Overcoming Chronic Neck Pain

Fix the Shoulder Blades

Fix the Posture–Upper & Lower Body

   –5 Posture Types in Profile

   –Left-Right Asymmetry

More Posture Exercises

Posture and Pain

Posture Topics

Thoracic Outlet Syndrome

Articles: Posture, Pain etc.

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Fix the Posture: Upper and Lower Body

Always seek medical advice first when dealing with neck, back, hip or shoulder pain or functional limitations. Pain or muscle weakness may have any number of causes; one is severe nerve root or spinal cord impingement, which needs more than exercise or any of the passive therapies.
Are we so beaten down by life, we have to stand that way too?
1. Upper Body Posture in Side View
2. Goals for Correcting Upper Body Posture
3. Preliminaries for Correcting Upper Body Posture
3. Exercises for Upper Body Posture
4. Lower Body Posture
5. Goals and Preliminaries for Correcting Lower Body Posture
6. Standing Tall

1. Upper Body Posture in Side View

I. Faulty Postures in Side View: All four of the main types of faulty posture seen in side or lateral view — Flat Back, Sway Back, Kyphotic-Lordotic, and Kyphotic Back— have some degree of excessive forward curve of the upper back that results in the "dead weight" of the head extending out over the chest instead of over the shoulders and squarely supported by the spinal column. In this forward position, the head's center of gravity (same as center of mass in a uniform gravitational field as on earth) lies significantly ahead of the neck's base of support at the top of the thoracic spine. This is like holding an 8 to 10 pound bowling ball one to several inches out in front of you—all day, every day—where it feels much heavier than if it was held close to the body. This unbalanced head position increases the head's tendancy to fall forward and the neck to bend with it unless the muscles at the back of the neck (the neck extensors that pull or bend the neck back) work harder and stay tight all the time (see illustration.)
slouched and improved postureIf chronically tight neck muscles are injured in an accident or strained by overuse, they do not heal well because of lack of rest and reduced blood circulation (tightness tends to keep the blood "squeezed out" of the muscle). Poor healing weakens muscles and keeps them inflamed, irritated, and prone to reinjury. With each new incident of neck strain, rear neck muscles further weaken. Eventually many daily activities —such as turning the head quickly while driving or using the arms in lifting and pulling—now cause neck pain that never would have occurred before. To avoid further pain, many sufferers limit neck range of motion (ROM) and the pain-causing activities. Doing less and avoiding neck movement leads to more weakness, neck stiffness, and reinjury. Eventually back neck extensors atrophy from over-work caused by forward head posture and chronic damage from muscle strains that never completely heal. All of which makes recovery even more difficult.
    Meanwhile the front neck muscles (neck flexors) that bend the neck forward and help balance the head by preventing it from falling backward, have little to do, since in slouched posture the head is already held forward. Thus the front neck flexors weaken and atrophy from disuse (not enough work) rather than from overwork like the back neck extensors. The weakness of front neck muscles is why many chronic neck pain sufferers are unable to lift their heads when lying on their backs. (I couldn't.) For details see Posture and Pain.

Persistent hunching of the upper back combined with rounding forward of the shoulders also causes:

— Stretching and weakness of upper and mid back extensors (in rib cage/thoracic spine region), which are the large group of back muscles that pull the spine erect and oppose the bending forward action of front abdominal muscles;

— Shortening and tightness of front chest muscles – the pectoralis major and pectoralis minor which makes raising and expanding the chest more difficult. A short, tight pectoralis minor is one of three possible causes of Thoracic Outlet Syndrome (TOS). The brachial plexus (nerve bundles at the front of the shoulder that control the arms) becomes compressed by the coracoid process of the shoulder blade when it is pulled forward and down by a tight pectoralis minor.

— Widening of the distance between shoulder blades, which causes stretching and weakening of the middle and lower trapezius—the muscles that anchor the shoulder blades to the middle and lower thoracic spinal column—and also stretches and weakens the rhomboids that anchor the shoulder blade to the upper thoracic spine. [However, strengthening the rhomboids also tends to pull the shoulder blades toward the neck, which is a negative when the shoulder blades already tend to rise toward the neck. (Note rhomboid fiber direction in illustration below.)]

