Tuesday, January 19, 2016

Scientifically Proven Fixes for Your Hunchback - Significant Improvements in Athletes Within 6 Weeks W/ Minimal Effort

In contrast to the routines I will discuss in today's SuppVersity feature article (thank you Timo for the inspiration), practicing the ab-pose has not been scientifically proven to help you fix your posture... although, when you look at how it's done, it's certainly not going to make things worse.
In contrast to 90% of the SuppVersity articles, the following text is not about a "recent study". No, it's my analysis of the existing evidence on stretching and exercise interventions to resolve a problem many of the guys at my gym developed either at their jobs, or as a consequence of doing nothing but bench presses and ballistic curls: the hunchback - or, as scientists would say, a "forward shoulder posture" (FSP).

Luckily, gymrats are not the only ones suffering from this problem. This is why an albeit small group of exercise scientists from has spent a considerable amount of time and effort to identify methods to reverse this ugly, and as a 2008 study in 40 university students whose pulmonary function decreased with increasing FSP degree shows (Ghanbari. 2008), even "breathtaking" problem.
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Since swimmers are one of the groups of athletes that appears to be most affected, it is only logical that they were also the subjects of a series of studies by scientists from the Virginia Commonwealth University and the University of Kentucky who investigated the a combined exercise and stretching intervention in two separate studies on hunched over swimmers (Kluemper. 2006; Lynch. 2010).

In the last mentioned study by Kluemper et al., the participants, 29 (14 male and 25 female) elite-level, high-school- and college-age competitive swimmers from 2 swim teams, performed a Theraband® latex-band base resistance training regimen consisting of (see Figure 1)...
  • Figure 1: Scapular retraction (top), external rotation (middle) and shoulder flexion for the lower trapezius (bottom | Kluemper. 2006).
    Scapular retraction - With the shoulder abducted to 90° in the scapular plane, the elbows flexed to 90°, and the forearms horizontal, the subject holds a section of the exercise band between the right and left hands and retracts the scapulae, stretching the band (Figure 1, top). The subject must maintain the original 90° position of the shoulders and elbows and then execute a controlled return to the starting position.
  • External rotation - The upper arm is positioned at 90° of shoulder abduction and 90° of elbow flexion. The forearm begins in a horizontal position and externally rotates into a vertical position. The subject then executes a controlled return to the starting position. The exercise band is fixed in front of the subject at approximately waist height at the beginning of the exercise (Figure 1, middle).
  • Shoulder flexion for the lower trapezius - With arms flexed to 90°, elbows fully extended, and palms down, the subject flexes the shoulders to 180° against the exercise-band resistance and then executes a controlled return to the starting position. The exercise band is again fixed in front of the subject at approximately waist height for the beginning of this exercise (Figure 1, bottom).
These exercises were performed three times per week during the subjectsʼ scheduled morning swimteam practice and with a built-in progression according to which the resistance (at the end of the third week the subjects progressed to the next higher level of resistance) and rep and set numbers progressed (see Table 1).
Table 1: Progression of the exercises | at the end of the third week the subjects progressed to the next higher level of resistance using the Theraband® latex band (Kluemper. 2006).
As the title of the study already tells you, this resistance training regimen was combined with partner-stretches for the pectoralis major and the pectoralis minor the scientists describe as follows:
Figure 2: Photos of the stretches for pectoralis major and minor (Kluemper. 2006) 
"The first stretch, for anterior chest muscles, required the subject to assume a supine position on a 5-in-diameter foam roll, which runs down the center of the back. The subjectʼs partner grasps the subjectʼs shoulders and slowly presses them down in the direction of the floor until instructed to stop and hold for 30 seconds. This was repeated twice per training session (Figure 2, top). The second stretch for shoulder internal rotators required the subject to assume a kneeling position in front of his or her standing partner and lace his or her fingers behind the head. The partner then reaches in front of the subjectsʼ arms and back behind the subjectʼs scapulae, lacing his or her fingers together, as well. The part ner pulls in a diagonal direction, both up and back from the subjectʼs trunk, until instructed to stop and hold by the subject (Figure 2, bottom). The stretch was held for 30 seconds and repeated twice per training session" (Kluemper. 2006).
Obviously, I wouldn't be telling you all that in detail if the result of Kluemper's study didn't show that this training combination of strengthening and stretching exercises can "reduce the forward shoulder posture present in most competitive swimmers" (Kluemper. 2006) - or, to be more precise, that doing these exercises only 18 times over the 6-week period was enough to significance reduce the scientists primary measure of FPS, i.e. the distance of the acromion from the wall (see Figure 3, left), when the subjects were standing with their backs against the latter in a resting posture (–9.6 ± 7.3 mm).
Figure 3: The photo on the left shows how the scientists measured how severe the subjects were hunched forward; the graph on the right shows the improvements in posture (reduction = subjects were standing less hunched over) - improvements which reached significance only during the especially important relaxed posture test (Kluemper. 2006).
Now, that's unquestionably a quite promising result for a six week study. It's also a result of which we are about to see that it may be that pronounced, because neither the stretches nor the resistance training were done just with the subjects body weight. While the latter, i.e. regular, non-partner-assisted stretches and relatively simple body weight movements can be effective, the increased resistance / force during the strength training and the stretches may explain why Kluemper et al. observed that impressive improvements in such a short timespan.
A 2015 study from the Illinois State University shows that the muscle-energy technique described in this box could be another treatment that can help you reduce your messed up posture by increasing the length of the pectoralis minor and reducing "the hunch" (Laudner. 2015).
Muscle energy techniques - an alternative treatment method? Being passively treated by a physiotherpist appears to be another method that can reduce your postural problems. In a very recent study Laudner, et al. (2015) were able to show that a treatment that involves what the researchers call "muscle energy techniques" will improvements the pectoralis minor length (PML) and forward scapular position in  applied to the pectoralis minor of asymptomatic female swimmers provided - likewise within six weeks. For the MET treatment, participants were asked to lie supine on a standard treatment table with the treatment arm off the table. The treatment arm was then passively moved into horizontal abduction, in line with the pectoralis minor and sternal fibers of the pectoralis major muscle fibers, until the end range of motion was reached.

