Correcting the Forward Head Fault

As I'm sure you've heard millions of times before, modern technology isn't doing our bodies any favors. Spending hours a day texting or hunching over a laptop is physically morphing out bodies. We're altering our fascia, compressing our spines, and stretching our muscles in ways that contradict our biology. Our traps are tight, and we're riddled with back pain.

Does your posture resemble that of the guy on the right or on the left?

The farther forward your head gravitates, the more weight your cervical spine (neck) has to support: in a "neutral position," the neck only bears about 12 pounds of load, but if your head juts forward only 2 inches in front of your center of mass, your spine now has to support ~32 pounds of load. When the spine has to work harder, so too, do the muscles that buttress (haha) the neck. If you've ever experienced neck pain, then I would wager that your posture needs improvement.

The "ideal" posture involves the joints to be centered from the top of the head, all of the way down to the lateral malleolus of the ankles. Notice how neither the rib cage nor the chin shift too far in front of the pelvis–these are both common compensatory patterns.

Ultimately, when it comes to addressing this dysfunction, I have a three-pronged approach:

1. Correct postural awareness. Cueing and awareness can go a long way. Forward head posture goes hand-in-hand with rounding of the upper back (kyphosis). Once you show a client where their center of mass is, they have a better understanding of proper alignment, and they're better able to recreate that position on their own.
2. Instil proper breathing mechanics. Chest breathing with an incomplete exhale will only aggravate any postural deviations. Full breaths initiating at the diaphragm with minimal chest expansion will promote optimal bodily function and positioning. Your breath influences every other muscular sequence in your body, and should be the priority of any corrective exercise program.
3. Strengthen the core and the neck flexors. The neck is an extension of the core, and, as such, if you display forward head posture, then we need to look there for answers. Similarly, I often find the neck flexors (sternocleidomastoids) to be weak or lack muscular endurance in these individuals.

Try this test: lay on your back, and pick up your head about 2-3 inches off of the ground. Hold your head up for 30 seconds. If you feel tightness in your neck, or your muscles start to twitch within that time, you need to build up the muscular endurance of your neck flexors. If you failed that test, then you definitely need some work.

Here's a good place to start:

1. Neck flexion
2. Cobra pose
3. Neck retraction against the wall
4. Neck nods
5. Bench neck bridge* (Note: This exercise should be used with caution, as there is the potential to strain your neck extensors. Start with holds of only 5-10 seconds for two sets. Gradually increase the lime you hold this movement.)

I would recommend performing two of these exercises at least two or three times per week. When it comes to improving posture, you have to be consistent and deliberate with your corrective exercises. If you stay on top of your drills, but continue to slouch at your desk, then there's little value to your postural training.

Another thing I've noticed is that the neck is often one of the first places people look to for help. Let's say they're struggling on their last pull-up. What do we see? The neck cranks into hyperextension to inch the chin over the bar. If you're grinding out that final biceps curl, you again see the neck shift forward to the rescue. These patterns are important to be mindful of during your training sessions. Don't use the neck to cheat your reps!

Once you treat your neck alignment, you'll notice that the rest of your spine will assume a better position, and you may even notice fewer incidences of back/neck pain and headaches.

Performing these exercises regularly, along with practicing proper sitting and standing positions will have a lasting impact on how you carry yourself. 

Text Neck: Checking Your Phone While Sparing Your Posture

This is not sexy.

Your phone buzzes. You pick it up to see a new text message from your friend. As you read the message, you look down at your hands like the Hunchback of Notre Dame.

Unfortunately, some of us spend the majority of the day in this position, at a computer desk, scrolling through Instagram, or even reading a book. As a result of these recurring movement patterns, the anterior muscles become excessively tight and chronically active, while the posterior muscles are long and under-active. This is the start of neck pain and potential cervical disk herniations down the line. (No bueno.)

Any type of corrective exercise you do to improve your posture will be for naught if you do not change your daily habits, as well.

This is serious business. Don't end up like the last guy.

There are a few different alternatives to combat this and create lasting postural changes. Here are two different ideas of how you can stay "on the grid" while simultaneously sparing your neck!

