Sunday, December 1, 2013

Improving a Rounded Upper Back

It is fairly common to have or see others with a rounded upper back. The spine curves forward prominently, the shoulders collapse toward the chest, and the head protrudes in front of the torso. This includes the conditions known as "forward head posture" and kyphosis. These have been written about extensively, but I have a few things to add about mobility and strength training as treatment where the skeletal structure allows for change.

While deviations from some ideal posture have been long blamed for causing pain and dysfunction, these accusations are not necessarily supported by research. Rather than suggest that treatment will fix or prevent some health problem, I will simply assume that the reader wants a more upright and tall posture and proceed to offer suggestions to help with that goal.

I will mention one exception because of its importance to exercise. If the upper back and shoulders round forward, and the upper spine is insufficiently mobile, reaching overhead can potentially cause injury. Because the shoulder socket points more downward than it should, reaching overhead can compress the tissues around the front of the shoulder, or the low spine may arch backward to compensate for the upper spine position.

One final consideration well supported by research is that posture can affect a person's self-esteem, and the perception of others.

The approach I recommend combines stretching, strength building, and movement practice. The body must be both enabled to change and trained to enact the changes. The exercises shown follow a progression so the earlier ones are part of the later ones, and the same fundamentals of movement are used throughout. Please note that these are only a few of the many good stretches and exercises which may help, some others are referenced below.

Key Principles
1. The practice must become automatic and habitual, not just part of an exercise session.
2. Training more of the body at once is better than isolating individual parts.
3. Training must be sufficiently difficult to promote change, and progressively harder. Stress stimulates adaptation.

Anatomy Background
The areas of the body to address are the upper spine(the part of the spine from mid-back to the neck is the thoracic or "t" spine), the shoulder blades(scapulae), head, and arms. When the spine curves forward it is called flexion, and bending backwards is extension. The scapulae can slide toward the front of the body or together toward the spine, called protraction and retraction(they can also rotate and slide up and down). The head moving forward and back is a combination of neck extension and flexion. The rotation of the upper arm along its axis is the last component. This is actually referred to as shoulder rotation. Typically the shoulders have too much internal rotation, bringing the forearms across the torso.

It is important to remember how connected these parts are. Each scapula has muscles attaching it to the spine, and the head of the arm sits against the scapula in what's known as the rotator cuff. Train the spine, scapulae, and arm together because that is how they are used normally. Isolating one part may be necessary in physical therapy, but not in functional training.

Incorporate your breath in all of these exercises. Use deep inhales on stretches to actively expand and lengthen, and on exhales relax further into position. On exercises requiring strength, on the inhalation focus your energy, then use the exhalation to aid in producing force.

One more point is don't try to create the t-spine extension by hyper-extending(arching) the low or lumbar spine. Hold your abdominal area tight to prevent this, also check the position of the bottom of the rib cage. The rib cage should not tilt or flare up and pull away from the pelvis.

Typical slumped posture
Anatomically better posture

On the left is t-spine flexion, scapular protraction, and internal rotation of the shoulder. This is not a good position to hold. On the right is much better default posture. Please note that movement and variation are more important than holding a single position rigidly. The exercises below aid in achieving and holding the posture to the right.
(Fortunately I am not very good at showing how bad kyphosis can be, but I decided not to include any scary illustrations of the worst cases.)


Shoulder Twist in Quadruped 
'Cat' plus easy shoulder twist down
'Cow' plus shoulder twist up
Begin in quadruped(hands and knees) to start moving the t-spine and shoulder from a constrained position. If you are familiar with cat/cow from yoga the spine part of this exercise will be familiar, with the addition of t-spine rotation and shoulder retraction and protraction. Go from a gentle 'cat' with flexed spine and protracted shoulder up to a strong 'cow' working hard to extend and twist the t-spine and pull the scapula up and in. Be sure the shoulder doesn't elevate toward the ear, and keep the hips in position- don't let the twist happen there.

