Levator Scapulae and Rhomboids hypertonus - victim or cause?

It is quite common to have a patient point to the levator scapula or rhomboids as symptomatic when they come for their first treatment. Many have become resigned to the problem and will tell you it is chronic.  The patient will often complain of headaches neck and shoulder pain. Careful observation may reveal shallow breathing and a tight diaphragm.  Some of these patients are using incorrect postural mechanics (i.e. Kyphosis) or ergonomics which can be revealed in the interview with a bit of detective work. Many patients have tried massage, chiropractic, PT, exercise, taping and dry needling with temporary relief at best. If ergonomics, mechanization or posturography are not a contributing factor and conventional investigation and treatment isn’t producing the desired outcome, then we need to look further.

 

Of course it is important to investigate structural elements like ribs and vertebral alignment first to ensure there isn’t restriction or malalignment. If the patient returns with repeated restrictions patient chart notes will start to flag a pattern indicative of ligament instabilities. Some of those patients have had trauma or are hypermobile and prone to instabilities. This is where having a good working relationship with a prolotherapy practitioner is important. Combined proliferation therapy treatment with manual therapy and soft tissue treatment can result in decreased hypertonus as the ligament integrity improves. Tight muscles can point to sprained or weakened ligaments.

 Once restrictions are cleared and ligaments don’t appear to be the problem we can then direct our attention to the muscle groups that may be the drivers of joint and ligament problems. Erector spinae, teres major, coracobrachialis, pectoralis major and latissimus dorsi are vital stabilizers to the shoulder and dramatically improve ease in motion when optimally tensioned. Levator scapulae and rhomboid hypertonus are common victims resultant of dysfunction in this group. Functional deficits in this group are the result of chronic and progressive lateral deflection of segments due to the highest relative frequency of flexion at the shoulder and trunk. The latissimus dorsi is influenced by pelvic positional dysfunction which can translate to the shoulder girdle. In all cases, these muscles will be sensitive to cross fibre palpation with a hard ropy nature and limited pliability.  Functional tests should demonstrate decreased response time, decreased proprioception, weakness or pain upon isolation. Compensation will be observed in the neck, contralateral shoulder and axial rotation of the trunk during testing. Each of these muscles requires optimal function to restore function to the shoulder girdle.

Treatment techniques abound with varying levels of effectiveness and retention. SRT techniques provide immediate improved function, verified with functional testing. This eliminates compensation patterns in levator scapulae or rhomboids while simultaneously restoring stabilization, strength, proprioception and response time. Through neuromotor re-education the ANS is down regulated.

This is only one element of treatment. SRT full shoulder stabilization involves assessment and intervention of additional dysfunctional muscle groups which are addressed in the Level 2 - Upper Quadrant SRT course. These techniques can be applied to a plethora of shoulder and neck pathology.

STAMINA® Rehabilitation Therapy courses begin in January 2014 in California and are CPTA approved CEU accredited. See www.staminaacademy.com for course details.