1. Hold your phone higher, or use a standing work station. Instead of looking down at the screen, you can get a nice little isometric exercise for the shoulders by holding your phone at eye level. If your office allows for it, buy one of those standing desks so that you don't have to slouch in a chair all day.



I prefer to write all of my blog posts in the Cobra pose...

2. Try the Cobra position if you're at home (or if you have a really low key office where your coworkers won't look at you like you're a complete lunatic). This allow you to actually reverse the conventional hunched position and get some extension in the thoracic spine. Plus, this position is great for building a foundation of shoulder stability.

Both of these positions allow you to maintain good posture as you read your e-mails.

Don't spend hours doing hundreds of corrective exercises, expensive physical therapists or chiropractors, and then proceed to look down at your phone all day. You will undo all of your (and your manual therapist's) hard work.

Remember that your body remembers patterns and repetition, so the position in which you spend the majority of your time is the one to which your brain will revert. You can crack your neck and stretch until the cows come home, but none of those changes will have any lasting impact without first considering your day-to-day habits and positions.

Check Your Ribs! 4 Exercises to Fix Your Rib Position

What's wrong with this picture?

Yes, this model has an incredibly impressive physique, but I'm referring specifically to her posture. Her ribs, in particular, are the first thing I notice.

Rib flaring is an extremely common postural fault. I mainly see this in women, but there are many men who are guilty of flaring ribs as well.

You might be thinking, "you can only see her ribs because she's so lean!" or " maybe that's just the way her ribs are!" No. Her ribcage sits that way because of core instability and a lack of thoracic awareness.

A forward ribcage usually goes hand in hand with other postural issues like lordosis and scapular winging. An unstable core results in dysfunction all up and down the kinetic chain. Ideally, we want to maintain our center of mass over our...well, center. There should be a straight line leading from the ear lobes all the way down to the ankles (lateral malleoli). Note the drawing on the right. This photo details the optimal posture: his weight is centered on his whole foot, his ribs sit directly over his pelvis, and his head does not jut forward like many sedentary, laptop-absorbed folks we see today.

If the ribcage protrudes in front of the hips, we cannot properly engage the rectus abdominis, and, thus, the function of the muscles around shoulders, hips, knees, and ankles will be compromised.

Additionally, the ribs will pull forward your center of gravity and affect your balance, along with your gait. Any movement will be altered, because your ribs are, quite literally, several steps ahead of you.

At the other end of the spectrum, take a look at Georges St. Pierre, a professional MMA fighter. You will notice that his core is rock solid and stable, unlike the bikini model in the above picture. Maybe that's why he's one of the most successful (and highest paid) fighters! Which of these individuals do you think has a stronger abdomen?

Someone's standing posture will tell you a lot about how their bodies will move during weighted exercises. Just imagine how both of these individuals will look once they press barbells overhead. The lifter with a flared ribcage will almost, 100% certainly, be hyperextended, while an individual with proper abdominal bracing can maintain a secure position.

Sometimes, a prominent ribcage will not be immediately visible while standing. In this case, I employ the wall slide test. If a client cannot bring their forearms to the wall without reaching their ribs forward, they fail the test. I now know that they have limitations in the shoulder, and I work from there.

This model does NOT pass the test...

9 times out of 10, telling someone to bring the "ribs down" is not enough to help them understand. I've realized that these people usually lack the kinesthetic awareness to do that--they don't know how to properly engage the musculature around the ribs.

When I see someone with ribs like the woman in the first photo, I immediately check their breathing. I am never surprised to see that these people abuse the muscles in their necks and chests to breathe rather than taking advantage of their diaphragms. Often, breathing alone will make a huge impact in the position of the ribs. Aside from doing breathing drills, I like to use the following exercises to teach my clients how to activate the muscles that retract the ribs:

1. Barbell roll-outs or TRX fall-out
2. Hollow holds
3. Rib cage movement drill
4. Deadbugs

Teaching proper joint alignment will allow for optimal posture and mechanics in all activities. Strive to employ better movement patterns. Don't lift weights you can't move without perfect technique. You may limit your risk of injury, and you will be much stronger in the long run. Keep your ribs down, and learn to utilize the core properly!

Behind the Neck Exercises: Do You Need Them?

