Most of us are very familiar with someone who has a hunched over posture, and what appears to be a hump on their upper back. This posture inevitably leads to chronic neck pain, shoulder problems, and even lower back pain and can be very difficult to reverse once it is developed. In the past we would normally only see this in the elderly but what we are starting to see these days is the onset of this problem in people much younger. It is even starting to get a different name, such as "text neck" or "Iphone hump". The amount of people stuck in the looking down at their phone position is speeding up the rate of postural decline, and you can just imagine what things will be like in another 20 years if we do not begin to change our habits now. However, it is not just modern technology at fault as there are several other factors that contribute to creating this problem. This is part one of a two part series about kyphosis and the dowagers hump, and in this article we look specifically at all the potential triggers and causes. Whereas part two shows you how to use exercises to correct this posture. Enjoy.
What Is a Dowagers Hump?
Dowager’s Hump is a forward bending of the spine. This outward curvature of the upper back and compression of the front sections of the vertebrae cause a person to lean forward, slouching their shoulders and rounding their back, which in turn, creates a permanent hump on the upper back.
This postural defect does not happen overnight and is created from many repetitive movements over a period of time. At first it starts out as a mild kyphosis before progressing into the prominent forward-leaning posture with fatty deposits seen at the base of the neck. These fatty deposits created from too much leaning forward are multiple micro compression fractures in the vertebra. Apart from not looking too good, it is also associated with incredible stiffness and pain and is definitely something to avoid.
It can be reversed if you already are suffering from it, but it is very difficult to change if it has been there for a long time. It is so much easier to prevent the onset of this posture than to find a cure.
The picture below is a great visual of the onset of kyphosis in a younger person and shows the beginning of a dowagers hump. At this point it is easier to reverse the degenerative changes as there will not be as many micro compression fractures compared to the old guy in his mid-70’s who has been that way for 50 years.
Notice the loss of height in the poor posture and how much the spine is being compressed. This highlights the effects of imbalance between the trunk flexors (your abs) and trunk extensors (your back muscles).
This type of posture is associated with lower back pain and in particular bulging discs! This is due to the development of a "C-curve posture" and loss of your spine's natural curve and spinal mechanics that ruptures the discs.
While it is easy to see how the C-curve posture encourages degenerative changes in the spinal column, what is not see easy to see is how this ruins your hip mechanics and scapula stability. The damage this position creates to the scapula in particular is considerable.
In the book "Fixing Neck Pain & Headaches" by Rick Olderman he states.
"Almost all neck pain and headaches I treat are primarily due to poor shoulder blade (scapula) function regardless of the structural diagnosis involved."
This is very important to understand for often people are getting massage for their neck and spending endless hours trying to stretch their neck muscles due to their excessive tightness they feel. All the while ignoring the role of the scapula and the real underlying problem which is the poor postural habits they have developed during the course of the day. Failure to identify these poor postural and movement habits means you will change nothing no matter how many massages or physical treatment you get.
What do you look for?
While we love to blame sitting for everything, and it is certainly playing a part in this, it is not always the only thing to consider. Let me explain.
What Causes A Dowagers Hump?
There are a number of possible causes for a person developing Dowager’s Hump. Sometimes it is a result of severe osteoporosis — a disease that causes thinning of the bones.
Decreased bone density occurs when bones lose minerals such as calcium faster than the body can replace them. The decrease in bone mineral density (BMD) and changes in bone quality make bones more fragile and more easily broken than bones of 'normal' density. Low bone density is known as osteopenia and is the range of bone density between normal bones and osteoporosis.
While osteoporosis is also common in people with malabsorption disorders such as coeliac disease and certain hormonal disorders, like type 2 diabetes it is often a disease created from lack of activity and poor lifestyle habits.
Women are more likely to develop osteoporosis than men due mainly to a lack of muscle mass to begin with, combined with a much more complex hormonal system. Women who have gone through menopause are at the highest risk of osteoporosis as their bodies can no longer absorb calcium as well as it did when they were younger.
