Are You Losing the "Fight Against Gravity"?

Have you ever experienced chronic shoulder/neck pain, spasms, fatigue, tenderness, or tension headaches after a long exhaustive day of work? Well if you have, you are not alone because issues in the upper shoulder region have become increasingly frequent in recent decades. The rise in neck pain is now second to only back pain in the occurrence of musculoskeletal disorders. The frequency of symptoms of neck disorders has caused it to become a major public health problem(1). It is not surprising due to the increased reliance upon technology, especially the computer. Many positions within the current national workforce require long durations in front of the computer causing fatigued posture and the development of chronic neck pain. Pilates classes have also been a culprit in contributing to shoulder tension through their ironic “relaxing” cues for the shoulders. Some examples taken from magazines, pilates studios and instructors include: “shoulders in your back pockets” and “Shoulders away from your ears” to name a few (2,3,4). Whether we are actively depressing our shoulders during pilates class or are inadvertently facing the consequences of gravity – neck pain has become an unfortunate frequent complaint in recent decades.

The source of the symptoms within the upper shoulder and neck region can be multi-factorial including injuries affecting muscle, tendons, joints, ligaments, and bones through mechanically overloading the biological structures(5). Overloading the tissue is common through high intensity forces or torques acting upon the body such as performing tasks in regards to lifting, pushing, or pulling objects. Alternatively, internal forces, such as friction, muscular imbalances, joint pressures and bony tuberances must be considered. The internal mechanics have not received much attention until recently due to technical limitations(6). Despite limitations in research, the importance of internal mechanics is significant and can be largely controlled through posture and body alignment and deserves more attention when discussing neck pain/disorders. Good posture alignment results in the body being in a state of musculoskeletal balance where weight distribution on the supporting structures ensures maximal joint stability(7).

Although neck pain and disorders can stem from a broad range of sources, many troubles in the upper shoulder region can be traced back to the upper trapezius muscle. In everyday pursuits the upper trapezius muscle is constantly working against gravity to maintain scapular positioning. The lack of kinesthetic awareness (bodily awareness of its position in space) results in a depressed scapulae (shoulder blades) or slumped shoulder look. (See Figure A below) I term this the “fight against gravity”. Unfortunately for many, gravity always wins resulting in a “Christmas tree” look.

So how is poor posture and the lack of kinesthetic awareness responsible for issues concerning the upper trapezius muscle? To understand the issues, one must become familiarized with the anatomical position as well as functions of the trapezius muscle (See Table #1 below). A thorough understanding of the upper trapezius will further illustrate the pronounced occurrence of issues related to the muscle. When the upper trapezius fibers lose the “fight against gravity” they experience mechanical stress through increased intramuscular tissue pressure(8). The increased intramuscular pressure results from the poor length-tension relationship by the muscle. With the shoulder slumped and the scapula depressed the upper trapezius is a lengthened state. To illustrate the effects of the increased intramuscular pressure experienced by the upper trapezius muscle practice the demonstration below.

Demonstration 1:
Take a rubber band and cut the band at some point creating a single strand. Stand in front of a mirror holding each side of the rubber band with one hand. Place one hand close to the neckline and the other end over the acromion process (shoulder) – Imitating the upper trapezius muscle orientation. Elevate and depress your shoulder while noticing the altered tension of the rubber band!

Over time, through constant static contractions of the lengthened upper trapezius, the muscle is susceptible to force development problems. Other physiological responses resulting from the high-tension development include altered blood flow to the muscle reducing oxygen supply and causing metabolites to accumulate. The physiological responses are responsible for the fatigue perception within the upper neck region(8). In summary, when the upper trapezius muscle is in a lengthened state it causes a cascading effect of muscular deformation through increasing intramuscular pressure(8), reduced blood supply(9), limited oxygen(9), and hindered force development(8). The mechanical and physiological responses cause the perceived fatigue, discomfort, pain, tenderness, spasms, triggerpoints, weakness, and headaches.

Understanding the complexity of upper neck/shoulder disorders is crucial to implementing an approach at eliminating pain and restoring function. With a multitude of disorders stemming from a mechanical stress overload of the upper trapezius muscle the focus will be placed upon addressing the overload.

The National Posture Institute’s 4 Points of Posture Program™
The four points of posture are simplified mental imagery cues that can be used to learn and establish a better postural alignment.

