Follow The Leader

By

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

In the last issue of Living Natural, we discussed how the hips are your "hub" or the "center of your body's universe" (See “. . . And The Hip Bonez Connected To The . . .”). Your hips are the foundation of the spine and can influence your posture all the way up to the head.

When your hips or more specifically your pelvis is out of level, everything that rests upon it will be out of alignment. This is frequently the case for people with chronic neck and shoulder pain who receive treatment that gives only temporary relief. One possible explanation for this is that misalignment of the pelvis has been overlooked or insufficiently treated.

Take a look at illustration “A”; it shows a muscle between the hip and the bottom of the rib cage called the quadratus lumborum. This muscle is most often injured in motor vehicle accidents, slip and fall or even a near fall. When this muscle is injured, it develops Myofascial Trigger Points and becomes contracted, 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, usually produces pain referred in a predictable pattern away from the Trigger Point. These points also trigger contractions in muscle. These contractions are called taut bands and they shorten the muscle fibers.

As you can see in the illustration, the effects of this muscle being contracted go all the way up to the neck. Notice that the buttocks and shoulders are both out of level as they “follow the leader”. Also notice, the difference in the leg length. With this kind of postural distortion, it should be easy to see why you might have upper back and neck pain.

A simple test to check for a shortened quadratus lumborum is one you can do at home. Lying on your back, have another person place their thumbs just below the bump on the inside of both ankles. Are the thumbs even? Is one higher than the other? In rare cases, some people actually do have one leg physically shorter than the other. However, in most people, the leg length difference is a result of triggered contractions in the quadratus lumborum.

Most people do not feel pain or discomfort at the hips or low back but do have upper back, shoulder and neck pain. They sit or stand leaning to one side to accommodate the shortened quadratus lumborum and avoid hip and low back pain. This distorted posture avoids pain at one end of the body and transfers it to the other end.

Another group of muscles involved with the quadratus lumborum causing 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 trigger points produce taut bands in the paraspinals unilaterally, these long muscles act like a tightened bowstring and the spine bends like a bow. This intern pulls the shoulder down on one side. Since your brain demands that its “windows”, the eyes, be level, the muscles in your neck must remain contracted on one side and elongated on other.

This was the case for Holly. She came to MyoRehab with ongoing upper back, shoulder and neck pain. Most treatments provided about two or three days of relief at best. She’d been searching for more permanent relief for about two years since she graduated from college.

During the initial evaluation, we observed Holly sitting, slumped over to one side, leaning on her elbow. She was tall and slim. As a law student, she said spent many hours in that position taking notes during long lectures. Her posture was distorted to accommodate the often uncomfortable seating which avoided hip and butt pain.

I explained that we would need to treat the pelvic muscles first to give her spine a level base for her upper back and neck. This treatment strategy combined with a specific home exercise program would provide the durable relief Holly was searching for.

Are your hips leading your neck and upper back into pain? If you’re tired of playing follow the leader give us a call at MyoRehab.