I am interfacing with my client’s chiropractor on her corrective exercises for upper crossed syndrome and an elevated right shoulder. He asked me to do everything possible to help lift her left shoulder and lower her right shoulder. I am having her do SMFR on both sides for her Sternocleidomastoid w/finger pressure, Levator Scapula and Upper Traps w/Thera Cane and stretching the same which are correctives for upper crossed and elevated shoulders. I have her doing cervical retraction exercises as well. But what single sided things should I have her doing? I’ve searched my NASM CES text and have not been able to find corrective exercises for lowering clients single sided shoulder asymmetry.
I find this an extraordinary request coming from a chiropractor without giving you any further suggestions but that is besides the point.
What you have her do all sounds a very reasonable approach. I have often found that asymmetries like that are very difficult to resolve and can sometimes only improved.
I would start by looking beyond the shoulder. One thing to consider is lifestyle. Carrying a purse predominantly on one side, carrying small children on one hip. Does she have a job where she uses one side differently from the other? Take a look at her hips. Are there any asymmetries? Upper cross syndrome usually does not stand on its own.
Wish you success.
Personally I would not be doing manipulation, I feel it’s out of my scope of practice. but It sounds like you really trust this Chiropractor, maybe he can show you what he wants you to do?
I would suggest having this client see a Physical Therapist, or work with a Licensed Massage/deep tissue worker.
Hello Nancy Latthitham,
I like to have my clients start teaching themselves to be ambidextrous throughout the day in all activities to regain balance. I also remind them that good posture is paramount throughout the day and night.
Is this person left handed? How do they move, sit and stand during the day? Do you know this client’s full history?
Unilateral work may show you more than bilateral exercises. Doing unilateral exercises for the entire body may help balance things out, also. I do not know the history; but, I believe that lifestyle posture may be the way to start and help enforce recovery. I find many people living out of proper balance and posture once the worst of the pain subsides. Meaning, crossing the legs when they are told by doctors to sit with feet on the floor at all times; to keep the spine neutral.
I hope this helps you; since, you know this already with your CES training. I would also get more details from their physical therapist and the chiropractor.
Best of health,
Natalie aka NAPS 2 B Fit.
You are on the right track with the SMR and stretching of the sternocleidomastoid, upper traps and levator scapulae. That is what I would do too, but I would only do this on her right side, the elevated side. She may have muscle imbalances on both sides with the right side being much worse. If you do the SMR and stretching on both sides, then each side improves and you still have an elevated right side. I would focus only on the right side until I noticed improvement and then I would add the left side to her program.
Since her right shoulder is elevated, I assume that her right scapulae is also elevated. The next thing to do is to activate her rhomboids, and mid and lower traps. Have her do rows with the TRX coaching her to squeeze her shoulder blades together and to keep her right shoulder down. Stand behind her and every time her right shoulder starts to rise tap it with your fingers to help her focus on keeping the shoulder down. You can also do the TRX one arm row and reach using the right hand. The NASM Ball Combo I and Ball Combo II are great ways to help her focus on the rhomboids and mid and lower traps. One more exercise I like to use Justin Price calls the Flasher. Have your client stand with her elbows against her side, directly below her shoulders, and bent at 90 degrees. Start with her hands out in front of her body. Ask her to squeeze her shoulder blades together and externally rotate both arms. Tell her to imagine she is opening her trench coat and smiling. Men usually laugh and women usually giggle at this image.
Nancy, my last idea I am sure you have already done. But have you taken your client through a complete movement assessment including the overhead squat test to determine if there are any other muscle imbalances that may be contributing to her elevate shoulder?
Sorry for such a long answer. I hope I have helped you with my ideas. Write back to me if you have any questions or want to talk over anything.