The Upper-Extremity Postural Distortion

For most people a normal work day begins with a 30-45 minute drive to work, followed by sitting at a computer for another 8 hours. That’s a lot of sitting … and all with perfect posture, correct? Maybe you’re sitting at your desk hunched over studying, or, slouched over your laptop on the couch surfing the net.

Unfortunately, most of us look like this:















Here's a quick test to determine if you may have a problem. Look in the mirror... do you see the back of your hands? If you do, then you're on a fast track to having shoulder problems - if you don't have them already. When your arms are at your side and your palms face behind you and the knuckles face the front, this indicates your shoulder blades are protracting (moving forward). Pain and injury await you. Slouching perpetuates the problem. Some people spend 5-10 hours a week in the gym building "big muscles". How long are you spending in your chair, slouching, building "shoulder problems"? It adds up and it ends in pain and loss of stabilization.

According to Dr. Gallagher of Gallagher Chiropractic & Sports Medicine Group:
“... in a standing position that there is 100 pounds of pressure placed on each intervertebral disc. Did you also know that in a seated, slouched position that the load doubles to 200 pounds of pressure per disc?”

Over time, there is a gradual increase in the thoracic kyphosis. Structural changes do not occur overnight. This is a result of repetitive postural stress on the kinetic chain. And once this postural distortion takes root and the muscle imbalances exist, one cannot simply “fix” the dysfunction by “sitting up” in the chair. Muscles have become overactive and underactive, pulling the body into this distortion.

This leads to rounded shoulders and a protruding head. What is commonly referred to as The Upper-Extremity Postural Distortion (The Upper Crossed Syndrome).

The probable overactive muscles: Pectoralis Major, Pectoralis minor, Levator Scapulae, Teres Major, Upper Trapezius, Anterior Deltoid, Subscapularis, Latissimus Dorsi, Sternocleidomastoid, Rectus Captious, and Scalenes.

The probable underactive muscles: Rhomboids, Lower Trapezius, Serratus Anterior, Posterior Deltoid, Teres Minor, Infraspinatus, and the Longus Coli/Capitus (Deep Cervical Flexors).

We say "probable" over/underactive because any combination of an over/underactive agonist/antagonist listed above can lead to problems. Without a movement assessment, goniometric measurements, and manual muscle testing, it's difficult to say what combination may be causing the problems.

The key muscles to address with flexibility and activation are the Pecs (major/minor), Latissimus Dorsi, Sternocleidomastoid, Upper Traps, Scalenes, and Levator Scapulae (the overactive/tight muscles) and the Mid/Lower Traps, Rhomboids, Rotator Cuff, and Deep Cervical Flexors (underactive/lengthened muscles).

That's a lot of muscles firing out of synch. I like to look at the isometric function of the muscles... what stabilization is being lost?

The muscles responsible for shoulder stabilization: Pec Major and Rotator Cuff.

The muscles responsible for scapular stabilization: Pec Minor, Mid/Lower Traps, and Rhomboids (also provides the rotator cuff a stable platform in which to work efficiently.

Stabilization of the Lumbo-Pelvic-Hip complex (L-P-H-C): Latissimus Dorsi

Muscles stabilizing the cervical spine: Sternocleidomastoid, Upper Traps, Scalenes , Levator Scapulae, Deep Cervical Flexors (Longus Colli, Longus Capitis).

The altered length-tension relationship in these areas can cause pain and lack of stabilization during overhead motions, loss of dynamic stabilization of cervical spine, and dysfunction with pushing/pulling movements. This can be noted by shoulder pain during shoulder press, bench press, and rows.

The loss of stabilization in these areas can lead to rotator cuff impingement, shoulder instability, biceps tendonitis, thoracic outlet syndrome, and headaches.

Again, without specific testing to determine exactly what muscle imbalance(s) are causing the problem, a "shotgun" approach to addressing the Upper Crossed Syndrome is as follows:

Self Myofascial Release (Foam Rolling) the Lattisimus Dorsi and Thoracic Spine.

Static Stretch the Upper Trapezius, Levator Scapulae, Sternocleidomastoid, Latissimus Dorsi, Pectoralis Major/Minor.

Activation of the Mid/Lower Trapezius, Rhomboids, Rotator Cuff, and Deep Cervical Flexors.

Y-T-A (Ball Combo I)
Prone Cobras
PNF Patterns
Cervical Retractions
Chin Tuck exercises

A good exercise library for the mentioned exercises can be found at www.nasmpro.com

In Summary:

- Strengthen the deep cervical flexors
- Strengthen the mid/lower traps, rhomboids
- Stretch the Lats, Pecs, Scalenes, Sternocleidomastoid, Levator Scapulae, and Upper traps

Chris Sellards
National Academy of Sports Medicine CPT, CES, PES
American Council on Exercise CPT