This is our follow up article to the previous, “What causes kyphosis and the dowagers hump” where we looked closely at the various reasons behind people developing this postural dysfunction.  If you have not read that article yet, go back and read it now completing any of the exercises I am about to show you. It is extremely important to identify and change the source of the problem for your exercise program to have any chance of working. And to be perfectly honest once you have done that you are half way to the finish line. The exercises we are going to show in this article will finish the job and restore any lost stability and strength you have suffered, so you never return to the poor posture you once had. Okay let’s get started.

You Must Start With an Assessment

The best tip I can give you for creating an exercise program to correct your posture is to let the results of the assessment guide you on what to do. What I mean by this is never follow a template or assume that everyone needs to do a certain exercise. Some of the exercises that I show you in this article may be perfect for you and work really well, and others may not. There is not one single way to fix your problem, only the way that is specific to you.

We are all unique and the various causes behind it will vary from person to person. Even though you may look the same, the reason for it may be completely different and as a result the solution will also differ.

The first thing I always start with is a static postural examination.

Posture Testing

Assessing your posture is critical to do first when designing a corrective exercise program as it defines exactly where to start. Whenever I do meet a person I have never met before, I begin to look at how they move, the way the stand, and the various positions their body is held in. Not all things are obvious to the naked eye and you need to use a more comprehensive testing procedure to expose where potential problems might be hiding.

Assessing your own posture is very difficult and I suggest you get the help of a skilled trainer or therapist to do this for you. There are some great apps these days you can use with IPADs that are also very effective. Watch the video below to see an example of this app in action.

Posture is defined as the position with which movement begins and ends. We know that a person who has kyphosis has poor posture, we just do not know exactly how much and also what other joints other than the thoracic are out of alignment. You must not fall into the trap of thinking it is only the thoracic spine that is at fault.

The goal of the corrective program is to restore the client to what is known as “ideal posture”. This is the position that the body is free from compression, strain, and where the muscles will function most efficiently.

In ideal posture, a line extending down the side of the body should run through the ear lobe, transect the shoulder, hip and knee joints and fall just in front of the ankle bone. Any deviations you see during the assessment you make a note of and keep in the back of your mind during the remainder of the assessment as it will give you clues as to other areas of dysfunction and poor alignment.

Another great benefit of completing a postural assessment is it gives you a baseline measurement that you can compare against with your program to see if you are making any positive improvements. Here is a great example of this with a girl who came to see me for help with neck pain and postural problems. Her job was a professional photographer and she spent many hours leaning over into a camera that had led to the development of neck pain, shoulder pain, and early onset of the dowagers hump.

Take a look at the before and after pictures over a 9 month period of her postural assessments. I am sure you would agree this is a great result.

I would love to say it always happens this quickly but very rarely is that the case. For starters she was quite young, and secondly she really put in the hard work to get the exercises done. She did not rely on the training with me to do the work which unfortunately many people are like this.

What is next?

Mobility & Flexibility Testing

You are certain to find many stiff muscles and trigger points with a person who has kyphosis, but it is important to define which areas actually need to be stretched. The worst thing you can do is stretch every muscle in the belief that more flexibility is better. If you stretch a weak and lengthened muscle you will make its opposing muscle tighter and create a stiffening approach from the body to create better stability of joints.

You must use an intelligent method of selecting stretches and this is how I do it.

If anything feels tight, or hard to do, this means it needs to be stretched. If it does not feel hard to do and the range of motion is good I will not stretch this muscle. I also look for variance between left and right and anything that is lacking range of motion needs to be improved to match the other side. You must strive to be symmetrical across all joints otherwise compensation takes over and faulty patterns emerge.

You can read more about this in the article - Mobility and flexibility which comes first and why

There are a few areas I am always highly suspicious of and they are shown below. You can complete each of these exercises to see if they are hard for you to do. If they are hard they now become part of your program.

Levator Scapula

The levator scap muscle in your neck is one of the nastiest areas to get really tight that will give you all types of pain and even headaches when it is really aggravated. Rarely does stretching of this muscle do anything to release the chronic stiffness it may have as it is a reaction to weakness from other muscles around the neck and shoulder.

For example when the scapula sits too low in a resting position it will not elevate correctly when you need to raise your arm overhead. This places a massive strain on the neck because the levator scapula is left to do all of the work without assistance from the scapula. Can you begin to see how trying to stretch this muscle is pointless if you fail to address the problem at the scapula? More on this soon.

