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Upper Crossed Syndrome
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Upper Crossed Syndrome

I am a non practicing dentist, & have had chronic muscle imbalance/pain issues in my chest, upper back & shoulders which has an official diagnosis of Upper Crossed Syndrome.   Basically it is a shortening and tightening of the flexor musles, ie upper trap, lat dorsi, pecs,lev scapula/psoas and a weakening/lengthening of the extensors and serratus anterior, along with the muscles that support the spine logitudinally. All tests normal incl MRI emgs CT scans etc.

QUESTION:  I've been told that due to the weakening in my back (I have pain in the cervical/thoracic junction down to about t5), I've also lost turgor/strength in the spinal ligaments in these areas.  They are stretched probably from posture as a dentist and I can feel this as being able easily "crack" or "adjust" these vertebrae with mild sideways stretching, which comes w short term pain relief in my back as well as around the ribcage. If I correct posture, and do the appropriate exercises in strengthening my mid back and loosening the flexors, will the ligaments heal and tighten? What if they are torn? Is there a way to surgically repair them without fusing the vertebrae? Or are torn ligaments unlikely without a specific traumatic incident? Is there any merit to prolotherapy? (prolotherapy involves the injection into the ligamentous tissue of inflammation causing solutuions (containing dextrose) with the theory that the inflammation recruits fibroblasts and regrowth of tissue)). thanx for your insight!
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Avatar_n_tn
I have never heard of upper crossed syndrome - you learn something new every day!

In general, conservative treatment (ie not surgery) is reccomended for ligament/soft tissue strain or damage. With the right combination of MULTI-DISCIPLINARY therapies to this type of problem, there should be significant resolution. THis involves the right type of PT and posture training, occupational therpay, analgesics, muscle relaxants, and psychtherapy for chronic pain /adaption issues. Any one of these alone is unlikely to succeed. Surgery is a significant trauam in and of itself and should be avoided unless really needed. Prolotherapy is unproven scientiffically, and should be used with knowledge of this, and prudent caution, and awareness of risks and benefit.

Good luck.
19 Comments
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Avatar_n_tn
Hi Cindy :

You make the whole issue so complex ,i believe the shape of your spinal column related to congenital or heridatory factors , but your job could only evoke the pain . I believe wrong /aggressive exercise/training could creat pain and more tightness .

If i were you i would not take the risk of injection , just ask The MD if he/she in your position will he/she has thus injection ??

I think  every deformity could be categorised according severity degrees .I like to add every time you keep erect thus could fatigue the mucsles thus which you are currently complaining .

I have not completed reading your post to reach the surgical approach or i did not take it much attentively .

Regards
Emad
www.somasimple.com/forums/
physiotherapist
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Avatar_m_tn
emad--- are you familiar at all with upper crossed syndrome? the syndrome is somewhat specific with regard to which muscles asre "lengthened" and weak (erectors), and which ones are "short" and tight (flexors). According to the literature, ifleft untreated or unrecognized, the spine in the cervico-thoracic junction (c7,t1 down to maybe t4 or 5) takes the blunt of the stress because it acts as the fulcrum for the imbalance...... there is also a fairly specific remedy which logically involves strengthening the  torso/upper trunk erectors and stretching the flexors. the syndrome is indeed quite painful constant spasm and pain in the upper/ mid back, neck, and chest---- if you are against prolotherapy and the proper exercises, what is your remedy?
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Avatar_m_tn
ps... emad, due to the pain i haven't practiced for 1 1/2 years, with very little improvement until my very recent diagnosis and proper muscle exercise/stretching........
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Avatar_n_tn
Hello Mike :

Sorry that you have not practised as dentist for the last years becausae of pain .

I advise you to search for The Feldenkrais Method speicalist or physiotherapist studied that method or Alexander Technique specialist ,there may be physiotherapist practise using those techniques .

