Rounded Back (The unknown truth about posture that no one is talking about)

Have you ever wondered how to get rid of your rounded back? You’ve probably tried a lot of exercises but haven’t really achieved good results. In this article, I’ll provide you with evidence-based reasons why that is the case and give you recommendations that actually work.

YouTube video
Watch the YouTube Video to this article.

The most important fact about posture

Posture is very individual, habitual, and variable.

That means there is no optimal posture, and the posture within a person can also vary greatly. Schmidt et al. conducted a very interesting study, in which they examined the posture of their subjects both before and after certain spinal movements.

They looked at extension, flexion, rotation, side bending, and each time after the subjects performed a movement, they returned to the resting position and analyzed what the posture looked like. It was found that the postures within a person were incredibly different, even though the intervals between measurements were very short. Simply going into maximum flexion, returning to the normal position, and suddenly the posture looked completely different.

How Does a Rounded Back/ Kyphosis develop?

There can be many different reasons for this. For some people, certain spinal deformities occur due to conditions such as osteoporosis, ankylosing spondylitis, or Scheuermann’s disease. However, many people without any medical conditions also develop a rounded back and “poor posture.”

I often see that posture is overly simplified to just the biomechanical level. In this regard, common claims are: my abdominal and chest muscles are too strong, my back muscles are too weak and that’s why I’m being pulled into this posture. This is the so-called “upper crossed syndrome” (which, by the way, isn’t even a real thing – but I’ll record a separate video on this topic).

Another common sentence is: I sit at work all the time, looking at my monitor, and that’s why my head goes forward, and my spine falls into this poor posture, making my back round and hunched.

This perspective is very one-dimensional.

Don’t get me wrong; these can definitely be contributing factors. However, various studies have shown that your thoughts have a significant impact on the posture you adopt.

Let’s assume for a moment that you have upper back pain and think that this back pain is due to your “terrible posture”. This causes a bit of panic in you, because you don’t know how to get out of this situation, as you have to sit most of the time during your working hours. Then it’s very likely that you have an above-average level of muscular tension in your back. Several studies like the one of Ross et al. 2017 have already shown this.

That’s why a very effective approach for these people is called Cognitive Functional Therapy. It’s about changing these negative beliefs regarding posture by encouraging relaxation in these positions or challenging the notion that your posture is related to your back pain. There is a lot of education involved, focusing on teaching how to relax in various body positions associated with fear.

Additionally, studies like Richards et al. (2016) show a strong connection between your emotions and your posture. Their study found that people with depression are significantly more likely to have a forward-leaning, rounded posture than those without depression. This point suggests that your emotions and beliefs can reinforce “poor posture,” which you should consider if you want to change your posture.

Does bad posture cause back pain?

Remember the study by Schmidt et al. I mentioned earlier about how variable posture is? What they also found in this study was that posture was independent of whether the subjects had pain. This means that the posture of people with pain was just as variable as that of people without pain. I hope this point has alleviated your fear that your posture is always fixed and not changeable. Posture is very, very variable and dependent on many different factors. But we will come to that in a moment.

Posture is not as important as most people think.

What do I mean by that? I mean that there is no clear connection between, for example, a rounded back and forward-leaning head and back or neck pain.

This means that you don’t have an increased risk of back or neck pain just because you have hyperkyphosis, meaning an “excessive” curvature in your back, or your head and shoulder blades are positioned more forward. Instead, we should view posture as having many variations of good and healthy postures.

Rounded Back Image by Adam Meakins

I saw this image on Adam Meakins’ Instagram channel and thought it was very, very fitting. So, posture is not that important in relation to pain.

Does bad posture reduce performance?

The answer is no. What’s even more interesting, is the fact, that seemingly poor posture and asymmetries can actually IMPROVE performance. A great reference for this is the study done by Afonso et al. 2022. I’ll cover the topic of asymmetries in more detail in a separate video, though.

Another important point is, that, practicing the sport itself will cause the exact adaptations you need for improving in that sport. If, for example, you are practicing a sport that requires a lot of rotation in the thoracic spine (like Tennis), then your rotation will improve by simply playing tennis.

Of course, you might be able to further improve your performance by including some rotation exercises into your workouts. I’m just trying to get the point across, that you don’t need to overly stress about “bad posture” ruining your performance.

Recommendations (Best exercise for Kyphosis?)

