Is your Neck Pain Upper Cross Syndrome (UCS)?

Upper Cross Syndrome (UCS) is quite literally a ‘pain in the neck’!

Have you visited your practitioner with neck pain? Do you have a desk-based job? Are you suffering from headaches?  If so, the likelihood is that your practitioner has diagnosed your symptoms as Upper Cross Syndrome (UCS).

This may make plenty of sense as he/she demonstrates the process on a flexible plastic skeleton, alongside lots of head bobbing and chair slumping. However, the second you get back into your car and start looking at your full work inbox and re-adopt a poor driving position, the advice that seemed so obvious and important just a few minutes earlier may be forgotten and your actions may have the effect of aggravating your symptoms.

What is Upper Cross Syndrome?

UCS is used to describe a muscular imbalance at the neck and shoulder girdle. It is most commonly seen in individuals who have a sedentary desk-based job. Being confined to hours in front of a screen often leads to certain muscle groups becoming “shortened and tight”, whilst others will become “long and weak”. This is as a result of imbalance in use between the different muscle groups.

Short and Tight: Posterior (back) neck musculature, upper trapezius and levator scapulae, pectoralis musculature.

Long and Weak: Anterior (front) neck musculature, rhomboids, middle trapezius and serratus anterior.

How does it cause pain?

Most commonly, symptoms include neck and upper shoulder pain, often with associated headaches and potentially arm symptoms. The postural changes seen above result in muscular imbalance and a forward head posture. This can simply increase the workload on individual muscle groups and lead to exhaustion. This tends to produce the constant dull achey symptoms around the base of the neck and shoulders.

The forward head posture can also affect joint performance and it is often this that leads to the more acute or sharp pains. Our skeletal system is designed to weight bear predominantly through the vertebral bodies of our spinal column. However, with the forward head posture, we tend to increase the load on the (facet) joints of our neck rather than utilising the vertebral bodies. This not only approximates our joints leading to wear and tear but also reduces the function of our spinal column. This often manifests itself as sharp pain in the neck on rotation (turning our head) and extension (looking up).

Other causes of pain tend to be as a result of neurological compromise, often predisposed by dysfunction to the joints or discal portions of the spine. These may manifest themselves as arm pain, pins and needles, numbness or more commonly as headaches.

How can Osteopathy help?

As Osteopaths, we see UCS many times a day and treatment will vary depending on symptoms and causality. However, the common principle remains the same, increase the movement in areas of stiffness to reduce the load on the areas under strain and improve muscular health to further support and maintain the changes that are made.

A wide variety of treatment approaches are likely to be used including manipulation and articulation of joints, soft tissue massage and stretching to improve muscular health. Further management will include exercises and most importantly education.  UCS is most commonly a result of habitual dysfunction and will require daily alterations to maintain long-term health.

Here are some great home remedies to help battle UCS:

  • Chin tucks – Stand with your back to the wall and attempt to press as much of your spine against it. Elongate the back of your neck and push back against the wall, aim to create the ever-gorgeous double chin. Hold for 5 seconds and relax for 2 before repeating.
  • Pec stretch – Standing within a doorframe, place one arm against the upright with 90 degree angles at both the elbow and shoulder. From this position, step forward to push your chest in front of your elbow which should be fixed by the doorframe. Please note that this is not an exercise to see how far you can get your head forwards so aim to keep your chin over your chest. Hold for at least 20 seconds and repeat on the other side.
  • Wall angles – Standing with your back to the wall, aim to elongate your spine and push as much of your back and neck to the wall. Please note that it is likely you will not be able to flatten your entire back to the wall due to your natural anatomical curves. With your arms by your side, slowly raise them up along the wall to above your head (much like a snow angel). To improve difficulty bend the elbows to 90 degrees and try to keep your hands in contact with the wall at all times. This exercise should be performed slowly and the aim is to strengthen your rhomboids muscles between your shoulder blades.
  • Thoracic extensions – Best performed seated so a great one for those long hours at the desk. Link your fingers behind your neck and bring elbows together by your ears. From hear, do what you do best, slump (You won’t hear me say that too often!). On your inhale pull your elbows part from one another whilst keeping your fingers linked and sit up to open your chest. You should aim to lift your sternum (breastbone) towards the ceiling during this movement. On the exhale relax back to the initial slump and repeat.  
  • Gym time exercises – Face pulls, seated row, lateral pull down, pull ups (please ask your personal trainer for advice during these activities if unsure).

Dominic Malone, Registered Osteopath, Teddington Osteopaths


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