By Denisha

Low back pain is a very common concern physiotherapists treat. Patients often express their pain as a “symptom of aging”—but this cannot be automatically assumed! Assessment would include collecting an in-depth history and then physically testing all components often involved with back pain: movements of the spine, muscle strength/tightness, core activation and any existing imbalances (ex. hip/knee concerns), as well as reviewing any current personal exercise programs. As a pelvic physiotherapist, there are also several other areas to consider and assess- including the pelvic floor musculature. Once we identify the driver of your pain, treatment can include manual therapy (hands on care for the joints/soft tissues), stretches, core activation cues, a home program tailored to you, ergonomic education and strengthening overall- just to name a few. TIP: Daily intentional movement is very important as prevention is key! 

Complied By Binumon Joseph, Registered Physiotherapist

Upper crossed syndrome refers to a particular configuration of overlapping overactive and under-active muscle groups in the neck, chest, and shoulders. Typically, poor posture causes the syndrome, including the forward head posture, which occurs when people use electronic devices, read, and drive. Those with upper crossed syndrome usually have the same or similar set of postural irregularities that people may describe as slouching. Many different stretching and strengthening exercises exist that usually offer relief for symptoms of upper crossed syndrome.

Fast facts on upper crossed syndrome

• Common causes include a hunched over posture, often an effect of repetitive tasks, such as computer use and office work.
• Symptoms include neck and back stiffness or aches.
• Exercises are the main treatment and can help strengthen the weakened muscles of the syndrome.
• It is not usually serious, but chronic issues of pain and damage to the muscles may mean treatment is usually wise.

With upper crossed syndrome the muscles of the shoulders, neck, and chest have become deformed.
Specifically, the back muscles of the neck and shoulders (upper trapezius, and levator scapula) become extremely overactive and strained. The muscles in the front of the chest (the major and minor pectoralis muscles) become shortened and tight. As a result of these overactive muscles, the surrounding counter muscles become underused and weakened. In upper crossed syndrome, this causes weak muscles in the front of the neck (cervical flexor muscles) and in the lower shoulders (rhomboid and lower trapezius muscles). The condition gets its name from the "x" shape that develops when regions of overactive and under-active muscles overlap.

Poor posture can be a cause of upper crossed syndrome.
Different movements can cause upper crossed syndrome, but most cases develop through poor posture, specifically sitting or standing with the head forward for prolonged periods. Activities that promote this postural position include:

• computer and laptop use
• driving
• watching TV
• cellphone browsing, texting, app, or game use
• reading
• biking

In some cases, injury or congenital disabilities may also contribute to the development or creation of the condition.

Symptoms
Common characteristics of upper crossed syndrome include:

• the head is consistently or often in a forward position
• inward curvature in the portion of the spine containing the neck (increased cervical lordosis)
• outward curvature in the part of the spine that includes the upper back, shoulders, and chest (increased thoracic kyphosis)
• elevated, protracted, or rounded shoulders, where the muscles are in a continuous state of being pulled or stretched forward
• the visible portion of the shoulder blade sits out instead of laying flat (scapula winging)

The deformed muscles associated with upper cross syndrome put stress on the surrounding muscles, tendons, bones, and joints, causing most people develop symptoms that include:

• headache
• neck pain
• strain in the back of the neck and often a weakness in the front
• chest pain and tightness
• pain in the upper back, especially the shoulders
• sore shoulder blades
• pain in the jaws
• tiredness
• difficulty sitting, reading, and watching TV
• driving for more than a short period because of pain or muscle tightness or soreness
• restricted range of motion in the neck or shoulders
• numbness, tingling, and pain in the upper arms
• pain and reduced range of motion in the ribs
• lower back pain

Exercises
The best way to treat upper crossed syndrome is through exercise and postural changes. Though some people may feel a lot of discomfort when stretching, it is important that they attempt some form of gentle exercise as restricting activity can cause stiffness and soreness.
People must ensure they warm up their tissues before exercising, either with gradual, gentle motions or by having a warm bath or shower. Begin all exercises gently and build up slowly.
 
Prevention
The best way to prevent and treat upper crossed syndrome is to avoid activities that require stretching the head forward for extended periods of time.
Other tips for preventing upper crossed syndrome include:

• limiting time spent watching TV, reading, using laptops and computers, or driving
• taking breaks every 15-20 minutes while sitting or engaging in problem activities
• getting enough cardiovascular exercise, ideally 30 minutes daily from low-impact activities, such as walking or swimming
• being aware of motions, movements, or activities that worsen symptoms and avoiding them for as long as discomfort continues
• doing stretches that target sore muscles of the back neck, shoulders, and chest
• doing strengthening exercises to target weakened muscles in the upper front neck and lower shoulders
• making sure the steering wheel, book, TV, or computer screen is sitting at eye level
• using a lumbar roll in chairs
• using a headset for long telephone calls or transcribing
• using a single pillow that retains its shape

Correcting or practicing proper posture is also an important part of avoiding and treating upper crossed syndrome.

​What influenced your decision to become a physiotherapist? 
From my childhood I was more interested in health issues and my back ground also gives me more experiences with natural medicines and traditional martial arts and their use in healing various health related problems. I was also interested in a system where there are fewer side effects. After my college studies I was trying to get into the medical field, from where I ended up in Physiotherapy, which I learned to be non-invasive and with less side effects and it also involves all population from paediatrics to geriatrics. Later when I completed my course I was more clear about my path and how I can utilize my ability for many of the health-related problems which opened up for me a door in to the world of different practice.

