Therapist Spotlight

Dealing with Tension Headache and Tight Shoulders: David and his Upper Crossed Syndrome

In my long career as a massage therapist, I have met a lot of patients who ask why their shoulders are tight, why their neck and head poke forward, and why they slouch. Then I explain to them that these are symptoms of ‘Upper Crossed Syndrome’ (UCS).

I’m sure you must have seen someone around you with Upper Crossed Syndrome, whether you knew the name of the condition or not. A person with UCS looks as if they are hunched over, with their head protruding forward and rounded shoulders. They’ll often complain of problems such as tension-type headaches, stiff shoulders, neck pain, mid/ upper back stiffness, arm and shoulder pain and/or numbness, cracking around the shoulder blade … the list goes on.

Let me give you a real case study of a 44-year-old client called “David”*. He came to The Massage Centre complaining of extreme strain and tension in the shoulders and neck, pain between the shoulder blades and one-sided headaches radiating into the right eye that had been occurring twice weekly for the past 3 years.

My first visual observations found a forward poking head, an exaggeration of the natural curve of the neck and a slouched posture. For about 20 years David had competed in marathons and triathlons, and also worked in a job that involved long hours at a desk. Sitting at the desk, in addition to training time spent hunched over the handlebars of his bike, had locked his posture into a state of contraction through the front of his body.

When I start treating new clients I always address the pelvis first using pelvic stabilization techniques, prior to dealing with chronic pain in any other area of the body. I want to make sure that each client achieves a balance between five basic muscle groups. A balanced pelvis forms a rim-like base for the spinal vertebrae, rib cage, shoulder girdle and head.

David’s assessment revealed a rotated pelvis, which meant that muscles of the lower back and alongside the spine were short on the right and overstretched on the left. I released the contracted right side and balanced the left side using myofascial spreading and cross-fibre gliding strokes before balancing the other muscles around the pelvis through deep tissue massage techniques combined with stretching.

You might ask: “Why did I bother with the lower body, as the main pain was in his shoulders, neck and head?” The answer is simple: total realignment. The main purpose of pelvic stabilization protocol is to create symmetry and balance to allow the innate wisdom of the body to heal itself.

To continue David’s treatment I started treating his Upper Crossed Syndrome by creating symmetry in the upper body and neck. UCS is an extremely common pattern of postural stress, caused by a combination of tight, shortened muscles of the shoulder and neck area “crossed” with their counterparts on the other side of the shoulder girdle that are then inevitably locked into a weakened, lengthened position.

These muscular tone imbalances can be caused by things such as poor posture, long term sitting at a desk, spending a long time driving in a car, injuries and incorrect sleeping positions.

Employing a combination of deep tissue massage, myofascial release, sports and other advanced bodywork techniques allowed me to create a great balance between tight (short) and weak (overstretched) muscles in David’s upper body.

At the end of our first treatment, I gave David some self-care suggestions based on my evaluation and treatment (a few stretches and strengthening exercises). A self-care routine is essential for the client to keep the new “normal” range of motion that was created during the therapy.

Once David’s shoulder and chest muscles had released, in the next few following sessions I could turn my attention to his neck. David’s history indicated that he holds his phone to his right ear by side-bending his neck to the right most of the day leading to extremely tight muscles on that side of his neck, and his head had a limited range of motion in right rotation.

After 6 sessions David was completely pain free and experienced a significant reduction in the tension in his neck and shoulders, greater neck mobility and, most importantly, his headaches were completely gone.

David has returned to his training and is planning his next marathon. Because he spends many hours a day hunched over at the computer which is so hard on his upper body, he gets monthly deep tissue/bodywork balance treatments to realign his posture and reduce stress.

*The client’s name has been changed.