Two To Tango
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
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
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.
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.