bulletin of Faculty of Physical Therapy in 2020 examined the effect of forward head and rounded shoulder posture on handgrip strength in asymptomatic young adults and explores the relationship between the craniovertebral angle and hand grip strength. The study demonstrated the handgrip strength was not affected by the posture in young adults. Additionally, the degree of the craniovertebral angle was not associated with an inverse effect on handgrip strength.

4. A study titled Efficacy of Kinesio taping and postural correction exercises on Levator Scapula electromyographic activities in mechanical cervical dysfunction: a randomized blinded clinical trial, published in Journal of Manipulative and Physiological Therapeutics in Aug 2020, concludes application of both Kinesio tape and postural correction exercises combined can significantly reduce neck pain and normalize elevator scapula activities in patients with mechanical neck dysfunction more than the application of either intervention.

5. A study titled Motor control training of deep neck flexors with pressure biofeedback improves pain and disability in patients with neck pain: a systematic review and meta-analysis, published in Musculoskeletal Science and Practice in 2020 concludes: Motor control training of deep neck flexors with pressure biofeedback is an effective intervention for improving pain intensity and disability in patients with neck pain and preferable to strength-endurance training of cervical muscles.

6. A study titled A study on the effectiveness of scapular retraction exercises on forward head posture, published in Journal of Public Health Research & Development, Jun 2020, measured the craniovertebral angle before and after the 5 exercises were performed (seated row, elbow push back, scapular retraction activation, arm slides, and lower trap row) and concluded: there is a significant effect of scapular retraction exercises in reducing forward head posture.

7. A great article and video by Erik Dalton on occipital neuralgia headaches titled Neck Headache‚Ķ..really?  identifies some problems in the lower chain that might cause headaches, as well as describes the Brugger test procedure to determine the location of the problem. The video includes a good demonstration of a technique to correct O-A joint fixation.

8. A short video, found at PhysioOsteoBook gives a good animation of how forward posture when sitting can cause pain in the upper back and shoulder.

9. A video, titled Engage the Skyhook, by David Lauterstein provides a great review of the anatomy and kinesiology of the suboccipital muscles

10. A short video, Cervical Radiculopathy, by Spine-health, explains what types of pain can be triggered depending on where a nerve in the neck becomes irritated. This can be helpful when treating arm, shoulder, and hand pain.

During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and  well thought out information and  decision-making outcomes. I am happy to share some of their assignments for you to enjoy.

Introduction:

neck-painMy client suffers from pain in the neck, upper back and shoulders. He finds himself hunched over and has lost two inches in height over the last few years. He would like relief for the pain and help in improving postural distortion.

The case study is relevant in a wider context, because many clients come with identical complaints. In our society, a hunched over posture is very common due to standard daily activities - most clients spend lots of time on smartphones or computers, drive a car for at least an hour or two per day and sit at a desk for work. Even those who do not sit at a desk often do some type of work that involves rolling the shoulders inward to "do work" in front of them (landscapers, chefs, cleaning personnel, cashiers...the list is endless). Holding the body in this posture keeps the muscles of the neck, chest and back in constant contraction or elongation, a condition for which the body arguably was not designed. This can cause pain and spinal distortions and can lead to other conditions as a result of the dysfunctional posture.

Client Overview:

Initial Inspection

Lateral view

Anterior view:

Posterior view

Observations

Client complaining of pain in neck, in sub-occipital region, in back of shoulders, upper back and rhomboid area, as well as headaches, jaw pain and periodic numbness or tingling in the arms and hands.

Injury History

During the client interview, I discover that the client has had multiple car accidents, shoulder and ankle injuries, all or some of which may be contributing to the postural distortion. He often feels as if "his head were on wrong". All of this may need to be addressed in a long-range plan.

Whiplash:

1985 (age 4) - was involved in a car accident in a pickup truck with a front bench seat, during which the truck was hit head-on by a drunk driver driving 60mph. The seat belt broke so the client fell down toward the floorboard and hit his head on the dashboard. The client suffered a concussion, an injured pelvis (numbness in pelvis, hip imbalance later in life) and neck injuries. A chiropractic evaluation at the time determined that C1 and C2 were out of alignment. The client reported anxiety later in life, which he believes is related to the accident.

