It Takes Two To Tango

By

George S. Pellegrino, LMT, CMTPT and Victoria L. Magown, CMTPT, LMT

If your hips are out of whack, dancing can be challenging. This was the case for Dianna, an aspiring tango student who began to suffer neck and shoulder pain. Her dance partner, a massage therapist, noticed her hips were out of level and suggested this might be part of the problem.

Several years ago, she suffered pain from a hip injury which, she said, “Just went away.” Did it? This injury left her hip bones out of level, distorting her posture. The hips are the center of your body’s universe and the foundation of the spine. They can exert their influence all the way up to your head, neck and shoulders, employing the spine as the conduit.

When the hips are out of alignment, over time everything that rests upon them will be out of alignment as well. People who have chronic neck and shoulder pain often receive treatment at the site of the pain that proves ineffective in providing lasting relief. One possible reason for this is the often overlooked connection to the misalignment of the hip bones that make up our pelvis.

  Look at illustration A. It shows a muscle between the hip and the bottom of the rib cage. This muscle is the quadratus lumborum. It is the muscle most often injured in motor vehicle accidents, a slip and fall or near fall. When this muscle is injured, it develops Myofascial Trigger Points which in turn contract the muscle, pulling the hip up and the rib cage down on the same side as the injury.

A Myofascial Trigger Point is a hypersensitive spot in a muscle that when stimulated, produces pain that is referred in a predictable pattern away from the Trigger Point. This point will also cause a painful contraction in the muscle.

As you can see in the illustration, the effect of Trigger Points in this muscle can go all the way up to the neck. Notice that the buttocks and shoulders are out of level. Also notice the difference in the leg length. With this kind of postural distortion, it’s easy to see why you might have upper back and neck pain.

Like Dianna, many people do not feel pain or discomfort in the hip or low back, but do have upper back, shoulder and/or neck pain. They sit or stand leaning to one side to accommodate the tightened quadratus lumborum and avoid the hip and low back pain. This distorted posture masks pain in the hips and low back and, in turn, aggravates pain in the upper back, shoulder and neck.

Another group of muscles contributing to upper back and neck pain are the paraspinals. This muscle group attaches to the sacrum, the bone that is at the base of the spine. From there, they travel the entire length of the back to the base of the skull. (Illustration B)

When one side of the paraspinals harbors Myofascial Trigger Points, it acts like a tightened bowstring and bends the spine like a bow. This causes the shoulder to be pulled down on one side. Since your brain demands that the eyes be level, the muscles in your neck must remain contracted on one side and elongated on the other. There are muscles in the neck that are shared by shoulder. This is often the connection by which upper back and neck problems evolve into a shoulder problem as well.

During Dianna’s initial evaluation, we observed her sitting, slumped to one side. This distorted posture helped to accommodate her hip and low back pain but was causing and perpetuating the upper back, shoulder and neck pain.

After successful treatment of the pelvic muscles, Dianna's upper back and neck pain decreased considerably. Due to years of this distorted posture, we needed to treat the upper back and neck muscles several times before we could obtain full release and were able to relieve her shoulder pain. A specific home exercise program enabled Dianna to return to her tango lessons and get on with her life.

It does indeed take two to tango! If you have upper back, shoulder and neck pain, your dancing partner might just be your hips! Give us a call at MyoRehab.