Or you may address it by yourself http://www.posturepage.com/bookshop/feldenkrais/

Good Luck

Emad
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Avatar_n_tn
Hi Cindy,
I have the exact same problem as you,ligamentous damage, even in the same areas[T3-T6]. All of my scans are normal, doctors diagnosed by deductive reasoning[also repetitive stress]. I can't tell you how many treatments I have had to get rid of this pain. I have tried many sessions of prolotherapy,absolutely useless. I have also tried chiropractic, lidocaine injections, facet injections and lots of pt.I do know there is a non-fusion stabilization called Dynesys system. The only problem is, I don't know if they will place it in the areas that we have trouble, and doctors don't seem to take this problem seriously, especially if they can't see it.I wish there were better diagnostic scans for spinal ligament problems.
Well, lots of luck to you.
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Avatar_m_tn
taylor, how did you develop this problem......??? research upper crossed syndrome.
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Avatar_n_tn
Hi Mike,
I am a violinist, and I believe I got this problem from playing 6 hours a day for years[since I was 2]. I think the ligaments on the right side of my spine were stretched from constantly twisting to the left, because it always locks out of place to the left. A physical therapist mentioned to me that I might have this syndrome.
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Avatar_m_tn
taylor- research the syndrome online- i could see easily how this could affect you, and i know it is painful. check out dr jolie bookspan's website about fixing your pain. ligaments can heal if your posture is corrected and you do the proper exercises. you can fix this problem .
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Avatar_n_tn
Hi Mike,
I did check out the website you mentioned, and it looks very interesting- I will give it a try. Thanks a lot for the advice-much appreciated!
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Avatar_m_tn
taylor, you , like me, didn't get like this overnight, it took decades. what is important (I communicated with dr bookspan a few time by emai) is that you don't just do the exercises and posture check (against the wall) and then go on with your day.  You need to keep the posture ALL DAY LONG. ie-- if you slump, slouch, or lean or flex forward (ie like when you play your fiddle) you negate whatever exercises you are doing. I'm 3 days into this routine and it is tough. i feel very uncomfortable trying to maintain the posture I establish when i stand against the wall. But when i do, i really do not have the old familiar pain.  we need to create NEW postures--- it's an ALL THE TIME thing........... Bookspan said you should also be doing the pec stretch and the trap stretch many times during the day-- as often as you can.. it will make it easier to maintain good posture because the shortened muscles will not be fighting so much.. do you watch American Idol??? ryan Seacrest has an awesone posture !!!! I noticed it last night... When i try to stand like that, i feel like i am straining. but that's ok--- eventually it should become natural-- like a new golf grip i guess.  also sleep flat on your back with a thin pillow to maintain extension. when you curl up into the fetal position you are shortening your front and stretching your back-- the opposite of what you want to do.  good luck-- keep me posted at ***@****
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Avatar_n_tn
I am wondering after reading your posts if maybe I have this. I have always had poor posture.  I never really noticed any problems until my 3rd child was born. I started having neck pain and trigger points all down my spine about a week after she was born. I am still having the same problem with a few new symptoms. The muscles along my spine hurt only when I am moving. If I flex my back or pull my shoulders back I have this awful pain and soreness. The pain is also bad between the shoulder blades.   I dont know if I did something after having my baby or if this is something that started years ago.  I was a cheerleader and was also in gymnastics from a very early age. Who knows....maybe I did some damage then and the birth of my child was the breaking point. I dont know about any of you...but I have tried massage and it was so painful afterwards that I couldnt bare to go back. I felt like my muscles in my back were bruised. It was awful!  CT scans of cervical and thoracic spine were normal so my Dr thinks it is definately muscular.
If anyone has any suggestions, I would really appreciate it!
Thanks!
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Avatar_m_tn
courtney, your problem sounds exactly like mine.... it's been a few weeks since i decided i had to try to fix my own problem, and committed to fixing my own back, and it is working!!!!! i had nasty pain in the middle of my back and between my shoulder blades. also in the upper trapezius muscle behind and on the sides of the neck. I was also very tight in the chest and got pain in my pectoral muscles. i still have pain, but it is better and i am able to lessen it more and more drastically each week with a few simple stretches and exercises.