However, we must not fall into the trap of believing that osteoporosis is inevitable and just a part of getting old. It can be prevented by eating the right foods and implementing a strength training program to improve overall bone density. Strength training should be seen as a necessity for the older female population, yet for some reason it is still not endorsed by the media or even the medical community as that important.
See the article – Why strength training for women is so important
When muscle strength declines from inactivity or a lack of movement it decreases bone density. Research shows that muscle strength declines 30% on average from ages 50-70 with more dramatic losses after the age of 80. Peak bone mass is reached at around 25 years of age and normally remains relatively stable until around the age of 50. After the age of 50, progressive losses of bone mineral density begins to occur.
Both of these things can be slowed by implementing strength training exercises and eating the right foods. Research has found that multi directional exercises with load improve bone density and bone strength faster than other forms of exercise due to the fact that they incorporate so many of the structural lines needed for everyday life.
Many younger people will think this is not relevant to them, but if you are someone who is overweight, does not do any form of resistance training, have a sedentary job, and rate their life as fairly stressful, then there is a good chance you will be developing early onset of bone density problems. And as we have already seen you are well on the way to acquiring the dowagers hump.
This is no longer just an old person's disease.
Calcium & Vitamin D
Addressing your nutrition requirements is another factor to consider for if you are eating a diet deficient in vitamins and minerals it will speed up the rate of your decline. To reap the rewards of your strength training program you must eat the right foods to assist the repair process. Once again this becomes even more important as you age as older people do not absorb vitamins as easily as younger people and will different requirements to ensure they meet their body’s needs. Once again this is something that is not spoken about anywhere near enough as we are constantly taught to rely on medications to treat problems after they have occurred.
We all know calcium is important for young children to build strong bones but it is just as valuable to the older adult. Calcium is needed to regulate heart rate and maintain bone mass, but unlike children where they soak it up like a sponge, absorption declines with age. Foods like sardines, Greek yoghurt, ricotta cheese & sardines have been shown to have higher levels of calcium than milk. Check out the full list of calcium-rich foods provided by the National Osteoporosis Foundation by clicking here.
Another thing to consider is Vitamin D deficiency.
This has been known by experts for a long time to disrupt the regulation of calcium, bone health, and the prevention of rickets. When you consider how many people of all ages have been found to be Vitamin D deficient it leads to some worrying signs to come. As we age, our ability to make vitamin D is reduced by 75% and research has found that vitamin D can get trapped in body fat, leading to a 55% reduction in blood levels for those who are over-weight.
You can read more about these factors in the article - nutrition requirements for seniors.
What are some of the other contributing factors?
Medications, Rare Disorders & Mouth Breathing
Dowager’s Hump can also be caused by some medications. For example, those taking medications to treat AIDS might develop a curvature of the spine as a side effect.
In addition, a condition known as Cushing’s syndrome, which causes the body to produce too much cortisol, can also lead to Dowager’s Hump. However, this is a rare condition, so it is often not the underlying cause. Sometimes steroid use can also play a role in the development of this condition. Steroids can be found in medications such as those that treat asthma.
Breath and posture are intimately linked. Good posture creates the best body mechanics for optimal breathing. Conversely, poor posture will lead to inefficient and laboured breathing that creates tension in your shoulder muscles (secondary respiratory muscles). Poor posture will change ALL movements and eventually lead to chronic tension, pain & fatigue! Often in the neck and shoulders first before changing other parts of the body. Your body will sacrifice anything in order to get a breath for if it does not imminent death awaits.
Forward head posture is the most common thing to see with a person who has difficulty breathing. No stretching, massage, or corrective exercise will ever change anything with the kyphosis posture if the reason for it is to find more air. The solution in this case is to improve the breathing mechanics first and then alter the posture with exercise and stretches.
