neck pain

Love for the Upper Trapezius

trapeziusI am lucky enough to know (and to live near enough to video!) an exceptional teacher, Lillee Chandra. Lillee has devised an ingenious solution for getting at that "spot" that you are always trying to squish at the end of the day. Enter Lillee:

In our tech-ready, chair-heavy modern world, the neck and upper back are a tension dumping ground for the majority of people. However, one of the most common areas of complaint lives directly under the swagging outline of the upper trapezius. Here, a convergence of many deep shoulder-to-head and neck-to-trunk musculature traverse, namely the: levator scapula, middle and posterior scalenes, and the supraspinatus.

Treating this pervasive trigger point epicenter on one’s own is compounded by the fact that to apply the most effective vertical pressure to it, one must push top-down into the shoulder. Even most thumbs (both trained and untrained), tire quickly when scrubbing along this supraspinous gutter that runs from neck’s bottom to the head of the humerus. These approaches are generally awkward for the giver but even more importantly, the source of pain tends to continually escape into hiding along the many folds of various muscular fiber directions exposed here.

Here is a way to finally treat yourself without having to exhaust yourself. This Yoga Tune Up® Therapy Ball solution allows you to get the most beneficial angle of approach while laying down in a relaxed position and using your feet to push instead of your thumbs.

                                                                                                                          

About the Author

Lillee headshotLillee Chandra, the founder of Chandra Bodyworks ,has a distinct approach to massage therapy and yoga that is fueled by more than 20 years of experience in competitive sports, movement arts, health education, and therapeutic bodywork. Her diverse clinical training, keen intuition, and exceptional hands-on skills have distinguished her as a leader among fitness and health communities. She is a known specialist in postural re-education, pain management, and injury and illness rehabilitation. Thai Yoga Massage, Craniosacral work, and Yoga Tune Up® strongly inform her hands-on therapies.

Her unique style of working with the body is significantly sculpted and nurtured from advanced trainings with Ana Forrest and Glenn Black, and now more recently, from her mentorship with Jill Miller.

In addition to her full-time private massage therapy practice in CT, Lillee continually extends her professional reach to students and teachers throughout the US by developing and leading anatomy and yoga teacher trainings, workshops and classes.

Lillee has taught at Kripalu Center for Yoga and Health, is a member of the International Association of Yoga Therapists (IAYT), and is a certified Yoga Tune Up® (YTU) Integrated Teacher. She is a top assistant to Jill Miller, a contributing author and editor for YTU articles and training curriculum and leads YTU Anatomy modules and YTU Teacher trainings nationally. She is currently concluding her Clinical Orthopedic Massage Certificate with Dr. Joseph Muscolino.

trapezius image by Anatomy for Sculptors

 

Shoulders Tug of War

Woman with upper back and neck painWhen I keep seeing a theme in my practice I know it’s time to write about it here on FFF. Lately I’ve been seeing a lot of people who are suffering from pain in their neck and upper shoulders/back, and they are trying to relieve or resolve the pain by pulling their shoulders down and away from their head, only to find that this makes the pain worse. While “pull your shoulders down” doesn’t exactly make my movement cue hall of shame (like, say, “tuck your pelvis” or “lift your chest” do), it does make my movement hall of lack-of-nuance. Since that just rolls of the tongue so easily, we’ll go with that.

“Pull your shoulders down” is one of those things that many people are mistakenly under the impression they need to be constantly vigilant about. In reality, most people’s shoulders are a totally fine distance from their head, and so when they are tugging their shoulders down, in what is a chronically overtaxed and tight area for most in our culture, they wind up agitating their soft tissue instead of relieving it. It’s kind of like the tension put on the rope in tug of war. If both teams are pulling the rope is taught. Tugging harder on the rope isn’t going to make it longer, it’s just going to pull the team on the other end around while creating more force and strain on the rope. When what we’re talking about is your tissue instead of a rope: Ouch.  In short, you can’t force yourself past an end range and expect to find more space. Instead you will find more strain.

Here’s where the lack of nuance issue comes in; Yes, most of us in our culture are suffering from overworked and tight muscles in this area. Namely the upper trapezius, levator scapula, and scalenes. Plenty of other things come into play because there are no local problems, but these places are for sure gummed up and tight. And when these places are tight, they can contribute to an upwards creep of the shoulders. But things aren’t always short and tight. We can have plenty of places that are pulled long and tight, and that happens a lot in the upper shoulders and neck.

