Put your clients on a regular program of strength and stretching exercises to improve posture and reduce back pain, both of which are often a cause of muscle weakness.

For the past several decades, a depressing health statistic has remained essentially the same: Four out of five Americans experience lower-pack pain and secondary effects. While we are not aware of the corresponding ratio for upper-back pain, it is undoubtedly too high and, based on our observations, a prominent physical problem that is becoming increasingly more common in adults of all ages.

Of courses, there are many probable causes for discomfort in the lower back, upper back and neck areas, and it is unlikely that any simple or single solution will successfully re-mediate or prevent all such problems. Nevertheless, two factors are typically identified as major contributors to reduced integrity of the spinal column, which can clearly lead to pain and related physical problems. These increasingly common factors, both associated with sedentary lifestyles, are muscle weakness and poor posture. Unfortunately, each problem adversely affects the other, as muscle weakness can result form poor posture, and poor posture can result from muscle weakness.

Fifteen years of research from the University of Florida Medical School has demonstrated that full-range strengthening of the lumbar spine muscles can significantly reduce or eliminate low-back pain in a large percentage of patients. It is therefore logical to assume that strengthening the muscles of the upper back and neck may likewise benefit people who suffer discomfort in these areas of the body. While there is less research quantifying the relationship between posture and pain, it is most likely that better posture will produce a corresponding reduction in spine-related discomfort.

The so-called forward-head/rounded-shoulder posture has become a common problem often observed in physical therapy evaluations. According to clinicians, this faulty posture frequently leads to neck, shoulder and back problems. For example, rounded shoulders may cause mechanical malfunction of the shoulder joint, resulting in tendon impingement, bursitis or rotator cuff injury. It is also possible that this posture causes increased feelings of fatigue due to the greater muscle tension and activation necessary for support purposes. Rounded shoulders may result in a kyphotic posture, which puts additional pressure on the anterior vertebral bodies of the thoracic spine. It is in this area, where there is insufficient trabeculae of the bone, that collapse may occur leading to reduce bone density, micro-fractures and loss of height. Add to these concerns the problems associated with forward head posture. The forward head position causes the weight of the head (approximately 15 to 20 pounds) to pull at the cervical spine, which may lead to muscle tightness, spasm and chronic tension headaches.

Study purpose and training programs

We conducted a study to determine whether an intervention program including aerobic activity, strength training, stretching and postural awareness would improve forward-head/rounded-shoulder posture and increase standing height.

Thirty-four men and women (average age 45 years) completed a 10-week posture intervention program, which was conducted twice a week in six-person exercise classes with two instructors per class. Each class was one-hour in length, and included about 20 minutes of aerobic activity (stationary cycling and treadmill walking), 10 strength exercises and 10 stretching exercises. Participants performed one set of eight to 12 repetitions on resistance machines for the major muscle groups. Each strength exercise was followed by a 20-second static stretch for the muscle group just worked. For example, the leg extension exercise was followed by a 20 –second quadriceps stretch, and the leg curl exercise was followed by a 20-second hamstrings stretch (see Table 1).

In addition to the basic program of endurance, strength and flexibility, all of the program participants received relevant information, verbal cues and positive reinforcement on proper posture. Two specific stretches for the chest and shoulder muscles were presented by the lead class instructor, who holds a master’s degree in physical therapy.

Assessment Procedures

All of the study subjects were assessed before and after the 10-week training period for bodyweight and body composition (lean weight and fat weight), as well as for forward head position and standing height. Participants did not significantly change their bodyweight, but did experience a 1.5 percent improvement in body composition, resulting form a 2.4- pound gain in lean (muscle) weight, and a 2.9-pound loss of fat weight. Their forward head position improved by an average of 0.4 inches, and their standing height increased by an average of 0.2 inches. Table 2 presents the pre-training and post-training data, and the statistically significant changes that resulted from the exercise program.

