Exercises to improve posture: Corrective Exercise for forward head posture

Google the term ‘Exercises to improve posture’ and you’ll find an array of articles and videos. Strangely, the term ‘Corrective Exercise’ is nowhere to be seen. It’s strange, because exercises to improve posture IS corrective exercise, but it is not widely spoken of and, therefore, a little known or understood concept even within the fitness community. The penchant, especially lately, is for one-size-fits-all HIIT workouts or steady state cardio or made-up strength routines. Whilst each of these has it’s use, very often the routine someone follows is doing more harm than good.

But surely doing something is better than nothing, I hear you cry. Well, mostly yes, but very often, no. Here’s why…

Back to my opening statement. Far from being unimportant, I’d suggest that corrective exercise is the most underrated and important concept bar none in fitness today. The reasons for this lie in the figures for back, knee, shoulder and hip injuries and pain issues – why are we seeing these large increases, and what are the underlying contributing factors? This from the NHS website;

  • an accident – such as a fall or heavy blow
  • not warming up properly before exercising
  • pushing yourself too hard
  • using inappropriate equipment or poor technique

All these points are relevant for us here, some indirectly and others directly.

  • An accident can mean the body compensates somehow in order to perform a given movement, be it walking or lifting an object. Essentially, where the prime mover muscle is damaged the wrong (synergist) muscles are used to complete a given task or exercise putting immense strain on the human movement system.
  • Warming up the correct muscles properly is important. The basic Level 3 Personal Trainer qualification teaches that a 10-minute jog on the treadmill and a couple of dynamic stretches prepares the body for exercise, but where the workout to follow is resistance or movement specific based it’s crucial to use the same movement patterns in the warm-up.
  • Pushing too hard is a factor when not correctly warmed up or when using improper form, too much weight or poor exercise selection. It’s not really possible to push too hard other than this.
  • I’m going to amend the final bullet slightly to ‘using inappropriate exercise selection and poor technique’ and focus predominantly here for the rest of this post.

The image shown on the Corrective Exercise page shows what might be termed ‘upper body dysfunction’, thoracic kyphosis, upper crossed syndrome, or in more layman’s terms, forward head posture. It’s a common compensation pattern often caused by sitting at a desk all day, among other things with one’s head in a forward position. Certain muscles become short and tight (overactive), and other muscles (their antagonists, or opposite numbers) become lengthened and underactive.

It can clearly be seen that the shoulder joint is not where it ought to be. In this posture dysfunction, we have two main muscles that cause the scapulae (shoulder blades) to become tilted forward (protracted) and outwardly angled – the pectoralis minor and levator scapulae, respectively. The main muscle that holds the scapulae down and back (depressed and retracted) is the lower trapezius. As a result of the ‘pull’ of the two aforementioned muscles the lower trapezius becomes long and underactive.

Exercise selection for someone with this, or indeed any other postural dysfunction is crucial, and should exclude anything that might exacerbate a problem and cause further damage. For example, it would be inadvisable for the lady in the image to do any kind of exercise that loaded up and put pressure on the shoulder joint because it is in the wrong position. Putting load through a joint that isn’t in the correct position puts strain on it and surrounding structures so not doing a particular (inappropriate) exercise can be as corrective as doing a corrective routine.

So, how do we correct a muscle imbalance, I hear you ask?

If you want a magic pill then feel free to waste your time on the numerous quick fixes you’ll find if you search for the term, ‘exercises to improve posture’. Sorry to disappoint but no single exercise will fix the problem, whatever it may be. The content online is mixed, to say the least. There are a couple of relatively comprehensive video tutorials but one thing that struck me when reviewing the material is that there is mostly no assessment in order to arrive at any given diagnosis, sometimes no specific referral  to any specific postural dysfunction, and no base in science (content for content’s sake to gain clicks). Some may provide relief and stretch a tight muscle in the short term but will not restore optimal biomechanics.

woman demonstrating forward head posture

Forward head posture, or upper cross syndrome

Sometimes a postural dysfunction is plain to see, other times not. Enter Corrective Exercise, a science-backed protocol that addresses imbalance in the human movement system. First comes a detailed assessment. There are cases where a visual assessment is enough to determine postural dysfunction, as in the picture on my web page, but other times it is necessary to undertake a movement screen and further manual strength and range of motion testing. Once an assessment is done and over and underactive muscles are identified we move on to a 4-stage protocol:

  • Release tight, overactive muscles
  • Stretch tight, overactive muscles
  • Activate underactive muscles
  • Integrate all muscles back into a correct operating pattern.
Corrective Exercise continuum

Corrective Exercise continuum (Credit NASM)

With upper body dysfunction, or forward head posture in mind, the long list of tight or ‘overactive’ muscles is as follows:

  • Pectoralis Minor; attaches from the scapula to the ribs. Pulls scapula forward when tight.
  • Levator Scapulae; attaches from the top of the scapula to the upper cervical vertebrae (neck). Downwardly rotates the scapula when tight.
  • Rhomboids; attach from the inside border of the scapula to the upper thoracic vertebrae. Becomes shortened where the scapula is downwardly rotated.
  • Latissimus Dorsi; attach from fascia in the lower back to the humerus (upper arm). Becomes short when shoulder blades are pulled forward.
  • Teres Major; attach from the scapula to the humerus.
  • Subscapularis; internal rotator of the upper arm (humerus)
  • Posterior Deltoid; become short when shoulder blades are pulled forward.
  • Upper Trapezius; attach from cervical vertebrae (neck) to upper spine of the shoulder blade. Elevates and downwardly rotates scapula when tight.
  • Coracobrachialis; attaches from the front of the scapula to the upper arm. Becomes tight where scapula in a forward position.
  • Anterior Oblique Subsystem; a synergy (group) of muscles responsible for flexion (forward bending) and turning in – more on this later.