There is another stretch I may use as a test and it often becomes part of the exercise program and that is shown in the video below.

Thoracic Mobility

Thoracic mobility is always very difficult for the kyphosis person for they have compressed the spine so much that it has lost a great deal of its mobility with extension and rotation. It is important to understand that the mobility of the thoracic spine is vital for the lumbar spine and the shoulder joint to achieve stability. Both of these joints are regularly exposed to injury when the thoracic region becomes stiff and rigid.

The video below shows you a very simple test to use.

Read this article to see a detailed explanation of this – Why thoracic stiffness leads to chronic pain

Internal Rotators of the Shoulder (pecs and lats)

The scratch stretch is a great way to assess any stiffness with the internal rotators of the shoulder that are usually chronically short and tight. The muscles of the pec minor and the latissimus dorsi will often need a consistent stretching program implemented to restore the posture back to an ideal position.

The video below give you a few ideas of how to test this area.

Releasing Trigger Points

Shoulder and neck pain easily develop several areas within the body that have severe tightness known as trigger points. And while stretching & mobility drills are great for helping to correct your problem, they do not help much in the initial stages of releasing these nasty hot spots. Sometimes we may need a much more aggressive approach using massage or small tools that get into the trigger point.

Once again these are tests for you if you do not find any trigger points you will know that this is not a factor and you will be spending more time with stability and strength exercises.

Watch the video below for ideas of how to do this.

Hips, Glutes & Hamstrings

Lastly we cannot ignore the impact any stiffness around the hips and glutes may cause to the overall posture of the body. Just like the thoracic spine the hips main purpose is to provide mobility for the body. When it loses this ability and becomes stiff and rigid it causes problems to the joints above and below. And in some cases it can be the cause of the kyphosis and dowagers hump.

The video below shows four stretches and the first two are very similar in that they are trying to release the posterior chain stiffness that is often behind a lack of hip range of motion.

A lack of hip mobility can cause a multitude of problems especially in the lower back and the knee, as a result of these structures attempting to compensate for the lack of movement at the hip joint. This is more common in non-sporting people who sit too often behind computers and generally do not move around enough.

I included a hamstring stretch to test as well for often this area becomes stiff when the spine is exposed to excessive compression and curvature. A bit like the levator scapula we discussed earlier, this is a reaction from the body to protect itself from weakness and further harm, meaning any stretching of the hamstring will have little effect. The solution is to correct the weakness at other muscles and joints.

To save this article going for too long I have not included all the other assessments with the knee and ankle which are important to assess as well. You will find how to do that in the article in the video below

That concludes our quick look at mobility and by now you should already have a list of exercises in your program to do. Now we need to look at the various stability exercises you will need to follow up with.

These exercises are provided in order of easiest to hardest and my advice is to treat each one as a test. If you pass the test move on to the next one and keep it as an exercise until you reach the end.

Stability Testing

Mobility and flexibility testing is fairly simple, but stability training and testing is anything but simple. True stability is all about TIMING! Being able to react with perfect reflexes to maintain joint alignment ready for efficient and smooth movement. The first few exercises we look at are very simple and require little in the way of reflex stability but as we move forward with the testing you will find the demand increases.

Isolated Neck Strength

Whenever we are talking about kyphosis and forward head posture we know that we must look at the muscles at the neck.

We have already discussed in great detail the tight muscles at the back and sides of the neck, but very rarely do people pay attention to the weak muscles under the chin that are responsible for holding the head in an upright position.

These muscles are known as the suprahyoid and infrahyoid muscles. You can feel them contract if you place your fingers on your throat and swallow your saliva. These are prone to weakness and when this happens the muscles known for overworking and tightness will begin to work harder and develop trigger points and eventually pain.

There are a few exercises I like to use to help people develop strength with these muscles without the complexity of coordination and other muscles becoming a factor. Check out the video below to see several examples of how to do this.

Lower Abdominal Strength & Lumbar Spine Stability

This test is to determine if your hips are disrupting your stability of the pelvis and the trunk. This is surprisingly hard as we find 90% of people fail this test! If you cannot stabilize yourself during this exercise this indicates you have an abdominal dysfunction where your hips are trying to stabilize your pelvis instead of your small stabilizing muscles in your abdominal region.

This can be contributing to thoracic dysfunction and the evolution of kyphosis.