For every exercise, there's an equal and opposite, behind-the-neck variation. Behind-the-neck lat pull-downs, pull-ups, push presses, strict presses, are just a few examples of exercises I've seen people try to do behind their necks. Perhaps they're trying to hit the same muscle groups in a new way, or target different muscles altogether. Regardless of the reason, I am not generally a fan of the behind-the-neck training club.

Given the overwhelming number of shoulders stuck in internal rotation and spines stuck in kyphosis for the average desk-worker or sedentary individual, many people already come into the gym with a slew of shoulder restrictions and postural limitations. The shoulder is the most mobile joint in the body. Because of the huge range of motion in the joint, many people have poor stability overhead. Men and women alike suffer from scapular flaring (see below) as a result of lifestyle habits and poor posture.

She may look like she's at peace, but she's forcing her shoulders into an unstable position!

It is often difficult enough for someone to maintain shoulder stability in the traditional variations of a pull-up or strict press. Now, once you start trying to do these movements behind the neck, you're just reinforcing a dangerous position that may lead to pain or injury in the future.

For starters, let's analyze the neck position of someone doing an exercise behind his neck.

If you've read my previous posts, you understand that the position of the neck impacts the position of the rest of the spine. This particular...gentleman is obviously very muscular. Despite this, however, his cervical spine (neck) is flexed, and he is reinforcing the dreaded forward head posture ("chicken head" posture). This exercise may be counterproductive for him as it could potentially lead to some neck pain down the line.

Now, let's move on to what might be happening to the shoulders in a movement like the lat-pull downs in the above photo.

As the result of the neck position, (because the human body works as a chain) his shoulder stability is also compromised. Ideally, his scapula should slide down the ribcage as he pulls the bar towards his traps. However, if the shoulders are internally rotated, the shoulder blade tilts forward and slopes off of the ribcage.

Many Olympic lifting coaches teach jerks or presses behind the neck, because it enables the athlete to keep his torso more upright in the dip. Unfortunately, for most, this might also damage the integrity of the shoulder position in order to maintain a vertical torso.

In an ideal situation, a behind-the neck exercise might be beneficial for an athlete. Unfortunately, the shoulder position is often compromised. If you have had shoulder issues in the past, you more than likely lack mobility or stability in the shoulder joint, and these types of exercises will just exacerbate your issues.

Unless you are certain you can sustain an ideal position in a behind the neck exercise, perhaps your routine is better off without them!

Test Your Squat

Here's a quick little test you can do on your couch to test your squat. Focus on maintaining an upright torso when you stand up from a seated position or when you squat. It's important to reinforce good movement patterns at home so that you can move well in the gym. Pay attention to the way you move and you will be surprised of what you find.

“Trust that the body is a self righting organism. Our job is to guide the process.” 

-Norene Christesen, PT, DSc, CLT, OCS

Why You Need to Have a Big Butt

Having a big butt is certainly preferable for models twerking in rap videos, but it's also extremely important in athletic performance. Weather you're a soccer player, a running back or just simply working out to maintain a healthy lifestyle, you need to make sure you're giving your butt the attention it deserves.

I know what you're thinking: "But Arianna! I can squat 250 pounds. My glutes are really strong!" In a perfect world, you would achieve glute activation in the back squat, but many of the back squats I see people execute in the gym make use of the anterior quadriceps muscle and recruit minimal activation from their posterior chain. The truth is, if you are a predominantly sedentary person (meaning you sit for 4+ hours a day at home or at work), you probably don't know how to correctly activate your glutes because you're not using them for the majority of the day. Fear not--you are part of the American majority who sits at a desk job all day. It's no wonder that we don't know how to activate the right muscle groups considering we don't use them as often as we should.

Underactive or weak glutes can cause a ton of problems, including lower back pain, knee pain, IT band syndrome, and a whole slew of other maladies. Your quadriceps may be strong enough to squat 250 lbs, but guess what? If you learned how to activate your glutes properly, you would easily squat over 300 lbs.

The gluteus maximus (one of three muscles that make up what we collectively call the "glutes") is the biggest muscle in your body. Now, if we learn how to properly employ the strength of this tremendous group of muscles, we are going to see some real magic happen. Whether we're doing a deadlift, a squat, a box jump or a clean and jerk, we need to learn to properly harness the power from our glutes in order to move the most amount of weight and avoid injury.