Regardless of whether you are a “long and tight” or “short and tight” person in this area, because of the sensitivity of the tissue here, tugging the shoulders down often just lights up the pain pattern. It can also be useful to know how nerve rich an area this is. In particular, the ulnar and median nerves exit your cervical spine (neck vertebrae) here to weave their way through your shoulder and down the arm. And nerves just don’t like getting yanked on.

So what to do for your cranky shoulders, neck, and upper back? First, the ultimate goal should be for the shoulders to rest, not for them to be chronically pulled downward with muscular effort. Second, giving the tissue some slack in your stretches for it often helps to unglue the area more effectively. And lastly, external rotation is your friend. Let’s talk about each one at a time.

Nuance! We like it in our movement cues! Here goes:

  • Shoulders are designed to rest. The beautiful design of our interior architecture is made precisely so that we can be supported from the inside out, not so that we need to be constantly efforting. I think sometimes we forget that the goal is to feel supported and fluid rather than to be striving in the direction of perfection (Wow I could go on a long tangent here about what that means about our cultural conditioning! Another time…). In other words, your tissue has got your back. That’s what it is designed to do. In the case of our shoulder girdle (which just means the entirety of what we define as shoulder structures), the clavicle, scapula, and humerus, and all the soft tissue that emerges from and weaves into those bones, make up this lovely structure that just rests on top of your ribcage. So before you do anything else, first ask if you really need to be pulling your shoulders down. Take a good look in the mirror. Are your shoulders really masquerading as ear muffs? Really?  In my experience, that is not the case for many people. If your shoulders seem to be a just fine distance from your head, why not give up yanking them down and see if this act of not doing actually resolves or relieves your pain. I have seen in many of my clients that when they stop forcing this corrective on themselves that they get better.
  • Give your tissue some slack. My brilliant Yoga Tune Up® colleague Lillee Chandra has a great way of describing this. She says that it’s kind of like when you have a drawer that’s stuck, and you keep yanking on it in the hopes that you’ll free the drawer to glide again, but it won’t budge. Ultimately what really frees the drawer is to stop yanking on it, and to actually push it back in until it gets back on its track, and then it slides open without the slightest glitch! A simple way to do this is by rolling your shoulders instead of pulling them down. You go through a full rotation of bringing them up to your ears, down towards your back, and then to rest in neutral. Another way to play with this is with the extreme trapezius shrug, which is in the video below and is from the Yoga Tune Up lexicon.
  • External rotation is your friend. Much of what we perceive as shoulders that are “too high” are actually shoulders that are internally rotated. Because we primarily use our arms in one configuration in our culture (out in front of us and internally rotated at the humerus while typing, texting, holding the steering wheel, carrying groceries, lifting weights, etc, etc) we tend to get stuck in internal rotation. Go back to your mirror and internally rotate your humerus (upper arm bone) as much as you can on one side. Does that shoulder now appear higher than the other side? And if you now externally rotate the humerus (the pit of the elbow will begin to face out) does that shoulder now appear lower? Magic! This doesn’t mean you need to be walking around in forced external rotation, but it can be a much more useful direction to stretch in than simply pulling the shoulders down. I also demonstrate this and talk about it in the video below.

Enjoy! And be kind to your shoulders. Give those guys a break this holiday season, ok?

And now on to the video:

   

DIY Friday: Upper Back and Shoulders Part 1

diyfriday (2)

*Do it yourself! Every Friday we do a roundup of great posts, videos, or other resources around a theme that help people to turn their bodies from cranky to happy.*

4927974025_116c045142_bI recently asked the Facebook tribe what they wanted me to give them help on in this week's DIY Friday and there was a whole lotta talk of shoulders and the upper back! I can't exactly say I'm surprised. We live in a culture that puts an awful lot of demand here in ways that our bodies are not well designed for. All of that looking at screens, sitting, and typing causes upper back, neck, and shoulder pain that our hunter gatherer ancestors were not having to deal with. I used to joke that the first person who came into my Rolfing® practice with no tension pattern in their upper trapezius would win a treasure chest of prizes. I have not given out any prizes. Call me a defeatist, but I have not even gone shopping for treasure chests. Ok partly that's just the practicality of having a hard time finding stores that carry treasure chests...

