Everyone agrees that having good posture creates an image of self-confidence and assertiveness.  Most people also know that poor posture can lead to painful back problems.  However, standing tall requires more than good intent. 

Slouching is not directly the result of laziness – rather, imbalances in muscular strength and flexibility will make it difficult for the most self-possessed person to maintain good posture throughout the day. The most common postural problem is aptly named Rounded Shoulder Syndrome.  This affects approximately 90% of the population, and will present unless a concerted effort is made to address its root causes.  Rounded Shoulder Syndrome is the result of internally rotated shoulders, and excessive outward curvature (khyphosis) of the mid back area.  Often, this also leads to excessive inward curvature (lordosis) of the back of the neck.  I like to think of this posture as the proverbial “computer slouch”. Although excessive screen time most definitely has caused an explosion of Rounded Shoulder Syndrome in recent years, it is the cumulative effect of hours of activities done in front of our bodies that results in the syndrome.  Most of what we do in our daily lives is done in front of our bodies, of course (no eyes in the back of our heads! – although with three boys I sometimes wish…).  Driving, cooking, writing, and so forth will all result in some degree of internal rotation of the shoulder joint.  The tipping point, I believe, has been the drastic change in lifestyle of the past twenty years – and by this I mean the shift to sitting all day in front of the computer, with no real need to get up except to go to the bathroom.

Back Problems Excessive sitting results in multiple issues related to back health.  When you are seated – even with good posture - your low back is in constant, low-level flexion.  Repeated and/or continuous flexion of the lumbar spine will eventually lead to a process called disc delamination, when the outer collagen rings of the lumbar discs begin to wear away.  Delamination can eventually lead to painful conditions such as bulging or herniated discs. Sitting for long periods also results in shortened hip flexors muscles (in the groin area), and weak gluteals (muscles in your butt).  This causes misalignment of the pelvis whereby the low back is permanently in flexion, allowing disc delamination to progress even when one is not seated.  When the low back is constantly in flexion, it is very difficult to stand up straight – which results in the shoulders rounding forward.  When the shoulders are rounded, the muscles of the mid-back area (rhomboids and mid-trapezius) become weak and overstretched.  This can activate the myostatic stretch reflex, which leads to those same muscles spasming in fear of being torn.  Many back spasms are the result of this mechanism.

Neck Problems When the shoulders are rounded forward, we automatically have to extend our necks more than usual to be able to look straight ahead.  Try it – get into your best slouch position and try to look at the computer screen without tipping your head further back.  Impossible, right?  Excessive extension of the neck compresses cervical spinal discs, and I usually tell my clients that the only good reason to extend your neck back is to catch snowflakes on your tongue or look for falling stars.  The degree of neck extension created by Rounded Shoulder Syndrome is obviously less than when star-gazing, but even chronic mild extension can cause pain in some people.

Shoulder Problems Rounded Shoulder Syndrome reduces the space available inside the shoulder capsule for the tendons and other relevant connective tissue to move around.  A healthy shoulder only has approximately 7 mm of space – rotator cuff problems can occur when this space is reduced by only 2 mm!  Unfortunately, rotator cuff tendonitis can lead to tears of the rotator cuff tendon, which do not heal well.  Many older adults have undetected rotator cuff tears which can be worsened by the wrong exercises.

Exercise Specialist Recommendations:

1. Get up and walk around every 20-30 minutes when working at a desk or computer.  The muscles that support the low back shut down after about 20 minutes of sitting, and moving around reactivates them.
2. Do the doorframe stretch.  Place your arms into what I call the “bank robbery position” – then place your arms against a doorframe.  Lean forward until you feel a nice stretch in your chest and shoulders.  Try to do this stretch three times per day if possible.
3. Do the lunge stretch.
4. Do shoulder shrugs.  Squeeze your shoulder blades together, then shrug your shoulders halfway up toward your ears.  Lower your shoulders – without releasing your shoulder blades – ensuring that your press them down as far as they can go (scapular depression - the most important componant of this exercise).
5. Do shoulder blade squeezes.  Put your arms up into the bank robbery position, then press your shoulders down toward the floor.  Then squeeze your shoulder blades together as hard as you can.  Release, and repeat 7-10 times.
6. Strengthen the muscles of the low back.  Consult with an experienced personal trainer or physiotherapist on how to safely strengthen the erector spinae muscles of the lumbar spine.
7. Make sure your computer monitor is at eye level, ensuring that you do not need to look down while you are working.  Favour your desktop (if you still have one!), as it is easier to work in an ergonomically correct fashion when you can adjust the positioning of the monitor and keyboard.
8. Choose exercise modalities that required an upright posture.  If you spend the vast majority of your waking hours seated, choose to walk or run for exercise.

Although Rounded Shoulder Syndrome and posture issues are endemic in our society, by incorporating the above suggestions you may find yourself in the minority of individuals who do not fall into this category.