In order to utilize the strength of the ever-powerful gluteal muscles, we must focus on activating them. Some great exercises can be found in my previous article about warm-ups, but I'll list a few more that I really like here:

• Single leg or weighted glute bridges
• Banded walks
• Reverse hyper extensions
• Single leg Romanian deadlifts
• GHD raise
• Bulgarian split squats
• Reverse lunges
• Side plank with abduction

Once you learn to properly engage your posterior chain, you will see tremendous gains in strength while simultaneously protecting your body from injury. If you have humongous quadriceps and a small butt, that should be a red flag to you that your glutes needs some more attention. Channel your inner Nicki Minaj and start building a bigger booty!

Sitting Is a Killer

What are you doing right now?

Chances are you're sitting at your desk as you read this. We sit on the couch to watch TV, get up to sit in our cars, sit at our desks at work and then repeat this vicious cycle the next day. Nearly all of us are guilty of spending too much time on our bums.

Unless you're one of the lucky few (like me) who work on her feet, you're probably sitting down for at least 8 hours a day. The unfortunate truth is that, even if you workout semi-regularly, when we sit, we are wreaking havoc on our bodies. Low back pain? Tight hips? These things are likely the result of you being seated for extended periods of time.

Human beings are not meant to be sedentary animals. We evolved as hunter-gatherers, and at that time, we were probably not sitting for any length of time; we were out on our feet for hours on end trying to find food to feed our families. Even when we were sitting, we weren't sitting in a "chair" as we know it today--we were probably sitting on the ground or a stone/stump/something of the like. We are meant to be active, and our bodies were made to move.

Image courtesy of www.drfox.co.uk

So why is sitting so dangerous? For one, when we sit, our hamstrings are shortened, and our glute activation turns off. Further, our hips are closed for extended periods of time. Our bodies adapt to what we do often, and if sitting is what we are most frequently doing, it will adapt to sitting! If our hips and hamstrings are shortened for extended periods of time, our muscles and connective tissues become adaptively short to accommodate this position. It is no wonder why our society is so inflexible!

Here are some other scary truths about sitting:

• Energy expenditure drops to 1 calorie per minute
• Fat burning enzymes decrease their rate by 90%
• After two hours of sitting, your HDL cholesterol drops by 20%
• People with sitting jobs are 2 times more likely to get some form of cardiovascular disease
• Sitting time has increased by over 8% since 1980

So what are your options? The standing workstation has gained a lot of popularity within the past year or two. If this is not feasible for you, your best bet is getting up every 30-45 minutes and stretching, maybe taking a lap or two around the office.

Brace Yourself: Focusing on Your Posture

Our posture is the foundation of every movement we make. Whether we're sitting, going for a jog, or doing a deadlift, proper spinal positioning is crucial to both preventing injury and the efficiency of your movement. The fact of the matter is that the movements you're resorting to at your computer desk are going to translate to your movements in the gym.

So what is considered "good posture?" Dr. Kelly Starrett, author of Becoming a Supple Leopard: The Ultimate Guide to Resolving Pain, Preventing Injury, and Optimizing Athletic Performance breaks it down into three easy steps:

1. Squeeze your butt
2. Align your ribcage with your pelvis
3. Tighten your core (about 20% tension for low-impact activities like sitting, 100% for a max deadlift)
4. Neutralize your head position and roll your shoulders back into a good position

Ideally, these 4 cues will lead you to a safe position regardless of the task. As I mentioned a few weeks ago in my post about core strength, a nice, strong core is essential to proper posture. Our core prevents our lower backs from arching and stabilizes our hips and shoulders. In these images, Dr. Starrett illustrates these concepts. As a point of reference, he places one hand under his breastbone (sternum) and another hand on his pubic bone. If your posture is aligned properly, your hands will be parallel to one another.

Image A illustrates a properly braced spine. In Image B, Starrett rounds his shoulders, and in Image C, his lower back is excessively arched.

Here, Kelly demonstrates all of the positions you can sit in comfortably with a braced spine.

So next time you're sitting at your desk at work, take a moment to focus on your posture. Are your shoulders rounding forward? Are you arching your lower back too much? If you are, simply stand up, follow the bracing sequence, and sit back down.