Correcting posture to prevent and treat neck and shoulder pain
Non-specific neck pain, tension-type headache, and shoulder pain are very common and in most cases they are present together and pathophysiologically associated with two bad posture: forward head posture and round shoulder posture (1).
Forward head posture is a forwad incliniation of the head with cervical spoine hyperextension which is associated with shoerting of the upper trapezius, the splenuis and semispinalis capitis and cervicis, the cervidal recector spinae and the levator scapulae musculature. This posture change the position of the scapula (shoulder blader) and decrease its ability to rotate upwardly, a common characteristic found in patient with shoulder impingement (pain at abaduction of shoulder joint).
Round shoulder posture is a forward deviation of the shoulders associated with a protracted (frount rotated) posiiton of the scapula as caused by a muscular imblance between the shortened pectoralis minor and a lengthened (weak) middle trapezius and serratur anterior. This increase anterior scapular tilt and internal rotation which hihgly associated with shoulder pain.
Exercises that strength weak muscles and stretch tight muscles can improve these two abnormal postures. A recent study by Lynch et al examined the effects of some of these exercises on the two postures and found significant improvement in the posture, muscle strength and posture-related pain (2).
These exercises are done in 3 sets of 10 repetitions, 3 times/week for 8 weeks. The exercises used in the study as following:
1. L to Y to W: with a gym ball under the torso, arms abducted to 90 degree and elbow flexed to 90 degree. Retracted scapula and externally rotate arms. Maintaining scapula retraction, raisie arm abouve head and fully extend elbow to form letter Y. Flex the shoulder and abducted at 120 degree. Then flex the elbows and move into a position of shoulder extension forming letter W by adducting the shoulder to 60 degree.
2. Scapular protraction: position in a prone hip bridge with forearms and tows supporting th ebody on floor, push up 1-2cm by protractint he scapuale abut acrively attempint to prevent wingling of the scapulae.
3. Pectoralis flexibility: lying supine on a foam roller aligned wiht spine, bring palms togheter in front of chest then horizontally abduct shoulder and retract scapula, keeping wrist and elbow aligned in the same plane as the body, hold for 5 second for 10 times.
4. Chin tucks: lying on the floor, pusing the head against the floor for 5 seconds.
These exercises can be easily modified into one exercise, but proper tutoring is needed to do it correctly.
1. Greefiled B, et al. Posture in patients with shoulder overuse injuries and healthy individuals. J Orthop Sports Phy Ther 21:287-96 (1995)
2. Lynch SS, et al. The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers. Br J Sports Med 44:376-381 (2010)