Liam is a 33 year old male patient that came into the clinic complaining of left elbow pain that was gradual. He could not recall any incident that triggered it. Nor did he have any previous trauma. He did say that as he was working out especially hard performing pull ups and bicep curls that left him sore in both arms, but not necessarily worse than his previous workout sessions.
Upon assessment I noticed several things:
1. He’s 6’3”
2. He’s a recent father of an 8 month old
3. His suit folds at the front of his chest and shoulders instead of laying flat across.
4. His head and neck enters the room 15 secs ahead of the rest of his body
5. and when he entered the room he was on his “crack-berry” emailing
In sum…he’s a sloucher.
When I probed further with questions I uncovered several interesting tidbits: He works on a trading floor where standing desks are foreign. He often falls asleep at the end of his day while sitting with this head bobbing and drooping forward on the couch, due his lack of sleep from the three previous nights of bottle feeding and diaper changing. Last but not least, here’s the most interesting fact of all: he recently downloaded a gaming app on his phone that he plays on not one but two 45 minute GO-Train commutes. During which he is normally looking from the height of 6’3” down to his belt line because he’s too tired to lift his “crack-berry” up to his face. Too tired because he wanted his trainer to beat the living daylights out of his arms so he can make an excuse to his career-sacrificing-feet-bloating-drained-loving-wife that he can’t lift his arms to pick up his 8-month old son at night for his nightly feedings, BUT he still wants his “gun-show” to make an appearance when they go on their scheduled trip to Cuba.
Soo…let’s put this all together…he’s tall…he slouches…he’s a recent father…he slouches…he’s on his phone constantly looking down…he slouches…he falls asleep while sitting…he slouches…he’s 33 years old and still plays games on his phone…he slouches.
Now at this point you may be asking: “ugh Lawrence, what does that have to do with his left elbow pain you mentioned 4 paragraphs earlier?”…Well, there’s a thing called a brachial plexus and some nerve roots in the neck that often get compressed with slouching. The ulnar nerve exits the neck and traverses down under the collar bone, under the pectoralis minor down the inside of the humerus, and down the inside of the elbow and forearm. Now, that would normally be okay because nothing happens when you slouch some of the time. BUT, everything happens when you slouch for a prolonged amount of time… to break it down for you:
Slouching daily while sitting for 1 hour napping bouts, PLUS 10-15 hours of slouching due to poor work ergonomic set up (because he’s 6’3” and the world was meant for 5’10” at best), PLUS two 45 minute bouts of slouching while on the Go-Train playing a silly gaming app that was meant for a demographic with voice-cracking and pimples.
Now to get down to the meat and potatoes…what to do: With some manual therapy and applying a mild-moderate amount of pressure I can slide the offending vertebrae in the cervical spine back off the pinched nerve and relieve the pressures. With some myofascial release, the muscles in the neck called the scalenes can be softened and any trigger points relieved. That, along with some postural correction techniques that can be applied on an hourly basis will help align the neck into the proper anatomical plum line.
Soo…do you get what I’m saying? It’s not the slouching that’s pinching and compressing his ulnar nerve…it’s the slouching for that extended period of time. And believe me, if you don’t fix that habit and I don’t mean your slouching, I mean your lifestyle habits of slouching, then you’ll have this issue for quite some time and I with a great deal of pride get to say…
“Your mother was right about telling you to sit up straight”! While she’s probably saying “I told you so!”
Connect with Physiotherapist, Lawrence Yu at the Adelaide Health Clinic by email firstname.lastname@example.org or by phone 416-367-5200.