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Topic 05

Posture & alignment

Forward head posture, rounded shoulders, and pelvic asymmetry can be seen as the result of some muscles shortening and others weakening to fit long-held postures. A common approach is to assess posture and movement to set the order of which muscles to release first and which to strengthen. An accurate assessment should come from a qualified healthcare professional.

Posture & alignment Related staged image
Staged image · not an actual patient

Do you have these symptoms?

  • From the side, the head sits in front of the shoulders (forward head posture)
  • The shoulders roll forward and lift, and the shoulder blades look like they stick out (rounded shoulders)
  • The pelvis tips forward with an excessive low back arch, or the knees lock backward
  • The pelvis differs in height or rotation from left to right
  • The normal curve of the neck is reduced and nearly straight (straight neck)
  • No injury, but holding one position for a long time causes stiffness that eases with rest

Causes and understanding

Postural syndrome
Pain that arises when normal tissue is under load for a long time, without tissue damage.
Effects of long-held postures
Tissue stretched for a long time slowly lengthens, and it returns to its original state even more slowly. Prolonged poor posture has a bigger effect than brief loads.
Upper crossed syndrome
A head-and-shoulder pattern in which the muscles at the back of the neck and chest tighten while others weaken. Common in people who spend long hours at a desk.
Lower crossed syndrome
A pattern in which the low back muscles, front hip muscles, and hamstrings tighten while the abdominals and glutes weaken. It strains the lower lumbar joints and pelvic joints.
Left-right imbalance
One interpretation is that asymmetric rotation of the pelvis and rib cage and the habit of putting weight on one side create left-right differences.
Daily habits
Long hours of computer or phone use, long study sessions

Assessment from a chiropractic perspective

  1. Posture analysisFront, back, and side photos are commonly used to compare the alignment of the head, shoulders, shoulder blades, pelvis, and knees.
  2. Posture type classificationAssessment typically looks at whether an upper or lower crossed pattern is present. Classification is usually made only when the specific muscle pattern is confirmed on examination.
  3. Muscle length testsThe Thomas test (front hip muscles), leg raise (hamstrings), and piriformis test are used to identify shortened muscles.
  4. Strength testsManual muscle testing (MMT) is a method used to identify weakened muscles.
  5. Movement pattern testsThe Functional Movement Screen (FMS) is a screening tool that uses 7 movements to look at mobility and stability.

How it's managed

1. Release short musclesLengthening tight muscles first is the generally recommended order. Short muscles are known to inhibit the muscles on the opposite side, so weak muscles sometimes get stronger after stretching.
2. Activate weak musclesMuscles that are still weak after stretching are usually addressed with strengthening exercise.
3. Balance trainingBreathing retraining and postural re-education are commonly used. For pelvic and rib cage asymmetry, combining breathing with lower-body exercise routines is a known approach.
Manual therapyAn approach used to restore joint movement and address trigger points. Manual and adjustment techniques are performed by professionals qualified in the relevant country, and whether they are appropriate is decided after assessment.
Daily habitsReviewing your work setup and avoiding sleeping face down with your arms over your head may help.

Exercise within a pain-free range, and stop if pain starts.

When to see a doctor first

  • Posture problems accompanied by nerve symptoms such as arm or leg numbness or muscle weakness
  • An older adult whose upper back suddenly becomes rounded (needs to be checked for a compression fracture)
  • A growing child whose rounded upper back does not straighten when lifting the chest while lying face down (needs to be checked for structural kyphosis)

Related columns

Coming soonForward head posture: why the load on your neck increases
Posture & exerciseRounded Shoulders: Why Releasing Comes Before Strengthening
Coming soonWhy your low back is stiff after sitting: lower crossed syndrome
Coming soonA posture check with a single photo of yourself

This article is for general health information. Everyone's condition is different, so an accurate assessment requires consulting a professional.