You can read more about the complex nature of breathing and various methods like Buteyko in the article - Do you know how to breathe correctly?
In most cases, kyphosis and the dowagers hump are caused by repetitive movements with your head held in a forward position. Let's look at some of these examples.
Lack of Self-esteem, Confidence & Depression
This is something that can be easily missed in an assessment, but make no mistake it could be the single biggest factor for driving all the problems. The scope of this article does not allow me to go into full detail about this complex subject as I am sure you can imagine there is no easy solution for psychological problems. What I want you to help you see is that when we are lacking in confidence and Self-esteem often our posture evolves into a hunched position to avoid making eye contact with people.
There is no exercise or nutrition remedy that will "fix this”, for the problem is in the mind.
Having said that, exercise can definitely help and here is a great example of where this made an impact.
Back in 2007 I worked with a 15 year old boy who had suffered with severe depression for many years that got to a point where he stopped talking to everyone, even his family. Part of his rehabilitation program was to get him to exercise, as the side effects of his medications were increasing his weight among many other problems. The doctors also believed physical activity would help to stimulate some of the “feel good” hormones his body was lacking, along with being around different people.
His posture as I am sure you can imagine was terrible, as he never looked anyone in the eye and constantly stared at the ground in his hunched over posture. I worked with him twice a week for 6 years and his development was slow and very awkward in the early years, but once he gained strength, he gained some confidence. And when that happened he began to open up both physically and mentally.
Do not underestimate the effect strength training can have on a person's confidence, especially someone who has been through some trauma or been weak their entire life. It can be a real game changer as to how they see the world. When we feel strong physically, we feel stronger mentally and instinctively stand taller with good posture.
Also the value of learning meditation and various other stress coping strategies can also have a profound impact on a person's mental and physical health.
To see more about this read the articles below
Poor Posture Created From Repetitive Movement
I must admit I am sick and tired of looking at a computer screen and my body is really starting to feel it too. And I know I am not the only one as I have had many discussions recently with people experiencing all types of shoulder and neck pain, largely attributed to sitting behind computers all day now they are working from home.
There is no doubting the computers are a big contributing factor and the fact so many of us are working from home more than normal is something we have to get used to. A few weeks ago we featured a great article about the hidden health dangers of working from home and since then I created an easy to read info-graphic to simplify the main points. This is great to share with any friends, family, or work colleagues.
But what I did not discuss in great detail in that article was ALL the other contributing factors to creating poor posture and the exercises that will help to correct it.
This is not limited to sitting, as this can be due to several things we do during the day such as:
- Our posture during walking
- Our posture standing
- Our sleeping position
- Occupations
- Hobbies (eg musical instruments)
- Postures used in various sports
- Poor gym exercises (eg ab exercises)
- Poor exercise technique
Anything that places us in a forward leaning position with our head looking down for hours on end leads to a build-up of calcium in the neck area which creates the hump.
In order for any corrective exercises to have a chance you have to identify these poor repetitive habits and change them to a good position.
Let's start with the obvious one being sitting.
Sitting Posture
You do not need me to tell you what is wrong with this position.
It is clear as day that this will lead to problems later on. Setting up your workstation correctly is an easy fix for this and I covered this in great detail in a recent article about working from home that includes simple pictures and instructions to get this right.
See this article for more detail – How to stay healthy when working from home
Stand up desks are another great invention that can make a big difference to your posture. There has been several studies have been completed as to the effectiveness on these desks with relation to back pain. One study showed a 32% improvement in lower back pain after several weeks of using standing desks. Another study published by the CDC found that use of a sit-stand desk reduced upper back and neck pain by 54% after just 4 weeks.
If you do not have a stand up desk then setting up your workstation correctly will be a good start and regularly taking breaks to give your hips and spine a break will be another.
Also pay attention to how you sit when you drive your car. Here is a simple tip to help you get this right. Adjust your mirrors when you are sitting in a perfect posture. If you are unable to see out of the mirrors correctly when driving you will know you are slouching. DO NOT adjust the mirrors to see better, instead adjust your posture.
