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Tuesday, June 6, 2023

Upper Body Dysfunction: What are your favorite corrective exercises and why?

Brent Brookbush

Brent Brookbush


Panel Discussion: Upper Body Dysfunction (a.k.a. upper cross syndrome, or protracted shoulder girdle)

What are your favorite corrective exercises and why?

Moderated by Brent Brookbush DPT, PT, MS, PES, CES, CSCS, ACSM H/FS

This Panel Discussion was originally posted on my facebook page - https://www.facebook.com/brent.brookbush - on October, 27th 2012

Ahmed Omer Can it be so protracted it is beyond repair?

October 27 at 12:33pm

Brent Brookbush Only it there is structural change that prohibits movement back to optimal alignment - for example, in individuals who's poor posture is coupled with osteoporosis and compression fractures in the vertebral bodies of the thoracic spine - most people can see big change with a little effort.

October 27 at 12:37pm

Ryan Crandall Posture is a very complex situation that trainers think they have a lor of control over(and we mean well) but might be something we have very little direct control of. Is posture a reaction to emotion? Attitude? Avoidance of pain? Anthropometric variation? Efficiency? Laziness? Motivation? Desire? With that, I do feel it's important to train in "3d" and be able to load and unload in all directions. Treat a person with kindness. Teach deep diaphragmatic breathing. I personally don't measure or look at static posture(I used to years ago) except in a fleeting way. I observe movement…conscious and below conscious. Seems to work. It's a interesting question and one that science hasn't solved just yet. My 2cents won't be the most popular, but that's my current thought based on experience, & interaction with some smart PTs. Cheers, back to work for me.

October 27 at 12:40pm

Ahmed Omer So is it more smr for the rhomboids and ity exercises?

October 27 at 12:40pm

Ahmed Omer Like what Ryan says. Perfect posture is a bit of a myth for me

October 27 at 12:43pm

Brent Brookbush Hey Ryan Crandall,

The reasons we adopt compensation patterns maybe complex, but the solution is not. We can have a major effect on posture via release, stretching and activation techniques and refining exercise selection. I'm not sure which part of the solution you find complex, but I would love to here more on why you abandoned corrective exercise.

October 27 at 1:21pm

Brent Brookbush Hey Ahmed Omer,

That's a good start, but there are many more muscles involved and tons more techniques that could be added to our list of corrective exercises.

October 27 at 1:22pm

Ryan Crandall Are we saying there is only one solution to "fix"? Are we able to fix someone who is excessively kyphotic due to negative emotions? Wouldn't another tool/tools perhaps be more effective? Is the ultimate goal to have better posture according to some standard or is the ultimate goal to have a client that can function better and with less pain? Is static posture directly related to pain (sitting up in chair as my brain is perceiving I've been slumped for too long and not getting adequate perfusion of oxygen into my back)? Is what we perceive as poor posture ever a chick or the egg type (comes first) type situation? I wouldn't say I've given up on "corrective exercise". I would say I adapt to the individual in front of me. I'm not certain if science has the official answer on "If we see protracted scapula then we always do this and this….or other examples." I truly don't think there is just one way of looking at posture. I'm not here to try to convince anyone, and I'm really not in the mood to argue about it…but I do think the counter point is valuable to listen to. Science is about questioning and then asking more questions…not thinking we have THE answer plug and play style (another reason I don't do FMS either). I'm done here. I will read with intention on hearing/listening but I'm done posting on this. Cheers and enjoy the weekend :)

October 27 at 5:12pm

Brent Brookbush Fair enough Ryan Crandall,

Debate and discussion are high effort intellectual activities and I respect anyone's wish to "bow out." I don't think there is one way, per se, but I do think an optimal way may exist. In my programming, predictive models of postural dysfunction (and for the advanced practitioner - further assessment) are used to refine exercise selection. I find this to be a powerful tool to enhance performance and reduce the risk of injury. Posture is not only "static," but "dynamic" as well - being the optimal alignment of bones and joints during any activity. Good form on an exercise is no different than good posture, it is just a question of how you want to get there.

Ahmed Omer, you are right to say that "perfect posture" is a myth in the sense that "perfection is a journey, not a destination." I have never had someone who maintained perfect posture (optimal extensibility and neuromuscular control of all joints) without consistent corrective exercise, but I have clients who can attain optimal posture after an integrated/corrective exercise warm-up (sometimes referred to as movement prep). Those who can reach this level of "alignment" generally see performance benefits that far exceed those seen with conventional training alone, and are rarely the victims of non-contact injury.

Last, although this is a wonderful side conversation, I was hoping for a little more on specific activities and exercises people use. There are readers who don't participate who look to these discussions for education. If are using corrective exercise… please share.

October 27 at 5:44pm

Karam Al-hamdani SMR of T spine, some T spine rotation flexibility exercises side lying, making sure the knee does not lift while I rotate to the opposite side, a variation could be a quadruped position with T spine rotation keeping shoulders in ER. one could also just simply release the pecs.

Stabilizing scapula and using balls on the wall or even elastics to work on protraction + horizontal abduction. There are many more examples it really depends on who I'm dealing with and what is going on.

October 27 at 6:39pm

Brent Brookbush Don't forget about levator scapulae and subscapularis release

October 27 at 8:48pm

Foster Burden I'm out of the training game (apart from conversations and the occasional workout with friends) for the most part, but for myself I still try to maintain an awareness of "good posture" as often as I can through sitting/standing up straight (with a neutral spine and shoulders down and back), and in the gym I try to focus more on back, particularly rows and reverse flies, as well as should scaption and external rotation. I agree that form is paramount in exercise execution, but I know that none of this works much into the corrective techniques you're looking to discuss, so I will remain on the sidelines as one willing to learn from those far more informed than I.

October 27 at 8:52pm

Brent Brookbush Actually Foster Burden, posture education and the refinement of resistance training exercise selection play a major role in attaining optimal posture. Although these techniques are not specific, they are essential if you expect to see progress from session to session.

October 27 at 8:54pm

Foster Burden I wouldn't begin to argue. I'm just claiming ignorance.

October 27 at 8:56pm

Brent Brookbush Sorry if it came across as an argument… I was actually lending a little support to the great points you made :-)

October 27 at 8:58pm

Foster Burden Much obliged. No worries. Y'all keep discussing and I'll try to take good notes. :-)

October 27 at 8:59pm

Michael Adam Clark I would recommend manual therapy techniques (ART, NMT, MyoTherapy, etc) over SMR. Many clients do not get into the specific tissues that are needed unless they are intuitive and/or know the specific muscles that need to be released. The best way to a…See More

October 27 at 11:02pm

Karam Al-hamdani love your comments michael i couldn't agree more nothing replaces the power of manual therapy

October 28

Brent Brookbush Hey Michael Adam Clark,

I agree that nothing replaces the hands of a skilled manual therapist, but that limits postural correction to those with a license (at least in my state), and we can't forget that a home exercise program is the only thing that is going to maintain the gains we attain during training. Not having self-administered techniques to share with our clients is a sure fire way to ensure our clients/patients will inevitably be back with the same symptoms and pain they started with.

Great assessment of over-active and under-active structures - I think you will appreciate my refinement of the "Upper Body Dysfunction" model. You can see it here - http://b2cfitness.com/cpt_blog/upper-body-dysfunction-ubd/ and you can see my repertoire of self-administered corrective exercises and sample routine here - http://b2cfitness.com/cpt_blog/upper-body-dysfunction-sample-routine/

© 2014 Brent Brookbush

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