Safety / Injuries
Upper Back and Neck Pain — Corrective Exercise for Kyphosis
Various repetitive external forces can affect posture. Sedentary lifestyles, the prevalence of the “desk job”, and the use of mobile phones have contributed greatly to poor ergonomics for people of all ages.
Relieving tight muscles in the neck and shoulders can prevent stiffness, muscle spasms, pain around the shoulder blades, and headaches. When proper posture is not maintained, spinal dysfunctions can develop quickly although they can also be congenital or related to disease or age. The good news is that many of these spinal issues can be corrected or reduced with corrective exercise and mindfulness of posture.
Good posture when seated or standing helps with muscle flexibility and core strength, along with many other structural benefits. Chronic pain and most physical dysfunctions are the direct results of poor posture, poor movement patterns, and a lack of strength in most individuals. Therefore, the use of a thoughtfully designed corrective exercise program is a valid countermeasure.
The spine is arguably one of the most important parts of your body. It is divided into five regions and serves as protection for the spinal cord and internal organs, provides structural support, and enables motion through the trunk.
The cervical spine includes the first seven vertebrae in the neck. The thoracic spine is the next twelve vertebrae in the middle of the torso. The following five vertebrae make up the lumbar spine with the sacrum (three fused vertebrae) and the coccyx (four fused vertebrae) at the base of the spine.
Without a spine, humans would not be able to stand upright. Nerve roots of the spinal cord originating in the brain are protected by the spinal vertebrae and these nerves are vital for the communication of neural input and output as well as movement.
Chiropractic treatment has become more common and it utilizes spinal manipulation. Administered by a Doctor of Chiropractic (DC), it addresses soft tissue around the spine to relieve pain and restore vertebral mobility and flexibility. However, many conditions of the spine can present at any stage of life that chiropractic adjustment will not address.
Common Spinal Deviations
Spinal and posture deviations are incredibly common in the United States. The most common spinal dysfunctions are:
- Lordosis - abnormal (excessive) inward curvature of the lumbar spine also called swayback
- Kyphosis - the abnormal convex rounding of the thoracic spine
- Flat back - the loss of spinal curvature in the cervical, thoracic, and lumbar spine
- Scoliosis - the abnormal lateral curvature of the spine
For this discussion, we will explore the condition of kyphosis and the corrective stretches and exercises that can address it.
Types of Kyphosis
There are several types of kyphosis commonly diagnosed. The symptoms of kyphosis are visual and physical and vary based on the origin and severity of the condition. Physically, someone will experience pain in the upper back, neck, and shoulder blades, fatiguing muscles, and stiffness. Visually, the appearance of the kyphotic curve of the spine will begin gradually. The curve angle, and thus the severity, can also be measured and monitored.
- Congenital kyphosis results from improper spinal growth in the womb and affects infants and children. The resulting spinal deformity can range in severity at the time of birth and progress if not addressed.
- Postural thoracic kyphosis is a direct result of poor posture over a long time. It is more common in adult females and is environmental. Sedentary deskwork and rounded shoulders from slouching are common causes.
- Degenerative kyphosis is caused by the degeneration of the spine causing it to lean forward over time. This generally affects the elderly.
- Thoracic hyperkyphosis is also known as a “hunch back” and presents as an extreme curvature of the spine more than 40 degrees. Though extreme, it can still be addressed and improved.
- Nutritional kyphosis is due to a lack of nutrients that contribute to bone growth and health, like vitamin D, and occurs in younger children and the elderly.
Physical therapy is the first thing that many people think of when it comes to correcting a severe dysfunction or recovering from surgery. While a physical therapist can address conditions with a more medical approach, the personal trainer and corrective exercise specialist can work with posture, pain, and the symptoms of kyphosis by addressing the muscular imbalances that contribute to the spinal deformity.
During the initial assessment, it is important to determine if your client can form a neutral spine curvature with self-manipulation; this means they can adjust their posture to create the proper s-curve. If they can do this, training with flexibility and corrective exercise can improve the deviation in most cases. If they cannot, this indicates potential additional structural issues beyond the scope of practice for a trainer and they must be referred to a physician or chiropractor.
Corrective exercises to improve kyphosis can range from simple range of motion exercises to back strengthening movements. Most people carry tension in their upper back and shoulders and proper attention paid to relieving tight muscles in the neck and shoulders will help to minimize pain and chronic discomfort.
1. Correct and Hold
This exercise will allow the client to correct the spinal curve and hold it, challenging the supporting muscles of the spine.
- Have the client stand upright. Place their back against the wall if needed.
- Cue them to tuck their chin and move their head back over the shoulders. They will feel their shoulder blades moving down their back while keeping the shoulders down and away from the ears.
- Instruct them to hold this position for 45 to 60 seconds before resting.
- Note: Muscle fatigue will occur, but pain should not.
2. Standing Shoulder Flexion
You can perform this exercise unilaterally or bilaterally.
- From a standing position with straight arms, have the client raise their arm slowly in front of their body, finishing in full flexion overhead. The severity of the kyphosis will determine their full range of motion passively.
