shoulder 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

 

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.

DIY Friday: Posture

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.*

2499047949_47fb90e481_zI predict that FFF will ultimately have somewhere approximating 63 gajillion posts on posture. That would make this the first of them! Oh, posture. Such an overused and misunderstood word. Quick! Have good posture! Did you just yank your spine up straight, tuck your butt under, and shove your shoulders back while puffing up your chest? Well stop it. Stop it I say! That sh*t is exhausting and will only sow the seeds of chronic pain. Like I said, 63 gajillion posts coming your way over the years on posture, so I’ll get into the nuance of that more later but for now I need you to trust me on 2 things:

1) “Good” posture should be effortless. It should involve standing in a way that allows you all the glorious support you are designed with so that you can feel that sense of poise when upright without efforting or gripping your way through it. Forget anything you ever learned about posture in ballet class or the military. Or from your harping parents. Please.

2) Today’s 3 DIY posts have been chosen because they will help you to experience and attain that effortless sense of poise. Have fun!

  • First up, yep, this is a re-post of yours truly on the Yoga Tune Up® blog. I am slightly obsessed with getting people to stop shoving/pinning/pulling their shoulders back (it causes so much unnecessary pain!), so a few months back I wrote this article. It also has a video on how you can release your own pec minor, the main culprit in forward shoulder position, using therapy balls. If you are therapy ball-less at home you can use a tennis ball or a rubber dog ball. Lacrosse balls, baseballs, and softballs (or anything of this consistency) are too hard in this area. This is one of my favorite end of the workday things to do: When your pec minor becomes a major pain.
  • Second, Whole Living just posted this fascia focused workout creator by Jill Miller, creator of Yoga Tune Up (and, full disclosure, my teacher). While they don’t talk about this workout specifically as a posture improver, it really does hit so many of the key areas that need to be addressed in order for you to have a shot at experiencing ease in your body. Give them a try, they’re harder than they look! And my one caveat is to be super, duper, uber mindful when you do any of these movements (especially Matador Arm Circles and Sliding Chest Extension) to turn off your upper trapezius! It’s the part of your upper back/shoulder that you’re always groaning about at the end of the day, and it is, if you’re like most people, hyperactive. You will need to keep telling yourself to let that area soften as you go through the movements in order to open up your posture instead of just reinforcing old habits: Fascia Focused Workout
  • Lastly, the woman who literally wrote the book on posture, Mary Bond, has this great post on how spatial awareness/support can affect your posture. It might sound kooky, but try it! Go for a short walk seeing primarily with your peripheral vision. Or try sitting in your work chair while being aware of the space above your head and behind you (and try to avoid the temptation to pull yourself up when you notice the space above you). It can be powerful stuff! Spatial Support for Your Posture. Oh and that book I mentioned is The New Rules of Posture.

Now get out there and strut your effortlessly sassy pants stuff!