What are the top three most common issues you help clients address?
It is very difficult to pin point 3 common issues, because there are a lot of issues that can be made better with physiotherapy. Common issues I come across is shoulder and neck pain/stiffness, low back pain, sports injuries and neurological conditions which include stroke and Parkinson’s. 

What types of conditions/injuries do you enjoy treating?
All sports injuries, neck, shoulder, back and leg pain/ injuries, Post concussion symptoms (mTBI, MVA), stroke, Parkinson’s. 

What types of treatment methods/approaches do you use?
I prefer to use more manual techniques, but I use therapeutic modalities such as IFC, ultrasound to help the initial healing process, followed with more with exercises and postural corrections. I do more hands on work with most of the conditions, which gives long lasting relief and prevention of symptoms. Exercises are one of the major compounds I insist for my patients.

What is your treatment philosophy?
Understanding the condition is the first priority, because I believe that if your diagnosis is right, 90% of your treatment is done. Experience counts- with more than 15 years in this field, I have been exposed to almost all types of clinical conditions and their physiotherapy management. Understanding the root cause and eliminating it rather than beating around the bush is important. I use modalities wisely to help overcome the present situation not solely relying only on them. I rely on active approach rather than to a passive one.

What might a typical appointment with you look like?
I listen to what the client wants to say, asking questions relating to the condition, physical assessment, various orthopaedic and neurological physical testing. I then discuss the findings with the client, explain the condition- from an anatomical perspective, then I use various treatment approaches.

If you could give everyone one piece of advice this winter what would it be?
Winter is the worst time for people with arthritis, those more susceptible to fall injuries and MVAs (Motor Vehicle Accidents). Those with arthritis should not expose their joints to cold, always cover up and keep warm. If you have a fall do not hesitate to see health care provider to check that nothing is wrong, because from a small fall you may later end up with some major issues.

What can someone expect an initial appointment with you to look like?
During an initial appointment we discuss the present situation, history of the complaint, work on finding out the cause, explain the condition- making you understand how and why it happened with anatomical explanation, possible treatments and a small treatment session depending on the available time and of course a home exercises programme for you to continue the exercises at home.

What do you like to do for fun?
I love gardening in summer (grow your own) fishing, biking, GYM, cooking, spend time with my kids, watching movies with my family.

This month we sat down to chat with our newest physio Steven. He is in clinic Tues/Thurs, and every other Sunday!

What influenced your decision to become a physiotherapist? 
I had many sports injuries growing up and have always tried to find ways to help myself rehab from those injuries. My interest in learning about the human body grew stronger when I enrolled in the Kinesiology program at York University and took courses in athletic injuries. However I soon realized that there was more to rehab than just helping athletes, I wanted to treat all kinds of injuries and that’s why I decided to go into physiotherapy. In this field, I can combine my passion for helping athletes return to their sports and also help treat pain and injuries that are affecting the lives of the general population.

What is your treatment philosophy?
I believe TENS and electrical modalities has its place in physiotherapy but I do not believe it should be used as the ONLY treatment option. I also believe that patients will have better results in their rehab if they spend more time with the physiotherapist instead of assistants. I believe that these two things are what separates Rebound Health and Wellness from other clinics, I do not use any assistants during my treatment sessions and so you will spend one on one times with me for your entire visit. Our treatment sessions will include more than just a heat pack on your back as well!

What can someone expect an initial appointment with you to look like?
We will first try to figure out the cause of your pain by taking a detailed history of your pain to narrow down the cause. Next, we will go through specific movements and special tests to pinpoint which exact treatment you will need. The rest of the initial appointment will be treatment of your problem areas using specific strengthening and stretching exercises, joint mobilizations, soft tissue massage, athletic taping, and electrical modalities.


What types of treatment methods/approaches do you use?
Once I find out what issues my patients have, I like to use a variety of techniques to treat those issues.

-Cervical, thoracic and lumbar mobilizations using various Maitland, Kaltenborn, Mulligan, traction, and Snag Techniques
-Mobilization of SI joint, knee, ankle, shoulder, elbow, wrist and phalanges
-McKenzie Method of Mechanical Diagnosis and Therapy for neck and low back pain
-Soft Tissue release techniques including Petrissage and Kneading Massage, Percussion Massage, Deep Friction Massage, Trigger Point Release Technique, GTO release
-Myofascial release techniques for commonly tight muscle groups including: trapezius, suboccipital, scalene, lats, hip flexors, piriformis, hamstring, gastrocs, quadriceps, supraspinatus, plantar fascia
-Therapeutic taping techniques using Leukotape and KT Tape

What are the top three most common issues you help clients address?
1. Shoulder pain (either from a rotator cuff issue or shoulder impingement) - don’t know if I should be specific or general
2. Neck pain (from pinched nerves in the that causes pain to radiate down the arm)
3. Low back pain

If you could give everyone one piece of advice this winter what would it be?
Hmmm, I would advise everyone to watch their steps and be careful of the slippery ice! It is much easier to prevent a fall than to deal with all of the pain and complications that come from a nasty slip and fall!

What do you like to do for fun?
 I like to play basketball, volleyball, badminton and basically any sport for fun. If I’m not being physically active, I like to relax by reading up on the news while listening to music or watching TV shows.

Book Online with Steven>>