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Upper Crossed Syndrome: A Common Pain in the Neck

Chronic Shoulder & Neck Pain: Upper Crossed Syndrome

By Cate Airoldi.

The clients that I see at Siskiyou Massage are generally very diverse as far as their treatment goals are concerned. Within the last month however, I’ve noticed an increase in volume of clients experiencing neck and shoulder pain, tension headaches, and chest tightness. I think this is in large part due to the fact that summer is over and people are returning to work and school, spending more time sitting, typing, studying, and reading. So what is behind this spate of upper extremity woes? The issue for many of my clients has been what is called Upper Crossed Syndrome (UCS), or at least portions of this postural dysfunction.

Upper Crossed Syndrome is common in our society, largely because many of us spend our workday sitting in front of a computer, driving, and doing the majority of our daily tasks with our arms out in front of our bodies. x-ray desk jockeyThe classic presentation of UCS is a person whose head sits far forward of their shoulders, has a rounded and weak upper back, and a tight, restricted chest. Let’s examine why this happens and why it causes pain.

Our bodies are constantly fighting gravity. Many of us respond to this force by simply giving in and allowing our bodies to collapse down onto whatever we happen to be sitting on. Take the common example of a person who spends 40 hours a week at a desk working on a computer. Typing and mousing necessitate keeping our arms out in front of our bodies. Our arms are quite heavy, and having them out in front all day long begins to pull the shoulders forward, away from the spine and toward the hands. We may not actually feel fatigued from this pull if we are able to rest our arms on a desktop, but the pattern this posture starts is undeniably unhealthy.

Upper-CrossedAs the shoulders are subjected to this forward pull by the arms, the area in between the shoulder blades (where the rhomboid muscles sit) becomes progressively overstretched, weak and sore. Think about this like a rubber band; if you pull on the band for a short amount of time and then release it, the band will bounce back. If you hang a weight from the band and leave it there the band will eventually lose it’s elasticity and become longer due to the combined forces of the weight and the downward pull of gravity. A common misconception is that tight muscles are the only muscles that cause pain. The opposite is often more true. Weak, overstretched muscles that are being pulled to their physical limit often cause pain and extreme soreness.

So where does all of this leave the chest, head and neck? You guessed it, forward of where they should be! As the shoulders (following the arms) move forward toward the sternum, the pectoralis muscles that make up the bulk of our chest tissue lose some of their operating space. Pectoralis major, in particular, is a broad, strong muscle that acts directly on the shoulder joint. However, as the shoulders move toward the front midline of the body, the pectorals are essentially forced into a smaller area. They adapt to this restriction by shortening their length and tightening up to fit within their new, smaller boundaries. It’s counterintuitive, but this is a perfect example of how overstretched muscles can cause more discomfort than shortened muscles. People rarely complain that their upper chest is sore, yet these are the muscles that have tightened down and become short. In contrast, the muscles opposite the pecs, (remember the rhomboids?) are chronically achy because they are stretched out and too long.

Lastly, we need to look at the head and neck. We’ve got our general picture now: you’re sitting at your desk typing away, your arms and shoulders are creeping forward, your upper back is rounded and hunched, and your abdominal muscles are probably not engaged to keep your low back stable and supported (that last bit is a whole different topic!). The head and neck follow this forward collapse and sink forward and downward toward the chest. Those overstretched upper back muscles have lost the battle and can no longer support the heavy head and neck, so they collectively move in the same direction as everything else.

headacheThe final adjustment the body makes with Upper Crossed Syndrome is to raise the eyes to the horizon so we can see what’s in front of us. This last bit is important. The head is already sitting out in front of its healthy alignment, and this last little tip of the chin upward essentially pinches the muscles at the base of the skull, the suboccipitals. This is perhaps the single most common area of complaint with clients exhibiting signs of UCS, pain at the base of the skull. I can’t even begin to count how many people have walked through the door and mentioned that their neck hurts right at the juncture with the skull. What follows is also very common: tension headaches, chronic neck pain and stiffness, and decreased range of motion in the neck and shoulders.

So what can be done about Upper Crossed Syndrome? More massage therapy, of course! The primary players in this syndrome are muscles, fascia, and soft tissue in general. If we spend enough time in any position, the body will adapt to it as the “new normal.” Even if it causes us pain. Massage therapy is incredibly effective in addressing UCS.  A therapist’s job is to find muscular and tissue imbalances and to address them. As you’ve seen, Upper Crossed Syndrome is the result of muscles becoming too short or too long. Not all people will demonstrate every aspect of UCS, there is of course variation in the population. However, a good therapist will assess where your imbalances are, help you to normalize the soft tissues, and also give you suggestions for self-care outside of the massage session. Treating this condition is very much a collaborative situation. Clients will need to perform the appropriate strengthening and stretching exercises outside of the massage to gain the most benefit from their treatments. 

Hopefully you’ve stayed with me throughout this closer look at Upper Crossed Syndrome. If not, dust off that old Anatomy book and take a closer look at things! Body imbalances can get complicated very quickly, but that’s part of the puzzle I love about bodywork. Stay tuned for a look next time at Lower Crossed Syndrome.

(Note: Cate is a treatment oriented specialist at Siskiyou Massage Clinic. She specializes in treating specific musculoskeletal complaints ranging from chronic pain and sports injuries to motor vehicle accident recovery)