All Posts tagged Poor posture

Shoulder/Neck Pain

Aching and stiffness in the shoulders and neck are an extremely common problem, especially for those involved in desk and computer working. If you feel like you need a daily massage, the real cause tends to be postural. Whilst seated, staring at a screen for hours on end, it is easy to fall into a slumped position, with rounded shoulders and the neck protruding forwards. Assuming this position day-in, day-out can result in shortening of the chest muscles and weakening of the small, postural upper back and neck muscles which work to pull the shoulders back. This results in the larger back and neck muscles such as Trapezius and the Rhomboids working harder and becoming tight and achy. Working on correcting these imbalances, by stretching the chest muscles and building endurance strength in the postural muscles such as the lower Trapz and Serratus Anterior can result in a long-term fix.

I treat neck and shoulder pain with soft tissue therapy, mobilization of the stiff joints, ELDOA exercises, shockwave, laser, and posture training.


Corrective Exercises for Excessive Thoracic Kyphosis Posture Evaluations, Part 8

In previous articles, I have written about normal postural alignment versus abnormal postural alignment, and how abnormal postural alignment can be detrimental to muscle function, is aesthetically unpleasing and might contribute to joint pain.

Since kyphosis is natural in the thoracic spine, we have to identify what excessive kyphosis is, which is typically the problem. Generally speaking, normal for a thoracic kyphotic curve measures 30-35.* Excessive kyphosis is greater than 35.* As doctors, we are used to looking at the static spine from the side to determine kyphosis. Using the Functional Movement Screen (FMS) or other movement analysis, we begin to see the interrelationships of muscle and fascial tissue attachments that may contribute to hyperkyphosis.

For treatment of hyperkyphosis, I often take the “bottom up” approach and teach patients how to lengthen the lateral column of the body, the peroneal group, iliotibial band, tensor fascia lata, lateral gluteal complex, quadratus lumborum, oblique complex, latissimus dorsi, and shoulder musculature to influence the kyphosis. When treating hyperkyphosis, always check the flexibility of the ankles, hips, adductors and anterior shoulder complex. The hip flexor tissue is fascially attached to the abdominal fascia, which connects to the external obliques, connecting to the pectorals, joining to the deltoids. As these structures become tight, they can influence thoracic kyphosis.

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Functional Movement Analysis (Part 6)

Do you ever feel weird when new patients come in who have been to other chiropractors and say, “Adjustments only provide temporary relief”? I’m sick of hearing it. Don’t get me wrong: I love seeing new patients, but I feel bad that this person almost gave up on chiropractic care altogether! Most chiropractors I meet are warm and caring, and they have a curious presence about them.

There’s also the business side, of course, and I’m just like you: I need new patients and I want them to stick around for the care and treatment they need. Posture analysis, movement analysis and anti-aging strategies are methods I focus on in my “rehab” practice to create long-term relationships. As we walk this pathway and journey of chiropractic – engaging the study of posture – we cross the broad terrain of static posture into functional movements. Using functional movement analysis, I see more clearly who patients are and how their individual range of flexibility and strength within a single body segment is connected to the greater whole.

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Winged Scapula – Posture Evaluations, Part 4

Most of the time when we think of a winged scapula, we simply think of weak serratus anterior muscles. But the longer you are in practice, the more you notice posture and become a better “muscle whisperer.” And then you begin to realize so much more. Let’s explore the posture impairment of winged scapula as it relates to the serratus anterior, rhomboids, lower trapezius, and pectoralis muscles.