— Stretching and weakening of the levator scapula at the side of the neck, but shortening and tightening of the upper trapezius. These two muscles suspend the shoulder blades from the cervical spine of the neck, and they become increasingly more important stabilizers of the shoulder blades as the middle and lower trapezius elongate and weaken their attachment to the thoracic spine in hunched forward posture. Though the upper trapezius becomes shorter and "stronger," the levator scapula weakens. The upper trapezius alone, is not strong enough to take over the work of the other shoulder blade stabilizers, and will eventually weaken from overwork and repeated muscle strain. It is also uncomfortable to feel the weight of the arms dragging on the sides and back of the neck. Any force generating activity, such as lifting with the arms, adds to the load and makes spasm more likely. This constant pulling or traction on the upper trapzius and levator causes irritation and hyperactivity, such that both muscles keep trying to raise the shoulders up toward the ears. Focal points of hyperactivity are felt as knots/trigger points especially at the levator scapula's attachment to the shoulder blade (red X in illustration at upper right) and at multiple areas along the back of the neck. The fleshy bodies of both muscles become sore and prone to spasm. Areas of muscle attachment on cervical vertebra and nearby joints, such as facet joints, become sore to the touch; facet joint pain from pre-existing arthritic degeneration may worsen. In some cases (like mine) neck muscle and joint inflammation become so severe that joint mobilization and therapeutic massage, rather than relaxing neck muscles, cause worse pain. (For more detail see How Posture and Pain.)

Improved Upper Body Posture brings the shoulder blades closer together and does not allow stretching/weakening of the middle and lower trapezius or rhomboids, all three of which transmit forces from lifting/pushing/pulling weight with the arms to the more robust thoracic spinal column of the back. With good stabilization of shoulder blades by these larger muscles, very little force is transmitted to the more delicate cervical (neck) spine by the upper trapezius and levator scapula, even when heavy loads are lifted.

An Exception: Depressed or Droopy Shoulder Posture

Sometimes it's the lower trapezius that is too strong and short (lower trap dominance), while the upper trapezius is elongated and weak. The neck may appear very long, the shoulders slope down steeply and in back, the shoulder blades are held too low. The best clue to depressed shoulder is that the collar bones slope down toward the shoulder joint. Sometimes only one shoulder is depressed—it's often the shoulder of the dominant arm, or whichever one holds the shoulder strap of a heavy purse or briefcase. A painful condition called Thoracic Outlet Syndrome (TOS) may be more common with depressed shoulders. (Symptoms of Thoracic Outlet Syndrome include waking from sleep with numbness, tingling, weakness of hands and arms. Thoracic outlet syndrome results from compression of the brachial nerves or plexus (the bundle of converging sensory and motor nerves of the arms that run from nerve roots in the cervical spine, down the neck and through a narrow passageway at the front of the shoulder and to the arms.). There are 3 areas in the shoulder where space is particularly tight, making brachial compression more likely. One of those spaces is between the collar bone and first rib. Thus, if the collar bone is held too low as in depressed shoulders, it may press down on the brachial nerves and crush them against the first rib. At the same time, the upper trapezius may try to protect the brachial nerves by involuntary contraction (protective spasm), which raises the collar bone to relieve nerve compression. See TOS page for more information and illustrations.)

2. Goals for Correcting Upper Body Posture:

Goals:

— Reduce postural kyphosis/hunching of the thoracic spine by stretching tight chest and front shoulder muscles, and strengthening weak upper and mid-back spine extensors.

— Improve Shoulder Blade Stabilization to the mid and lower thoracic spine by strengthening and shortening middle and lower trapezius, thus taking stress off the neck muscles—upper trapezius and levator scapula—that suspend shoulder blades from the cervical spine.

— For Depressed Shoulder(s) only :
       i. Decrease downward range of motion of the shoulders by shortening and strengthening the upper trapezius and levator scapula with shoulder shrug exercises (with arms at side, just lift shoulders towards the ears). Avoid having the shoulder(s) drop all the way down after the shrug. Remind oneself often to keep shoulder(s) higher and more squared.
      ii. Stretch the lower trapezius muscles. The same exercise that strengthens and shortens the upper trapezius, the shoulder shrug, also stretches the lower trapezius. Shrugging up high with or without weights, and holding for 30 seconds will help stretch tight lower traps. Avoid carrying heavy weights around (the gym, for instance) and letting the weight drag down your shoulders and upper trapezius. Keep your shoulders level.

— Develop the habit of self-correcting posture during the process of strengthening postural muscles, and continue that habit after good postural muscle strength has been achieved and improved posture becomes easier to maintain. See key practices below.

