Tuesday, September 14, 2010

The Neck Pain Saga –Part 1 – The Trapezius

    The trapezius muscle originates at the base of the skull as well as from a thick ligament (ligamentum nuchae) that arises from the neck vertebrae and from the spinous processes of thoracic vertebrae.  It is a large muscle that is theoretically divided into three parts because its fibers lie in three directions and move differently.  The upper portion’s fibers insert on the lateral (outer) third of the clavicle.  The middle portion’s fibers insert on the acromion process (outer top portion) of the scapula.  The lower portion’s fibers insert on the spine of the scapula.  The upper trapezius (traps) works to elevate the scapula (shrug the shoulders upwards).  The middle fibers of the traps retract the shoulder blades (pull the shoulder blades back and together).  The lower fibers of the traps depress the scapula.   These actions set the shoulders in their proper position. In their proper position, the shoulder blades (the scapulae) form a support like a cup to cradle the head on top of the body.  So it is the trapezius muscle that forms this support meant to hold the head in an erect posture.  When we thrust our head forward we render the trapezius fairly useless of this major duty.   With our head forward, we use the muscles of the neck to support the head instead, dangling it in front of our shoulders.  These neck muscles are not meant to work this way.  Their fibers are aligned in other directions so that their optimal forces pull down toward our shoulders and chest not to push upwards toward our head.  When we use the muscles improperly, they fatigue, and even become damaged and this is the source of so much neck muscle pain and pathology commonly seen.  To correct, or better, avoid developing unhealthy posture and neck pain, one should maintain a healthy trapezius muscle.  Attention must be devoted to all three portions of the muscle.  Shoulder shrugs are a common exercise, well known to most that will exercise the upper traps.  Reverse flys are an example of an exercise that strengthen the middle trapezius though care must be taken to elevate the arms in a “Y” pattern and not simply extend them behind them horizontally because this will emphasize working the rhomboid muscle.  It is harder to find examples of exercises to strengthen the lower traps.   There is an excellent example pictured on the website :(http://www.staceyjaffmd.com/trunkwork.html) Standing with knees bent, slightly flexed at the waist with a straight back, keeping both arms straight, you hold a single weight in both hands and then raise and lower the weight for 12- 16 repetitions.  In the exercise pictured a simultaneous squat is performed to maximize the work accomplished.  There are other trapezius exercises as well, these are just examples. 
      With a strong, healthy trapezius you set yourself straight, literally, correcting, at least, one plane of your posture. 

Monday, September 6, 2010

Getting in shape for a new activity.

     Blog number one.  I wonder how often they start this way?  I have not read many.    It took quite a while to set up the site so my creative drive to write has ebbed.  But this was to be a short topic. 
     I bought new boots this weekend, Labor Day sales adding to their irresitable appeal.  Taupe, suede, to the knee with five inch platform heels.  Now those readers who might be doubting that a board certified physician, especially one specializing in Physiatry might ever purchase such high heels please remember I am human first, and female.  These two aspects of me will win over the medical degree almost always when there are boots at stake, at sale price, that fit well.    I was practical for about 10 minutes in the store, making sure they fit and that I could walk normally.  Then I strut around for another 10 minutes squealing inside (subconsciously making sure my toes did not turn gangrenous).  When I got home I started my new exercise program.  If I am to wear these new boots I am going to have to get my ankles in shape for them.  Ah, here is where my geek shows.  The shoes fit, do not misunderstand me.  But my ankles are not used to holding my weight in the position of such extreme equinus (that means my foot in an extreme pointed position like a ballerina pointing her toe).  I need to improve the range of motion across my ankle, specifically, plantarflexion (or pointing my foot).  I found a photo of the position I like best for stretching the front of the ankle and lower leg:

You gently lean back onto the left leg in this position, using your arms to hold your weight so that you do not over stretch.  You should not feel any pain.  Try holding the position for 30 seconds, fo this 3-5 times each day.  Then switch legs.
    I also wear the boots around the house for short times (30-60 minutes) for conditioning purposes.  The only problem there is that I need help getting them off.  The guys down at the front desk have been very kind about helping with that. 
       See, I do take my own advice.  I do get in shape for "extreme" new activities.