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Heal that Hunchback!

Correcting Kyphosis

Have you ever been mistaken for a malformed Parisian who lives in a Cathedral and rings bells? If so, you could suffer from kyphosis. Kyphosis is defined as an exaggerated forward curving of the thoracic portion of the vertebral column. In lay terms it's been called "hunchback" or "slumped shoulders."

Look around your gym (and perhaps in the mirror) and you'll see many weight trainers with this condition. Correcting it could improve your physique, make you stronger, and even decrease your chance of getting an injury. As an added bonus, people won't call you "Quasi" or Igor, which is always nice!

Let me tell you a little story about how kyphosis can negatively affect your lifting. One of my first patients at the Athletic Performance Center showed up with some serious kyphosis and the worst case of shoulder tendonitis I've ever seen. This 40-year-old trained four days a week and had the body of someone half his age. However, he had a problem: his shoulders were wrecked!

He used to start his training with flat and incline barbell benches. Eventually they hurt too much so he switched to dumbbells. Soon, those hurt too much as well, so he switched to dumbbells with a hammer grip. He'd naturally been progressing to exercises that used less and less shoulder rotation, and when he came to us he had stopped doing any chest or shoulder movements whatsoever. His condition had gotten so bad he couldn’t even put his arm around his wife at the movies!

His kyphotic posture had lead to an extreme amount of stress being placed on his rotator cuff muscles. It was so bad and his muscles were so beat up that his body was laying bone instead of scar tissue to stop the area from being injured any further!

Just like its good buddy lordosis (an abnormal inward curve in the lumbar spine), a small degree of kyphosis is natural; however, the more extreme it gets the more problems it can cause. A large kyphosis can lead to mid-back pain (especially between the shoulder blades), shoulder impingement, and a myriad of other issues. In other words, it’s something that needs to be addressed if you want to stay healthy and keep your weight training on target.

With regards to correcting your kyphosis, a multi-pronged and holistic approach is most suitable. The three main players in improving an excessively kyphotic posture are specific strengthening, specific stretching, and an improvement in your posture throughout the day.


Key Anatomy

Before we discuss things any further, a brief overview is necessary to discuss the key muscle groups involved in kyphotic posture. Not only will this give us a better idea of what muscle groups are working, but what groups are working against us and what we can do to solve the problem:

Hip extensors: gluteus maximus, hamstrings

Hip flexors: psoas, iliacus

Trunk extensors: spinal erectors

Trunk flexors: abs, external obliques

Internal rotators: subscapularis, pectoralis major, latissimus dorsi, teres major, anterior deltoid

External rotators: infraspinatus, teres minor, posterior deltoid

Scapular elevators: upper fibers of trapezius, levator scapulae

Scapular retractors: rhomboids, middle trapezius fibers

Scapular depressors: lower trapezius fibers

Keep in mind this isn't an exhaustive list as there are also many synergists and stabilizers used to produce these movements, but when we're looking at developing a program to improve kyphotic posture, these are the key players.


The Hips and How They Can Affect Kyphosis

Many rehabilitation "experts" would have you believe that if you strengthen your scapular retractors/depressors and stretch a little, your kyphotic posture problems would vanish. This is far from the truth. Instead of focusing on the true culprit in many cases (e.g. an anterior pelvic tilt), they focus only on the problem, not the actual cause of the problem. This local approach may work in some instances, but by failing to address the true cause, the problem will usually reoccur once rehabilitative exercise has ceased.

Anterior pelvic tilt is quite often the culprit. When you have a severe anterior pelvic tilt, the upper body has a tendency to overcompensate. Think about your spine as an "S" that must be equal on both the top and bottom. If the bottom half of the S is small and thin, the upper part will be small and thin as well. This is how a normal spine should look. However, if the bottom part of the S is very wide, the top part of the S will have to be very wide as well to compensate and balance out the bottom. Therefore, you can do all the upper body exercises and stretches you want, but until you solve the problem at the hips your results will probably always be sub-par.

So what if your hips are the problem; what can you do about it? Usually people who have issues with their hips have signs of either pelvic crossed or layer syndrome. When someone exhibits an anterior pelvic tilt, the hip flexor muscles (psoas and iliacus) are usually very tight and overactive. The psoas is usually the culprit here. Since it originates from the lumbar spine, hypertonicity and tightness create an increase in anterior pelvic tilt, which then creates a disruption throughout the low body and trunk.