Practical Application

Based on these findings, it would appear that a 10-week program of basic endurance, strength and flexibility exercise is effective for significantly improving body composition by increasing lean weight and decreasing fat weight. When combined with postural awareness training and two specific stretches for the chest and shoulder muscles, the basic exercise program also seemed effective for improving functional posture by decreasing forward head distance and increasing standing height.

Written questionnaire surveys completed by the participants prior to the final assessment revealed an overwhelmingly positive response to the training program. Their comments included noticeable improvements in personal posture, reduced neck and shoulder-area discomfort, and less low-back pain. Essentially all of the respondents committed to continued postural awareness and to a regular exercise regimen, therefore indicating that they perceived the program to be both physically important and personally beneficial.

Although the long-term effects were clearly encouraging. While our findings with average adults may not be applicable to the geriatric community or persons with long-standing postural problems, we saw no indication that the training program was harmful, and obtained considerable evidence that it was helpful to the participants.

Exercises, Machines and Stretches

Physical Changes Resulting From 10 Weeks of Basic Strength, Endurance and Flexibility Exercise (34 subjects)

Setting up a posture-training program

When setting up a posture-training program, it is important to provide adults and seniors with a basic program of endurance, strength and flexibility exercise for comprehensive conditioning of the cardiovascular and muscular systems. Once a reasonable level of overall physical fitness is attained, you can add supplemental training. In our experience, this simple approach has proven both safe and successful, with essentially no injuries and a high level of participant satisfaction based on our written program evaluations.

We, therefore, recommend an eight-to 12-week basic exercise program that includes about 20 to 25 minutes of continuous aerobic activity (e.g., treadmill walking/jogging), about 20 to 25 minutes of standard strength training (e.g., 10 to 12 exercises) and about five to ten minutes of static stretching. A properly performed basic exercise program provides many physical benefits, including significant posture improvement.

In addition to the basic exercise program, give relevant verbal cues and related reminders for practicing proper posture. Also, teach two specific stretching exercises for the chest and shoulder muscles. These should be performed on a daily basis in the following manner.

Chest stretch. Instruct your clients to stand facing a corner and rest their forearms on both corner walls. Make sure they maintain tall posture and upright head position as they gently lean their chest forward toward the corner. Have them hold this for 20 to 30 seconds, and repeat three to five times.

Shoulder stretch. Have clients stand with good posture and hold a dowel (36-inch wooden rod) behind their back, palms facing forward. Next, they should raise the dowel upward, maintaining proper posture and keeping the arms extended. Have them hold this for 20 to 30 seconds, and repeat three to five times.

Finally, give regular positive reinforcement to your clients whenever they exhibit better posture. For example, acknowledge clients who sit without slouching on the weight machines, who stand tall on the treadmill and stepper, and who keep their head up and shoulders back throughout their training session.

Data Collection

To collect objective data on your clients’ postural improvements, follow standardized procedures for accurately assessing head position and standing height.

Forward head measurement (goniometer). Place the vertical arm of the goniometer (locked at a 90-degree angle) just in front of the clients’ ear. Measure the distance (nearest ⅛ - inch) on the horizontal arm of the goniometer to the midpoint of the acromion process (bony protrusion on top of the shoulder joint).

Height measurement (tape measure, goniometer). Have your clients stand tall in stocking feet with their back close to the wall and in line with a vertical tape measure (attached to the wall). Make sure their head is neutral without tipping forward or backward, and not touching the wall. Rest the goniometer arm horizontally across the top of their head, and record their height to the nearest ¼-inch where the goniometer intersects the tape measure.

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Reference:

1. Risch, S., N. Nowell, M. Pollack, et. al. Lumbar strengthening in chronic low back patients. Spine, 18:232-238,1993
Scott Worobey, Rita La Rosa Loud and Wayne Westcott conduct research studies on exercise effects at the South Shore YMCA in Quincy, Mass.

Wayne L. Westcott, Ph.D. is the  author of the new book Strength Training Past 50.

More Books from Dr. Westcott

CEC: Current Strength Training Research by Dr. Westcott

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