Fortunately, i have medical training (i am a dentist) and studied anatomy, so when i read about Upper Crossed Syndrome and the muscles invlolved it all made sense. You may need to get an anatomy book and study, but your case sounds very familiar and actually reassures me that I myself do not have some phantom disease or condition causing all this pain.
It doesn't matter how you got this way, but it is indeed a postural issue. If your MRIs and tests are all normal, or at least do not explain your pain, then you need to study the anatomy/muscles involved in this syndrome, and consult with a personal trainer or qualified posture/exercise therapist to help you get started fixing yourself. I would start with Dr. Jolie Bookspan's website.. good luck.... you can keep me posted at ***@****....... Ps i played 18 holes last week for the first time in 3 years!!!!!
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Avatar_m_tn
courtney-- read your post again...... 1. I too was painfully sore after having those same mid-back/painful muscles massaged--- these muscles do not need massage, they need the opposite, which is strengthening. stretching them or loosening them with massage could be making you worse. your neck and UPPER back muscles need the massage. the middle and lower trapezius muscles, along with the very painful rhomboids (again, get an anatomy book or muscle chart) need to be WORKED. get committed and after a few weeks you should begin to feel better--- again-- i never met him, but Dr. Jolie Bookspan may have saved my life--- i was in agony 24/7.
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Avatar_n_tn
Thank you Mike for your input.  I am desperate at this point. I have worried myself sick over this....worrying that I have some life-threatening disease.  It makes me feel better to know that I am not the only one with this problem.  Don't get me wrong.....I'm sorry that you suffer from this, but it does make me feel a little better knowing that it's not serious. I will look in my anatomy books. I am an RN but am a little rusty on all the muscle anatomy. I work for a neurosurgeon and anything outside of neuro is foggy. :)
You said that you get the bilateral neck tightness also?
I have even had some dizziness when this first started. It was almost like a whiplash or something. The muscles around my neck and upper back are always tight. I feel like no matter what I do they don't relax. Does this sound familiar?  I have researched and researched trying to find some answers and maybe ease my mind. I really appreciate you responding to my post.  I will definately keep you posted.
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Avatar_n_tn
Mike.....one more thing...did you ever feel an overall weakness.  When I am really sore I feel weak all over even in my legs. It sometimes feels as though all of my muscles are sore.  My Dr. even mentioned possible Fibromyalgia.  I sure hope not! I was just curious if you have experienced this also.
Thanks!
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Avatar_m_tn
courtney---- your case sounds strikingly similar to mine. when your muscle balance is out of whack, strange things happen-- usually i'd get weird pains in different places each day, along with the familiar mid-back pain (between the shoulder blades) and neck pain (scm, upper traps). It confused the heck out of my MDs. I'm tellin ya, read about Upper Crossed Syndrome. Do a search for Bookspan, Vladimir Janda (who idetified the syndrome) and Erik Dalton. I'd lay odds that this is your problem. There is no phantom disease that causes these symptoms, it's muscle imbalance and you can fix it. I am better now than I was when i made my last post. i hired a personal trainer familiar with the syndrome. i'm fixing this problem on my own. If left unchecked, it can only get worse, and I'm sure could lead to FM-- which in the opinion of some experts is a widespread myofascial issue. Read, study, and get to work--there's a good chance you'll feel better in a month.
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Avatar_m_tn
PS--- one lesson---- after  3 years and tens of thousands of dollars in medical costs and surgeries that did not help, i have learned one thing: No one can fix your body better than you can in this case. It takes research and work.I have given you the research/answers it took me 3 years to find. All you have to do is decide to get better. How badly do you want to feel better?????? Now get goin. Did you see "The Lord of the Rings?"  Gandalf said to Frodo: "All you have to decide is what to do with the time that is given to you." Now go do your pectoral stretch and trap stretch. then stand against the wall and check your posture. Then stay like that---- forever... it's simple. Go. NOW!!!! (and stop hunching over your computer)
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Avatar_n_tn
Thanks Mike!  I will get on this now. I really appreciate the great advise. I am glad that you are feeling better!  Hopefully I will be better soon also.  Thanks again and take care!
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