- An assisted stretch can be achieved if the flexion is guided with external pressure provided by the exercise specialist at the end of the range of motion.
- Hold for 20 to 60 seconds keeping the shoulder down in the socket before returning to the start position.
3. Scapular Range of Motion
More commonly called a shoulder roll, this is a range of motion through the shoulder blades.
- Standing in a neutral position, cue the client to elevate the scapula by raising their shoulders to their ears.
- Next, cue the retraction of the shoulder blades by having the client pinch their shoulder blades together, engaging the rhomboids. Neck remains as relaxed as possible.
- With rhomboids still engaged, they now must depress the scapula, drawing them down the back as far as possible with the lats.
- From the lowest point, the rhomboids are released to allow for shoulder protraction as far as possible.
- Finally, they will relax and return to the neutral starting position to begin again. The full range of motion should take 20 to 30 seconds and ensure the client is actively engaging their muscles to extend to the fullest range of motion possible.
Repeat this exercise 10 to 15 times before resting.
- Have the client lay prone (face down) on a mat, arms outstretched overhead and legs long. Head and spine are neutral to begin with shoulders down away from the ears.
- Initiate lifting of the lengthened legs and arms simultaneously by cueing glute and lower back contraction.
- Hold at the top for a 3 count before a controlled release back to the start position.
5. Chest Stretch
Postural kyphosis can be a result of overactive pectoral muscles. Addressing this tightness will allow the relaxation of the upper back and a release of tension surrounding the spine.
- Standing, have client extend one arm straight and place it on a stationary object about chest height.
- They will physically turn their feet to increase the angle of horizontal extension and rotate their entire body until a stretch is felt in the anterior deltoids and pectorals on that side. Shoulder must stay down and away from the ear.
- Hold for 30 to 60 seconds before releasing and switching arms.
6. I-Y-T-W Scapular Movement Series
A progression of the superman, the scapular movement series will challenge the latisimus dorsii, subscapularis, rhomboids, and related back and shoulder musculature and stabilize the spine.
- Have the client lay prone as if starting a superman. Neck and head are neutral, arms outstretched overhead and legs long. Shoulders are down away from the ears.
- Cue the retraction of the shoulder blades- they will brace through the core and lift the upper body only. Palms facing each other overhead. This is the “I”.
- Maintaining the upper body elevation, cue the client to begin adduction of the shoulder, stopping at a 45-degree angle to the head. This is the “Y”.
- Continue the adduction until arms are at a 90-degree angle, shoulder blades still retracted with palms now rotated towards the floor. This is the “T”.
- The final range takes the arms from the “T’ position and, breaking at the elbow, further adducting the elbows as far as possible towards the ribcage, depressing the scapula and squeezing the Rhomboids, with hands outside of the shoulders. This is the “W”.
- They will progress their arms back out in the reverse order until arms are extended back overhead at the starting position.
7. Dumbbell Row (Unilateral or Bilateral)
To strengthen the upper back muscles, a row is a simple way to engage the muscles surrounding the spine after the chest has been stretched. Ina gym or fitness facility, a row can be completed with dumbbells, barbell, cable or machine. This is a single-arm dumbbell row:
- On a bench, one arm and the same side knee are propped. The opposite leg is moved back behind the hip, dumbbell in hand, and arm fully extended, and chest facing the floor. The core is engaged and the shoulder will remain in the socket during the entire range of motion.
- Cue the client to draw their elbow towards the ceiling, squeezing through the rhomboid, keeping the back flat, the chest still, and ending with the dumbbell just below the chest.
- Returning the dumbbell to the starting position completes the movement.
- Repeat for 10 to 15 repetitions before switching arms.
There are many other ways to improve kyphosis like simply adjusting your sitting and standing posture. Being muscularly aware as often as possible is equivalent to doing constant corrective exercise!
How to Design a Corrective Exercise Program to Improve Kyphosis
Personal training focuses on helping clients build strength, stability, and balance while corrective exercise aims to improve someone’s quality of life and sport by minimizing pain and reducing movement dysfunction.
As a Corrective Exercise Specialist, you gain the knowledge and access to the tools and assessments needed to find and correct all types of postural and movement dysfunctions. Assessments will always be the first and most important step in any exercise programming, but especially one aimed at corrective exercise.
The stretching and strengthening exercises most effective to treat kyphosis can be administered as a program on their own or easily incorporated into a normal fitness routine. Many individuals with the condition are fully functional, but may have a restricted range of motion through their spine, shoulders, and back. Many will have pain or discomfort that the trainer must be aware of and help them work through as well.
A personal trainer with a kyphosis client who is involved in a normal program may include some of the above stretches and a back-strengthening exercise in each workout as a large part of the warm-up. The intention is to address the condition, but also to work towards optimal body positioning and range of motion for general movement to minimize pain and discomfort.
Continue your education as a Corrective Exercise Specialist to better understand the assessments and programming you need to be successful with any client!