3. Preliminaries to Posture Correction:

Tailor Corrective Exercise to Your Posture Type:

— Posture at rest depends on the sum total of relative strengths and weaknesses, balance and imbalance, among muscles and muscle groups that operate the joints of each individual's body

— Use your specific posture faults as a guide to help decide which muscles need strengthening and which need stretching. A general exercise class will probably not improve posture and may work against you.

— Picking only the exercises you like to do, strengthens muscles that are already strong and doesn't help muscles that are weak, and may cause or worsen muscle imbalance. Don't only strengthen the muscles seen in frontal view such as those of the chest, front of shoulder, the abdominal 6-pack area, fronts of thighs (quadriceps) and upper arms (biceps); Opposing muscles in the rear, including triceps, rear deltoids, rotator cuff muscles, gluteal/butt muscles, hamstrsings and especially back extensors—which are responsble for keeping us erect and in good posture alignment—will weaken and elongate. Don't train your way to hunched posture! Give posterior muscles such as back extensors, gluts and hamstrings at least equal time, if not more, to compensate for the way we customarily use our bodies. (e.g. more bending forward than bending backward, more sitting than standing or walking, more rounding shoulders forward than lifting the chest and keeping shoulders back, more bending head down instead of looking straight ahead, more bending elbows than keeping the arm straight.)

Exercise Safely: Slow Down for Stretching and Control for Strengthening:

Stretching:

— Stretch in a slow, mindful manner. Quick or bouncy movements activate the stretch reflex, which causes immediate contraction of the stretched muscle—the muscle actively resists the stretch, which is the opposite of the intention. Also, in bouncy stretches the extent of the stretch is uncontrolled, and before one realizes, damage may already be done.

— Allow time—weeks to months—for stretching to be effective. Increasing the length of a too short muscle requires addition of muscle units called sarcomeres. (ref)

— Duration of stretches: Studies done in young and middle-aged adults show that a minimum hold of 30 seconds gives good results, while 60 seconds does not improve the outcome. In adults older than 65, muscle response is best for a hold of 60 seconds. Abstract from another study showed that 12 repetitions of 15 second durations, 6 reps of 30 sec. durations and 4 reps of 45 sec. durations of active stretching were equally effective at increasing hamstring length when performed 3 days per week for 12 weeks in young adults.

Strengthening and Shortening:

— For strengthening exercises, allow time—weeks to months—to shorten and strengthen an elongated, weak muscle. Decreasing the length of an elongated muscle requires maintaining the normal, shorter length with good posture to encourage remodeling by removal of muscle units.

Perform strengthening exercises in a controlled and mindful manner to protect joints and to maintain correct postural alignment. Slow movement during strengthening exercises has advantages: 1. There's no momentum to help the prime mover/agonist (the muscle responsible for the specific movement or the concentric contraction phase of the movement) such as in lifting a the weight, and 2. the antagonist (the muscle on the other side of the joint that opposes the prime mover) can't just let go of the weight and relax all the way, but remains tense as muscle fibers slowly lengthen and the weight is lowered (eccentric contraction). [To operate a joint requires a pair of muscles or muscle groups working opposite side of the joint. For example, to close the elbow, the biceps in front of the upper arm contracts, while triceps at back of arm lengthen; to open, the triceps contracts, while the biceps lengthens. Eccentric contraction may yield greater gains in muscle strength. See the article, How eccentric training speeds muscle strength gains. Arthur Jones, developer of the Nautilus exercise machine, advised two seconds to raise a weight and 4 seconds to lower,   to take advantage of eccentric contraction or negative work as he called it.]

If a workout causes pain, try to figure out why (or get an expert to help) before continuing:
     i. Reasons a joint may be painful: imbalance between prime mover and antagonist muscle pair; joint stabilizer muscles too weak for intensity of the exercise; unbalanced workouts; poor body mechanics during exercise (e.g. stretching the shoulder capsule with forward shoulders); incorrect technique; or exercising when fatigued, which increases the risk for all the preceding.
    ii. Soreness in the "belly" of a muscle that disappears by the next workout is okay.
   iii. Eccentric exercise may cause delayed onset muscle soreness in the belly of a muscle, but with rest, the muscle heals and quickly adapts to prevent damage and soreness when the exercise is repeated.