The biggest tip I can offer you to look for during static posture evaluation for scapular winging is this: If you can see the entire medial border of the shoulder blade, you should suspect serratus anterior dysfunction. If you see only a portion of the medial scapular border or the inferior angle (usually the lower half or third of the medial scapula border), then you should suspect excessive shortness of the pectoralis minor, and lower trapezius and serratus anterior muscle weakness dysfunction. Again, if you only see half or a third of the scapula border protruding away from the rib cage, this is known as “pseudo-winging” and implicates shortness of the pectoralis minor, along with lower trapezius and serratus anterior underactivity or weakness…

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The Shoulder and Scapula Posture Evaluation, Part 3

Let’s discuss normal shoulder resting posture so we can determine if there is a link between a postural deviation and pain. Static postural analysis is performed before range-of-motion examinations, orthopedic testing, movement pattern assessments and palpation analysis. When I perform a static posture evaluation, I focus on subtle asymmetries or deviations from normal patterns to aid my diagnostic decisions and treatment transition decisions (passive care to active therapy). I allow myself the time to pause and focus on what I see posturally before beginning other procedures. The changes I see in static posture and functional-movement assessments, visit to visit, help me navigate through the treatment process.

I ask the patient to stand with their shoes off, hands at their sides, in their normal, relaxed position. The evaluation is done with the person in a standing position, which accounts for the normal effect of gravity on the individual. I observe the patient from the front, side and posterior. I look to see the person’s chronic holding patterns.

Look for postural deviations, including forward head, forward shoulders (scapular protraction), humeral internal rotation, and increased thoracic kyphosis. All of these deviations have been implicated in the development of shoulder pain.1-4 

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Forward Head Posture Part 2

According to Dr. Al Sears, muscle is the first physical sign of aging, in the sense that people who age well are often well-muscled, which protects them from age-related ailments including pain and disease.

Evaluating Posture Distortions

I know that evaluating forward head posture leads to one of those “chicken and egg” questions. Is it ascending or descending; from top to bottom or bottom to top? Sometimes I know the answer and sometimes I have to guess. I just look for patterns and sequences of how all this stuff works together in my patient’s big picture. For example, have them sit on a chair or a stool; observe from the side as they sit down and stand up. Watch the head and neck area only. The normal pattern is for them to lead with the posterosuperior aspect of the head. If the SCMs and suboccipitals are dominating, they will lead with the chin. This is a faulty pattern…Read more…



I was recently asked to answer these four question about posture for Delicious Living Magazine based in Boulder, CO.  
1. In a nutshell, what causes bad posture? Americans spend an average of eight to ten hours each day at work. During our work time, we often sit unconsciously in improper body positions and engage in repetitive movements that create muscle imbalances leading to poor posture; poor self esteem; psychological distress & depressive symptoms; lack of a variety of movement in our activities of daily living; overall poor flexibility.
2. What negative effects does poor posture have on the body? “To live a long, active, energetic life, few things matter more than good posture” – American Journal of Pain Management;  Nerves get abnormal tension placed on them and can cause inefficiencies within the neuomusculoskeletal system; muscle imbalances and joint dysfunctions associated with poor posture can create areas of too much motion in certain spinal segments causing instability. These areas may then wear out prematurely, while other areas may have too little motion in the spine causing range of motion/mobility dysfunctions; anytime we have an asymmetry in the body we are more susceptible to injury – overactive muscles vs underactive muscles can cause asymmetry; poor posture can cause incoordination of muscles and balance systems of the body;  I think one of the reasons actors and actresses have “presence” when they walk into a room is because many of them have been trained in proper posture. 
3. How does one start to improve their posture? Look at the foot/ankle for pronation issues and use an insert or orthotic if necessary – this can help improve gait and posture; improve faulty breathing patterns, especially paradoxical breathing; improve your balance by training it – for example, standing on one leg while maintaining good posture is a simple exercise maneuver; Engage in consistent use of the foam roll to provide self-myofascial release and self massage; stretch overactive (tight) muscles; perform isolated muscle strengthening of weak muscles and movement patterns; use bodyweight, free weight or kettlebells to perform whole body exercises; consult with a practitioner who understands the concepts of good posture – when I teach other doctors, I call this being the “muscle whisperer” – understand what the muscles are saying while performing a posture evaluation. 
4. What are the top 3 things to remember when attempting to improve your posture? 1. Become aware of the things that you are doing, even the things that you don’t even know you are doing that are contributing (harming) to your posture. 2. Think of staying in a ‘tall spine’ posture (while sitting, standing, exercises); take frequent breaks from siting and use the Brugger’s postural relief position as one of the those style of breaks 3. Know what it feels like to be in proper posture alignment and frequently try to duplicate that feeling – sometimes clients don’t even know what good posture feels like and looks like.    