Instructions

1. Lying on your back with a blood pressure cuff or your hand place underneath your low back at belly button level.
2. Bend your knees to 45° raise both legs in the air keeping the knees bent. Pump the cuff up to 40mm/hg draw your belly button inwards and slightly rotate your pelvis backwards which will flatten your low back into the cuff rotate your pelvis to the point where the pressure in the cuff raises to 70mm/hg. If you do not have a cuff rotate your pelvis until you feel a light pressure on your hand.
3. Lower both legs back to the floor maintaining the pressure on the cuff. The pressure on the cuff should not vary greater than +/- 5mm/hg throughout the exercises.

While these first few exercises are a great starting point, on their own they will not be enough to make any lasting changes.

In the previous article we featured a quote that you should have printed in the back of your mind

"Almost all neck pain and headaches I treat are primarily due to poor shoulder blade (scapula) function regardless of the structural diagnosis involved."– By Rick Olderman

This is very important to remember for it tells you that must assess this and correct any dysfunction for your postural stiffness to change.

Scapula Stability  

This is where starts to get a bit messy so I will do my best to make it simple for you to follow.

What we have to consider is that the body has developed stiffness from poor repetitive movement that has now created instability and weakness at the scapula and shoulder joint. The body now has no choice but to further increase stiffness in this area and reduce range of motion of the spine and shoulder while this weakness and instability remains.

The most common impairment associated with shoulder impingement is scapular related, and if poor stability is present as you raise your arm overhead, the upper traps will not function as they are designed to, resulting in stiffness and tightness in the neck. It is important to know that the upper traps must work with other muscles to create optimal stability and movement. Without assistance from serratus anterior and the lower trapezius the upper traps cannot produce upward rotation on its own, so finding ways to help these muscles work together is essential if you want to restore stability to the scapula and shoulder.

As you will see shortly the upper traps are very much a big part of the problem here.

To give you a good visual of the role these three muscles play with this motion of the scapula we have provided a great picture below.

Problems we see with overhead movements when these muscles become dysfunctional are

1. The scapula moving over the thorax instead of around it
2. Excessive elevation of the scapula as the neck is pulled into rotation towards the head
3. Lateral flexion of the neck and the trunk in opposing directions

The poor stabilising strategies during over-head movements create areas where joints have excessive mobility. And it is in these areas the body will create abnormal amount of stiffness to protect the joint, and this is where people will feel their pain. But these muscles are doing their job to protect you from more serious harm, so releasing the trigger point without addressing the poor stability that created it in the first place is futile.

My favourite drill for doing this is the serratus anterior wall slides.

Serratus Anterior Wall Slides

The following drills are aimed at the serratus anterior and lower traps, to teach your body how to keep the scapula attached to the thorax and held in optimal alignment while the arms move overhead. Most of these tests will become a part of your exercise program and the only time I would not use them is if there is pain present.

The wall slides drill shown above is without doubt the most valuable exercise for improving scapula stability and this will set a great foundation for exercises to come. I would use this drill for ALL cases of shoulder dysfunction it is that good.

This is a great way to learn how to retrain stability and control of the scapula.

Instructions

1. Start with your arms against the wall as if in a plank position standing up.
2. Position your arms so that you are in a V angle. This encourages greater activation of the lower trapezius muscle.
3. Position your scapula in perfect alignment and begin to slowly slide your arms up the wall
4. The key to this exercise is to feel your scapula wrap around you as your arms lift up without losing your posture and posterior tilt of the scapula.
5. You may feel you need to step into the wall as your arms slide up which is fine
6. Lastly make sure you can control the movement on the way back down as this is where most people will lose form.

Single Arm Stability & Mobility

This test is quite difficult to do and integrates the entire body with a huge emphasis on shoulder stability. Mobility and stability are maximally challenged along with stability of the trunk and core. This may be too painful for most with shoulder pain so if it hurts leave it until your pain has subsided.

However this is a great test to use when you are not in as much pain but you know your shoulder is not stable or mobile enough to complete functional exercises or activities without aggravating your joint and going backwards.

You will need a partner to observe this test and note if there is any scapula winging or hip cheating taking place.

Make note of any difference between right and left and if there is any pain or compensation.

Using a Stick to Give You Postural Feedback

Many people are great at setting up with good posture at the start of an exercise but as they begin to move they are unaware that their body has moved out alignment while they were concentrating on the complex tasks needed to do the exercise. This can become very frustrating and you have to be careful of giving the person too many cues where they end up confused and in a state of paralysis by analysis.

