Postural problems; should I be forcing my shoulders back or not?
December 6, 2013 3:00 PM   Subscribe

I was recently diagnosed with shoulder instability/thoracic outlet syndrome/shoulder impingement syndrome stemming from a lifetime of computer with forward head and rounded shoulders posture. I have been working on exercises to help strengthen my back muscles, and have also been stretching my neck and chest. One problem I cannot get a straight answer on, However, is knowing whether to keep my shoulders pulled back in everyday life or not. Can anyone share with me evidence of the benefits of squared shoulders, or anecdotes of their experiences with keeping their shoulders held back on a daily basis?

My impingement is improving but not totally healed yet. My upper back muscles have become stronger through my physical therapy, and I have been using them to help keep my shoulders back (through my rhomboids, I believe) as I go about my day, even when sitting. I am not sure if I am forcing them to go back too far, and I get wildly varying opinions on this topic.

Sometimes pushing the shoulders back feels very good and natural, But sometimes my upper back and shoulders get tense as a result. It seems that no one I ask can give me a straight answer when it comes to correcting posture, except that my chest should be up. I have received wildly differing opinions from doctor to doctor. One tells me that my shoulders should remain relaxed and overdoing my posture is not a good idea. One other I have been seeing believes that the only way to correct postural imbalances is to keep the shoulders held back until they attain muscle memory and stay back on their own. Hearing conflicting advice confuses me to say the least.

Does anyone have any personal experience with postural problems, and has holding the shoulders back helped at all? Is holding them back all day the ideal and will become natural with time? Or is this overdoing it, with relaxation being preferable? Then again, I was relaxed with my rounded shoulders and that's when this problem started in the first place... please share with me your stories, mefites!
posted by Thanquol180 to Health & Fitness (20 answers total) 29 users marked this as a favorite
I have the same issue. I was in physical therapy for it for about six months because the pain had gotten so severe. The physical therapy helped, but I'm not sure my posture really looks that much better. I'm not sure my shoulders are further back. I would agree with the book by Esther Gokhale, 8 Steps to Pain Free Back, that holding shoulders back can actually increase strain, so she recommends occasional "shoulder rolls" instead. I agree because I had held them back before and was getting more headaches. I also tried a posture bra that forced them back and that seemed to cause more problems too.

I use an application called Timeout for my mac that suggests breaks and do the rolls during the breaks.

Then there is a whole school of anti structuralists who think it the pain has nothing to do with anything and correcting posture will not help. Though honestly I would prefer to correct my posture because I feel it looks better.
posted by melissam at 3:08 PM on December 6, 2013

I had a moderate Programmer Hunch that I've fixed with daily yoga (including handstand work and copious down-dog/up-dog cycles, pulling the shoulders back the whole time) plus squats, deadlifts, pull-ups, and dips.

My postural goal is to maintain a fairly (but not completely) shoulders-back, chest-proud, back-straight, head-up position. I try not to do any of that to a degree that would be overcorrecting, for instance, I don't keep my shoulders completely back because my shoulders (now) can go beyond a solid neutral position. I also find that the goal is to do all that while being as relaxed as possible. This took a while to retrain myself.

I think it's quite important to consciously keep good posture during the day, e.g. while sitting, until you attain the necessary upper back strength and shoulder mobility and it becomes natural.
posted by daveliepmann at 3:16 PM on December 6, 2013

I think you aren't getting a straight answer because it isn't a binary question. The answer is somewhere in the middle, somewhat closer to "pulled back" than hunched. You're right that if you pull your shoulders back as much as possible you'll be in a position with a lot of tension that isn't great to maintain all day. The answer isn't to relax completely and round your back again, it's to dial back the tension in your back to a level that you can maintain all day, essentially.
posted by telegraph at 3:28 PM on December 6, 2013

Since you're a guy, this is gonna sound really weird, but this is what worked for me when it came to figuring out what "proper" posture is. Because I too was getting all hung up on "shoulders back" and was over compensating that way.