‘Round back’ or ‘humped’ back treatment protocol

Spinal extension exercises prevent natural progression of kyphosis.

Ball et al.

Department of Physical Therapy Education, School of Allied Health, University of Kansas Medical Center, Kansas, KS, USA.


The angle of kyphosis increases with age with the most rapid increase occurring between 50 and 60 years. The progression of kyphosis was prevented in women ages 50-59 years who performed extension exercises three times a week for one year. INTRODUCTION: The purpose of this study was to (1) measure the progression of the angle of kyphosis with age and (2) determine whether spinal extension exercises prevent progression of hyperkyphosis in women 50-59 years of age. METHOD: Part 1: Cross-sectional study of changes in posture with age, determined by measuring spinal curves in 250 women 30-79 years of age. Part 2: One-year prospective, descriptive analysis of the effect of extension exercises on posture in women 50-59 years of age. Depth of the cervical curve (CD), area under the thoracic curve (TA), and height were measured using a device developed at Kansas University Medical Center. Changes in CD and TA in women compliant with extension exercises were compared to those in non-compliant women. RESULTS: Kyphosis increases with age in healthy women, with the greatest difference observed between women 50 and 59 years of age. The progression of kyphosis was greater in women who did not perform extension exercises compared to those who performed extension exercises three times per week for 1 year. The difference in change in CD and TA between the two groups was highly significant (CD p = .0001, TA p = .0001). CONCLUSIONS: Kyphosis increases with age in healthy women. In this study the greatest difference in the angle of kyphosis was observed between the fifth and sixth decade. Exercises which strengthen the extensor muscles of the spine can delay the progression of hyperkyphosis in the group included in this study, i.e., women 50-59 years of age.



Chronic Pain

I am not in favor of expensive, ineffective and potentially dangerous “treatments” for chronic pain while ignoring causes and prevention of chronic pain. I devote my time spent with clients on examining the causes and most importantly, focusing on how we can prevent acute pain from becoming chronic pain.

I find out what my clients vitamin D levels are. If they are low, they must be elevated to within normal levels. I recommend omega 3 fish oils to all my chronic pain patients. I figure out what exercises clients will do consistently. Diet & supplement recommendations are vitally important. I also recommend my clients eat a low-glycemic diet.

Chronic low back pain or neck pain is a disease we often give to ourselves. Poor posture and a lack of variety of movement are two of the most common causes I see in most cases.

In Most Cases, Chronic Pain is Preventable…
In the absence of trauma or other known disease, most pain that I treat is caused by lifestyle and environmental factors. That means that pain can be improved by eliminating these factors. Some of the risk factors for low back pain are possible to avoid. Maintain good sitting posture, avoid slumping over while sitting, and use proper mechanics while lifting.

In just about every degenerative disease the cause is from the poor choices we make and the habits we develop over a lifetime.

Let’s talk about how you can improve your quality of life.


Posture & Low Load Exercises

Scapular Retraction

Lie with your upper arms straight out to the sides, elbows bent 90°. Pinch shoulder blades together and raise arms level with floor. Keep shoulders down.

Hold for 2 breaths.
Repeat 20 times per set.
Three sets per session.
Complete 1 session per day.


Tighten stomach and slowly raise right leg and lower opposite arm over head. Keep trunk rigid, back flat and hips level.

Hold for 2 breaths.
Repeat 20 times per side, per set.
Two sets per session.
Complete 1 session per day.

One Leg Bridging

With legs bent, lift buttocks so hips are level and elevated. Then slowly extend one leg; keep thighs level and stomach tight.

Hold for 30 seconds.
Repeat 2 times per set.
Two sets per session.
Complete 1 session per day.

Lower Abs

Bend both knees, feet together on floor and stomach tight. Slowly lower one knee to the side and return.

Repeat 50 times per side, per set.
One set per session.
Complete 1 session per day.