But in the hopes that I'll be handing out prizes for supple upper trapezius muscles soon, here's part 1 of a 2 part post on some of the most crucial alignment issues that we face in our shoulders and upper back, as well as some very juicy self massage strategies that are likely to have you shouting, "Hallelujiah!"

Before we bust out the therapy balls, here's a video from me ranting about one of my most despised hall of shame alignment cues. You've all heard it before, "Pull your shoulders back." Argh! To see how this cue may be causing a significant increase in your upper back pain and why I would get so complain-y about something so seemingly innocuous, give it a watch:

And now, finally, the moment you've all been waiting for. Knowing how to work on that cranky tissue on your own. First, to deal with the internal rotation, shoulders creeping up and forward thing that I describe in the video, here's a quickie therapy ball strategy to unglue your pec minor muscle, one of the main culprits in forward rounded shoulders (it's an oldie from before FFF):

Last but very, very much not least, this is the good stuff that you're wanting to get into at the end of every workday. Jill Miller shows you her Yoga Tune Up® therapy ball strategies for getting at the upper trapezius, supraspinatus, and rhomboids. Heavenly! This is a powerful 4 minutes and 55 seconds everyone. It might just change your life (as it does mine at the end of every Rolfing or writing day).

 

*Jill and I are both using the original sized therapy balls in these videos, and they can be found here

photo by Sam MacKenzie

 

DIY Friday: Losing Our Heads (and How To Regain Them)

diyfriday (2)

*Do it yourself! Every Friday we do a roundup of great posts, videos, or other resources around a theme that help people to turn their bodies from cranky to happy.*

The screens! The screens! What a love hate relationship I/we have with them! One the one hand... Um hi there! I wouldn’t even be communicating with any of you without them. Among many other things, technology has given lots of people a voice and a gathering place here in The Land of Blog, and for that I am hugely grateful.

7275218206_4888f9a1a1_bBut as an embodied person, who happens to write about embodiment via this handy computer I am currently on, ugh! Frustrating! I also notice that running 3 businesses means that I am now fully addicted to my phone as well, bowing my head to its screen as if in some weird prayer ritual a gajillion times a day to respond to emails and texts. Do I need to do it that often? No, but alas I am working on my “rat to the pellet lever” type addiction to the thing. And I suspect I’m not alone. Look around you. We are the pre-cyborgs. Carrying around our not-yet-built-in gadgets and bowing our heads down to the ever beckoning screens.

The addiction piece is a big one here, but, apologies, for now I’m going to leave you guys to grapple with that one on your own, while I grapple with it on my own. (And hey now, if you have handy tips for being less addicted, add them to the comments below). We will instead talk about what is going on when we lose our heads and how to retrieve them before we are feeling 90 years old at any age.

First, there is the obvious impact on the spine. Anyone who has had low back problems is probably very familiar with decoding what I mean when I write “L4/L5, L5, S1”. If you don’t know what I’m talking about here, I am referring to a grouping of your lowest vertebrae in your spine, and this bit of letter plus number body code speak is actually quite well known these days by laypeople because so many people have disk herniations* at these levels of the spine. In other words, if you didn’t know what I meant you are in a lucky minority. This epidemic of herniations has happened because the scourge of sitting has been going on for long enough and people do it for so many hours in every day, and improperly by sitting with a tucked under pelvis instead of on their sit bones (aka the ischial tuberosities).  But that's fodder for another post…

Back to the neck: I predict, and I’m definitely not alone here in my prediction, that “C6/C7, C7/T1” will be the new hot trend in disc herniations. I kid. But seriously, we’re headed for some trouble here (as in, we’re already in trouble here and it’s going to get worse.)  These levels of the spine are at a different transition point, right where your neck ends and back begins. In other words, right where you hinge forward when you look at your phone or your while-curled-up-on-the-couch laptop screen. We’re going to see a ton of unpleasantness here, and for those of you with kids (I’ve got a 6 year old) their generation is being primed for this at a very young age. So save yourself and your kids by starting a family project of reclaiming your heads.