Great article to check out is – How much compression does sitting create on your spine?
Walking Posture
I also covered this earlier this year in our article about the value of walking for back pain. I made the note in that article how Dr Stuart McGill made note of how poorly Americans tend to walk.
Firstly, he notes that Americans tend to have a poor postural head down approach to walking, as opposed to the Russians who had a chest out and stand tall approach. The Americans tend to lead with their head placing them in a constant falling forward position that has potential to place significant load on the lower back. Over time, a bad habit of this poor “spinal stacking” can lead to serious issues and contribute to the kyphosis posture and over time the dowagers hump.
The Russians on the other hand tend to have a taller more stacked approach to their gait cycle. This helps with proper “spinal stacking” and enable them to use the core more effectively stabilise the pelvis and spine.
I could also include loss of balance, poor vision, and the fear of falling in this category. This is more common with older adults who have lost significant muscle strength and their fear of falling forces them to look at the ground when they walk. However, we must be careful to ignore that some of these problems begin when people are in their 40’s and evolve over time. If we recognise these problems early enough you can use exercise to prevent the rapid decay of their movement and posture.
You can read more about this in the article – Prevent falls with older adults using reflex stability exercise
We have corrected sitting and walking, now for one of the other activities we spend approximately one third of our life doing, and that is sleeping.
Sleeping Position
During a normal week you could spend as much time sleeping as you do working so it makes sense to consider the position you sleep in as a factor for creating postural problems.
The sleeping position can be very difficult to change for it is hard to stop doing something when you are not awake. The worst position to sleep in is on your stomach. If you sleep on your stomach now PLEASE STOP! This is a disaster to your body when it is asleep as it is supposed to relax.
During sleep the muscles and ligaments are not instructed not to hold and protect the spine as much as when you are awake, and as a result of this are more vulnerable to excessive strain from poor sleeping positions. Leaving your head and neck in a strained position for hours on end while your body is relaxed is a guaranteed recipe for pain.
Sleeping on your back can also pose a problem especially if you have a pillow that is too large. Both of these positions will reinforce the forward head position and keep the muscles attaching from the neck to the base of the skull to remain short and tight.
It is impossible for me to advise which exact position is best for you as we are all so different. If you think your sleeping position is a problem and want to know more about it I suggest to get the book "Sitting on The Job" by Scott Donkin. There is an entire chapter devoted to the sleeping position with many great tips and ideas to help you find what works for your body.
Occupations, Sports & Hobbies
All of these things you could be spending endless amount of hours with and there is a good chance it could be a contributing factor. For example I have had to help people in the past who were
- Geologists leaning over for hours looking into microscopes. (Click here to see a You Tube video of an interview I did with this guy explaining his story of how he overcome his injury)
- Surgeons leaning over for endless hours operating
- Photographers leaning over all day looking into a camera (I will show you a case study of a photographer in part two)
- Violin players and drummers
- Competitive rowers stuck in trunk flexion
These are all perfect examples of how a repetitive action can force your body into a horrible hunched over posture. Now, this does not mean you need to change jobs or give up your hobby or sport. What it does mean is you will need to have an exercise program that combats the damage these activities may create. More on this in part two.
Poor Exercise Selection & Poor Exercise Technique
We could not conclude this article without discussing the damage that many of the abdominal exercises used in gyms today are creating.
Without a doubt the most abused exercise in the gym is the sit-up or abdominal crunch. There is nothing good to be gained from this exercise at all.
Repeated trunk flexion is the fastest way to develop a back problem like a bulging disc. And doing endless reps of sit ups or crunches to help you get in this position is pure craziness. Even worse when you consider people may be doing this to help with a back problem thinking that they need a stronger core! As the abdominal musculature become progressively shorter and tight, the following postural aberrations may be seen:
- Short and tight upper abdominal musculature
- Depressed sternum
- Forward head posture increasing chance of neck and shoulder injury not to mention poor breathing
- Increased thoracic kyphosis and of course, the dowagers hump!
