Quasimodo Worked on Wall Street

Sunday, October 26th, 2014

It’s no secret that sitting all day is slowly killing us. Humans are not designed to be hunched over desks, be it sitting or standing, for 8+ hours a day, but I’ve accepted the fact that I’m not going to change the working habits of New Yorkers. Instead, I want to chat a little about proper head and neck posture, so that you can give yourself a fighting chance at being able to look at more than just the floor when you’re in your 70s.

Good standing posture starts with the feet. In the previous Movement of the Week posts, I’ve discussed proper posture from the waist down, setting an important foundation for head and neck positioning. If you haven’t been keeping up with the moves, check ’em out here. Adjusting that pelvic position will have a significant effect on your upper back and neck positioning, thus it is imperative that you start here and work you way up.

For those of you who are already Movement of the Week Masters, let’s work our way up the spine to that neck and upper back area. While we all like to think that we look like this:


In reality, most of us are sitting around looking like this:

In PT parlance, this is referred to as “forward head posture with an increased thoracic kyphosis,” more commonly known as “slumping”, “slouching”, or “the way that nearly everyone sits.”

                      Side view of the human spine.

                      Side view of the human spine.

The thoracic and cervical areas of the spine when viewed from the side, have inherent curvatures. Like curve of the lumbar spine, are imperative for proper spine health and function. Standing and sitting with a slouched posture exaggerates these curvatures, causing muscle imbalances and joint dysfunction. At the thoracic spine, a slouched posture means increased spinal flexion, aka an increased likelihood of looking like Quasimodo when you get older. As that thoracic spinal flexion increases, the shoulders drift forward, causing the pecs to shorten and tighten, the back musculature to lengthen and weaken, and overall shoulder function to be significantly compromised. To demonstrate this point I want you to try this: slouch down as much as you can (while sitting or standing) with your upper back rounded as much as possible, now try to raise your arms. Put your arms down. Now sit up (or stand if you were standing before) nice and tall and try to do the same thing. Did I just blow your mind??? Here we see the important role thoracic spine extension plays in shoulder mobility and function. More to come on this in future posts.

                            Upper Crossed Syndrome

                            Upper Crossed Syndrome

At the neck, this typical desk jockey forward head posture comes at the expense of the upper cervical spine, where we see excessive extension, and the lower cervical spine where we see excessive flexion. When we slouch forward and round our backs, our neck, left to its own device, would also flex, causing our head and eyes to be pointing down towards the ground. Because our brain always wants to keep our eyes level with the horizon, it tells our neck to extend, or lift up, our head so that we can look straight ahead. In order to accomplish this, we poke our heads forward and excessively extend our upper cervical spine while the bottom of our cervical spine, most closely related to the thoracic spine, stays in flexion. In doing so, we introduce a tremendous amount of shearing at the vertebra of the cervical spine and cause significant muscle imbalances at the neck. More specifically, at the front of the neck, we see the deep flexors of the neck which are responsible for stabilization being put on stretch and becoming very weak. The posterior (back/rear) neck musculature, responsible for holding your head up all day, is placed in a shortened position, becoming tight and restricted. Tension in this area leads to headaches and altered jaw mechanics, most commonly referred to as TMJ dysfunction. Collectively, these thoracic and cervical impairments are referred to as an upper crossed syndrome. 

                                    The Wall Test

                                    The Wall Test

Check yo’self: Proper posture is not achieved by simply squeezing your shoulder blades together and retracting your chin like you’ve smelled something bad. Instead, I want you to think about making subtle changes to help bring the entire spine into better alignment. The goal of this segment is to get your ears to line up directly above your shoulders. Last week I introduced the Wall Test to you, and we’re going to revisit that concept again this week. I want you to stand with your heels, glutes, and upper back against a wall. Remember, you should have only about a hands-worth of space between the wall and your lower back. From here, gently, emphasis on GENTLY, draw your shoulders back and down to ensure that they are touching the wall. *PT Disclaimer: the cue of shoulders down and back is not necessarily universally applicable, nor is it the most functional position for overhead motions, however, the majority of people with FHP and an increased thoracic kyphosis can benefit from this cue as a starting point.* Your rib cage should not pop up when you do this. Next, retract (tuck in) your chin using the muscles in the front of your neck to get the back of your head to touch the wall. At this point, your ears should be in line with your shoulders. This right here is the ideal alignment for your head and neck.

For many of you, entering into and maintaining this position is going to be extremely difficult. While I’d love to tell you to just suck it up, in reality, your years of being married to that desk will likely cause you to forego a lifetime romance with a sweet little thing called good posture for a one-night stand with Captain Shoulder Pinch. To that end, here's a video from the great Kelly Starrett over at Mobility WOD demonstrating some mobility drills you can do to help get yourself more comfortable in that new posture. Watch the video, work on that new posture, and try to get up from your desk at least every 20 minutes. Your body will thank you.

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