Key Posture Practices —> Remind oneself frequently to:

First key practice: A.) For those with flat and sway backs, squeeze/tense the muscles in the mid-back around waist level and butt (gluteals) muscles to straighten the spine and bring the upper body squarely over hips in sitting and standing. B.) For those with hyper-lordotic backs, concentrate on lengthening the lumbar spine between bottom of ribcage and top of hips to lessen lordosis, and straighten pouched-out anterior abdominals/rectus abdominis

Second key practice: Practice rising breaths. Fill the top of the chest (sternum area) with air to stretch tight upper chest muscles and naturally reduce rounding of the thoracic spine (if it's still flexible) and help to bring the neck and head back over the shoulders (see Standing Tall). Notice how good it feels to take a deep breath when the bottom of the rib cage is not buried in the abdomen. Lifting the chest also lengthens the area between the bottom of the rib cage and top of hips, and straightens the rectus abdominis, which tends to pouch out when rib cage is depressed. (Avoid arching the back with the in-breath. The inward lordotic curve of the lower back should not increase when lifting the chest. )
     †rectus abdominis or "6-pack muscle" is one of a pair of long vertical muscles that extends from the lower ribcage to the pubic bones of the pelvis. The action of the rectus abdominis is to pull the ribcage/chest downward, to bend or flex the back forward. Crunch exercises are done to strengthen the rectus abdominis. However, if crunches are not balanced with exercises that strengthen back (extensor) muscles, then hunched posture may result. [We already do plenty of forward bending activities during the day. Don't go to the gym and train for hunched posture too!]

Third key practice: Correct faulty posture habits that tend to worsen left-right asymmetry** such as a lower shoulder or tilted neck. Stand with weight evenly distributed between both legs, weight should be evenly distributed between the heal and the forefoot or ball of the foot, and the pelvis level. Sit with back straight and both feet on the floor, not one leg folded under the butt or one leg crossed over the other. Do not lie on the same side in bed to read. For mothers and babysitters: alternate sides when holding babies on the hip.
   ** See Fix the Posture: Left-Right Asymmetry

Fourth key Practice: When lifting, pulling or pushing weight, concentrate on keeping shoulder blade movement controlled, but do not impede it. When the arms lower and the shoulder blades are returning to their resting position do not let them "crash" back down as the arms are lowered. Any mismatch between arm movement and shoulder blade movement makes pinching of shoulder joint tissues (capsule / rotator cuff tendons / bursa) between the bony knob (acromion) coming off the shoulder blade and the head of the humerus bone just below it, more likely. [I concentrate on doing a lift as if my shoulder blades were doing the work.] Remember not to impede the shoulder blades' normal movement, which is needed to keep the head of the upper arm bone (the humerus) centered in the very shallow socket (glenoid cavity of the shoulder blade), otherwise there is risk of dislocation of the shoulder joint. Observe your back in a 2-mirror set-up and notice the movement of the shoulder blades as arms rise upwards.
— If you lift a light weight to the front of the body, you might notice how middle and lower trapezius strain to stabilize the shoulder blades as they pivot apart and glide to the sides. It is important that the back muscles be strong enough to stabilize the shoulder blades; otherwise the shoulder blades and the weight of the arms drags on the two neck muscles—the upper trapezius and levator scapula—that suspend the shoulder blades from the cervical spine.

Fifth key practice: Keep thumbs facing forward when arms are at the side. If backs of the hands usually face forward and palms backward, then the side of the arm is actually rotated to the front, signaling that the head of the upper arm bone is rotated forward in the shoulder socket. If habitual, the back of the rotator cuff/joint capsule complex becomes over-stretched and weak; the front becomes too short and tight. Try the Thumbs Up Exercise to stretch tight front shoulder muscles and help balance muscles and tendons that anchor and center the humeral head in the shoulder socket.)

3. The Exercises for Upper Body Posture

Fix the Shoulder Blades Exercise: a generally pain-free exercise that consists of pulling down and squeezing together the shoulder blades, and then holding for an isometric contraction. Very importantly, a mirror set-up is used to provide visual feedback, which is needed because of how difficult it is to sense activation of the correct muscles. This exercise strengthens lower and middle trapezius, and rhomboids; returns upper traps and levator scapula to their optimal lengths and helps them strengthen; and repositions shoulder blades. (the pull-down part is not for those with depressed shoulder syndrome) Corrects forward head and postural/flexible kyphosis (rounded upper back that's not rigid). And eliminated my chronic neck, shoulder and upper back pain, inflammation and tightness within 2 to 3 months. See instructions and illustrations: Fix the Shoulder Blades Exercise.

