When looking at wheelchair bound individuals, each individual pattern of movement is different from the next.

Sitting, back pain, head aches...why??

A few weekends ago, I was afforded the opportunity to work with BC Wheelchair Basketball as they hosted a Canada West tournament. This tournament was in preparation for the upcoming Canada winter games taking place in Prince George. I could go on for ages to speak about just how amazing these athletes are; how they’ve been able to overcome adversity, both physical and mental, to become the best at what they do. Not only is the sport itself fun to watch, but the whole game is surrounded and supported by other former wheelchair athletes, fathers, mothers, husbands, wives, brothers, sisters and children who aim to give back to their respective community. It is apparent, more so than in any other sport I’ve ever seen, that the sport is just the surface, and that there is a greater impact on a holistic level to the lives of all involved.

If you haven’t seen a game, you’re missing out. You should treat yourself.

Ok, lets get back to some MSK talk. The human movement pattern fascinates me. However, with individuals who are wheelchair bound, the typical bipedal motions of movement are, most certainly, affected. When looking at wheelchair bound individuals, each individual pattern of movement is different from the next. Whether an individual is hemiparetic, paralyzed from T5 and down, or has unilateral lower limb dystonia, they must propel themselves forward in their chair, pick up or shoot a basketball, in a different manner. I will definitely be doing some more investigative work to understand this further and will report back to my legion of blog readers (In a dream world.)

I want to relate today’s blog to an issue that I saw this weekend.  Given the hunched over body position for wheelchair propulsion, multiple athletes approached me asking about their chronic upper back and neck pain. In my first blog post, I discussed posture and briefly touched on Vladamir Janda’s upper crossed syndrome. Today I want to further elaborate on this topic and give everyone a picture view as to what it actually is.

Upper crossed syndrome (a.k.a proximal or shoulder girdle crossed-syndrome) is defined as tightness within the upper trapezius, levator scapulae, pectoralis major, pectoralis minor, and suboccipital muscles (the headache muscles); combined with weakness of the deep neck flexors, middle and lower trapezius, rhomboids and serratus anterior.  I suggest leaning on dr. google for images of each of these muscles. Or you can take my word for it that they are found in the neck, chest, upper back and shoulders.

This pattern of muscle imbalance creates dysfunction within the joint of our neck, upper back and shoulders. Specifically, the transitional zones where the vertebrae of our spine change morphology:

  • Atlanto-occpital joint (where our head meets our neck)
  • C4-C5 segment (mid way down the neck)
  • Cervicothoracic joint (where our neck meets our upper back)
  • Gleno-humeral joint (shoulder joint)
  • T4-T5 segment (mid point of our upper back)

An individual who has these muscle imbalances typically display:

  • Forward head posture
  • Increased cervical lordosis (neck curve)
  • Increased thoracic kyphosis (upper back curve)
  • Elevated and protracted shoulders
  • Rotation or abduction and winging of the scapulae

These postural changes in our spine reflect a domino effect into our shoulders. Our glenoid fossa becomes more vertical due to serratus anterior weakness. This then leads to rotation and winging of our shoulder blades. This in turn affects the stability within our shoulder. The cascade effect then calls upon our levator scapulae and upper trapezius muscles to compensate for the lack of shoulder stability.

As you can see, these muscle imbalances can cause quite a cascade effect. It’s no wonder that individuals with this stooped forward posture complain about headaches, neck, shoulder, arm and upper back pain.

So this then leads us to the ultimate question: if this is me, what on earth can I do about it?

  1. Go back to my post on posture. Learn it. Love it. Use it.
  2. Consult an expert in the field of muscolskeletal dysfunctions (Chiro, Physio etc.) They will help you in treating muscle imbalances with their respective techniques (I use Active Release Technique, proprioceptive neuromuscular facilitation and exercise rehabilitation; I have found great success with this.). They will also guide you and instruct you on how to do certain movements, tasks, and exercises PROPERLY, as these could potentially be worsening your current condition.
  3. If you feel you must do it all on your own without the help of an expert here’s my quick how to guide: stretch your pecs, upper traps and levator scapula. Strengthen your rhomboids, serratus anterior, lower traps and deep neck flexors. Consult Dr. google for a few exercises on how to do each one.

In another post I will touch on the neurological perspective when looking at chronic musculoskeletal pain. I feel that it would be a bold move to tack it on to the end of this. It is pretty interesting stuff! Tell your friends. 

As always, if you have any questions, concerns or comments, please post them below or stop by Satori and we can grab a tea (I’m officially off the coffee now) and chat about it all.