In the last post I discussed how a head-forward posture can,
due to the additional load on the posterior cervical region, contribute to
several injuries and orthopedic disorders. In this post, I will discuss a common
relationship that a head-forward posture has with the shoulder girdle. The sinew
channel relationship to this imbalance will also be discussed with the emphasis on the importance of assessing and treating this common
pattern with acupuncture, tuina, and corrective exercises. In the next post, we will
look at how this postural pattern relates to zangfu disharmony. Acupuncturists
can greatly improve their results by recognizing and addressing this common
postural imbalance when treating a wide range of conditions.
Upper cross syndrome describes a common postural pattern
first discussed by Vladamir Janda, a Czech physician. Janda
described this common upper body muscle imbalance as an X with one leg of the X
consisting of a group of overactive (locked-short)* muscles and the other
consisting of a group of inhibited (locked-long) muscles. This common pattern
is seen with a head-forward posture and scapular protraction.
*Note: locked-long and locked-short is
terminology used by Thomas Myers and also employed by Sports Medicine
Acupuncture. The tendency is for practitioners to think that inhibited muscles
will feel soft and weak on palpation and that overactive muscles will feel ‘tight’.
The reality is that there is often tension in both and they are both locked,
one in a lengthened position, the other in a shortened. For practitioners of
Chinese medicine, it might be helpful to consider the terms 'deficient' and 'excess.'
The muscles that contribute to this imbalance are listed
below and grouped according to the overactive, locked-short leg of the X and
the inhibited, locked-long leg of the X:
- Overactive: Pectoral muscles, posterior cervical extensors, levator scapula, upper trapezius
- Inhibited: Lower and middle trapezius, anterior cervical flexors
The pectoralis minor is particularly important in its
influence on scapular protraction as it has direct attachments to the scapula at
the coracoid process. From the coracoid process, the pectoralis minor has an
attachment to the 3rd, 4th, and 5th ribs. The
fibers attaching to the 3rd rib have a relatively more horizontal
fiber direction compared to the more vertical 5th rib attachment.
This line of pull creates a medial rotation of the scapula, while the 5th
rib attachment creates more of an anterior tilt. Scapular protraction often has
components of both of these when the pectoralis minor is short.
The lower and middle trapezius, highlighted in blue, balancing the pull of the pectoralis minor, highlighted in red. |
Balancing this line of pull is the lower and middle
trapezius and the rhomboids. The lower trapezius balances the downward pull of
the pectoralis minor while both the middle trapezius and rhomboids counter the
movement of the scapula away from the midline. Both the lower and middle
trapezius and the rhomboids have a tendency to become inhibited and fail to
properly resist the pectoralis minor.
From A Manual of Acupuncture, by Peter Deadman. Notice the connection of the LI sinew channel to the thoracic spine. |
For acupuncturists, it can be very informative to review the
pathway for the Large Intestine and Lung sinew channels. The Large Intestine
sinew channel expands the influence of the primary channel as it attaches to
the thoracic spine. I believe this to include a continuous sequence of muscles
and fascial structures which start with the first dorsal interosseus muscle
(accessible at LI-3 and LI-4) and continuing up the arm to connect, via the
middle and lower trapezius, to the thoracic spine. The Lung sinew channel
begins at the thenar muscles and continues up the arm to connect, via the
pectoralis minor, to the ribs.
What this means is that the internally-externally related
Lung and Large Intestine sinew channels work together to balance the shoulder
girdle on the ribcage. When there is an imbalance between these two related
channels, this is frequently seen with scapular protraction.
However, upper cross syndrome also describes cervical muscle
imbalance. This includes the overactive cervical extensors on the posterior
neck and the inhibited cervical flexors on the anterior neck. These can also be
seen as an imbalance between internally-externally related sinew channels. The
Urinary Bladder sinew channel includes the posterior cervical muscles, while the
Kidney sinew channel includes the deep anterior cervical muscles such as the
longus colli and longus capitis.
Even the pectoralis major can be seen to have a connection
to the Urinary Bladder sinew channel. Through the thoracolumbar fascia, the
Urinary Bladder sinew channel has a branch that I interpret as the latissimus
dorsi. The latissimus dorsi attaches to the medial lip of the bicipital groove,
in very close proximity to the attachment of the pectoralis major. However,
classically the sinew channels are said to converge, and I believe the
pectoralis major to be also part of the Heart sinew channel, so it is a region where the Urinary
Bladder and Heart sinew channels converge.
BL-60 Kunlun, from A Manual of Acupuncture, by Peter Deadman |
Also, there is a branch that attaches to the shoulder and
connects with another area of convergence, the lower trapezius (this time converging with the LI sinew channel). In my view, both
of these branches of the Urinary Bladder sinew channel (lats and lower traps) help explain how
excessive pathological Yang can rise and contribute to tension manifesting in
excess (overactivity) in the neck, shoulders and chest. It is helpful to review
commentary about BL-60 Kunlun and
understand that this point ‘Clears heat and lowers excess’. In addition it ‘pacifies
wind and leads down excess’. This involves Liver disharmony with pathological Yang
rising up the Urinary Bladder channel. This rising Yang often contributes to occipital headaches, neck pain, and shoulder pain. BL-60 Kunlun
treats the manifestations of this rising Yang, often in combinations with SI-3 Houxi. Being a Jing-River point, it is an excellent point to
relax the sinews, in this case associated with the Urinary Bladder sinew
channel.
BL-60 Kunlun
is a useful distal point to treat the rising Yang activity which contributes to
the imbalance discussed with UCS, but in order to fully take patients out of this
dysfunctional pattern, it is necessary to treat locally. Acupuncture to motor
points of the affected muscles (both inhibited and overactive) is a great
strategy to reset dysfunctional muscle spindles and balance the
internally-externally related channels. In addition, tuina/myofascial release
and corrective exercises help increase the therapeutic results.
UCS, therefore, offers fantastic insight into the
coordinated balance between the sinew channels and common patterns of
dysfunction that occur between internally-externally related channels. The
Lung-Large Intestine sinew channels work together to balance the shoulder
girdle, while the Urinary Bladder-Kidney sinew channels work together to balance
the cervical spine.
"BL-10 Kunlun treats the manifestations of this rising Yang..."
ReplyDeleteTypo : BL-60