— Prone "Y", "T", "W" and "L" Positions Exercise: Similar movements, as in Fix the Shoulder Blades Exercise, but done against gravity, which adds to difficulty. In brief: Lie prone (face down) on floor, place arms in one of the four positions, have thumbs pointing up and keep shoulders down away from ears, squeeze the shoulder blades together while lifting arms and chest (but do not lift the chest more than 1 or 2 inches off ground to avoid hyper-extension of lower back and excessive load that may damage delicate facet joints. See precaution.). Hold a few seconds then lower the chest. See detailed instructions and the video at Fit And Busy Dad.com. Excellent for strengthening mid-back spine extensors, middle and lower trapezius and stretching chest muscles. See similar exercises in article by McNitt-Gray and Mathiyakom.

Variant of prone exercise for Depressed shoulders: Lie face down. Place hands on back of head, fingers interlaced. Squeeze shoulder blades together and lift arms off the floor, but not chest. Elbows should not lift higher than wrists. Do not arch the neck. (adapted from Rick Olderman's book and McNitt-Gray and Mathiyakom)

Arm Slides: Face the Wall "Y" Corrective Exercise and Wall Angels

Arm Slide variant for Depressed Shoulder: when elbows are level with shoulder, shrug shoulders up toward ears to elevate shoulder blades. (adapted from Rick Olderman's book)

 

4. Lower Body Posture:

Maintaining improved upper body posture is much easier when the lower body is properly aligned. It is the lordotic/inward curve of the lower back that positions the upper body over the hips and allows a stable erect posture. Without a lordotic curve, the entire body tends to tilt forward, and posterior muscles such as hip extensors (hamstrings and gluteals) and back extensors are tight and overworked trying to keep the entire body from falling futher forward. (Other primates like chimpanzees don't have a lordotic curve in the lower back, but only one long kyphotic curve. Mostly they move about as four legged animals, using their knuckles to support their curved–over upper bodies. When they do walk on two legs, it's only for very short distances.)

5. Goals and Preliminaries for Correcting Lower Body Posture:

Goals:

— For flatback and swayback postures, increase lumbar lordosis and bring the upper body over the hips for firm support.

— For hyper-lordotic lower backs, reduce the lumbar lordotic curve.

— For swayback, strengthen weak abdominal muscles (external obliques) that have allowed the upper body to shift backwards, and pelvis to shift forwards.

— For hyper-lordotic back, to strengthen weak abdominal muscles (external obliques) that have allowed the pelvis to tilt far forward.

— Remind oneself frequently not to hypre-extend the knees.

— As with upper body posture, be gentle with stretching and controlled with strengthening exercises. Remodeling of muscle tissue takes time as contractile units are added to increase the length of a muscle, or removed to shorten a muscle.

 

Lower body posture in side view is determined by two factors:

  1. Tilt of the pelvis

Figure 1. The pelvis is attached to the base of the lumbar spine by the Sacrum, a large, thick vertebra–like bone that connects to the curved plate–shaped Iliums of the pelvis via strong ligaments and two Sacroiliac Joints. These joints and ligamentous connections interlock the sacrum and iliums, which allow very little independent movement; in effect, both move as one. If the pelvis tilts forward, the sacrum, with lumbar spine attached, is also pulled forward resulting in excessive inward (lordotic or anterior) curve of the lower back. If the pelvis tilts backward, the sacrum and lower spine back are pulled backward, which results in straightening of the lumbar curve as seen in Flat Back Posture. See below Effect of Pelvic Tilt

Pelvic Tilt is determined by the relative strengths and weaknesses among four groups of muscles that attach to the pelvis: Abdominals and Hip Flexors at the front of the pelvis/hip, and Low Back Extensors and Hip Extensors at the back of the pelvis/hip. See below, Four groups of muscle that control pelvis tilt.


Why be concerned about pelvic tilt when it's the neck or shoulders that hurt? Ultimately neck posture depends on alignment of the body below the neck.
—If the pelvis tilts too far backward, the lumbar curve is flat and the upper body tilts forward of the hips. The neck and back extensors have to work harder to keep the head and upper torso from falling forward.
—If the pelvis tilts too far forward, the lumbar spine takes on a hyper-lordotic "C" shape. To counter-balance the extreme curve, the upper back becomes hyper-kyphotic—a reverse "C" shape. The curve of the upper thoracic spine determines the slope of the first thoracic vertebra (T1), which is the a base of the cervical spine. The lowest cervical vertebra, C7, lies on T1. If the slope of T1 is steep, it points toward the front of the body. Then C7 and the rest of the neck will also point forward and the head will extend out over the chest. If the neck is flexible and able to curve in a "C" shape back towards the shoulders, the head will remain supported over the shoulders. But if the neck is not flexible, the result is forward head posture.
— In ideal balanced posture, T1 points more upward and the neck need not curve drastically to keep the head above the shoulders.
For more information on the determinants of cervical posture see Cervical Alignment Variations in Different Postures and Predictors of Normal Cervical Kyphosis, Hey et al. (Spine. 2017)