This overactivity causes an inhibition of the hip extensors, primarily the glutes. When the glutes are inhibited, you often see other extensor muscle groups such as the spinal erectors or hamstrings take on the added workload left over by the inhibited glutes. Think about it: how often do you hear about someone pulling their low back or hamstrings? It’s probably an everyday occurrence in some of the larger gyms. Now think about how often you hear of someone who pulled a glute… probably not often, if ever. Not only do the hamstrings and low back have to take over an increased workload, but they also tend to get tight in the process.

Last on the list, but certainly not least, is the abdominals. If their strength isn’t up to par and the low back is shortened and tight, you have an even greater increase in lordosis. So what’s the basic premise here? Stretch the hip flexors, hamstrings and low back, while working on increasing activation and strength in the abs and glutes. Decreasing your anterior pelvic tilt can go a long way in improving your upper body posture with no direct work for the upper body whatsoever.


A Strategic Plan to Kill Kyphosis

Now, once we’ve solved the problem at the hips it’s time to start working on the upper body musculature. Remember, we'll be using a multi-pronged approach here that'll strengthen, stretch, and re-educate the body to function in a more optimal fashion.


Strength Training for the Upper Torso

Obviously, strength training is going to be necessary to break the kyphotic cycle. The main muscle groups we'll be focusing on are the scapular retractors and depressors (rhomboids and middle/lower trapezius fibers), and the external rotators (specifically teres minor, infraspinatus, and the posterior deltoid). These muscle groups don’t need an extreme amount of loading to be trained thoroughly, so when performing them leave your ego at the door!

To improve the muscles acting on the scapula, very specific strength training is a must. Here's a list of the best exercises:

Scapular Wall Slides (SWS)

I discussed these in my previous article, "Back on Track," but I think they should be described again, especially since I’ve gotten tons of responses to this exercise alone. The great thing about SWS is that you can perform it anywhere you have a wall!

Standing with your upper back and butt against a wall, walk your feet out approximately 18 inches away from the wall. Lift your arms up so that your upper arm is parallel to the ground and the lower arm is perpendicular, with the elbows and hands pressing into the wall behind you. From the starting position, try to pull your elbows back into the wall and down. This exercise is as hard as you make it, so take it easy to begin with then crank up the intensity once you start getting comfortable. If you're performing this exercise correctly, you'll feel it in between the shoulders blades.

Prone Cobras

Another low maintenance exercise is the prone cobra. This will aid in improving the extension of the thoracic area along with strengthening the upper erectors, rhomboids, and middle trapezius fibers.

To perform this exercise, lie face down on the floor with your arms lying next to your torso with the palms up. Initiate the movement by squeezing the shoulder blades together and raising your upper chest a few inches off the floor. A key point: as you come up, externally rotate your arms so at the midpoint your palms are facing down. Hold and squeeze at the top, then lower under control to the starting position.

Face Pulls

This exercise really focuses on the scapular retractors, specifically the rhomboids and middle fibers of the trapezius. Face a lat pulldown or low pulley machine and grab the rope with an overhand grip. Pulling through the elbows, take the middle of the rope in a straight line towards the bridge of your nose, forehead, or throat (the higher you pull, the higher on your back you'll target). The key is to make sure you fully retract the shoulder blades at the midpoint, squeeze, and then return to the starting position.

Scapular Depressions on a Pulldown Machine

Yet another little known exercise is the scapular depression on a lat pulldown machine. You'll want to load up the weight on this one, but work to "feel" the movement first with lighter weights and then progress from there.

To start, grab the bar with a slightly wider than shoulder-width grip and make sure your lats are in a stretched position and your elbows are locked. From the starting position, initiate the movement by trying to pull your shoulder blades down, resisting the temptation to unlock your elbows. Pull the shoulder blades down, squeeze, then return under control to the starting position.

Prone Shrugs

A very simple exercise designed to train the rhomboids and middle trapezius. Lie on a chest-supported row machine and let the arms relax. Lock the elbows and perform the movement by retracting the shoulder blades. Squeeze at the midpoint, and then slowly lower under control to the starting position.