Due to the possibility of glenohumeral instability among swimmers, the therapists proceeded cautiously in all participants during the MET application. The arm was held at this barrier for 3 seconds. The shoulder was then brought out of the stretch slightly, and the participant was instructed to ‘‘pull against the investigator’s resistance towards the opposite hip.’’ This contraction was performed isometrically with approximately 25% of the participant’s maximal effort for 5 seconds. Immediately after this contraction,  the entire sequence was repeated with the arm again being passively horizontally abducted to the new range of motion.
Obviously, this hypothesis is speculative, but it is hard to ignore the fact that the benefits in the previously cited 2010 study by Stephanie S. Lynch, which used "only" body weight strengthening exercises and regular stretches (see Figure 4), were significant, but, compared to the results of the Kluemper study, which used a progressive resistance training program and more intense, partner-assisted stretches, less pronounced.
Figure 4: Overview and description of the exercises in the Lynch study (Lynch. 2010).
In Lynch's study twenty-eight National Collegiate Athletic Association division I varsity swimmers performed the body-weight exercises that are depicted and explained in Figure 4 likewise three times per week, but for eight, not just six weeks, scheduled around their regular team practice and strength training sessions.
"Subjects in the intervention group were trained using an instructional video of the exercises as well as being provided with an illustrated handout. Descriptions of the exercises are shown in tables 2 and 3. Strengthening exercises targeted the periscapular muscles. Stabilisation of the scapula throughout the exercise routine was emphasized during instruction. Subjects performed three sets of 10 repetitions of all strengthening exercises. The stretching portion of the intervention aimed at increasing the flexibility of the pectoralis muscle group and the cervical neck extensors. [...] Subjects logged the number of times the training was performed. Random checks by the investigator were performed to ensure compliance as well as the correct execution of the exercises." (Lynch. 2010).
Lynch et al. selected the exercises "based on literature which suggests selective activation of the lower trapezius/middle trapezius and serratus anterior, lengthening of the pectoralis minor and improving deep cervical flexor function and improving posture" (Lynch. 2015).
Figure 5: Changes in forward head angle, shoulder translation and scupalar distance (Lynch. 2015); I deliberately chose the same scale for the primary axis as in Figure 3, even though a direct comparison is not exactly scientific.
As the data in Figure 5 goes to show you, there's little doubt that the the exercises worked. A direct comparison with the changes observed in the Kluemper study, however, appears to suggest that adding resistance / pressure during strength training and stretching can significantly accelerate the progress... although, it should be said that without a head to head comparison in a single study, this must remain a very speculative hypothesis.
A 1990 study by Lo et al. reports that 43.8% of athletes who are competing in sports with upper arm involvement complain about shoulder problems, learn how to fix them in six weeks!
Bottom line: Obviously the way I previously compared the two studies with different subjects and exercises is not exactly scientific - and still, I would be really interested to see a study test my hypothesis that the use of resistance bands and partner assisted stretches would produce greater improvements than body weight exercises and regular stretches, in general.

Until this head-to-head comparison will have been done and my hypothesis will have been confirmed, though, the only thing I can tell you "for sure" is that doing any of the previously outlined exercise + stretching regimes will help you to improve your posture | Comment on Facebook!
  • Ghanbari, Ali, et al. "Effect of forward shoulder posture on pulmonary capacities of women." British journal of sports medicine 42.7 (2008): 622-623.
  • Kluemper, Mark, Tim Uhl, and Heath Hazelrigg. "Effect of stretching and strengthening shoulder muscles on forward shoulder posture in competitive swimmers." Journal of sport rehabilitation 15.1 (2006): 58.
  • Laudner, Kevin G., et al. "Forward Shoulder Posture in Collegiate Swimmers: A Comparative Analysis of Muscle-Energy Techniques." Journal of athletic training 50.11 (2015): 1133-1139.
  • Lynch, Stephanie S., et al. "The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers." British journal of sports medicine 44.5 (2010): 376-381.