January 19, 2018 written by Marty Morales

Dr. Vladimir Janda’s Upper Crossed Syndrome was an eye opener for many practitioners.  In it Dr. Janda stated that a syndrome occurred when people were exhibiting slumped shoulders.  Not only were the shoulders slumped but a muscle imbalance and muscle weakness pattern arose.  This combination lead the way to Dr. Janda creating an approach to slumped shoulders that included assessment of the shoulder regain along with exercises to strengthen weak muscles. 

Practitioners of manual therapy have stepped in as well, using their skills and modalities to address soft tissue tightness. 

But is this where the story ends?  For the Structural Integration (SI) practitioner, this is the beginning of the story.

In this article we will explore the potential for further work using the Upper Crossed Syndrome as a model and exploring two different ways of working from an SI point of view.

Upper Crossed and Directional Resistance

So, let’s say we’ve got a client with Upper Crossed Syndrome (UCS).  They may typically exhibit the posture as seen in the image above.  As Dr. Janda pointed out there’s tightness in the pectoralis area and in the upper trapezius area. 

In the MMASI form of SI, we deal with a term called, Directional Resistance.  Directional Resistance is the palpatory sensation you get when you sink into tissue (into end range) and you feel that the tissue resistance in one specific direction.  The idea of Directional Resistance permeates through the whole of the Morales Method of SI and allows the SI practitioner to work from a ‘functional’ perspective.  Why is this important?  Let me describe a common scenario (not 100% of the time but this is a common scenario) that happens with UCS. 

I may usually see a client with the typical UCS and they may look a bit like this:

Source:  

As I start to palpate the pectoralis tissue and the upper trapezius tissue, keeping Directional Resistance (DR) in mind, I find that the DR will go in this pattern:

Meaning the tissue will be resistant in the superior direction in the anterior territory and will be resistant in the inferior direction in the posterior territory.  I may then start to work in the direction of resistance, going superior (or superior-lateral if the case may be) and inferior (or inferior-lateral if the case may be) in order to create movement or fluidity in the direction of resistance.  The objective here is to create the option or possibility for the shoulder to not have to round.  Work including the arm in order to involve the scapula is also included in this work.  When an appendage (like the humerus in this case) is utilized, care is taken to understand how the rotation of humerus may affect the palpation of the DR of the tissue being worked.

How Do We Know Where To Work?

The Janda approach is great at describing areas to work but as we’ve seen, it may not be necessary to work all of the pectoralis tissue and it may not be feasible time-wise to spend effort working every square centimeter of tissue in the anterior and posterior territories.

For this reason I teach my students to use the secret weapon of manual therapists:  Palpation.

Instead of working ALL of the pectoralis, I encourage my students to follow this method: 

1. Sink to the tissue and palpate to feel where on the pectoralis you feel the MOST DR.  Use that as your starting place. 
2. Stay at the level of depth that you feel is END RANGE and work in the DR.  Slow and steady wins the race.
3. While working the anterior area, you can keep one hand on the pectoralis tissue while the hand moves the client’s arm.  As you’re moving the client’s arm in abduction and/or extension, feel with your other hand where the tissue of the pectoralis doesn’t want to move.  This is where you might want to work.  Follow steps 1 and 2 above.
4. The same can be done on the posterior territory.  You can move the client’s arm as before but also move the scapula.
5. When moving the scapula, have your hand on the rhomboid area to feel for the DR of the upper trapezius, rhomboids, and lower trapezius.
6. You can also have your hand in the territories listed in #5 while moving the client’s humerus

 UCS and SI

Besides using the approach of DR to work UCS, we can also look at UCS from a global perspective, as it is seen when performing SI work.  Before we discuss SI strategies, let’s first ask ourselves two questions with regards to UCS.

1. When looking at a client with UCS, would we assume that the rest of their body is in ‘normal’ alignment?
2. If we answered ‘no’ to question #1, then why are we not working UCS involving the whole body?

A glimpse into the world of SI:  SI practitioners see UCS as not just an upper body issue but as a WHOLE BODY ISSUE. 

Would we expect this?
 

When SI practitioners look at UCS, we look at how the following main body parts will affect the shoulder girdle:

1. Hamstrings
2. Talus
3. Pelvic Girdle (this can be shifted forward as a result of the client attempting to find balance in gravity
4. Atlas
5. Abdominal tissue (superficial and deep) and visceral tissue
6. Resting eye position (the client may have a different orientation to horizon and may need to adjust it in response to a change in their shoulder girdle 

These are just a few of the places an SI practitioner may look at when addressing UCS (in addition to the territories the Janda Approach looks at).  Keep these in mind when working with your clients.  Your client is not just the sum of their parts.  They are a dynamic being with many intersections and relationships that make bodywork a rewarding and challenging craft.

Original article can be viewed on Marty's blog here