Strength Training for the External Rotators

The following exercises will strengthen the muscles of the external rotators. The external rotators are often undertrained or simply not trained at all. Not only can this lead to tendonitis and shoulder impingement, but at the very least you'll develop some serious muscle imbalances around the shoulder. I highly suggest reading T-mag's "Cracking the Rotator Cuff Conundrum" article if you're interested in a greater understanding of the functional anatomy of the external rotators, along with some exercises to strengthen these muscles. I'll also describe several other options if you want new and fresh ways to beef up your external rotation strength.

Shoulder Horn

The shoulder horn is an excellent (albeit somewhat pricey) piece of equipment that allows you to isolate the external rotation muscles. I know, I know…normally I’m all about integrating muscles to produce superior results; however, most people who are trying to perform a basic external rotation are using about every muscle group except their external rotators, so I make an exception with exercises developing these muscles.

Using the shoulder horn, the external rotation movement is a piece of cake. Lock your elbows into place and you’re ready to rock. Rotate the weight up to a point where your lower arms are perpendicular to the floor, then lower slowly and under control to a point just below parallel to the ground. Poliquin stated that your external rotation strength should be approximately 9-10% of your maximal bench, so use that as a goal to shoot for in your training.

Poor Man’s Shoulder Horn

This budget version is usually quite effective, but you need to be in tune with your body to make sure you aren’t compensating or pumping your ego versus your external rotators.

To start, sit on a flat bench and bring one leg up and place the foot flat on the bench. Take a light dumbbell in the same hand and press your elbow into the inside of your knee. From this position, you can go through full ROM external rotations.

One problem I usually see is that people start getting carried away with the weights and you'll actually see their legs drifting out to help them obtain a better mechanical advantage. To counteract this, press your elbow into your knee and your knee into your elbow at the same time. This will make sure that the workload will be firmly placed on the external rotators where it should be.

Scarecrow

I have to thank my old powerlifting coach Justin Cecil for teaching me this one. It hits all the external rotators very hard and is a truly humbling exercise!

Start off with very light plates in each hand (2.5 pounds will usually do) and position your body like you're in the bottom of a good morning: chest and head up, butt back, weight on the heels. Let the arms hang down and relax before you begin. Start off with a rowing motion, pulling through the elbows and squeezing the scapula together. From here, externally rotate your arms to a point where they're parallel to the body.

Next, press the weight out over your head. Follow this same pattern back in reverse order to the starting position. Try to make this exercise as robotic and methodical as possible to fully reap its benefits. Perform three sets of 12 repetitions with a two second tempo on each part of the movement.


Stretching and Mobility Work

While strength training is important to correcting our problem, it’s only one-third of the solution. Another very important part of the equation is stretching the antagonists, specifically the internal rotators.

Pec/Shoulder Stretch

At some point in your training career, you have to counteract all those bench presses you’ve been doing since you started lifting. This basic stretch will help stretch both the pecs and the anterior deltoid muscles.

Grabbing a doorway or something similar at approximately shoulder height, "soften" the elbow and turn your torso in the opposite direction until you get a mild stretch in the front of your shoulder and pecs. Hold for 20 seconds, then repeat on the opposite side.

Lat Stretch

Even though the lats are on the back side of the body, one of their primary roles is internal rotation, so they must be stretched as well. To perform this stretch, find a bar or something immovable that's just above waist height. Stand back and outstretch the arms while wrapping the fingers around and interlocking them. Push the butt back and keep the chest up until you get a mild stretch along the side of your back. Hold for 20 seconds, rest, then repeat.

Foam Roller Exercises

Foam rollers are the new buzz in the rehabilitation world, not only for their role in myofascial release but also with regards to improving flexibility. The first stretch is shown below and will work to stretch out your anterior delts and pecs.

Basically, all you're going to do is lie on top of a foam roller, which will be placed along the length of your back. Let your arms hang down to the sides and let your chest and shoulders relax. You have to let gravity do its job here. Think of your arms as heavy or dead weight. Hold for a couple of minutes and you should be feeling better. Nothing too difficult here, but we're trying to relieve some of the excess tension most of us keep in our chest and shoulder muscles.