Because lumbar lordosis is important to the stability of upper body posture, I believe that physical therapy for musculo-skeletal pain of the neck and upper back should include correction of lower body posture. Initially, this takes more time, but treating piecemeal and having to repeat physical therapy later for the same problem (e.g. neck pain) or a different problem (e.g. frozen shoulder and torn rotator cuffs) that stems from the same root cause (poor posture) is a waste of time and money (the patient's, the government's and the insurance company's); and is a waste of one of the few opportunities a patient has to receive one-on-one help from a qualified professional. (for more on Improving Physical Therapy Practice: A Patient's View).

2. Angle of hip and knee joints

Backward bending or extension of the hips and knees is limited, but this limitation gives stability to the body in standing position so that the legs can't "buckle backwards" (Kendall et al.) But in swayback posture the hips and knees have a slight backward bend/ hyperextension that causes the hips to hyper-extend and the pelvis to shift forward ahead of the feet. This is an unstable position and without a counter-balancing weight or body part behind the feet, the body would fall forward. The counter-balance is provided by the upper torso, which shifts backwards to compensate, see Swayback Posture:


Four groups of muscles control pelvic tilt:

Muscles That Control Pelvic Tilt.

 A. Two opposing muscle groups attach to the anterior (front) half of the pelvis:
1) Abdominals (Rectus Abdominis, External oblique) exert upward pull on pelvis.
2) Hip Flexors (Rectus femoris, Tensor fasciae latae, Iliopsoas, Sartorius) exert downward pull.

 B. Two opposing muscle groups attach to the posterior (rear) half of pelvis:
3) Low Back Extensors exert upward pull on the pelvis.
4) Hip Extensors (Gluteus maximus, Hamstrings) exert downward pull.


With all four groups of muscles in balance, the pelvis is held in neutral position, giving the lower back a slight lordotic (anterior) curve. This alignment of the lumbar vertebra results in 80 – 90% of upper body weight being supported by the column of thick round vertebral bodies, and gel-filled discs between the vertebral bodies, in a uniform manner, while the remaining weight (10 – 20 %) is supported by the more delicate rear facet joints.

When pelvic muscles are unbalanced, the pelvis may tilt forward or backward depending on which muscle groups are too weak and/or elongated and which are too strong and/or shortened relative to their antagonist muscle group.

When pelvis tilts forward, the resulting hyper-lordosis transfers too much weight/force to the rear facet joints, causing more pressure on rear facet joints leading to osteophyte formation leading to narrowing of nerve channels etc.;

When the pelvis tilts backwards the resulting flat or kyphotic lower back transfers too much force to the front edges of both vertebral bodies and the discs inbetween; causing the discs to wear unevenly and develop micro-tears in the over-stressed areas, which leads to premature loss of fluid and disc height. However, a kyphotic lower back may open up facet joints enough to improve symptoms of nerve root impingement. (see Pathophysiology of Low Back Pain and Sciatica in Medscape and More Effects of Slouched Posture – structure and mechanics of intervertebral discs and spinal injuries, and aging of the spine.)

 

Types of Faulty Lower Body Posture and Specific Muscle Imbalances:

Hyper-lordotic Back: Some or all the following imbalances contribute to a hyper–lordotic lumbar curve: Weak anterior abdominal muscles (esp. External Oblique) allow the anterior pelvis to tip down and forward. Tight hip flexor muscles (esp. the Iliopsoas) pull the anterior pelvis down and forward. Tight Low Back Extensors pull upward on the posterior pelvis and weak Hip Extensors cannot counter the pull. Also see Kyphotic-Lordotic Illustration.

Flat Back: Tight Hamstrings pull pelvis down in back (and elongated/weaker low back extensors allow it), thus producing posterior pelvic tilt, which straightens the normal lordotic curve. Strong abdominals pull up on anterior pelvis further accentuating posterior tilt and weak hip flexors allow it. Also see Flat Back Illustration.