2016 (May, age 35) - the client was involved in a rear-end collision. His car was hit from behind, with the other car going approximately 20 mph. Immediately after the accident, the client reported a stiff neck. He was treated the same day by a chiropractor, who realigned C1 and C2. Over the next few days, his previous whiplash symptoms resurfaced: pain and swelling in the sub-occipitals, blurry vision, followed by depression and anxiety for 6 weeks, hands continually going numb and the inability to concentrate.

2016 (July, age 35) - the client was involved in another rear-end collision. His car was hit from behind, with the other car going approximately 30 mph. This time he did not seek medical treatment, but reported similar symptoms; swelling in sub-occipitals, headaches, blurry vision, TMJ and depression.

Shoulder Injury:

2010m - Crossfit, while performing overhead squat with 135 lb bar, his arms overhead with elbow locked, his right shoulder gave out. His elbow bent and the client felt pain around the superior lateral border of the scapula. He has been a basketball player for all of his life, but after the injury feels a stabbing pain when he releases the ball. The pain is not as he lifts the arm in shoulder flexion, but specifically when he extends the lower arm from the elbow to push the ball, on the right side.

The client recently used a very heavy garden tool to break up sod while gardening and felt pain with a similar movement. He felt the pain while driving the tool downward as opposed to up, specifically when extending lower arm to drive tool down into the soil.

My observations: There could be a problem with the supraspinatus tendon from the original injury or possibly a triceps tendon impingement. The client reports pain when I press in both of the tendon areas.

Additional Injuries:

1995-1999: Various muscle sprains playing basketball, torn cartilage in right knee

1999: Grade 3 sprain and fracture to right ankle, subsequent grade 2 sprain and fracture to same ankle; later grade 2 sprain to left ankle

2000: Grade 2 sprain and fracture on both right and left ankles

2001: Grade 2 sprain and fracture on right ankle

While all of these injuries and accidents have clearly contributed to the postural distortion, I will begin by addressing the basic structural dysfunction that is generally believed to cause head forward syndrome. This will address his original complaint of pain in the shoulders and neck, his hunched over posture and some of the other symptoms I observed, like the limited range of motion in his head and the shallow breathing.

Intervention Overview

Head forward posture is widely credited to have been discovered by Dr. Vladimir Janda in 1979. He defined what is now known as "Upper Crossed Syndrome." It is a muscle imbalance pattern denoted by tightness in the chest and back of the neck and weakness in the front of the neck and lower back. Clinically, there is a crossing pattern through the shoulder that looks like this: tightness in the upper trapezius, levator scapula and suboccipitals on the dorsal side, crossed with tightness in the sternocleidomastoid, pectoralis major and pectoralis minor on the ventral side.

Since the tight muscles are continually contracting, the weakened muscles are in a perpetual state of stretch. As they are trying to hold the body up against the force of the tighter muscles, they are in a constant state of eccentric contraction. A widely accepted theory states that trigger points develop in muscles such as these which are continually contracting, which causes the client to feel pain in these areas and areas of referred pain.

My client reports pain in many of the areas designated as trigger points and referred pain areas for Upper Crossed Syndrome, including the side of the face, jaw, sub-occipital region, upper back and rhomboids. He also displays several symptoms indicative of Upper Crossed Syndrome, including shortness of breath, decreased range of motion of the head and hand numbness.

Treatment Plan:

The plan is to stretch the muscles which are locked short, combined with releasing some of the trigger points and later activating the muscles that are locked long. Exercise at home will be critical to activating those muscles.

Over the last few massages, I have been warming and massaging the pectoralis muscles first to release them, including skin rolling, deep effleurage, compression and passive stretches. In addition, I have been working on releasing the sub-occipital muscles through positional release, deep friction and compression. I have also incorporated some passive stretching of the neck, focusing slightly more on the right side, as that side appears to be more contracted. The upper trapezius has also been a focal point for deep effleurage and compression.

I have also made sure to massage the trigger points in the muscles that are lengthened, specifically the rhomboids and lower trapezius. After addressing the trigger points, I massage these muscles with effleurage strokes in the direction of their origins in order to avoid further elongating them. Finally, I have given my client some exercise suggestions in order to strengthen and reactivate these muscles.

The goal is for my client to get some relief from his pain and to slowly begin to release the tightened muscles. As he is able to do this, the overstretched muscles should be able to slowly return to their original length; doing the exercises at home should help him strengthen them, which will help the healing process.

