Thoughts from the journey… Excerpts from a day in the life of Sherry McLaughlin

20Aug/091

The upper trapezius/opposite hip link…

I had a guy come in today with complaints of L upper trapezius pain that began insidiously over the past 5 months. He told me that his pain increases when he walks (he walks up to 4 miles a day) or when he is holding objects for a long period of time. He has a history of chronic lower back pain, L MCL tear (s/p 15 years) and broke his ribs on his R side 7-8 years ago in a motorcycle accident.

Visual observation revealed his R shoulder to be at least 1.5" higher than his L in sitting and standing. This position puts the L upper trapezius in a long/weak position and remember, it is usually the long/weak things that cry out in pain.

So, I set out trying to figure out why his R shoulder was sitting up so high. Checking the three key rotational spots, here is what I found:

Ankle - Decreased subtalar joint eversion on the R ankle; Decreased dorsiflexion on the L

Hips - Decreased L hip adduction (tight gluteus medius/ITB) and internal rotation (iliopsoas trigger point); Decreased R FABER (believe it or not, this normalized following counterstrain to the R quadratus lumborum trigger point)

Thoracic spine - limited L>R, primarily due to thoracic tightness (in other words, the range was normalized with thoracic NAGs)

After making the above corrections, his shoulder height was symmetrical. I told him to try walking his 4 miles tomorrow to see if his L shoulder pain was any better during that activity.

In the mean time, he is doing exercises to improve L hip adduction, R subtalar joint eversion and R gluteal loading and thoracic rotation.

The point is this: When the painful upper trapezius is on the lower shoulder, don't work to raise that shoulder up. Instead, hunt down the reason why the opposite shoulder is sitting higher. As you can see, the cause of a higher shoulder goes way beyond upper trapezius tightness. In this case, it came from a subtalar joint that wouldn't evert, a tight quadratus lumborum and a stiff thoracic spine and an opposite hip that wouldn't adduct. By the way, it isn't uncommon to see a quadratus lumborum trigger point on one side, and a gluteus medius trigger point on the other. They are, after all, functional synergists.

Until next time...

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  1. Wow, I love how you really took a whole body approach to what would seem like a simple cervical problem. I’m a PT student on my ortho affil now and would love to have that kind of ability to really put the whole picture together!


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