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Strategies for Correcting Bad Posture – Part 2

Written on December 1, 2010 at 7:51 am, by Eric Cressey

Today, we move forward with more strategies for correcting bad posture. In case you missed it, be sure to check out Strategies for Correcting Bad Posture: Part 1.  We pick up with tip #5…

5. Don’t overlook a lack of glenohumeral (shoulder) joint internal rotation. When it comes to bad posture, everyone thinks that the glenohumeral joint is only a “player” when it’s stuck in internal rotation; that is, the ball – or humeral head – is rotated too far forward on the socket – or glenoid fossa – meaning that the individual just doesn’t have adequate external rotation.  And, this is often true – especially in non-athletic populations.

However, you’ll also very commonly see poor posture folks who present with big glenohumeral internal rotation deficits (GIRD), particularly on the right side (for very legitimate reasons that go well beyond the scope of this article).  This is much more common in athletes, particularly overhead throwers (read more: Static Posture Assessment Mistakes).  When the posterior rotator cuff is stiff/short and there is an internal rotation deficit, we have to substitute excessive scapular protraction (winging) or thoracic flexion/rotation each time we reach for something.

So, for many folks, posterior shoulder mobility and soft tissue work is an important inclusion in cleaning things up in terms of appearance, function, and shoulder health.  If – and only if – you’ve been assessed and it’s been determined that you have an internal rotation deficit that compromises your total motion at the glenohumeral joint, you can integrate some gentle sleeper stretches (scapula stabilized!) to get a bit more ROM in the posterior cuff.

6. Don’t overlook a lack of glenohumeral (shoulder) joint flexion. The shoulder is a tremendously mobile joint, so we need to appreciate what goes on outside the transverse plane as well. In particular, I see shoulder flexion limitations as a big problem. These limitations may come from the lat, teres major, long head of the triceps, or inferior capsule.  Another overlooked cause can be posterior cuff restrictions; it’s not uncommon to see both GIRD and major shoulder flexion limitations on the same side.  As the picture below shows, the infraspinatus and teres minor run almost vertically when the arm is abducted a mere 90 degrees – which means that they’re struggling to lengthen fully to allow full shoulder flexion (and abduction, for that matter).

These restrictions that can contribute to both faulty compensation patterns in certain positions, as well as overall bad posture chronically.  Let’s have a look at what these issues look like in the real world. First, in someone with a shoulder flexion limitation, you’d first want to check them in the supine position, with the knees flexed and back flat (to avoid substituting lumbar extension for shoulder flexion).  Ideally, the arms should rest flat on the table – so this would be a “not-so-hot” result (especially since the arms “fall” to the sides a bit instead of staying in “attempted flexion”):

Next, let’s take this same shoulder flexion limitation, and look at what would happen actively.  In the first three reps of the video below, take note of the position of our subject’s head at the start and finish of each rep; you’ll see that as he “runs out” of shoulder flexion, he substitutes forward head posture.  On the next three reps, after I cue him to keep his cervical spine in a more neutral posture, he has to arch his back excessively (lumbar hyperextension) to complete the movement.

Now, imagine taking this walking disaster (only kidding; I had Dave fake it for the video, as he’s actually a finely tuned trained killing machine who can’t be stopped by conventional weapons – and he’s single, ladies) taking up overhead pressing, Olympic lifting, or just reaching for a glass on the top shelf.  Then, imagine him doing those tasks over and over again. Obviously, the posture will get worse as he reinforces these compensation schemes – but something is going to surely break down along the way; it’s just a question of whether it’s his low back, shoulder, or neck!

Correcting these issues is easier said than done; as I noted, there are several structures that could be the limiting factor.  However, for those looking for a relatively universal stretch they can use to get a bit of everything, I like the wall lat stretch with stabilization, one piece of a comprehensive (but not excessive and boring) static stretching program included in Show and Go.

