Steven Hefferon is a Certified Massage Therapist (CMT) and an internationally know expert on back pain. He has considerable experience in correcting the muscular imbalance that's associated with low back pain, and has written more than 30 articles. Here, he discusses one cause of such pain in women - overly large breasts. Robert Griffith, Editor.

Large breasts, reportedly occurring in over 1 million US women, may be a source of considerable back pain. Some women, in fact, suffer with severe pain, deteriorating posture, and are at risk for spinal deformity and other repetitive stress injuries to the shoulders and upper extremities due to their proportionately large breasts.

These problems result from changes in the normal anatomical structure caused by the excess weight on the chest and weak muscular support. Another fact related to this condition is that some women even feel ashamed and actually try to hide them buy altering their posture by allowing their shoulders to roll forward. This abnormal posture will possibly put pressure on an area of the upper body near the shoulder called the thoracic outlet. When this occurs, a bundle of nerves and blood vessels can become compressed and cause pain and discomfort down the upper extremities.

Very large breasts not only can cause a reduction in the normal curve of the upper and mid-back region but will potentially also cause severe low back pain. When the upper vertebrae of the spine are altered, the lower vertebrae then assume more stress. The challenge for these women is to maintain an efficient posture through proper strengthening and "CORE" stabilization exercises.

Workouts may make things worse

Active women with large breasts are especially prone to back pain. Constant breast movement from high-impact exercise can cause acute pain due to muscular oxygen deprivation and fatigue. The muscles in the back bear a significant burden trying to support very large breasts during vigorous exercise.

Physical therapy, posture exercises, and even pain medication are often a woman's first line of defense. Many doctors recommend purchasing customized bras or sports bras that can better distribute the substantial weight of large breasts across a larger area, thereby reducing muscle strain and improving overall breast positioning. This is especially important for women with a small frame, as their breasts place stress on a more concentrated area.

What can be done

Before any women begins any exercise program that is intended to help with their back pain, they need to have to have a full physical assessment performed, making sure that any postural dysfunctions are accounted for and their associated muscle imbalances are corrected. Muscle imbalances can be described as one muscle group being overly strong and tight and the opposing muscle groups weaker and overly stretched out.

Postural dysfunctions can be described as abnormal position of the pelvis or abnormal position of the upper neck, head and shoulders. As mentioned earlier, a woman can hold her shoulders in a rounded position, thus adding the weight of the breast and rotating the shoulders internally, depressed and adducted (pulled towards each other), which pulls the head forward of the shoulder and in turn will causes the neck to be pulled forward and down.

Many other adaptive responses may occur, including counter-balancing the weight of the body in the upper spine as well as altering the position of the pelvis. The pelvis usually accommodates the most, while also having the greatest influence on the curvature on the spine.

What you can do before the last resort

What I have just described is a process that is repeated every day; however, no single piece of high-tech diagnostic equipment available can systematically piece it all together. Many chain reactions occur that may cause low back pain, which is why physical assessments are so critical.

The assessments need to take into account the postural dysfunction of the upper neck, back, and shoulders as well as the position of the pelvis. Determine which muscles are tight and overly strong and which muscles are weak and not able to support the body adequately. There needs to be a comprehensive plan to accomplish a new resting tension or elimination of any muscle imbalances. Essentially, the patient will be asked to do a very unbalanced workout to get back to a more balanced state and to a point that her body can support the extra stress, throughout the rest of her life.

The last resort

Failure to address the postural issues may necessitate a more drastic solution. There is a steadily increasing number of women who choose breast-reduction surgery. Make sure to use this option as a last resort, since there are risks and negative side effects from this operation.

In addition to the external scars, scarring inside the breast may also occur. Until recently, doctors were concerned that this might interfere with the accuracy of a mammogram - and in doing so increase the risk of breast cancer. But it turns out that for some women, breast examination and mammography may actually be easier to perform after breast reduction. "From the standpoint of the physical exam, it may be more difficult to pick up a very small lesion [lump] in a woman with very large breasts," says Charles Finder, MD, a radiologist in the Food and Drug Administration's Mammography Quality and Radiation Program.

Other drawbacks to breast-reduction surgery may include a lack of sensitivity in the nipple and a decrease in sexual response. Many doctors also caution that there can be a significant reduction in milk supply after surgery. Some women find they can't breast feed at all. On top of that, the average cost of breast-reduction surgery in the USA is close to $6,000 and can run much higher, depending on where you live. As a result, many insurance companies have written breast-reduction surgery out of their coverage completely.

Fortunately, there are alternatives to surgery that can bring relief to women who suffer from back pain caused by overly large breasts. Muscle balance therapy is a safe and effective way to restore some stability to the pelvis and spine, in order to help the body tolerate the stress of everyday life for such women.

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