But then one day, for some reason, rather than thinking of proper posture as "shoulders back", I thought of it as ".....boobs out." Rather than concentrating on my shoulders, I focused on showing off my cleavage. And that got me to concentrate on my back as opposed to my shoulders, which really made me align myself more properly.

i'm not sure how you'd try to do that without having boobs yourself, but....try that?
posted by EmpressCallipygos at 3:53 PM on December 6, 2013 [7 favorites]

They're called the pecs.
posted by computech_apolloniajames at 4:20 PM on December 6, 2013 [2 favorites]

Hi all,

Based on the advice so far, I'll keep doing what I'm doing for the most part. I might dial it back a bit, but will make sure the manboobs are fully out :) . If you have any other advice, please post. Thanks!
posted by Thanquol180 at 4:53 PM on December 6, 2013

Minor ways that I correct my own posture:

-- Stand as though a string is attached to the top of your head, holding you up (like a puppet).

-- Align your shoulders with your hips (ie, don't hunch your shoulders forward past your hips).
posted by rue72 at 5:04 PM on December 6, 2013 [1 favorite]

When I changed my posture I did it by holding my body as close to correct posture as I could comfortably get without forcing anything. I held it until my muscles were starting to tire, then relaxed and let myself stand how I was used to. This meant I didn't get any strains or aches. It took a while but it meant that I was strengthening my muscles without over doing it. Eventually it was easier for my body to be in correct posture than incorrect. I'll also second the "boobs out" advice. I changed my posture for horse riding, my instructor said that to improve my posture in the saddle I should imagine a hot guy was watching me ride and to stick my chest out :-) It certainly helped.
posted by Ranting Prophet of DOOM! at 5:09 PM on December 6, 2013

I've posted about Egoscue Method postural alignment therapy before because it's made such a difference for me. The director of their Nashville clinic (they have clinics around the world) has a blog where he sometimes posts before-and-after photos. Here's one example of somebody who started out with a fairly profound forward hunch. Here's another pretty amazing one.
posted by Lexica at 6:21 PM on December 6, 2013

I had similar issues, and my physical therapist recommended focusing on my core in addition to back/shoulder muscles -- doing lots of core exercises, and thinking about posture from the standpoint of "strong core, standing TALL and lifted up" rather than shoulders back (which you can do with a weak/unengaged core, but that will lead to more back pain). The image of posture coming from my core rather than my shoulders helped a lot (as did the core exercises).
posted by rainbowbrite at 7:17 PM on December 6, 2013 [1 favorite]

Please read the Katy says blog. Be forewarned, it's rather addicting. Here is a snippet: "The following contains how the standard “pull your shoulders down your back” is really a 2-D correction for a 3-D problem. But why type a bunch of words when I could cut and paste a video instead?"

I learned SO MUCH from this lady. I work on this area constantly and get more relief from rotating my shoulders than anything.
posted by icanbreathe at 7:41 PM on December 6, 2013

Core and back strengthening are what you're after. Also, lots of stretching! Trying to pull your shoulders back consciously can lead to a lot of tension and can be counter productive. Strength + flexibility is the way to go.
posted by way_out_west at 7:54 PM on December 6, 2013

If you take a picture of yourself in profile is your head sticking forward? It is possible to pull your shoulders back and still have bad posture because your head is hunched forward. For this reason I've found it most helpful to imagine a string connected from the crown of my head to the ceiling, pulling my entire body straight. If you do this, your chest should naturally stick out a bit, and you shouldn't even have to do that much with your shoulders.

I've been doing a lot of pullups in the past few months and it has definitely helped my posture.
posted by pravit at 8:02 PM on December 6, 2013 [1 favorite]

I agree with pravit's way of thinking about correcting posture. Shoulder posture comes from the rest of your posture being correct.

