Positive Health Online

"Pull back your shoulders!" This must be the most common and popular piece of postural advice ever given. This must also be one of the most misguided.

Maybe you heard it many times from your parents when you were in your slouched teens. Later on, your friends and loved ones might have uttered this unsolicited advice to you if you had the misfortune to exhibit what is known as round shoulders.

Many years later, still round-shouldered, even if you have been religiously carrying out their instructions, and now in pain partly because you have been carrying them out, you visit your physical therapist or fitness instructor of choice only to hear again and again this annoying if not infuriating admonition. And, if you are unlucky, you might even have to hear another pearl of postural wisdom that goes like: "lift your chest high".

It sounds reasonable enough. If you have round shoulders, that is, if they have migrated forward, it seems logical to pull them back where they belong. It is just common sense, you might say. But what passes for common sense is not always plain Cartesian common sense; in other words, it does not always equate with good sense.

The mother of all postural defects and distortions is hyper lordosis (undue / exaggerated concavity of the spine). Round shoulders are no exception. 'Square' shoulders requires that the spine on which they attach has normal curves with a cervico-thoracic (neck and upper back region) and a thoraco-lumbar (lower back) lordosis. The point where they meet is called kyphosis (backward or dorsal convexity), with an apex around the 7th thoracic vertebra.

Although it is the kyphosis that usually gets all the attention (simply because it is easier to see bumps than hollows), it is the lordoses that are the primary cause of round and painful shoulders with limited range of movement.

A common postural defect is the forward head posture which is caused by the shortening of muscles attached to the front of the cervical spine and the upper thoracic spine. These muscles pull the head forward and, with it, the neck and upper back (the area between the shoulder blades).

But the muscles in the front of the neck are opposed by the ones covering the nape of the neck and upper back, which also have the tendency to become too tight. So, not only the head is displaced forward but it is also tilted back relative to the neck. The end result is an increase of the cervical (pertaining to the neck) and upper thoracic spine's lordoses (the arches in the spine).

The same postural scenario usually happens also in the lumbar and lower thoracic spine: the pelvis is pulled forward by the shortening of the ilio-psoas muscle, thereby increasing the concavity in this region. The more these two concavities (upper and lower segments of the spine) are moving forward, the more the transitional region (the kyphosis) seems to protrude, giving the appearance of a round back.

In fact, the middle of the back has not moved back as such, it only acts as a hinge from which the lordoses above and below it migrate forward, thus making the kyphosis more apparent.

The round back becomes the offending feature and gets the lion share of the therapeutic intervention. Due to the current obsession with strengthening, to flatten this disgraceful bump, this means to recruit and exercise the back muscles; and, with the core stability craze, to strengthen the popular core muscles. Of course, the shoulders are not forgotten, and are part and parcel of this strengthening regime: "Pull back these shoulders!"

But, since the primary cause of both round shoulders and round back originates from an excess of muscle tone that shortens the muscles which subtend the arches in our spine, these remedial efforts can only fail as they increase even more the culprit - the lordoses.

Check it for yourself. Pull back your shoulders (I never thought I would end up asking you to do such a thing)! If your sensory appreciation is not too dull, you'll not fail to notice that in the process you'll have also arched your lower back and/or your neck and upper back region. In other words, you have compounded the problem.

And problems there are or will be. A study demonstrated that the shape of the cervical and thoracic spine influences the range of movement of the shoulder. A round back makes the shoulder blades tilt forward and a head forward posture provokes a strong tension in levator scapula muscle. An exaggeration of the thoracic kyphosis, in other words a round back, causes a decrease in the range of movement of shoulders which is at the origin of severe disabilities such as rotator cuff injury and frozen shoulder to name a few. Don't forget though that the round back is not the culprit, but just the transitional zone between two concavities that became too deep.

The remedy to this postural problem doesn't lie in a simplistic and misguided exhortation. It requires tailor-made sessions designed to decrease the arches in the spine. But whatever you do, don't pull back your shoulders!