Underactive muscles we need to activate and integrate are:

  • Lower Trapezius; attaches from the mid-back (thoracic spine) to the lower inside border of the scapula. Becomes long due to opposing force of the pectoralis minor and the levator scapulae.
  • Deep cervical flexors;
  • Serratus Anterior; as above. Attach from front side of scapula to the spine, keep the scapula tight to the ribcage.
  • Infraspinatus; part of the rotator cuff group of muscles, an external rotator of the humerus. Becomes relatively weak due to the dominance of its antagonist (subscapularis, causes the opposite joint action).
  • Intrinsic Stabilization Subsystem; muscles of the core, specifically those that stabilise the spine.
  • Posterior Oblique Subsystem; a synergy (group) of muscles responsible for extension (backward bending) and pulling action – more on this later.

The low hanging fruit I’m going to deal with here are the aforementioned levator scapulae (release and lengthen), pectoralis minor (release and lengthen), along with the lower trapezius (activate and strengthen), deep cervical flexors (activate), latissimus dorsi (release and integrate) and upper trapezius (release).

In the following images you will see pec minor and levator scapulae releases using a lacrosse ball to find a sore spot, or what can also be known as a trigger point in the muscle and gently apply pressure. I will ask clients to hold the position for a minimum of 30 seconds and sometimes a minute. Sometimes a palpable release can be felt, which is what we’re looking for. This release technique is called self-myofascial release (SMR) and utilises the principle of autogenic inhibition, where we try to trick the muscle into releasing and straightening the kink in the muscle fibres that could not otherwise be released by simply stretching.

Levator Scapula release

Levator Scapula release with lacrosse ball

Pec minor release

Pec minor release with lacrosse ball

The second phase is to lengthen the muscle, using one or other of the numerous stretching techniques available to us. I will use a combination of static, dynamic, and isometric stretching at various times, depending on the kind of programme I’m working on with the client. For example, I’ll use static and dynamic stretching for my resistance trainers, and my mobility clients, golfers and runners will utilise more isometric stretching because strength through a wider range of motion is required. Once the pec minor and levator scapulae are ‘loosened off’, we can move to the next stage where the muscle exerting the opposing force (the antagonist) is addressed.

Wall slides for serratus anterior activation

Wall slides for serratus anterior activation

Lower trapezius activation on Swiss Ball

Lower trapezius activation on Swiss Ball

Deep neck flexor activation

Neck flexor activation with band

The third phase is activation. In the picture above you can see my client performing an exercise sometimes called a prone ball cobra, which, when performed correctly targets the lower portion of the large trapezius muscle. The lower trap attaches between the medial border of the scapula (shoulder blade) and the thoracic spine. The thumbs are pointing upwards, adding a greater squeeze to the muscle in the retraction phase. Activating this muscle helps to pull the scapulae back (retraction) to an optimal position. We also work on the serratus anterior with a wall slide exercise (see right). This muscle pulls the scapula close to the ribcage and forms the articulation of the scapulothoracic joint, which technically isn’t a joint, but one structure (scapula) articulating on another (the back of the ribcage). Rotator cuff strengthening will also help, specifically the external rotators (infraspinatus and teres minor), using the banded exercise shown below, and also deep cervical (neck) flexor strengthening with a band.

external rotation with band

External rotation with band

Once these muscles are activated, we then need to restore a correct firing pattern and restore optimal muscular and nervous system operation.

Phase four is what we call integration, in this case to optimise posterior oblique subsystem (POS) operation, which is a synergy of muscles that resist forward bending (flexion) and turning in. This consists of the gluteus and latissimus dorsi muscles so a pulling action along with a hip extension exercise is needed. Here we use a squat to row exercise with a resistance band, for example. Form is more important than load here as it is about cementing a movement pattern rather than endurance or strength building.

I utilise this process either as a warm-up, or as a 30-minute circuit, routine as follows:

  1. Release: Levator scapulae, Pec Minor (possibly Latisimus Dorsi too) 30-120s each
  2. Stretch: Levator Scapulae, Pec Minor & Lats, 30-120s each
  3. Activate: Lower Trapezius, Middle Trapezius, Serratus Anterior, Neck Flexors, external rotators. One or two sets of 15-20 reps.
  4. Integrate: Squat to row with resistance band. 20 reps, form is more important than load.

How long does correction take, I hear you ask? Well, I have known some cases where an underactive muscle can be woken up and back to optimal movement in 2 sessions. In more complex and longer-term defects, the process can be a long one – a year or more. Focus and discipline is required, but the benefits of embarking on the process are many. Even where the posture does not visibly correct quickly, I have clients report to me that they experience less pain or feel stronger. Depending on the client we can gradually expand the range of possibilities as we go, adding more demanding mobility or resistance elements and making sure we keep it interesting. Regular and frequent assessment and reprogramming is the key.

So, there you have an example of some exercises to improve posture, a basic corrective exercise routine for forward head posture, in this case. Part 2 will deal with postural dysfunction around the pelvic hip complex. I hope you’ve taken something away from reading this and that it helps in some way. Whatever exercise regime you embark on it’s important to listen to your body – it will tell you what’s going on if you tune in and pay attention! That said, try not to just give in to discomfort, indeed the point of this post is to show that it’s possible to move beyond a pain situation and restore peace and harmony in the human movement system. Please do not simply fade away into a decrepit state because you can’t do something or you think you’re too old. The first of those two points is only ever temporary, and the second is just conditioning from society and need not apply. Age is not the enemy but doing nothing is. Corrective exercise can get you back on the path to optimal, pain-free movement once again!

Thanks for reading, please drop over comments and questions.

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