When you consider how many of us are stick sitting all day in a position that looks exactly like a sit up, why would you want to go to the gym and punch out another hundred more at the end of the day!
This is where the body building world has convinced us that all muscles are the same and can be treated like a bicep. When you understand that the body is not designed this way you become smarter in how to design workouts with exercises that enhance movement with timing and efficiency instead of just feeling the burn.
Watch the video below to see a detailed explanation of how this works. (In part two I will show you a lot of exercises that improve core strength without the risk of ruining your posture)
You will also find a stack of information about the correct way to use core training in the links in the articles below
Next major concern I have with gym exercises is poor technique.
There are many exercises like the leg press and the bench press where I often see a person perform the exercise in a crunch position with a forward head posture. The reason for this is that they are recruiting their rectus abdominous muscle to act as a stabilising muscle. While this enables them to push out more load and improve strength with their global muscles, it comes at the expense of their posture and their spine. Modern fitness equipment allows us to train our body in sitting positions that do not demand high levels of coordination, stability, and posture. We learn it is possible to avoid learning these fundamentals before lifting loads or moving fast and the principle of “earning the right” is not needed.
I love the fact people are going to the gym to improve their strength, bone density, and get in shape. It is just unfortunate that they are taught poor form when they get there that often leads to pain and injury. Never sacrifice technique in the gym and always adopt good posture with every exercise. Make sure you watch the video below that explains what happens when you neglect good technique.
Stay tuned for part two where we go into detail of how to assess your own posture and develop an exercise program to correct your faults.
In the meantime here is a quick video to watch with some simple ideas to get you started.
Resources to Help You
There obviously is a lot more things to consider and if you are someone suffering with back pain, neck pain, or shoulder pain I would encourage you to get it diagnosed by a qualified health therapist. There is some great programs below you can you instantly download that provide you with all of our assessments and corrective exercises to restore your body back to good health. Click the image below of the program you require.
Summary
I hope this article provides you with a greater understanding of the factors behind postural problems that deplete our energy, ruin our movement, and over time develop into injuries and pain. Many people suffering from chronic pain are looking for a remedy or a solution to remove the pain and suffering. Removing the pain is not addressing the real problem, which is why the pain was there in the first place. This article shows you how you can identify the source of your trouble and in part two I will show you how to use exercises to correct it. But to be perfectly honest you are already half-way there by finding the cause of your trouble.
There is no doubting that our working lives will be different for quite some time, maybe forever. What I am already beginning to see is the evolution of postural injuries from poor working environments and over-use of modern technology like mobile phones, IPADs, and laptops that place our bodies in horrible positions for hours at a time.
To see young people in their 20's and 30's already showing signs of a dowagers hump is frightening and we must start spreading the message of how to avoid this.
Like everything to do with health, it is always easier to prevent problems than find a cure.
If you live in Melbourne and would like to know more about our personal training or core strength programs click the image below to request a free consultation and I will get back to you within 24 hours to schedule time.
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 15 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References:
- Mccrindle Research
- Sitting On The Job - By Scott Dunkin
- Movement - By Gray Cook
- Osteoporosis Australia
- Corrective Exercise Solutions for the Hip & Shoulder - by Evan Osar
- Back Pain Mechanic - by Dr Stuart McGill
- Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
- Low Back Disorders - by Dr Stuart McGill
- Ultimate Back Fitness & Performance - by Dr Stuart McGill
- Core Stability - by Peak Performance
- Athletic Body in Balance - by Gray Cook
- Anatomy Trains - by Thomas Meyers
- Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
- Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
- How To Eat, Move & Be Healthy by Paul Chek
- Scientific Core Conditioning Correspondence Course - By Paul Chek
- Advanced Program Design - By Paul Chek