Be Fit For Life

with Ellen Cohen-Kaplan

Before you get stuck in that position……..

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This weekend I attended a conference on Upper Crossed Syndrome and trigger points given by Katie Adams, the founder of 360 Neuromuscular Therapy Associates I have a lot of respect for these folks. They can diagnose referred pain, uncoil muscle knots, and relieve chronic discomfort through their advanced techniques. Although the course was intended for massage therapists, I wanted to understand more and know when to refer people for chronic myofascial pain. Upper Crossed Syndrome is a condition where there’s a forward posture of the head, neck and shoulders, often resulting in slumped shoulders, forward hanging head, weak upper back and tight chest muscles.  There are 11 muscles that work together to move the shoulder, so it’s not surprising that this is a major area of concentration for trigger points.

These are a few pearls I’d like to share with you.

1. It takes only 30 minutes in a static sitting position to cause trigger points to form, those small tangles of muscle fibers that are tender to the touch, or give us pain even when not using those muscles. Each person’s pain is predicated on the positions he/she assumes for many hours per day. For most of us, this is a sitting position, with head, neck and shoulders forward, with elbows and fingers flexed. Think of the sheer volume of things we do in this position: driving, computer work, sitting watching TV or movies.  Even exercise can be a culprit if you’re cycling, running or regularly working out just the front part of your body. We need to strengthen and release the extensor muscles on our mid and upper backs and back of our shoulders, which become weak and inhibited, and stretch and release the tight flexor muscles in our chest and front part of our shoulders.

2. Specificity is more important than pressure when working with trigger points. I used to think the more I could withstand the pressure during a massage, the better and more effective the massage was. Some soreness is expected, but if you’re in a lot of pain a few days after the massage, it may have been too much. When a trigger point is found, apply pressure on it from 8 seconds to a minute until the pain dissipates or lessens considerably. A knowledgeable massage therapist will get to that spot quickly, and ideally be able to release it. Your time during a massage may be better spent focusing on the spots that are particularly sore, rather than getting a full body massage (although I know that feels great!)

3.  The inflammatory trigger points, when examined chemically were higher in acidity, thus relating back to the efficacy of an anti-inflammatory diet. This focuses on foods that are more alkaline-rich like salad greens, cauliflower, citrus fruits, and avocado and spices such as chili powder, curry, paprika, cumin and ginger. Drink water with lemon or lime slices to increase alkaline before eating acid-promoting foods. Go to to check out more anti-inflammatory foods.

4. Referred pain is very common. You may feel pain in your biceps muscle, but the nerve pathway causes it to be passed on down the line to that area- the origin is often from a different place in  your body. We’re connected through an intricate network of nerves, muscles, and fascia that run from our toes to the base of our skull.

An ounce of prevention may be better than a pound of cure. Try to get to the root of the cause. Stretching, strengthening and frequent changes of position are your first line of defense. Some simple ways to do this are outlined below.

  • Set a timer on your phone or computer for every 30 minutes to remind you to take a break, stretch and change positions.
  • Sit on a stability ball which may prevent you from being in the forward flexed posture.
  • Shoot for the ergonomic  position # 3  and the comfortable workstation pictured below.

computer-workstation-ergonomics-seating-posture-1                                images-8

  •  Self massage, rolling, and finding and applying pressure to your trigger points can help reduce pain and restore circulation to the area. A small hand massager, like these from Brookstone can make a sizable difference in increasing blood flow to the area.  841263p

Get regular massages if you have ongoing pain and spots are usually sore and tender. If the pain does not dissipate after 1-4 treatments of myofascial work, either by a massage therapist or neuromuscular therapist, the source of  the pain is likely not related to muscle and fascia .

  • Do this Brugger’s exercise- less than 1 minute every half hour can make a difference!


Stay tuned next week for a post that deals with specific exercises you can do to strengthen your back and neck extensors. Small changes in habits and positional awareness can make a large difference in pain reduction and improving posture. Think of what you can do to get to the cause of your symptoms. Better posture will help you balance your flexor and extensor muscles, reduce pain, and make you appear years younger than you are – it’s much cheaper than a face lift!

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