By Chuck Wolf
The client/patient presents with the familiar rounded shoulders, posterior pelvic tilt, and head forward posture. All we want to do is place our knee between their scapula, grab their shoulders and pull them back…and say, “There, now stand up straight!” This scene is all too common and, historically, the fitness professional has advised the client to stretch the pectorals, anterior deltoids, abdominals, and strengthen the posterior shoulder complex.
At times, we placed the client/patient on a seated row machine and strengthened the posterior shoulder, parascapular musculature, and latissimus dorsi from this position. We have good intentions; however, are we looking at the symptom or the problem? In other words, are we addressing the functional cause?
Round Shouldered Posture (Kyphosis) is a muscular imbalance that causes forward roundness of the low back (flexion of the lumbar spine on the pelvis), increased round shoulder posture (thoracic flexion), and forward head tilt (cervical flexion).
Viewed from the lateral perspective, the client is slouched in their standing posture (there is a reduction in lumbar and cervical lordosis, increased thoracic kyphosis or flexion, shoulder and scapular abduction (protraction), and a relatively posterior tilted pelvis). The traditional approach of stretch the anterior shoulder region and strengthen the posterior region is only part of the solution.
From a biomechanical reaction, when the upper thoracic spine becomes further flexed, the lumbar and cervical spines will flex and the pelvis will tilt posteriorly. Or when the pelvis becomes posteriorly tilted, the lumbar spine will flex, the thoracic spine will flex further, and the cervical spine will reduce lordosis, head tilt forward and downward. In all, but very rare cases, will this reaction occur.
A Brief Look at the Spinal Reaction of Pelvic Changes
Let’s quickly analyze how the pelvis can affect spinal position.
First, stand with feet about hip width apart in a bilateral neutral position.
Now imagine reaching your head to the sky, not looking up, but stand tall from the greater trochanter of the femur to the top of the head (refer to photo 1).
Place the back of the hand at the lumbar spine. Typically, there should be a natural lordotic curve at the lumbar spine, the head is held upright with a natural lordosis in the cervical spine (refer to photo 2).
Notice how the lumbar spine is relatively extended to the pelvis and the concomitant relative anterior tilting of the pelvis to the spine. You may want to observe this from the lateral side view.
Next, round the shoulders (scapular protraction) and notice how the lumbar spine flexed, the increased thoracic flexion and loss of cervical extension, head shift forward and downward. Also, note the position of the pelvis as it tilted posteriorly on the lumbar spine. This is often the postural alignment many of our clients/patients possess (refer photo 3).
For the moment, imagine you are walking in the shoes of those that present with kyphosis and the health and fitness professional tells them to stand up straight with their shoulders pulled back. They try to heed the advice, but now stand with this strain on their face as they have adducted their shoulder girdle but have not addressed the posterior pelvic tilt. They now have an abrupt compressing conflict at the thoraco-lumbar junction. The reason for this is the pelvis has a relative flexed position with the lumbar spine and the distal thoracic spine begins to extend at the thoraco-lumbar junction near the still flexed lumbar spine. Notice that the pelvis is tilted posteriorly to the lumbar spine.
Create the Environment for the Client to Become Successful
To improve the kyphotic condition, we must create an environment of success for our client. For this to naturally and functionally occur, the pelvis must be relatively anterior tilted to the lumbar spine, thus creating lumbar extension. To achieve this, position the client into a posterior lunge with the right leg (refer to photo 4).
Make sure the right heel remains on the ground. Notice how the right pelvis has become anteriorly tilted to the lumbar spine. Place the back of your hand at the lumbar spine and observe the increased lumbar lordosis. To improve shoulder girdle posture, extend the left arm while it is abducted about 15 degrees to waist height. Notice how this movement pattern creates scapular retraction (adduction) of the left scapula, the thoracic spine extends, lumbar spine gains relative lordosis, the cervical spine improves its lordosis while the head draws back, resulting in greatly improved posture.
If desired, have the client/patient hold a rubber tube to add resistance as they extend the arm. This will add resistance for the parascapular muscles, posterior shoulder, and latissimus dorsi. As a functional alternative, use a dumbbell in the left hand, flex forward from the waist and reach the left arm anteriorly to waist or knee height (refer to photo 5).
Then extend the torso back and reach the arm back while slightly abducted at waist height (refer to photo 6).
This will create a scapular retraction and help strengthen the posterior shoulder girdle and back. The rationale for the forward flexion is to allow the posterior muscles to undergo a lengthening or pre-load. When muscles move through the pre-load phase, they eccentrically contract to decelerate the forward motion. Physiologically, the eccentrically loaded tissue stores approximately 3-9 times more energy than the concentric unload action. Whenever we perform any efficient movement pattern, muscle tissue moves through a pre-load, lengthening phase (eccentric), stabilizing phase, then an unload, shortening phase (concentric). In this case, the posterior muscles lengthen in the pre-load phase, undergo a stabilizing moment just prior to changing directions when we then extend back through the hip and back while we extend our arm with a posterior reach.
Perform 10-15 repetitions, 2-3 sets, and then repeat on the opposite side. Be sure to change leg positions to address both sides of the back. In this way, we can functionally create an environment for success to improve posture.
To find out more about kyphosis and functional training and to take his sessions, catch Chuck Wolf at canfitpro2019!