Newsletter excerpts: upper crossed syndrome and text neck--Dec 2018

Michelle Burns
December 30, 2018

Here is some of the information I recently shared in my December newsletter. Each newsletter has a specific focus.  This month is focused on upper crossed syndrome and text neck information. If you would be interested in receiving my newsletters, please head over to my contact page and sign up.


I receive a weekly update on anything published anywhere on the internet that includes information about neck problems.  I try to glean the best of the information and provide a brief synopsis of the information. If you come across any information that you think would be good to share, please also feel free to pass that information along to:

1. A review article, titled Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration, published in Spine J in Dec 2016, concluded: our review…suggests that mobilization, manipulation, and clinical massage are effective interventions for the management of neck pain. It also suggests that electroacupuncture, strain-counterstrain, relaxation massage, and some passive physical modalities (heat, cold, diathermy, hydrotherapy, and ultrasound) are not effective and should not be used to manage neck pain. 

2. A study, published J Manipulative Physiol Ther in Oct 2016, titled The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline concludes: a multimodal approach including manual therapy, self-management advice, and exercise is an effective treatment strategy for both recent-onset and persistent neck pain.

3. A study published in J Bodyw Mov Ther in April 2017, titled The local and referred pain patterns of the longus colli muscle found: the pain referral pattern during deep massage and needling of the longus colli was primarily local, with referral to the ipsilateral ear and lateral to the ipsilateral eye. Some subjects reported pain on the contralateral side of the neck.

4. A study, Comparing Trigger Point Dry Needling and Manual Pressure Technique for the Management of Myofascial Neck/Shoulder Pain: A Randomized Clinical Trial published in J Manipulative Physiol Ther in Jan 2017, concluded: both treatment techniques lead to short-term and long-term treatment effects. Dry needling was found to be no more effective than MP in the treatment of myofascial neck/shoulder pain.

5. A study, Comparison of isometric cervical flexor and isometric cervical extensor system exercises on patients with neuromuscular imbalance and cervical crossed syndrome associated forward head posture published in Biomed Mater Eng in 2018, concluded:  compelling, mechanistic evidence as to how Isometric cervical extensor system exercise is more beneficial for the restoration of neuromuscular imbalance than isometric cervical flexor system exercise in individuals with cervical crossed syndrome. 

6. A study, Effectiveness of the Pilates Method in the Treatment of chronic mechanical neck pain: a randomized controlled trial published in Archives of Physical Medicine and Rehabilitation In Sept 2018, concludes: this trial demonstrated the effectiveness of the Pilates method for the treatment of chronic mechanical neck pain, resulting in improvement of pain, function, quality of life, and reduction of the use of analgesics.

7. A study published at ScienceDirect—Annals of Physical and Rehabilitation Medicine, titled The effectiveness of kinesio taping on pain, range of motion and disability in patients with chronic neck pain: A randomized controlled study concluded: kinesio taping in addition to conventional physiotherapy provides additional benefits in chronic neck pain.

8. A study in International Journal of Basic and Applied Research titled Immediate effect of muscle energy technique for upper trapezius muscle on neck pain concludes: Statistically, muscle energy technique was found to be significantly effective in reducing pain and increasing cervical range of motion.

9. A study in Middle East J Rehabil Health Stud, Oct 2018, titled Muscles recruitment Pattern in People with and without Active Upper Trapezius myofascial trigger points in the standing posture concludes: latency in the onset of muscles activity and altered muscles recruitment patterns. The altered muscles recruitment pattern may lead to changes in motor control strategies and poor control of movement. Finally, these changes can cause a poor control of movement and increase the possibility of damage to the shoulder and cervical muscles in patients with an active myofascial trigger point in the upper trapezius

10. A study, published in Complementary Therapies in Clinical Practice and uploaded to ScienceDirect in advance of publication Feb 2019, titled The effects of qigong on neck pain: A systematic review concludes: Qigong might have a beneficial effect in some individuals with neck pain, although not necessarily more effective than therapeutic exercise.



  • An iPhone app—Goniometer Pro measures active craniocervical ROM (ACCROM). A study done in July 2018 and published in Annals of Physical and Rehabilitation Medicine A new iPhone application for the measurement of active craniocervical range of motion in patients with nonspecific neck pain: a reliability and validity study concludes : the iPhone app possesses good reliability and high validity. It seems that this app can be used for measuring ACCROM.


  • Management of Neck Pain Disorders: A Research Informed Approach, is now available as an ebook. Written by world-renowned researchers and clinicians in the field, the book provides a comprehensive insight into the nature of neck pain disorders within a biopsychosocial context to inform clinical reasoning. The ebook costs $46.36
  • Erik Dalton has a great blog post about First Rib Fixation on his website. “As a fan of Vladimir Janda’s provocative body of work, I have highlighted his research throughout my teaching and hopefully integrated his wisdom into mainstream bodywork. I’ve written extensively on aberrant postural patterns associated with his infamous upper crossed syndrome, such a protruding neck, rounded shoulders, kyphotic t-spine, jutted chin, hyperextended O-A joint, and internally rotated arms. Yet one overshadowed gem of Janda still exists—the humble pain generator deeply hidden within his upper crossed pattern—The Fixated First Rib.”
  • Erik Dalton shared a neck flexion test in his article Myosckeletal Techniques for Funky Necks on his Technique Tuesday blog post. “Forward bending of the head toward the chest with the client in a supine position should initiate the following firing-order sequence: longus capitis, longus colli, SCMs and anterior scalenes. The deepest intrinsic muscles must fire first starting with longus capitis (flexing the head on the neck) followed closely by longus colli, which initiates the beginning of neck flexion. The anterior scalenes and SCMs can then join forces to produce smooth head-and-neck flexion toward the chest. The commonly seen substitution pattern is SCMs, anterior scalenes, longus colli, and longus capitis. This aberrant pattern causes the chin to reach toward the ceiling rather than tucking into the chest during the first two inches of neck flexion efforts. The sternocleidomastoid muscles (SCMs) are usually reliable neck flexors when allowed to fire in proper order. However, during the head raise test they serve as poor subs for longus capitis/colli due to their insertion at the mastoid process. When longus capitis//colli are reciprocally weakened due to hypertonic suboccipitals, these deep neck flexors give way to the powerful SCMs which are forced to fire first, causing the head to cock back into extension (not flexion). The neck flexion test is positive if the chin moves toward the ceiling in the first two inches of neck flexion.
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