 

Literature Review:

According to research, manual manipulation of the tissues is not as effective as manual manipulation combined with exercise. In randomized trials, it has been found that the use of these multiple modalities has resulted in a decrease in pain and increase in client satisfaction.

Results:

After multiple massages, the client has slightly increased range of motion in his neck and his shoulders. He reports a decrease in his pain symptoms, and his chest appears slightly more elevated with the shoulder slightly less protracted. The change is subtle, but noticeable both to me and my client.

We will continue to address his Upper Crossed Syndrome, while slowly adding in therapies to address the related issues of whiplash and the shoulder injury.

References:

Burns, Michelle, BSRN, BSAltMEd, LMT, Regaining Healthy Posture: Tools for Relieving Upper Crossed Syndrome, 2014

Jandaapproach.com

Gross, A., Kay, T., Hondras, M., Goldsmith, C., Haines, T., Peloso, P., Hoving, J. Manual Therapy for Mechanical Neck Disorders: A Systematic Reviw., Manual Therapy, 2002.

 

During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and  well thought out information and  decision-making outcomes. I am happy to share some of their assignments for you to enjoy.

On March 30th a friend and client, I'll call Aaron, came to me with stiffness and a limited range of motion in his neck due, he believed, to sleeping on it in an odd position.neck-pain This was the first time in my practice as a massage therapist that I was presented with an acute condition and asked if I could help correct it. Aaron was not interested in receiving a full body massage; he just wanted help alleviating his symptoms. His work is physically demanding in a  field related to construction, so not having full range of motion in his neck was proving difficult.

Aaron came to me two days after he woke with the symptoms. He was unable to rotate his head and neck to the left beyond a few degrees from center and could not fully extend his head. Aaron believed his symptoms came from a sleeping position but also indicated that he had been actively working since then, which likely exacerbated the condition; as he was snot allowing his body to rest.

Th stiffness Aaron was experiencing was the result, I believe, of muscles in his neck spasming as a result of overuse or incorrect use. In Aaron's case, it was likely a result of his sleeping position as well as his active job. The muscles involved appeared to be the sternocleidomastoid on the left side, and the splenius muscles on the left side. The superior and middle fibers of the trapezius, as well as the levator scapulae, appeared to be tense as well on both sides of the neck. With time and rest, this condition should have cleared itself up. Given the space to relax, I believe the range of motion in Aaron's neck would have been restored. If strain continued to be applied to the muscles, I imagine the condition could have worsened, causing headaches and radiating into other parts of the body.

For Aaron, I decided to perform a half an hour session focusing on positional release and stretching of the neck and shoulders. As the neck tightness was largely a result of an acute incident, I thought providing those muscles with relaxation through positional release and safe movement with light stretching was the best option. A shorter session providing pain relief and increasing range of motion was what my client wanted. Aaron was not interested in a  full body session at the time, though I encouraged him to return for a relaxation session in the future to help with some of the chronic tension he held from having an active lifestyle.

In the June, 2014 issue of the International Journal of Physiotherapy, an article titled Effect of Positional Release Technique in Subjects with Subacute Trapzitis (Carvalho, Sweety Charles, et al.) showed that positional release combined with stretching had "significantly more added effect than trapezius stretching alone in improving pain, functional disability and cervical movement." In the study, a total of 8 sessions were performed over the period of 2 weeks; and both the control group and study group saw a decrease in pain and increase in range of motion. So, while stretching is effective in treating muscle spasms, it is not as effective as combining stretching with positional release therapy.

In treating Aaron, I hoped to decrease his pain and increase his range of motion; I believe the passive stretching and positional release techniques performed met these goals. While passively stretching  his neck, Aaron indicated a number of times feeling the stretch continue into his arms and lower back. He did have reduced pain andgreaterr range of motion immediately following the session, and these metrics continued to improve over the following 48 hourse. Within two days of treatment, his range of motion had returned to normal and he experienced no pain. If Aaron returns for continued treatment, in addition to the passive stretching and positional release, I will perform Swedish relaxation techniques to encourage stress reduction and myofascial release because of the referred sensation he felt during passive stretching.

Reference:  Sweety Charles Carvalho, Vinod Bau.K, Sai Kumar.N, Ayyappan V.R.. Effect of Positional Release Technique in Subjects with Subacute Trapezitis. Int. J. Physiolther: 2014;1(2).91-99.

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