Now on to the DIY:

Regain your head intervention #1:

Remember that phone prayer bow that I described earlier? Here’s how I break the cycle:

  • First, a little movement experiment: Get up from your computer and, bow your head forward as if you were looking at your phone. In other words, drop your head and narrow your gaze as if you were looking at a screen. Keep your head and vision like that and then take a little walk around the room you’re in.  Do you feel 90? Well you look 90, so knock it off. Losing your head instantly ages you everywhere, not just in your neck. You start getting shuffle-y all over the place.
  • So let’s reclaim the top of your head first, shall we? Without tugging your head up like you had some imaginary traction device on, simply bring your head back to normal (it bears repeating: do not pull your head up to the ceiling in mock good posture, or shove your chin back to flatten your neck out. This only sets you up for a different pain pattern whilst giving you an attractive double chin).
  • Now you have simply brought your head back up away from looking at the imaginary phone. If you heeded my warning about not tugging your neck long, you’re likely still a little forward with the carriage of your head. Goofy as it may feel, give yourself a gentle tapping on the crown of your head, or the very top most point of your head. This invites an awareness in of where the top of your head is. You can then gently(again no tugging!) follow that awareness to an upright head posture.
  • The top of the head is a very common body blind spot these days. Most of us (including me on my heavy phone use/Rolfing client days) lose connection to that. The gentle crown o’ the head tap is so simple but can have a huge result. Pepper it throughout your day. It may have the bonus effect of making your boss think you are having a nervous breakdown and inviting you to take a personal day. It’s worth a shot.
  • Next up (you’re still standing right? I’m going to make you walk around more) let’s play with your vision. The other thing that shuts down our body-wide movement potential is this narrowing of the gaze via the tunnel vision that exists only for the screen. So instead, start looking very consciously with your peripheral vision. Notice if that feels weird. For most of  us these days it does, because we  wear the imaginary screen blinders for such large portions of our day.
  • Keep that “looking through your peripheral vision” action going and now take a walk around the room. Don’t be surprised if you feel a bit off balance. Your peripheral vision is likely rusty, and you need to reclaim it gradually. This impacts your actual vision, but also, as I mentioned, movement potential and responsiveness (what if a ninja attacks your from the side after all?). Play with turning your peripheral vision on consciously through the day.  This is one you can do without anyone even knowing you’re expanding your movement vocabulary, so go for it.

Regain your head intervention #2:

Want a longer, more upright neck? Jill Miller of Yoga Tune Up® shows you how to lengthen the tissue on the front of your neck, mainly the platysma and scalenes muscles, which, when shortened,  are a large part of why people turn into vultures. Go slow and use broad touch with this. Imagine you are trying to slowly and gently warm up and stretch a piece of dense taffy. Rubber band snapping sensations are no good. 

Regain your head intervention #3: 

Kelly Starrett of Mobility WOD has got you covered for addressing positioning when using your phone and computer. Check it out in his post, Death by Texting. And please heed his warning when he says that he's not asking you to stick your chest out when you externally rotate your arms. Don't shove your chest forward with this! That will only agitate your neck over the long term. 

Lastly, why not cap this all off with a laugh by checking out The Oatmeal's comic on The Evolution of our Spines and Speech. Hilarious perfection. 

Go forth and use your gadgets without hating on your neck!

*Important footnote: The diagnosis of a disc herniation is, in my opinion, a hugely simplified view of what’s going on when people experience back pain. Beyond it being simply my opinion, data shows  that pain frequently does not correlate with what is going on with the discs. Often times when a thing can be easily measured, as in, “Look! There it is on the MRI!” people get told it is the whole story. But nothing in our bodies exists in isolation, so there is always a myriad of other things going on with the muscles, fascia, nerves, etc. So for the purpose of this blog I am using the simplified “disc herniation” issue to illustrate specific locations in your body clearly. It’s also handy because many people know what I mean via the diagnoses they have been given. But please know that it’s not just your discs I’m referring to here, and when you have a musculoskeletal/fascial issue it’s never just one thing. We just happen to live in a culture that loves a good bullet point. But bodies are not bullet points.

Photo by Roger G1

Your inner cobra (getting to know the deep core)

cobra1The upright human posture and plantigrade gait requires a delicate balance to keep the ventral cavity operating at its functional best. Solving problems in the abdominopelvic region has focused primarily on the horizontal belt surrounding it: the transversus abdominis and its fascial connections to the thoracolumbar fascia and neural connections to the levator ani of the pelvic floor. The concept of ‘core support’ has ramifications to proper sacroiliac stability, lumbar support, pelvic floor health and continence. and a good foundation for respiration – and even on up to shoulder balance and neck strain.

