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Chronic Neck & Upper Back Pain? This Could Be Why

What is upper cross syndrome?

Upper cross syndrome is a common postural dysfunction that explains a muscle imbalance between your chest, back and neck muscles. While looking at a person from the side, an “X” can be drawn over the shoulder and neck region and divided into two arms. One arm shows muscles that are typically tight and over used, whereas the other shows muscles that are weak and under used. It is important to understand that a muscle can be tight both when over shortened and over stretched. An over stretched muscles can cause a burning pain which is why you may notice the pain in the upper back but not the chest. The pectorals muscles of the chest are tight shortened muscles in this case, whereas the upper trapezius and levator scapula muscle are tight and over stretched. The pectoral muscles are huge muscles, so it is not surprising that they over power the smaller weaker muscles of the back, pulling your shoulders into a rolled or slumped forward position. Your inhibited and weak muscles are not able to give opposition to the tight muscle groups, which further adds to the poor posture.

What is the cause?

The most common cause for developing upper cross syndrome is poor posture with the shoulders and head slumped forward for prolonged periods of time. Most people will think of sitting at a desk all day as the only time you have bad posture but it can be anytime you are doing something for prolonged periods like standing, driving, cellphone use, or slouching on the couch watching tv.

What are the symptoms?

Typical symptoms include achy or burning pain felt in the upper back between the shoulder blades and/or in the neck usually at the top where the neck meets the skull. There will be a noticeable head forward posture, with rounded forward shoulders when viewing yourself from the side. Another common symptom associated with this postural dysfunction is headaches. These headaches can be pain referred from your upper trapezius, which is felt in the temples and behind the eyes. On a more long term scale, upper cross syndrome can lead to joint dysfunction of the atlanto-occipital joint, the cervical vertebra 4/5/6 and even the glenohumeral joint. This joint dysfunction is due to muscles pulling at the joint in wrong ways and this causes stress on the joints that can lead to degeneration of the articular surfaces, which further adds to the pain in the area.

What to do about it?

Manual therapies, such as massage and chiropractic, can be very helpful in correcting the problem. Massage therapy is helpful in reducing the pain that is associated with the syndrome, decreasing headaches, and stretching the tight muscle groups. Chiropractic therapy can help to ensure the joints are in correct working order, as well as stretching tight muscles. After the manual therapies, there are three key steps that need to be done at home in order to keep everything functioning as it should, as well as reducing the pain and headaches.

A. Be aware of your posture throughout your day. If you look like the person in the following figure when sitting at your desk, a change needs to be implemented. The ideal posture while sitting at your desk should be with your feet flat on floor, your knees and hips at 90 degree angles and facing forward, not splaying out to the sides. The keyboard should be placed so that your elbows are bent at a 90 degree angle and position so you do not have to lean forward to reach it. Your computer screen should be set up so you don’t have to move your head up and down to look at it. This is usually accomplished by the top of your monitor being in line with the middle of your forehead

B. Stretch the pectorals and levator scapula muscles on a daily basis. Remember the pecs are huge muscles and have different fiber directions, so they need to be stretched in three ways. The best place to do this is in a door frame. See pictures below

C. Strengthening the weak muscles will help to improve posture and take strain off the opposing muscle groups. Strengthening has been proven to improve the ability to maintain neutral posture during prolonged period of sitting. This was proven by a study done on people with chronic neck pain. They demonstrated a reduced ability to maintain a healthy posture especially when distracted by daily tasks. These people were given an exercise program that targeted the neck flexor muscles and showed an improved ability to maintain a neutral posture while working.* This study could be taken one step further by adding back strengthening which would improve the ability to hold your shoulders and neck in correct posture throughout your day. To attain stronger back and neck muscles here are some exercise you can do at home or at your office.

The neck flexor exercise seams simple but is effective in reducing the head forward posture. This is done by placing the back of the head against the wall, tucking your chin down to make a “double chin”, while the back of your head stays against the wall. Hold posture 3 seconds. Repeat 3 sets of 10 repetitions.

Using a Thera-band to strengthen the muscles between your shoulders, while sitting or standing have your back straight, elbows bent at 90 degrees and your palms facing each other. Hold the Thera-band in each hand and pull outwards while squeezing your shoulder blades together and down. Hold posture for 3 seconds. Repeat 3 set of 10 receptions.

Hope this was helpful in keeping you comfortable and moving well.

Selah Clark RMT

* Deborah Falla, Gwendolen Jull, Trevor Russell, Bill Vicenzino, Paul Hodges; Effect of Neck Exercise on Sitting Posture in Patients With Chronic Neck Pain, Physical Therapy, Volume 87, Issue 4, 1 April 2007, Pages 408–417,

Studying: Deborah Falla, Gwendolen Jull, Trevor Russell, Bill Vicenzino, and Paul Hodges: Effect of Neck Exercise on Sitting Posture in Patients With Chronic Neck Pain. , Physical Therapy, Volume 87, Issue 4, 1 April 2007, Pages 408–417,

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