Pain in the upper back and neck are common complaints that have people seeking medical attention. Far too often, doctors treat the pain with medication and chiropractors perform spinal adjustments without first addressing the soft tissue (fascia & muscles). Many massage therapists go straight to the areas of pain and seldom seek out the root cause of the pain.
I don’t mean to criticize fellow health care professionals. I truly believe that we all do the very best we can with the knowledge we have at the time. Unfortunately, it is the clients who have to pay the price for our shortcomings.
There are a number of factors that can cause pain in the back and neck. Auto accidents, sports injuries, a sedentary lifestyle and sleeping on ones stomach are just a few. It is important to perform a thorough evaluation to see if the cause of the pain is related to joint dysfunction, neurological impairment, soft tissue restriction or all of the above.
THE PATHOLOGY
The most common cause of upper back and neck pain is poor posture due to muscular imbalances. The head and shoulders are pulled forward, the chest is caved inwards and the upper back is rounded and hunched slightly.
The anterior muscles of the chest (pectoralis major / minor, subscapularis) and neck (SCM, anterior / medial scalenes) are in a shortened (concentrically contracted) state. This result in the posterior muscles of the upper back (rhomboids, middle trapezius) and neck (upper trapezius, levator scapula, posterior scalenes) to become overstretched (eccentrically contracted) and weak. It is these overstretched muscles that become painful as they are constantly working to pull the head and shoulders back to neutral. They become ischemic (lack of blood flow) which prevents them from receiving the oxygen and nutrients they require.
TREATMENT
The first step in the treatment is to release any fascial restrictions of the anterior musculature. Once these concentrically contracted muscles are lengthened, the posterior muscles can then begin to return to their normal resting position. Any trigger points found in the pectoralis minor, subscapularis, SCMs and scalenes, must be released and then stretched. This re-trains the neural pathways to the muscles that “forgot” what it was like to be lengthened. These muscles must be stretched NOT strengthened.
The muscles close to the spine (lamina groove) must be released of any fibrosis. Then the fascia of the posterior musculature should be pulled back towards the spine to allow those eccentrically contracted muscles to have a place to return to. These muscles must be strengthened NOT stretched.
Any joint restrictions of the thoracic and cervical spine, as well as the shoulder, can then be addressed.
Clients are often confused as to why I will spend more time on the front of the chest and neck when their pain is located on the back. I believe it is our responsibility to educate our clients so that they can have a better understanding of how posture affects their health.
Precision Sports Therapy
7827 Convoy Court #400
San Diego, CA 92111
(619) 820-9924 |