7. Don’t ignore the thoracic spine. The previous two examples focused exclusively on the glenohumeral joint, but the truth is that it is tremendously dependent on thoracic spine positioning.  Ask any physical therapist, and they’ll tell you that if they can get the thoracic spine moving, they can instantly improve glenohumeral joint range-of-motion without even touching the shoulder (this is incredibly valuable with folks who may have stiff glenohumeral joints that can’t be mobilized aggressively following shoulder surgery; they need ROM in any way possible).  And, truthfully, you can substitute a lack of thoracic spine extension for the shoulder flexion problems and compensation schemes above, and a lack of thoracic spine rotation can work in much the same way as a GIRD (substitute excessive scapular protraction with reaching tasks).

If you ever want to quickly check to see what limiting thoracic extension does to someone’s upper body posture, just put them in supine position and push the sternum/rib cage down – which will bring the thoracic spine into flexion. Watch what happens to the position of his chin, and the size of the “gap” between his neck and the table:

Now, just consider what kind of “yank” this puts on the sternocleidomastoid chronically…

…and you’ll understand why a lack of thoracic spine mobility can give people enough neck pain and tension headaches to make Lindsay Lohan’s hangovers look like a walk in the park.  And this doesn’t even consider what’s going on with scalenes, suboccipitals, levator scapulae, subclavius, and a host of other muscles that are royally pissed off!  Also, think about all those folks in your gym doing hours and hours of crunches (especially while tugging on the neck).  Ouch.

For that reason, we need to get our thoracic spine moving – and more specifically, we need to get it moving in both extension and rotation.  I’ve mentioned in the past that the side-lying extension-rotation is one of my favorites (assuming no symptoms); remember that the overwhelming majority of the range-of-motion is coming from the upper back, not just the shoulder:

Here’s another we’re using quite a bit nowadays in our folks who have good internal rotation (which we want to keep!):

8. Watch your daily habits and get up more frequently. I’m at 1,140 words for this post right now – plus several pictures and videos.  In other words, some of you might have been hunched over your computer screens trying to figure out what I’m saying for over 20 minutes now – and that’s when “creep” starts to set in an postural changes become more and more harmful (both aesthetically and functionally).

With that in mind, make a point of getting up more frequently throughout the day if you have to be sitting a ton.  Likewise, “shuffle” or “fidget” in your chair; as Dr. Stuart McGill once said, “The best posture is the one that is constantly changing.”  Now, shouldn’t you get up and walk around for a few minutes?

I’ll be back soon with Part 3 of this series, but in the meantime, I’d encourage you to check out Show and Go: High Performance Training to Look, Feel, and Move Better, a comprehensive program that includes many of the principles I have outlined in this series.

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20 Responses to “Strategies for Correcting Bad Posture – Part 2”

  1. Raymond Watts Says:

    Great article :-)

    I instruct a Personal Training course here in the UK and am looking to recommend a ‘corrective exercise’ instructional DVD, what would you recommend?

    Raymond :-)

  2. Eric Cressey Says:

    Raymond,

    Definitely check out Assess and Correct and Building the Efficient Athlete; both are good bets.

  3. Rick Kaselj Says:

    .

    EC,

    Great stuff.

    The shoulder flexion is a big one that people overlook.

    Rick Kaselj of http://ExercisesForInjuries.com

    .

  4. john Says:

    Great post–ever since I’ve been working at my computer, I’ve needed a long hip and shoulder warm-up to prevent low back pain and what felt like hamstring inhibition. I went through many frustrating workouts before figuring out how to solve the problem. Anyway, the moral of the story is to not get a job where you sit a lot.

  5. Darius Gilbert Says:

    Great stuff Eric!

    What’s the difference in placing the hand behind the head as opposed to placing the hand behind the back in the quadruped extension and rotation exercise?

  6. Eric Cressey Says:

    Darius,

    It puts the glenohumeral joint in a more internally rotated position for the mobilization. Usually, internal rotation is the area where there is the most to be gained from mobilizing the t-spine, in my experience.

