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Kyphosis: Is it a Thoracic or Pelvic Problem?


Round Shouldered Posture (Kyphosis), is a muscular imbalance that causes forward roundness of the low back (flexion of the lumbar spine on the pelvis), increased round should posture (thoracic flexion), and forward head tilt (cervical flexion). Viewed from the lateral perspective, the client is slouched in their standing posture as there is reduction in lumbar and cervical lordosis, increased thoracic kyphosis or flexion, shoulder and scapular abduction (protraction), and a relatively posteriorly tilted pelvis. The traditional approach of stretching the anterior shoulder region and strengthening the posterior region is only part of the solution. From a biomechanical reaction, when the upper thoracic spine becomes further flexed, the lumbar and cervical spines will flex and the pelvis will tilt posteriorly. Or when the pelvis becomes posteriorly tilted, the lumbar spine will flex, the thoracic spine will flex further, and the cervical spine will reduce lordosis, head tilt forward and downward. In all, but very rare cases, will this reaction occur.

A Brief Look at the Spinal Reaction of Pelvic Changes

Let’s quickly analyze how the pelvis can affect spinal position.

First, stand with feet about hip width apart in a bilateral neutral position as indicated in Photo 1.

Now imagine reaching your head to the sky. Stand tall from the greater trochanter of the femur to the top of the head but avoid looking up.

Photo 1

Place the back of the hand at the lumbar spine. Typically, there should be a natural lordotic curve at the lumbar spine and the head is held upright with a natural lordosis in the cervical spine. (refer to photo 2)

Photo 2

Notice how the lumbar spine is relatively extended to the pelvis and the concomitant relative anterior tilting of the pelvis to the spine. It could be helpful to observe this from the lateral side view.

Next, round the shoulders (scapular protraction) and notice how the lumbar spine flexed, the increased thoracic flexion, loss of cervical extension, head shift forward and downward. Also, note the position of the pelvis as it tilted posteriorly on the lumbar spine. This is often the postural alignment many of our clients possess. (refer photo 3)

Photo 3

For the moment, imagine you are walking in the shoes of those who present with kyphosis. Imagine the physical strains they have placed on their bodies. Add in the health and fitness professional who tells them to stand up straight with their shoulders pulled back. There is a struggle to heed the advice, but additional strain has been added because of their adducted their shoulder girdle. This additional strain and an unaddressed posterior pelvic tilt. They now have an abrupt compressing conflict at the thoraco-lumbar junction. This is because the pelvis has a relative flexed position with the lumbar spine and the distal thoracic spine begins to extend at the thoraco-lumbar junction near the still flexed the lumbar spine. Notice that the pelvis is tilted posteriorly to the lumbar spine.

Create the Environment for the Client to become Successful

To improve the kyphotic condition, we must create an environment of success for our client. For this to naturally and functionally occur, the pelvis must be relatively anterior tilted to the lumbar spine, thus creating lumbar extension. To achieve this, position the client into a posterior lunge with the right leg. (refer to photo 4) Make sure the right heel remains on the ground. Notice how the right pelvis is anteriorly tilted to the lumbar spine. Place the back of your hand at the lumbar spine and observe the increased lumbar lordosis. To improve shoulder girdle posture, extend the left arm while it is abducted about 15 degrees to waist height. Notice how this movement pattern creates scapular retraction (adduction), of the left scapula and the extension of the thoracic spine. The lumbar spine gains relative lordosis and the cervical spine improves its lordosis while the head draws back, thus resulting in greatly improved posture.

Photo 4

If desired, have the client hold a rubber tube to add resistance as they extend the arm. This will add resistance for the parascapular muscles, posterior shoulder, and latissimus dorsi. As a functional alternative, use a dumbbell in the left hand, flex forward from the waist and reach the left arm anteriorly to waist or knee height (refer to photo 5).

Photo 5 Photo 6

Then extend the torso back and reach the arm back while slightly abducted at waist height. (refer to photo 6) This will create a scapular retraction and help strengthen the posterior shoulder girdle and back. The rationale for the forward flexion is to allow the posterior muscles to undergo a lengthening or pre-load. When muscles move through the pre-load phase, they eccentrically contract to decelerate the forward motion. Physiologically, the eccentrically loaded tissue stores approximately 3-9 times more energy than the concentric unload action. Whenever we perform any efficient movement pattern, muscle tissue moves through a pre-load, lengthening phase (eccentric), stabilizing phase, then an unload, shortening phase (concentric). In this case, the posterior muscles lengthen in the pre-load phase and undergo a stabilizing moment just prior to changing directions. This occurs when we extend back through the hip and back while extending our arm with a posterior reach.

For the best results, have your client perform 2-3 sets of 10-15 repetitions and then repeat on the opposite side. Be sure to change leg positions to address both sides of the back. This way, we can functionally create an environment for success to improve posture.

Improving Posture Through the Flexibility Highways

The same posterior lunge position can be used while stretching the anterior aspect of the client with kyphosis. Please refer to the photos at the end of this piece as a guide. However, the stretches can be combined with the movement patterns and to create a "load/unload" for both the anterior and posterior chains.

When performing the Anterior Flexibility Highway stretch, the client will be able to lengthen the myofascial structures of the calf and hip flexor of the same side. The hip flexor tissue is fascially connected to the abdominal fascia, which connects to the external obliques, connecting to the pectorals, connecting to the deltoids. As you can start to appreciate, the body is intricately connected from the distal joints and tissues to the proximal joints and tissues through the myofascial matrix.

Lateral Flexibility Anterior Flexibility Anterior X-Factor

When performing the Lateral Flexibility Highway stretch, the client will be able to lengthen the lateral column of the body, the peroneal group, iliotibial band, tensor fascia lata, lateral gluteal complex, quadratus lumborum, oblique complex, latissimus dorsi, and shoulder musculature. This is necessary to allow the connecting anterior tissue structures to have reduced lateral fascial tension to allow efficient movement.

When performing the Anterior X-Factor stretch, it is critical to be able to stretch the opposite hip flexor and adductor and opposite anterior shoulder complex. These regions are connected through the fascial tissue through the abdominals and obliques. When the fascia is tight along this diagonal pathway, it can inhibit rotational and extension movements and contribute to kyphotic posture. When viewing the actions and tissue structures of these 3 Flexibility Highways, the fitness professional should be able to extrapolate that kyphosis is not strictly a sagittal plane issue, but a tri-plane result of tissue tightness.

Utilizing a strategy that impacts all three planes of motion will create an environment for the client’s success to improve posture. It is important to note, that the three Flexibility Highways are only part of the solution, as all 6 Flexibility Highways need to be considered when approaching a comprehensive plane to improve kyphotic posture. You can read more about the Flexibility Highways by referring to the article, "Flexibility Highways: A Roadmap for Improved Performance", written by this author, which can be accessed in the "Articles" section on PTontheNET.

References

  1. Chain Reaction Explosion Seminar, Wynn Marketing, Adrian, Michigan, 2001
  2. Carlsoo, Sven, How Man Moves, 1972, London, William Heinemann Ltd.
  3. Clark, M.A., "Integrated Flexibility Training", Thousand Oaks, Ca., National Academy of Sports Medicine, 2001
  4. Dykyj, Daria, Ph.D., "Anatomy of Motion", Clinics in Podiatric Medicine and Surgery, July 1988, Vol. 5, No. 3
  5. Inman, Verne, Human Walking, Williams & Wilkins, 1981
  6. Schamberger, Wolf, The Malalignment Syndrome", Churchill Livingstone, 2002
  7. Wolf, Chuck, "Flexibility Highways", 2003