Sway Back: Short, tight Hamstrings pull down on posterior pelvis, tilting it backward and flattening the normal lordotic curve. Weak, elongated one-joint hip flexor, the iliopsoas, cannot oppose. The External Oblique abdominal is elongated and weakened from accommodating to the backward sway of the upper trunk. Also see Sway Back Illustration.

Asymmetric: One hip higher and more prominent. Cause may be postural/handedness asymmetries, structural scoliosis or a combination of the two. On the side with the lower hip, core muscles between upper body and lower body are stretched. On the side with the higher hip, core muscles are compressed and thus short and tight; On the side with the higher hip, which is also swayed to the right, the gluteus medius, the main hip stabilizer muscle, is over-stretched and thus compromised in helping to stabilize and center the head of the femur in the hip socket. Poor hip stabilization may cause pain, increased risk of hip injury and arthritic changes. On the side with the low hip, some hip muscles and lateral leg fascia are tight, which can cause knee pain. See Left-Right Asymmetry

To correct pelvic tilt to neutral, the pelvis can be deliberately tilted frontward or backward depending on type of faulty posture: see posterior pelvic tilt exercise and also this video: pelvic tilt exercises. But if hip or back muscles are tight, changing pelvic tilt may seem impossible or may cause muscle tingling or soreness. Best to see a doctor in case of radiating nerve pain. Otherwise, specific exercises directed at the 4 muscle groups that determine pelvic tilt, either to help stretch over–tight, shortened muscles, or strengthen opposing weak, elongated muscles, are needed. The specific exercises to use depends on whether excessive anterior or posterior pelvic tilt needs to be corrected. See The Different Types of Faulty Posture....

6. Standing Tall:

Before postural self-correction can begin in earnest, it's important to feel/understand what standing in an upright position, perpendicular to the ground, is really like. What a surprise, when I realized that standing against a wall felt unnatural because my normal posture was, and always had been, leaning forward and bent at mid-back. No wonder I couldn't easily bring my head to touch the wall behind me, and later would have neck pain from trying. Come to find out, all I needed was to take a deep breath to lift my chest, which reduced thoracic kyphosis and straightened my mid back. Amazingly simple, but I was so accustomed to my hunched posture, that at the time, I didn't think of it.

Also notice whether one's body weight is evenly distributed over the soles of both feet, from side to side, and front to back. More pressure on one foot than the other indicates asymmetry between the two sides of the body. (see Faulty Postures in Front and Back Views) More pressure on the ball of the foot and big toe, indicates that one is leaning forward. "Forward Body" is a strain on the posterior muscles of the trunk and legs, which remain in constant contraction* as they try to keep the off-balance body from falling forward; the pelvis is pulled on by tight hamstrings and tilts backward in order to pull the lumbar spine and rest of upper body vertical. Perhaps being so used to rushing to get everything done, we don't even bother to straighten up but lean forward in anticipation, toward the direction we hope we are going with our lives (rather than going around in circles), and the habit sticks whether running, walking or standing still ....Maybe by bringing more balance to the way we stand, we will bring more balance and stability to our lives in general.

For a good demonstration of wall standing and ideal sitting posture:
See the video: How to Improve Your Posture — powered by ehow.

*Kendall et al.    (The hamstrings, in particular, tighten when the body leans forward. Poke a finger into the back of the thigh and feel the muscle tighten as you lean forward slightly. Take care not to fall.)

Finding the Determination To Change:

Balanced Posture

Some people know they have poor posture and simply accept it.

It's just the way I stand....It's comfortable....It's me.

Others have poor posture, but believe they have good posture. After all... spouse, friends, doctors, physical therapists and exercise instructors have never said anything about poor posture; even though mom might have, but who listens to moms? And the bathroom mirror only provides a front view, which doesn't show a forward head or a hunched back, especially when we're focused on blemishes, bags under the eyes, beard hair or wrinkles (and for women, applying make-up to hide them). A photo doesn't often help because most are taken face–on, though you might find a side view in an unposed group shot, but unflattering views are often dismissed and discarded ...along with any other evidence of an unattractive or unhealthy appearance that doesn't fit one's self image (which may be unrealistic, and is resistant to change).

Accordingly, the first step is to really look at your body from the front, the back and side, and preferable while performing daily activities. But how many people have their own videographer? Instead, one must arrange for a two mirror set-up that shows side and back views (see such a set-up here); and then be completely honest with yourself in front of the mirror (tougher than you'd think).