Now, let’s move on to the recommendations I have for you. Studies, like the one by Seidi et al. 2014 have shown that a rounded thoracic spine position, or a rounded back, can be changed.

The crucial thing is, that the choice of exercises doesn’t matter. It’s not about performing specific stretching or strengthening exercises, but rather spending more time in a more extended position of the thoracic spine.

That means: if it’s your habit to always be in this forward-leaning body position, then your posture will reflect that. Therefore, we need to look at incorporating more upright positions into your daily life so that you will habitually take in this position more frequently.

How can this be achieved? From motor learning literature, it’s clear that external focus points and constraints work very well (Chua et al., 2021).

Let’s start with external focus points. Instead of focusing internally on how your thoracic spine moves, imagine moving your sternum upwards towards a certain point in the room. This will help you learn the movement much faster than if you focus on the internal movement of your spine. The further away the focus point is from you, the better this motor learning seems to occur. So rather than concentrating on a point right in front of you, try to imagine moving your chest to the other end of the room.

You can use this important tip about external focus points immediately in all exercises you do. Try working with more extension in the thoracic spine when performing deadlifts, squats, or specific mobilizations for the thoracic spine. Ask yourself the question: How can I find external focus points that help me achieve more thoracic spine extension?

That was point number one, but I also mentioned constraints that can be utilized. As I said, posture is shaped by your habits. This means it would be smart to adapt your environment in a way that automatically leads to more extension in the spine. I spoke about this with Dr. Sam Spinelli.

Rounded Back  - Dr. Sam Spinelli  (E3 Rehab)
Interview with Dr. Sam Spinelli (E3 Rehab).

He really likes to work with seat wedges for people who often find themselves in a slouched position. Since the seat wedge gets higher towards the back, your pelvis is automatically tilted more forward, making it much, much harder for you to get into that rounded position. So, you are restricted in the rounding of your spine.

Another idea for a helpful restriction would be if you are someone who likes to lean back into the chair and thus tends to get into that rounded position. If you put something on the backrest that pokes you when you lean back, you will automatically stay more upright.

There’s also the option of using an exercise ball, which has no backrest at all. This will make it much more difficult for you, to stay in a slouched position for a prolonged period of time – and you won’t even have to think about it!


Literature

  • Afonso, J., Peña, J., Sá, M., Virgile, A., García-de-Alcaraz, A., & Bishop, C. (2022). Why sports should embrace bilateral asymmetry: a narrative review. Symmetry14(10), 1993.
  • Chua, L. K., Jimenez-Diaz, J., Lewthwaite, R., Kim, T., & Wulf, G. (2021). Superiority of external attentional focus for motor performance and learning: Systematic reviews and meta-analyses. Psychological bulletin147(6), 618–645. https://doi.org/10.1037/bul0000335
  • Richards, K. V., Beales, D. J., Smith, A. J., O’Sullivan, P. B., & Straker, L. M. (2016). Neck Posture Clusters and Their Association With Biopsychosocial Factors and Neck Pain in Australian Adolescents. Physical therapy96(10), 1576–1587. https://doi.org/10.2522/ptj.20150660
  • Ross, G. B., Sheahan, P. J., Mahoney, B., Gurd, B. J., Hodges, P. W., & Graham, R. B. (2017). Pain catastrophizing moderates changes in spinal control in response to noxiously induced low back pain. Journal of biomechanics58, 64–70. https://doi.org/10.1016/j.jbiomech.2017.04.010
  • Seidi, F., Rajabi, R., Ebrahimi, I., Alizadeh, M. H., & Minoonejad, H. (2014). The efficiency of corrective exercise interventions on thoracic hyper-kyphosis angle. Journal of back and musculoskeletal rehabilitation27(1), 7–16. https://doi.org/10.3233/BMR-130411
  • Schmidt, H., Bashkuev, M., Weerts, J., Graichen, F., Altenscheidt, J., Maier, C., & Reitmaier, S. (2018). How do we stand? Variations during repeated standing phases of asymptomatic subjects and low back pain patients. Journal of biomechanics70, 67–76. https://doi.org/10.1016/j.jbiomech.2017.06.016

Gino Lazzaro

Gino has a Master's degree in sports physiotherapy. In his company Perform Perfect, he offers highly individualized 1:1 Pain Coaching for athletes who have been dealing with pain for more than three months.

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