  7. Steve Edling Says:

    Excellent. Great exercises to help my patients with chronic poor posture. Adjusting the thoracic spine does improve shoulder mobility and allows one to start implementing exercises.

  8. David Says:

    Eric,

    On the lat stretch with stabilization, are you stabilizing the scapula while stretching?

  9. Patti Says:

    Excellent detail Eric. Great reference for us!!

  10. Dan Says:

    With regards to T-Spine extension mobility, are there any methods other than foamroller/tennis ball SMFR and Mobilization?
    I have a client who responds well to scapular retraction, sleeper stretches, lat/teres major stretches, and even T-Spine rotation mobility. What hasn’t worked a single bit is any T-spine extension mobility exercises. The client cannot even actively push their chest up during exercises, or if they do, nothing visible happens.
    I am completely stumped.

    By the way, I check your website every single day and your stuff is the standard from which I base most everything else on. Fantastic information.

  11. Sean Carver Says:

    Another quality article Eric! I\’m currently at week 8 of your Maximum Strength programme and feel stronger and healthy then ever.

    Thank you

  12. Eric Cressey Says:

    Thanks, Sean! Definitely check out Show and Go next; it’s a great progression from Maximum Strength (and on sale through midnight tonight).

  13. poh Says:

    Eric, are all these exercises for shoulders found in your shoulder program DVD set?

  14. Eric Cressey Says:

    Yes, we include a ton of different exercises on the DVD set.

  15. jb Says:

    I can’t thank you enough for all the work you’ve done on assessment/correction. My P.T. is continuously impressed by my anatomical comprehension and directional cues, which I owe to your writing. From the early T Nation articles to these more recent posts, with your information, I’ve been solving and improving all along the way. Thanks. Killer handlebar stache.

  16. Robert Says:

    Great post Eric as allways!

    Today I just have small workshop on some parts that you explain in this post! If I readed before I would apear much more smart :)))

    I consider posture as major part of successfull sport movement. What is your oppinion on this?

    Keep up, the good work I know I like it!

    Thanks, Robert

  17. Daniel Pope Says:

    I just wanted to say I’ve been following your information for years now Cressey. I remember first seeing you at an Old Dave Tate and Joe Defranco seminar way back in 2005 or 2006. Its great to see your progress. I was a sophomore in college then and have since then worked in the sports performance field and am now finishing my docotorate in physical therapy. I’ve used your info all along the way and it heavily influences how I train for my sport(strongman). I think I bought every book you recommended at your building the efficient athlete seminar (still trying to get through sahrman’s stuff!) Keep up the excellent work. If you want to see your work in action(through me) I post all my training on strengthfoodlife.blogspot.com

  18. hooch turner Says:

    What about the person who computes lying down? Will creep devastate them in the space of 20 mins? I read that sitting creates 125% pressure through the lower back, whereas standing is 100% and lying down is about 25%.

    I lie down a lot, because I can’t tolerate sitting very well (and because I’m scared of this ligamentous creep boogie man that McGill has spooked us with). I feel lying down stretches out my ‘lateral chain’, probably my QL, which can kind of go into spasm. I figure, we lie for 7-10 hours every night, so some extra can’t be too bad.

    I have maximum strength and show and go, but am afraid to start into them: ie add fitness on top of the dysfunctions in my back. I’m doing lots of rolling, bear crawls, get ups, and other such body weight stuff without any major issues. Should I just give it a shot someday?

  19. Anthony Says:

    Eric Im a baseball players and have had chronic pain in age area pointed to under #6 yet I have good (although not perfect but much better than the picture) supine thoracic extension..what could be causing my pain? I did notice though that when I try to do the elbow to instep lunge with rotation I completely fail and cannot rotate very well at all

  20. Eric Cressey Says:

    Anthony,

    I’d strongly encourage you to see a qualified physical therapist in your area.

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