Causing factors:

• Psychological stress
• Computer work for long periods
• Driving for long distances
• Sewing / knitting / crocheting
• History of whiplash injury
• Sustained positions with shoulders pulled forward and upwards.

Action Plan:

• Mobilizing: It needs to be performed slowly without force and it is much more successful if the movements are repeatedly sporadically throughout the day.
  • Turn the head as far left as possible and then slowly back to the centre position, then to the right and back again 1x to each side
  • Bend the neck with the chin as close as possible to the chest and back to the original position 1x
  • Look straight ahead, do not turn the head sideways. Move the left ear towards the left shoulder as far as possible by tilting the neck sideways. Repeat to the right. 1x to each side
  • Roll shoulder backwards x10

• Stretches: A stretch must always be done in the correct position – no shortcuts. The limb moves slowly (not with sharp and sudden stretching movements, or bouncing or oscillatory movements) until the end of the range of motion and a comfortable stretch can be felt and it is then held for up to 30 seconds 1x at a time and sporadic repetition throughout the day is recommended

• Trapezius stretch: Stand with the back against the wall – heels slightly away from the wall. Do not straighten knees. Tilt the pelvis backwards so that the lower back touches the wall (back must stay against the wall = policeman for proper execution) raise the arms sideways to shoulder height and bend the elbows 90˚ upwards. Keep this angle and move the forearms together so that the elbows and forearms touch (keeping the lower back against the wall). If the stretch is not too intense, the hands can be pushed upwards as far as possible without elbows separating or back leaving the wall.

• Levator scapula stretch: Stand / sit looking straight ahead and imagine a straight line forward in line with nose and straight lines to the right and left in line with ears, forming two 90° angles that lie next to each other. If the left side is stretched, the nose should be turned about 45° to the right, without tilting the head to any side at any time. Bend the neck straight downwards until a “good” stretch is felt. This is held 30 seconds and repeated to the left.

• Reinforcement of the posture muscles in the upper back is extremely important!! Stand as with the stretch of the trapezius muscle. It is imperative that the lower back keeps touching the wall as well as the back of the head. Raise the arms sideways and bend the elbows as with the previous stretch. The forearm and the top of the hands must touch the wall. Now move the arms upwards against the wall while keeping the elbows at 90°. The upward motion is slow and stops as soon as the lower back or arms leave the wall. Repeat untill tired. The back usually becomes tired between the shoulder blades. This exercise is done only once a day.

Reference: Rene Bredenkamp, Physiotherapist
rbred@xsinet.co.za

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