Upper Cross Strain Patterns and Dowager’s Hump

Most of us can agree that one of the major complaints we see as manual therapists is shoulder dysfunction or pain between the shoulder blades. Sometimes this can be caused by trauma but mostly we are going to see kyphosis which is the rounded back caused by upper cross strain patterns where restrictions occur in the Upper Traps, Levator Scapula and the Pecs. When this pattern occurs most times, you will see a downward glide of the scapula on the ribcage and outward rotation. Lower rhomboids are usually weak as well. I know when I give home training exercises like the reach roll and lift you see it all the time with clients who have a very hard time lifting the arm. Simply because the weak lower traps and the brain has forgotten how to use these muscles due to the muscle imbalance like the upper cross pattern.

The muscles like traps and pecs are in a state of isometric contraction at all times. This in turn can cause imbalance in the facets throughout the spine. So, it is important to treat both the restricted tissues and restore balance to the facet joints. Many times, only the soft tissues are addressed and not the joints. So, in turn the client keeps coming back with the same discomfort and never gets real pain relief. By working these structures and offering stability training for your client, you will see big improvements. But you have to address each of those. Remember to assess and determine where the cause is and not just treat the source.

Also keep in mind, when shoulder movement occurs it is important for scapula stabilization to occur as well. If the thoracic spine is dysfunctional then the scapula is going to have a hard time stabilizing onto the ribs which connect to the thoracic spine. Treat the joints in the thoracic and you may see big improvements in the shoulder without ever touching it. That’s why assessments are so crucial to developing a treatment plan. Another treatment to use with clients presenting with kyphosis is to be sure to move the tissue lateral to medial as the tissue has spread laterally due to the rounded back. We want to give the spine somewhere to come back to. You may even see flat spots in parts of the thoracic. It will look like bound up tissues around the spine the vertebra is closed. With this you would want to scoop the tissue from medial to lateral.