I had a 22 year old guy come into my clinic earlier this week with right shoulder pain. He first hurt it a month ago while boxing, and then re-aggravated it playing basketball last week. All he wanted to do was to "fix" it so that he could get back out onto the court.
I proceeded to perform my typical shoulder examination after taking his subjective history. One of the things that really jumped out at me was his posture. After putting him through a full movement screen, I told the eager hoops player that his shoulder issue was infinitely fixable, but that his bigger picture for good long-term shoulder, neck and back health was addressing his poor posture. I'll explain why, and offer a quick tip on what you can do to assess your own posture.
For a young athletic person, this patient had what's known as a forward head, forward shoulder carriage. In other words, when viewed from the side, his head protruded forward so that his ears were well in front of his shoulders. His scapulae (wing bones in the back) were also riding upward and tilting forward, contributing to a "slouched" appearance. This posture, SO typical of a desk jockey logging 8-10 daily hours staring at a computer screen, puts the shoulder complex in a poor mechanical position. The results can include dysfunctional movement patterns, increased risk for impingement syndromes of the rotator cuff, impaired diaphragmatic breathing, and myofascial pain in the upper back, neck and shoulder regions, to name a few.
I would be doing this young patient a disservice if I only addressed his pain and didn't work to help him improve his posture, his movement patterns and by extension his shoulder function. So, what did I do?
The thing that I tell people is the first step towards correcting posture is gaining AWARENESS. So that's where we start. Odds are, most of you have very little idea of what you look like in profile. When you look into a mirror to check yourself out, you're only seeing one plane of symmetry. If your shoulders are even, you probably feel that you are in good alignment. A simple technique that I employ in the clinic is to grab a patient's cell phone camera and snap a picture of them in profile, without prior instruction. I then ask them to back up against a wall so that their heels, butt, shoulder blades, and the back of their head are touching the surface. I then ask, "How does that feel?" Inevitably, the response is, "Weird!"
Next, I ask the person to stand in profile, retract their head (as if making a double chin, not tilting the head backwards into cervical extension), pull their shoulder blades down and back towards their spine, brace their belly, and squeeze their glutes. It's basically the position that I had them assume against the wall. I then snap another picture and compare the before and after.
The reason why I have found this simple drill to be of such value is that it allows people to SEE what good posture looks like immediately after FEELING what good posture feels like. They have instant feedback that tells them, "No, I suppose I WON'T look like I'm marching in the military if I actually carry myself with correct posture." The reason that it feels so strange initially is that their current posture is their sense of normal. I want to teach people to learn a "new normal", and the visual feedback is a great first building block towards that crucial awareness that I mentioned.
So, I've provided you with one small anecdote as to why good posture is important (healthy shoulders!). There are many more, including the simple fact that it looks better! If you want to know what your posture looks like, grab a partner to snap some quick pictures and try these simple steps. If you do indeed have an "aha" moment when you finally see what you look like, try this one last piece of advice. Rather than to try to remember all those kinetic check points to keep in line, just think about "Getting Tall". If you try to get the crown of your head as close as you can toward the ceiling, as if a string were attached and pulling you there, then everything else will fall in line. It may be a bit overly simplistic, but I have found that people are much more likely to remember to "Get Tall" and therefore remain compliant. As I mentioned, attaining good posture always starts with awareness.
So start "Getting Tall" everybody, and watch as you eventually begin to feel and move better as a result!
Jim Horn, MSPT
Chelsea Physical Therapy
& Rehabilitation
(212) 675-3447