Analogies that have helped me and my clients when I was working in a job that involved this:
* Imagine a string pulling up from the very crown of your head, tipping your chin slightly down, lengthening the spine up the back of your neck, lifting your ribcage, lengthening your back and allowing your shoulders to sit in a nice neutral position. This should also put your pelvis in a nice neutral position.
* Think of having an imaginary trumpet, as you put it up to your lips your chin tucks a little down and back and having your arms in this position puts ribcage and shoulders in the right place.
* Imagine having your back against a flat wall. Do not try to completely flatten your back, but make sure the back of your head is touching the wall.

I tend to feel that 'boobs out' by itself leads to arching the back.

Similarly, thinking of putting shoulders back can lead to sticking chest out and arching the back. However, I see what you mean - even if I have my chest and back and neck in a lovely neutral alignment, I can move my shoulders a few cm forward and back. If I have them all the way pulled back, I lose flexibility in posture because I do things like swing my arms while walking, so I don't think this is ideal.

If I instead think about using my back muscles to pull my shoulders down, there is less uncertainty about where they should be positioned. Maybe that's something to try.
posted by kadia_a at 12:42 AM on December 7, 2013

The crumpled puppet method works for me: Thinking of being pulled up by a string at the top of my head. That addresses the stooped head and neck problem too.

After my RC surgery I did a lot of exercises to strengthen my upper back and shoulders, and core stuff helps overall.
posted by Room 641-A at 3:58 AM on December 7, 2013

Hi everyone, I have been experimenting with the puppet idea, and it does seem to puff my chest out. It also puts me into the double chin pose, which is a bit uncomfortable (and my face looks fat!) I do have pretty bad forward head, so maybe this would be something good to work on for me.
posted by Thanquol180 at 5:24 AM on December 7, 2013

The male-appropriate mnemonic I've heard for "boobs out" was "strut past the pretty girl on the beach".

Another way to describe "shoulders back" is the Olympic lifter's version: "put your shoulderblades in your back pockets". This reminds me to avoid pulling the shoulders up as they go back.
posted by daveliepmann at 5:52 AM on December 7, 2013 [1 favorite]

The best advice I've gotten about this sort of thing was from a friend who used to be a band major and has lovely posture. She was trained to imagine a hook under the lowest part (inferior end) of her sternum/breastbone with a string attached to it pulling straight up towards the ceiling.

Try this and you will see that everything else falls into place naturally - shoulders go back, head comes up, chest out, etc. This trick works better and is easier to imagine than the others, IMO.
posted by nemutdero at 10:23 AM on December 7, 2013 [1 favorite]

Sometime Alexander Technique teacher here, with an Alexander-centric perspective.
The rounded shoulders feel relaxed to you, but you are most likely pulling them forward and down. Doctor #1 is giving correct advice that is useless to you because you need to notice the tension before you can relax it.

You will relax a bit in front if you tighten in back (reciprocal inhibition); Doctor #2 is trying to encourage this, and you should experiment with it, but don't play tug-of-war with your habit all the time. Tension is the problem, the position of your shoulders is a symptom. What you want is to open in front, not to close in both front and back.

Imaginary strings lifting you are much a better idea than pulling yourself back and forth. Take care not to tense up elsewhere while playing with that idea - you are practicing yielding, not trying to achieve a position.
Another experiment: try exaggerating the habit for ten seconds or so, then relaxing - notice what relaxing feels like.

An Alexander teacher can help you notice the habit (the first step towards not doing it) and show you some ways to undo it when you notice it. You should know whether it's useful within a few lessons. Feldenkrais work is relevant too and includes lots of experiments you can try at home. But there's really no substitute for 1:1 coaching when you have a blind spot.
posted by nixt at 12:32 PM on December 7, 2013

When my physical therapist was addressing my bad posture and 'forward head' the very first thing she had me work on was stretching out the back of my neck. It was so tight that I couldn't really get into the right posture let alone maintain it. The exercise? Making a strong double chin with head pulled back for 5 repetitions of 5 seconds each. It definitely helped and gave me some structural perspective on what was going on as well.
posted by thegreatfleecircus at 4:13 AM on December 8, 2013

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