To change one's posture, to change anything, means turning away from comfortable ways of being in the world, and accepting short-term discomfort. This is not the muscle-soreness or getting-out-of-breath kind of discomfort (in fact it usually feels better to stand up straight) but the mindful, will–power kind. Correcting posture doesn't have the intensity of aerobics or weight training, but does require persistence until weak, stretched-out muscles tighten and strengthen, making it easier to maintain improved posture without consciously tensing muscles all the time.

Weak, stretched-out postural muscles are like the elastic waistbands of old underwear. Waistbands get stretched and loose, and underwear won't stay up. Loose waistbands can't fix themselves, but loose, weak muscles can. And with the right exercise and correct use, muscles regain optimal length, strength, and resistance to stretching.

But a caveat: once the work is done, and the muscles restored, if the slouching habit returns, so will poor posture. The body is always changing and one of the ways it changes is to adjust to how it's being habitually used.

Of course, to overcome inertia and improve posture, we need at least one great motivator and better if several. It helps to have reasons backed up by evidence that posture improvement is important and necessary. Those reasons might include: 1) reducing chronic musculo-skeletal pain, 2) improving appearance, 3) feeling of well-being, 4) helping to prevent injuries, and 5) delaying age-related spinal changes. But change is difficult, especially for future gains. Sometimes motivation needs to be more immediate such as reduction in existing chronic pain or desire to improve appearance. And sometimes there are rare epiphanies of self-awareness, such as when I'd given up finding help for my neck, and having glimpsed myself looking old and bent over, I finally realized: that if nothing else in my life ever improved, I could at least fix my posture.

Some of the benefits of frequent self-correction of posture:

— Serves as therapy for the neck by regularly reducing harmful loads on the cervical joints caused by poor head, neck and shoulder blade alignment.*

— Trains and strengthens the postural stabilizing muscles while they are being used in everyday activities, and while they are at their optimal length, which they are, when the body in correctly aligned*
 (*adapted from Gwendolen Jull)

— Standing and sitting tall positively effects the way people feel about themselves and how they conduct their lives. Studies in both men and women show that briefly assuming an open and expansive posture decreases the stress hormone, cortisol, increases testosterone and increases feelings of power and tolerance for risk. A closed, contractive, submissive posture has the opposite effect. (Power posing: brief nonverbal displays affect neuroendocrine levels and risk tolerance. by Carney et al.)

— As reported by Muraven, Baumeister and Tice (Longitudinal Improvement of Self-Regulation Through Practice: Building Self-Control Strength Through Repeated Exercise, J. Social Psychology, 1999) Diligent self-correcting of posture over 2 weeks, strengthened self-control/willpower and improved performance on unrelated tasks requiring self-control. (Of course it's not just posture self-correction that works; any long term attempt to change habitual behavior gives similar results. On the other hand, short term attempts to change habits deplete self-control and often fail, but even in failure—it's the practice, itself—that leads to improvement over the long term.)

Remind oneself frequently to:

— Keep the body evenly balanced between ball and heel of foot. (Especially important for those with foot and toe problems. When my forward leaning posture had improved, the enlarged arthritic, joint of my big toe (Hallux Rigidus) became much less painful.)

— Keep knees loose to avoid hyperextending both knees and hip. But don't bend/flex them too much!

— Bend/hinge at the hips, not at the waist and upper back, which rounds the spine. Keep the back straight, and use a combination of hip bending and knee bending to get as low as one needs. The more flexible the hips (and looser the hamstrings), the less the knees need to bend, (and keeping knees behind toes takes stress off knees and puts it on the large muscles of the thighs. (You can feel the difference by touching your front thigh muscles, the quadriceps, while bending both ways: knees beyond toes and knees behind toes.), The resulting movement looks like the action of sitting in a chair—the butt sticking out to the rear — not a pretty maneuver — in fact it's called a "squat" which isn't a pretty name either —but it strengthens thigh muscles, and avoids putting stress on the back. It's when the back is rounded in bending that it's most prone to injury. (see "Torso Flexion (bending forward) Loads and the Fatigue Failure of Human Lumbosacral Motion Segments" by Gallagher et al.)

— Include Upper Body Alignment: Keep the mid back straight and chest lifted without excessively arching the back (in both sitting and standing) by elongating spine from hips to chest.

For more Tips on Improving Posture—see Spine Universe: "All Ergonomics Articles" — Includes "Is Your Cell Phone Killing Your Back?", "Proper Backpack Habits" and "Taking Care of Your Back"

See 5 types of faulty posture in profile, and specific exercises

 

 

 

© 2017 Rochelle Cocco