While support in this outer belt is important, and the exploration has produced positive results for patients, less emphasis has been placed on a primary myofascial relationship which is of equal importance to human function, which could be termed our inner ‘cobra’. The cobra lurks inside the belt, and is essential for easy lumbar support of the rib cage, and links the rhythm of breathing and walking.

Cobra 2Our inner cobra is made up of the psoas major muscle and the diaphragm considered together as a functional unit. While these are often depicted as separate in the anatomy books, in the dissection lab the fascial connections are very clear between the diaphragm and the psoas major.

The posterior diaphragm is rooted into three structures: 1) the crura, which blend from the aortic arch into the anterior longtudinal ligament along the front of the lumbar vertebrae, 2) the psoas major (and, if present, the minor) which reaches down from each diaphragmatic dome to the lesser trochanter of the femur, and 3) the quadratus lumborum rooted down to the iliac crest and iliolumbar ligament (and in fascial terms beyond into the iliacus and iliac fascia).

There are two cobras, one on either side of the spine. The tail of the cobra is the lower end of the psoas, curled around the neck of the femur parallel to the pubofemoral ligament. The cobra’s ‘body’ goes forward of the hip joint itself, and then retroperitoneally back behind the organs to lie of either side of the lumbar spine. The ‘hood’ of the cobra is the spreading dome on each side of the diaphragm. In the image, the cobra’s face would be at the front of these domes, approximately at the end of the 6th and 7th ribs.

Cobra 3Considered as a functional whole, the balance of these two muscles is essential for respiratory and spinal health. Get the balance and function of these two cobras correctly, and it will matter less whether your patient has ‘washboard’ abs or ‘washtub’ abs. With a strong and balanced cobra, tight abs are less necessary to upper body support.

When the cobra gets too short, the cobra lifts up and exposes its throat, so to speak – in postural terms, the lumbars get more lordosis and the rib cage tilts back, restricting breathing in the back of the diaphragm. When the cobra loses tone, the head of the cobra dips, the lumbars fall back and the rib cage falls, restricting breath in the anterior part of the diaphragmatic domes.

Learning to read and correct the position of the cobra offers a new aspect to core support that supports the upper body easily, dynamically, and with less residual tension than just slamming down those abs.

Endlessly tightening the TvA, though it does offer increased support, also restricts movement, especially respiration and the organ excursion from respiration essential to their health. Your organs are ‘massaged’ neatly 20,000 times per day by the breath – restriction of the ‘abdominal belt’ and the ‘abdominal balloon’ may create support at the cost of essential function.

Learning to see, assess, and treat the ‘cobra’ of the psoas-diaphragm complex renders core support truly at the core, linking pelvic neutral and lumbar neutral with an easily functioning diaphragm.

                                                                                               

*The original post Cobra  is re-posted here with permission from from Anatomy Trains and Tom Myers

About the Author

Thomas Myers studied directly with Drs. Ida Rolf, Moshe Feldenkrais, and Buckminster Fuller. He has also studied less extensively with movement teachers Judith Aston, Emilie Conrad, and in the martial arts. His work is influenced by cranial, visceral, and intrinsic movement studies he made with European schools of osteopathy.

An inveterate traveler, Tom has practiced integrative manual therapy for over 30 years in a variety of clinical and cultural settings, including 10 years in London, and traveling practices in Hamburg, Rome, Nairobi, and Sydney, as well as a dozen locales in the US. He is a member of the International Association of Structural Integrators (IASI).

Author of Anatomy Trains (Elsevier 2001) and a set of supporting videos, Tom has also penned over 60 articles for trade magazines and journals on anatomy, soft tissue manipulation, and the social scourge of somatic alienation and loss of reliance on kinesthetic intelligence.

A certified Touch-in-Parenting instructor, Tom retains a strong interest in peri-natal issues relating to movement.

Living on the coast of Maine, Tom directs Kinesis, which conducts professional certification and continuing education courses worldwide.

To read more about Tom Myer's work, please visit Anatomy Trains.