help for student with excessive kyphosis

[Jim Pickles]

Following the closure of Studio Relax here in Brisbane, I've started teaching a new ST class for a group of the displaced students. One of the class members (who I have taught on and off for several years) has more kyphosis than he wants – while it is not actually disfiguring, it leads to some awkwardness in posture and walking, and apparently led to him needing physio on his lower legs because when walking he has to tilt the whole body backwards a bit to look straight ahead. The kyphosis has not improved even though he has been doing ST (or P and F) classes for several years now (but then, neither has it got worse). I presume it is functional, not structural (I’ll have to ask him his history). He is male, mid 50s, muscular, stocky build.

If possible, I'd like to do something for him in my classes. I've looked through this site, but only found one relevant thread (shoulders forward thread). That emphasised to me the issue of tight hip flexors, which we will certainly work on - those are an important element of my classes anyway.

Olivia's Arch Body Hold video is highly relevant, for activation and use of the middle and upper back spinal muscles - the "pull the sternum forward with a string" cue certainly works well for me when I test it.

If I say my own thoughts and experience in this: Obviously, we have more body tissue in front of the spinal column than behind it. Therefore we have to contract the muscles along the back of the spine to stop ourselves flopping forward. We naturally do this strongly in the waist and neck where muscle activation is essential. But in the middle-upper back, the rib cage stops us flopping forward, so we can get in the habit of neglecting the deep spinal muscles at this level. Eventually, this leads to the spine curving forward at this level, increasing kyphosis as we age, and compression of the rib-cage, with all sorts of undesirable consequences.

In me, who has had some degree of kyphosis for years (from desk work and general neglect of my body), regaining control of these muscles has been a great breakthrough. Even though I had been doing yoga for years (with a lot of locusts – i.e. arch body holds) I had managed to avoid using the deep spinal muscles in this area. Some group classes with a very knowledgeable physiotherapist Selina Tannenberg (at Fitness Wonderland, Brisbane; I commend her to everyone) identified neglect of these muscles. My memory is that the yoga sphinx was the best way of learning activation – first pushing the shoulders wide in the sphinx, dragging the elbows and hands back against the floor, pushing the upper spine and therefore chest forward between the shoulders, and then lifting the sternum (the latter is similar to the cue from Olivia’s video, described above). Because the body is supported on the elbows in this position, maybe it will work better than a position where the whole torso is lifting itself off the ground, because we want to develop awareness of muscles in a small specific area. We do this routinely in my other class, and the class members report that they do develop awareness of and activation of the upper-middle back over time.

Incidentally my own neglect was at slightly higher up the spine than Olivia points to in her video, and assuming that kyphosis tends to develop most at the level where muscles are least activated, then in this student it would be higher too.

I can presumably cue the spinal muscles in the right area by running my fingers vertically a little on either side of the spine (though I have to be careful in women because this can tweak the bra-strap). It least in me, there was a short area with complete neglect and complete lack of awareness of what the muscles were doing. Regaining control here now means that I can stand properly straight, and my efforts to “stand up straight” don’t involve me tilting the rib cage up and back as they did before.

So I will try both methods with the class member. If anyone has any comments or any other suggestions, I would very much appreciate hearing them.

Thanks,

Jim.

[Jennifer]

nm

[Kit_L]

Passive back bends over support would be my choice: get some movement in extension first and then activate the muscles for support. This might sound odd, but for kyphosis, flexing the spine before any attempt to straighten it is essential (spinal muscles cramp otherwise). And even though the textbooks say these muscles are "lengthened and weakened", if you palpate them, they will be very tight. Stretch in flexion first to soften them.

An aside: when the body is well aligned (and the HFs are loose enough to allow this) no tension in the paraspinal muscles is needed to support the whole spine. I demonstrate this every workshop. Most spinal tension is unnecessary tension, and results from the APT caused by the HFs. Many people's neck pain, for example, simply disappears then the HFs are stretched properly.

So, for this student, loosen HFs, flex middle and upper back, then try to elongate/extend middle and upper back over support, and finally teach the activation/strengthening exercises recommended. IMHO, the movement capacity (ROM) needs to precede any strengthening/activation work.

Last point: some kyphosis is DISH; if this is the case, and the vertebrae have started to fuse, the kyphosis will be very difficult to alter by any significant degree. Ask this student if he has had an X-ray to determine this.

[Jim Pickles]

Many thanks for that very informed reply, and setting out a strategy for us to pursue.

Many thanks for your help,

Jim.

[Emmet Louis]

As a case study; I'm working with a guy who is a computer programmer lately, when we started he had the ultimate computer guy posture, IR shoulders, head forward, Kyphoisis, Tight HF etc. His Kyphosis was extreme, maybe costing him 2 inches of height when standing.

I prescribed for him to hold initially ten minutes a day passive back bend over support with a weighted bar. He does this either sitting over the end of his bed or over the couch. He's using a standard door frame pull-up bar as its what he has at home. At the same time I was cueing him to focus on breathing into his rib cage trying to feel it expanding. Result is he looks like a new man.

[Craig]

Im sure a good dose of passive hanging would do wonders as well!

[Kit_L]

Craig: you took the words literally out of my mouth (I was returning today to post exactly that!). Yes, passive hanging is an excellent partial antidote.

[Keilani Gutierrez]

no wonder. my spine lenghtened a great deal when I started training in Oct '12. i should get back to hanging from time to time.

[Kate Abernethy]

Have just added deadhangs to my workouts and am getting a very good stretch in the torso skin/fascia - feels like there's at least a couple of inches room to grow :-)

[SwissDanny]

I should do more of this too. I like Tsatsoulines version that is to contract everything (active trap/shoulder raise, plus strong hollow hold) and the relax into it, but I find I need to stretch the lats individually first (using a stall bar type side stretch) to really get the benefit of the straight hang.

[Rory Rathbone]

Great Info guys. Thanks so much.

[SDowd]

So many great suggestions already!

 

The only thing I would add is some targeted tissue work (at whatever level he can tolerate...foam roller, lacrosse balls or "other") for the muscles alongside the spine (to release their hold!)