One of the best ways to get around this problem is to use a stick on their back to give them feedback as to where their body is while they move. For such a simple idea it is incredibly successful in helping them find the posture they need to execute movements correctly.

You will see how important the stick is in the two following tests that will also become a big part of your exercise program.

Push-Ups

When it comes to trying to strengthen serratus anterior and lift the rib cage there is not many better exercises to do this than the push-up. While a bulk of the workload is performed by the chest, shoulders and triceps, the exercise cannot be done correctly without almost every muscle in the body participating. Even the abdominal muscles must work hard to stabilize your torso and prevent your hips from sagging.

The push-up in theory is a very simple exercise, however, many people with postural imbalances struggle to do this correctly and it may take some time to get this right. When you eventually develop the correct form your scapular will be able to move fluently and wrap around the rib cage with ease.

And when this happens you will build incredible strength into the serratus anterior.

Instructions:

1. Lie face down hands a comfortable width at shoulder height.
2. Take a diaphragmatic breath (belly breath) and draw your belly button inwards. Exhale through pursed lips pushing yourself up to a plank position keeping your head and spine in alignment.
3. Inhale as you lower back to the ground.
4. Repeat for the prescribed number of reps.

Bending (Deadlift)

The deadlift is a great exercise to strengthen the muscles that hold you in an upright tall posture. This is rated by many as the king of strength training exercises as it requires incredible mobility at the hips and the thoracic region while simultaneously strengthening your glutes, core and upper back muscles! It simply improves many of the things we try to do separately all at once.

In terms of improving posture this is simply the art of standing up tall and learning to use your hips to bend correctly. This exercise if performed correctly will address any weakness at the core and hips that could be contributing to the kyphosis posture.

There are many versions of the deadlift and I like to use all of them, but it is always wise to start with the easiest versions first that have more of a focus on timing and posture, than brute strength.

Instructions:

1. Position the kettlebell on the floor between your legs so that you cannot see your shins in a mirror from the side.
2. Standing with feet a comfortable width apart. Reach down keeping the natural arch in your low back, and neck tucked. Touch the kettlebell keeping good posture.
3. Inhale and engage your core before you begin to stand to the top position, exhaling and when at the top and gently rolling your shoulder down and scapula apart
4. At the top repeat the inhaling process before lowering to the ground.

Now that you have the technique mastered it is time to look at the big strength movements you can progress to. Always make sure you have perfect technique for the risk of injury is very high if you get this wrong.

Apart from the obvious load difference this differs a lot from the previous version in that we are now going to lift the weight from the bottom up! This is where the legs will now be heavily involved and a key component of the lift.  

I suggest to read our article – Which Deadlift version is best for you to see more on the various techniques you can use.

After learning how to bend correctly it is time to use loaded carries and farmers walks.

Loaded Carries & Farmers Walks

Carrying a heavy load is arguably the most common strength activity we use in in life, and it is also one of the most challenging. Yet, it is highly under-rated and many do not even regard this as an exercise. When you understand just how many muscles and complex interactions are involved to perform this movement efficiently, you gain a better appreciation of how valuable this can be to use in a workout.

This is an activity we use every day when we pick up the shopping bags at the supermarket, a suitcase when we go on holidays, lifting a wheelbarrow in the garden, and endless other activities at work and at home.

Two examples of these are shown below.

Here is a great quote from Gray Cook as to the value of loaded carries.

"This is one of the central problems in Western fitness: We try to lift things before we have carry capacity. Take the kind of weights you want to lift and carry them. Let’s carry those with alignment and integrity under load. Guess what would happen if we all did more carries than lifts? You wouldn’t be looking for correctives. This can help your endurance.

It can help your core stabilization. It can help your posture.

This is where balance starts—carries, not with deadlifting; not with bench pressing and not with single-leg deadlifts, and not with Turkish getups and swings and push presses.

Balance starts with work capacity. Alignment with integrity is good balance. A balance beam on the floor is a pre-requisite for this, but now alignment with integrity under load is a good rebuttal." -  Gray Cook.