1. Stand Tall
a. Visualize the vertebral column lengthening and growing taller

2. Hold Chest/Shoulder High
a. Visualize opening up the chest and creating a geometric 90 angle of the shoulders and leveling out the shoulders

3. Retract Scapulae
a. Visualize holding a pencil between the scapulas (Shoulder blades)

4. Contract Abdominals
a. Visualize drawing the belly button toward the spine and isometrically contracting the core musculature.

Integration of the four points will position the musculoskeletal system in a more optimal alignment. Point one standing tall will reduce the compression upon the vertebral discs. Point two will create symmetry in the shoulders through creating a geometric 90-degree angle. In order to create a 90-degree angle (leveling out the shoulders) many will have to elevate their shoulders resulting in a better length tension relationship of the upper trapezius muscle tissue. Point three is abducting the scapulas through retraction that positions the glenohumeral joint in a more optimal anatomical position. Point three focuses on minimizing the rounded shoulder posture (abducted scapula/internal rotation/shoulder pronation). Finally, point four contracting the abdominals isometrically will neutralize the pelvis and create the natural curvatures in the spinal column.

Demonstration #2:
In a normal alignment, take two or three fingers and palpate the upper trapezius muscle fibers. Assess the tone of the muscle tissue (firm, pliable, knots, etc.). Implement NPI’s Four Points of Posture and then re-assess by palpating the upper trapezius. The length-tension relationship should have created more soft and pliable tone to the muscle structure!

Implementing the four points prior to engaging in exercise movements is crucial toward establishing better postural alignment. Through reinforcement of the points new neural pathways will be established creating better length tension relationships amongst tissues. The body will become balanced, ultimately enhancing functional capacity, and reducing any symptoms within the upper trapezius and upper shoulder/neck region.

NPI Summary Points
- Your body is always working against gravity - “Fight Against Gravity”
- Slumped Shoulders/Depressed Scapula = Lengthened/Weakened Upper Trapezius
- Develop a kinesthetic sense of the glenohumeral joint
- Implement NPI’s Four Points of Posture to improve alignment
- Establish Better Alignment by Strengthening Weakened Tissues

Table #1 – Origin, Insertion, and Movements of the Upper Trapezius(10)

REFERENCES

1. Fejer R, Kyvik KO, Hartvigsen J: The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J 2006, 15(6):834-848.
2. "Pilates and Posture - Achieving Good Alignment - Pilates for Good Posture." Pilates - Exercises and Equipment for Strength and Flexibility - Pilates DVD Reviews and More. Web. 08 Sept. 2011. <http://pilates.about.com/od/pilatesexercises/a/PilatesPosture.htm>.
3. "Pilates Magic Circle: Core Exercises | Women's Health Magazine." Women's Health: Health, Fitness, Weight Loss, Healthy Recipes & Beauty. Web. 08 Sept. 2011. <http://www.womenshealthmag.com/weight-loss/magic-circle>.
4. Sommers, Susan. "Keep Your Shoulders Down!" Pilates Instructor New York City 10023, NYC, Pilates over 50. Web. 08 Sept. 2011. <http://www.pilatesbodynyc.com/keep-your-shoulders-down/>.
5. "WHO | Data and Statistics." Occupational Health. WHO. Web. 01 Apr. 2011. <http://www.who.int/research/en/>.
6. Herzog W. Biomechanical analysis of human and animal movement. In: Windhorst U, Johansson H, editors. Modern techniques in neuroscience research. Umea: Springer; 2003. P. 869-92.
7. Kendall, Florence Peterson. Muscles, Testing and Function with Posture and Pain. Baltimore, MD: Lippincott Williams & Wilkins, 2005. Print.
8. Armstrong TJ, Buckle P, Fine LJ, Hadberg M, Jonsson B, Kilbom A, et al. [1993]. A conceptual model for work-related neck and upper-limb musculoskeletal disorders. Scand J Work Environ Health 19(2):73–84.
9. Larsson, R., H. Cai, Q. Zhang, P. Å. Öberg, and S. E. Larsson. "Visualization of Chronic Neck—shoulder Pain: Impaired Microcirculation in the Upper Trapezius Muscle in Chronic Cervico-brachial Pain." Occupational Medicine 48.3 (1998): 189-94. Print.
10. Calais-Germain, Blandine. Anatomy of Movement. Seattle: Eastland, 2007. Print.