Hello and good evening/afternoon/morning to those of you who still follow my blog (although it’s been dormant for a while) and to those who perchance have happened upon my writings.
Between my recent readings which have included Tribes (Seth Godin) and The War of Art (Steven Pressfield), maturation in my work as a strength and conditioning coach, and recent entrance into the gauntlet of fire that is the first term of my DPT (doctorate of physical therapy) program, I’ve felt a calling to write more. If I want professional writing to be a part of my career, I’ve come to the realization that I should approach writing as a regular endeavor rather than “waiting” for the perfect inspiration to strike. Here it goes.
My aim of today’s post, and the others to come, is to share:
- my journey in education and life
- my raw opinions, thoughts, and unanswered questions on topics relating to physical therapy, movement, mindset, nutrition, and training
- some insights and tips I think could benefit other practitioners, athletes, and everyday folks in the realms of physical, mental, and emotional self-care
I go through phases of curiosity over different areas of the body and pathological movement patterns I see around me. As of late, upper back “tightness” (specifically in the region of the top three or four vertebral segments of the thoracic spine) has been on my radar (although, I really dislike the use of the word “tight” as a qualification due to its ambiguity but at this point, I don’t know a better alternative), and I’ve been seeing needs to remedy it everywhere. My mom who is a runner swings her arms from her glenohumeral joints while her scaps and upper back remain fixed and the other day, woke up at 4:30am up with a non-traumatic spasm in her upper back and neck that was so bad she was nauseous and couldn’t move for hours. My dad and two of my training clients, all of whom spend long hours seated at computers, lack rotation in those upper thoracic segments and have recently developed anterior/middle shoulder aching and pinching sensations in the proximal regions of their shoulders. I, personally, have also worked around my own cervicogenic “tension” headaches that occur from workouts or during times of stress (read: sitting in school or studying for long hours) for the last couple of years, and I believe a stiff upper back to be a contributor.
The cluster of associated signs includes some degree of an anterior head carriage, tight upper traps/pec minor/levators/scalenes/
SCMs SCOMs, and/or internally rotated shoulders (yes, I’m pretty much describing upper cross syndrome). Really, who doesn’t have some degree of UXS nowadays? With such prevalence, I think it’s important for me, as a practitioner, to learn how to address it, but I get frustrated because I haven’t figured it out yet (and I don’t think that many practitioners have either). I’m constantly running into sticking points with myself and my clients, and I think that sticking points arise when a prescribed intervention addresses a symptom of a problem rather than the root cause or only part of a more complex root cause. For example, massaging an individual’s tight levator might provide temporary relief, but without addressing the reason that muscle is tight, it will undoubtedly get tight again. Performing a thoracic spine mobilizing intervention (i.e., spinal manipulation, “open the book,” “thread the needle,” etc.) may be a good step in the process of alleviating upper back issues but if the root cause is related to suboptimal respiration mechanics (for example, excessive use of accessory musculature), the 20,000 breaths an individual takes in a day utilizing those dysfunctional mechanics are going to quickly revert any progress made until addressed.
As I type these thoughts, the conclusion I’ve arrived at for today (and it may be different tomorrow) is that the best way to address upper back “tightness” is
1) to learn how to differentially assess each of these areas, including breathing, soft tissue quality, strength/capacity of affected musculature (MMT), mobility, and mechanics in a way that helps identify weak/dysfunctional links and address those specifically.
2) continue learning and refer to other practitioners when problems arise that are out of your scope
As a final thought, any interventions/treatments done only once will not completely solve problems that have occurred over many days/months/years. Consistency with an intervention over a period of time is the only way to create and enforce the desired adaptations.
What are your thoughts on this topic? How do you assess and approach it? Do you run into sticking points with your clients/self?
Yours in Movement,