You can read more about this in the article - Farmers walks and loaded carries are the most under-rated movement

Overhead Strength & the Depressed Shoulder

Now to really confuse you, in some cases I would advise against heavy farmers walks. Why? For the reason that gravity naturally pulls your shoulders down during those movements. And while this sounds like a good thing it can lead to problems with the scapula being pulled too far down and back. This is known as shoulder depression and is extremely common with the kyphosis posture and dowagers hump. This causes all types of problems for the shoulder and neck and a real stiffening strategy being used by the body to protect itself.

In a healthy shoulder from a front on view you should see a slight downward angle of the clavicle. If you do not see this you know that scapula dysfunction is present and weakness of the upper traps is very likely. From the rear view you can easily see the scapula held in depression as shown in the pictures below.

Secondly you can test this via strengthening exercises.

Recently I have observed the difference in strength in several female clients with pushing movements. They were able to generate considerable strength in horizontal patterns but very little with vertical movement. This lack of consistency exposes the weakness in the muscles used with overhead patterns and the upper traps being one of the main players.

It is interesting when you consider the rate of shoulder injuries in males versus females that it is significantly greater in the female population. Females generally present with greater mobility than males which can be a good thing if the joints are controlled, however it can pose huge problems when poor movement is combined with weak muscles. Click here to see results of a study about this.

This is where my mindset has changed from previous years when dealing with neck pain in female clients, especially those who have never spent time developing overhead strength. I am suspecting the stiffness in their neck and shoulder is more to do with weakness than overuse.

Below is a great video showing a gradual progression for improving your overhead strength.

Developing strength back into the upper traps will take considerable time so you must be very patient and gradually progress. You will find a step by step approach to this shown in the program below.

Barbell Squats

The squat and the lunge are interesting exercises and something many people would not associate with correcting kyphosis and the dowagers hump. These two exercises are known more for their value of adding strength to the powerful leg muscles. And while this is true they can play a valuable role in improving the strength of the spine.

In part one of this series we discussed in great detail the danger of severe osteoporosis — a disease that causes thinning of the bones. You can eat all the calcium and protein you want, but if you do not apply loads to the body there will be no change to the strength of the bones.

One hundred years ago we did not need gyms as our lives were much more labour intensive and our body would have received all the load it required to keep our muscles and bones strong. But with our sedentary lifestyle our bodies are literally wasting away from inactivity.

We must use strength based exercises that force our spines to extend against load. The squat differs to the deadlift in that we can avoid any depression of the shoulders by placing the load above the shoulder. This in turn demands huge amount of strength from all the muscles that hold the ribcage upright to avoid losing posture.

I would start with a dumbbell squat shown in the video on the left before progressing to the much more complicated front squat seen in the video on the right.

*A Word of CAUTION*

You must be very careful not rush to do these or to go too heavy straight away, as people with severe kyphosis may find these exercises too difficult, especially the barbell versions.

You can read more about the many versions of the squat in the article – 7 Squats to build leg strength and bulletproof knees

Additional Resource to Help You

There obviously is a lot of other exercises I could include but to prevent this article from taking up another 5000 words I have a FREE REPORT you can download that has pictures and instructions of the exercises I have left out.

Summary

That concludes our two part series on kyphosis and the dowagers hump and I hope this has given you all the information you need. All the strategies we have discussed over these two articles will prevent or treat this postural condition.

The most important thing to understand is you must identify the trigger/s of the problem first for your program to have any chance. All of these were explained in part one and if you have not started making changes to the things that were causing your problem go back and do it now.

Once you have made that important change the exercises listed in this article will have a dramatic effect on your posture. Some will be harder than others so you must be patient and be disciplined to do the work. If you stick to your plan it will all come together and you will never look back.

For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 300 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily. You can also subscribe to our FREE fortnightly newsletter by clicking here.

If you live in Melbourne and feel you need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 15 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.

References:

• Mccrindle Research
• Sitting On The Job - By Scott Donkin
• Movement - By Gray Cook
• Osteoporosis Australia
• Corrective Exercise Solutions for the Hip & Shoulder - by Evan Osar
• Back Pain Mechanic - by Dr Stuart McGill
• Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
• Low Back Disorders - by Dr Stuart McGill
• Ultimate Back Fitness & Performance - by Dr Stuart McGill
• Core Stability - by Peak Performance
• Athletic Body in Balance - by Gray Cook
• Anatomy Trains - by Thomas Meyers
• Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
• Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
• How To Eat, Move & Be Healthy by Paul Chek
• Scientific Core Conditioning Correspondence Course - By Paul Chek
• Advanced Program Design - By Paul Chek