The next stretch is called a "prayer." Start off on your knees with the roller in front of you. Place your hands together on the roller and, while keeping your chest up as much as possible, push your arms forward to let the foam roll underneath your arm towards your body. As you're rolling the foam out, you should get a nice stretch in your lats. Come back to the starting position and repeat for the necessary amount of repetitions (usually two or three sets of 10 to 12 reps works well).

Thoracic Extension on PVC Pipe

This doesn’t necessarily fall under the realm of stretching, but it's part of our holistic approach to improving kyphosis. Often people who suffer from kyphotic postures can produce very little or no extension around the thoracic spine, so this exercise will address that issue.

Many outside of the powerlifting world may not have heard of this one, but it’s an excellent way to mobilize the thoracic area and improve thoracic extension. When speaking with my colleague Dr. Michael Hartle, he stated that the elite Japanese bench pressers were performing this exercise with a six inch PVC pipe prior to their attempts! If I were you though, I'd start out with a one or two inch pipe and progressively work your way up.

To perform the exercise, lay on you back with your knees flexed and feet flat on the floor. Place a small piece of PVC pipe underneath your thoracic vertebrae and raise your hips slightly. Slowly work it up and down along the thoracic section of your spine, holding each position for about 20 to 30 seconds.


Posture Improvements in Daily Life

Okay, so we’ve taken our hour or two in the gym four times a week and made some progress with regards to our kyphosis. But even if you're training eight hours a week, what are you doing to improve your posture for the other 160 hours? I’m going to give you a few tips to further improve your posture while you're out of the weight room.

Whether it’s driving, sitting at a desk, or getting the "computer hunch," most of us can afford to become more aware of our posture throughout the day. We need something that'll give us cues even when we aren’t thinking about our posture. Here's one trick. Before you go to work, have someone place a piece of tape along the width of your upper back (on your skin). The key is to have proper posture when they do this, so make sure your chest is out and your shoulder blades retracted. With this piece of tape in place, any time you start to slouch, slump over, or get all kyphotic on us, you'll feel a nice tug on that tape.

If you're too lazy to try the tape experiment, follow this one simple rule to improve your posture throughout the day: when in doubt, stick your chest out! When you stick your chest out you quickly and naturally improve your upper body posture. Try it right now!

Another nice combatant in the fight against kyphosis is Brügger’s relief position. Brügger is a manual medicine expert in Europe who studies how repetitive strain movements (such as sitting) can affect your body. Research has determined that 30 minutes of sitting in a fully flexed position can lead to ligamentous deformation in the back. Therefore, he came up with his relief position to help restore the body’s natural alignment and make workers healthier and more effective. To perform the Brügger exercise, follow the instructions given below:

1) Perch at the end of your chair (e.g. move to the edge of your chair and sit up straight).

2) Spread your legs slightly and turn your feet out.

3) Relax the traps and extend your arms down.

4) Turn your palms out so they're facing away from you and spread the fingers apart.

5) Push the chest up and out while keeping the chin tucked in.

6) Take in three deep breaths: take 10 seconds to inhale and 10 seconds to exhale, but don't hold your breath! Think about blowing the tension out of your body as you exhale.

The Brügger position should be used every 20 to 30 minutes when sitting. By adding this in, you’ll not only feel better during and after long sitting spells, but you’ll also be more productive as well!


The Program

Now that you have an idea of what it takes to correct your kyphosis, we need to map out a training program geared toward addressing the problem. Here's how I’m currently working to improve my upper body posture within my own training program:

Thursday — Upper Body Day 1: External Rotation Strength & Stability

Shoulder Horn, 2 x 10, 313 tempo

Sunday — Upper Body Day 2: Retraction/Depression Strength & Stability

Depression on LPD, 2 x 10, 353 tempo

These "mini-goals" are performed either at the end of your workout or as a separate workout later in the day. Mini-goal workouts shouldn’t take more than 15 to 20 minutes and are designed to give a lagging body part an added boost. Feel free to experiment with all the variables involved: load, sets, reps, time under tension, rest period, exercise order, and exercise selection.

Finally, here are some notes as to how I’ve rounded out my program:

Use the information I’ve given and formulate a program that'll help you annihilate any semblance of kyphosis from your frame. Leave the hunchback gig to Quasimodo!


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