04 Mar Posture and Pain (Part II)
Last post we discussed how posture can influence pain in different ways. Sitting at a desk for long periods of time leads to x, y, and z; muscles certainly become overactive (a muscle or group of muscles that are short, tight, and strong) as well as underactive (lengthened and/or weak) which may contribute to pain on a daily basis. Part II of this post is designed to give you simple solutions to create a better balance to enhance posture and hopefully relieve some minor aches and pain along the way.
For the sake of not overlooking medical diagnoses and identifying specific movement impairment syndromes, we will take a look at exercises that generally lead to relief of pain, reduction of symptoms, and normalizing static posture. The shoulder is a very complex ball and socket joint with multiple equations that can contribute to moving pain free. We are going to use an inhibit, lengthen, and activate sequence (3 / 4 phases of the continuum) borrowed from the National Academy of Sports Medicine (NASM) Essentials of Corrective Exercise Training.
The first step should be to inhibit an area and calm the central nervous system (CNS) using a technique called self-myofascial release (SMR). The CNS regulates the length of muscles from the input of different types of receptors (muscle spindles and golgi tendon organs). Muscle spindles are receptors in the belly of the muscle that detect changes in muscle length and rate of length change. Golgi tendon organs senses changes in muscle tension and rate of tension change.
SMR is commonly known by using a foam roller, lacrosse ball, or handheld device (like a theragun which promotes percussion therapy). For rounded shoulders, the most common area that may be perceived as “tight” is the pectoralis muscle group (you can follow along by palpating underneath the collarbone towards your armpit). This is the muscle we would like to inhibit as it may contribute to your shoulders being positioned anteriorly. We’ll be using an Alpha ball as our piece of SMR equipment (seen below). Time and tension will be determined by the user based on pain sensitivity.
- Lie on your stomach with your opposite forearm supporting your head
- Place the ball on your pec with the same arm outstretched to your side
- Breathe regularly and allow the ball to sink deeper into the tissue
- ADVANCED*: move your arm while keeping your chest pinned down on the ball. You can internally rotate and bring the hand to the small of your back and move your hand overhead to free up more restricted tissue
- Do so for at least 60s and move the ball to a new location along the pectoralis group and repeat.
The next step is to lengthen an area and reduce fascial tension in the system. We do this by stretching the targeted area that we just spent time doing soft tissue work on. One of my favorite ways to do this requires a door, a rig, or a wall that you can anchor your arm and pivot away from. It is commonly called a doorway stretch.
- Position yourself at the entrance of a doorway
- Place your hand, forearm, and elbow along the side of the door to trace the frame
- Stay square at first and step through with the same leg as the arm that’s supported by the door frame
- Lean forward until you feel a stretch along your chest and hold for ~30s for each side
- ADVANCED*: You can change the height and orientation of your elbow/forearm to feel different areas of the pec, bicep, etc.. and you can rotate your sternum away from the anchored site (if I am stretching my right pec, I will be stepping/leaning forward with my right foot and rotating left)
The last step we will be going over is activation of underactive/lengthened myofascial tissue. Here, we are aiming to reeducate underactive muscles (in this case, the erector spinae of your thoracic spine). Again, there are a ton of ways to approach this but for the sake of simplicity we will be using a fan favorite at Kinetik called Dynamic Blackburns. For our physical therapy gurus out there, we coined it as a dynamic blackburn as we combined all of the movements required individually into one fluid motion (prone horizontal extension, abduction, scaption, etc. in IR, neutral, and ER; scapular depression, posterior tilt, upward rotation, etc.).
- Lie on your stomach (either on the floor or a bench) with your hands behind at your side
- Start with a chin tuck (double chin) and axial extension (crown of the head reaching away from your shoulders) to maintain a neutral spine
- Pull your shoulders back and down towards your tailbone and extend your chest from the ground
- Externally rotate your arms so your palms are now parallel to the ground as your reach your arms overhead
- The movement should be fluid: control the timing of arms while maintaining a neutral spine (chin tucked, axial extension, thoracic spine extended, and more importantly shoulders not dumped anteriorly)
- Once you reach overhead, it should almost look like you are performing a superman. Once you’ve reached that position, slowly work your way back the way you came
- As you bring your hands back to your sides you should internally rotate your arms to return to the starting position
- Return to a relaxed state. Repeat for 10 reps.
- ADVANCED*: A pair of 2.5lbs weight in each hand will humble even the most veteran athletes. Perform more reps, add sets, use weight, and/or implement bands to increase the difficulty of this exercise.
Having rounded shoulders is a standing issue in today’s population, especially with all of the smart technology that is available to us (tablets, phones, computers, etc.). If you have rounded shoulders please give this routine a try! Remember, this is a generalized approach to a very complex system. We recommend that you consult your primary care physician, sports doctor, or a knowledgeable practitioner to determine a proper management strategy suited specifically for your needs.
– Paolo Isaac