Shoulder Sweep
Start - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -> Finish
Start by reaching forward
Sweep the arm along the ground above the head, tracking the hand with the eyes. The lower leg is straight, and the upper leg is bent, with the knee pressing on a medicine ball, foam roller, yoga block, etc, to keep the pelvis from turning. Start by reaching forward and allowing the back to round as I show in the close-up, then straighten the spine and pull the shoulder back as the hand sweeps along or near the ground. Engaging your vision really helps achieve a better range of motion, and keep extending the t-spine the entire time.

Shoulder Traction
Here's a stretch that adds joint distraction in the shoulder. This is a good place to practice using your breath to enhance the stretch. Move the body to stretch at different parts of the joint, and don't neglect to extend the upper spine, as shown in the third panel. Add shoulder external rotation- in this position the thumb points backwards.

Shoulder traction

To the left is a way to do the stretch with a dowel or broomstick. In this version the lower hand pushes up and back on the arm being stretched, and turns it into external rotation. The stick and pushing arm can also be held behind the torso.

Stick Overhead Reach
Next is another way to use a stick for mobilization. Working both shoulders at the same time makes it possible to really emphasize scapular retraction. Another way to think about the movement to try to push the chest through the shoulders. Include external rotation in the shoulder by trying to bend the stick, with the middle bowing forward(most sticks won't actually bend, you just make the effort in order to activate the muscles.) Do the exercise for reps, bringing the bar up from hip level to over and behind your head, holding for a second or two. Try to arrive in the stretched position when the stick gets to the top. Twist the body vertically, and raise one arm higher on each side as you turn(my photo doesn't show this well). There should be a diagonal stretch from one foot across the front of the body to the opposite hand.

Shoulders together
Chest open
This starts as a mobility drill, but can be progressed by adding a resistance challenge. Many gyms have weighted bars used for aerobics classes that work very well for this. Twelve pounds is a common weight, and that's plenty for most people. The combination of mobilization and strength building makes this a programming staple for many of my clients.


Typically when we choose exercises, we think of muscles or areas to strengthen, and that is the basis for the first two exercises shown. The facepull and row directly target the muscles in the back of the shoulders and the t-spine. In functional training, we think of movements to train and for posture, I suggest thinking in terms of global movement patterns. Do some specific corrective exercises, but of equal importance is to make every exercise in your workout part of your posture program. What that means is creating the habits and the 'motor patterns' to maintain posture in a wide variety of situations, not just the ones deliberately focused on the areas of interest.

(Motor patterns are how all the muscles contract and relax to to conduct a physical activity. For instance, to lift a weight overhead some shoulder muscles create the force to move the weight up, others hold the arm securely in the shoulder socket, and muscles in the spine and hips are very active in giving a stable base for the shoulder.)

As you do any exercise, make the elements of movement described above part of the motor patterns you are teaching yourself. Some examples:

Cable machine with rope handle                                                                            Elastic bands
This exercise is primarily for the back of the shoulder to counteract the typical position of having the arms internally rotated and held in front of the body, such as at a computer. The t-spine can still be included, and it is surprisingly hard to keep the head held back. Beginning and end positions are shown on an adjustable cable machine with a rope handle, then a way to do a facepull with only elastic bands is shown on the right. This could be done with a single long band and a hand towel substituted for the red band shown. Create all the movement with the scapulae and arms, and don't lean or arch back. Very little weight or resistance is needed, as this is not a strong position for the shoulder. Five to ten pounds will be enough for most people.

Bent Over Row

First shown with kettlebells, then resistance bands. The weights or band try to pull you into a rounded position, you do the opposite. It takes practice to hold alignment here, so this is a good place to check yourself with a camera.

Hold a kettlebell or dumbell in each hand. Fold forward at the hips, not the waist, keeping the entire back straight. Pull the elbows up while retracting the shoulders. Try to extend the t-spine even more at the top, and keep the head in line with the spine and pulling backward. Don't let the shoulders move toward the ears, actively pull them toward the hips. This is sometimes called "putting your shoulders in your back pockets." With resistance bands the positioning of the body is the same.

Farmers Walk
Shoulders back!
Tall, head back!
An all-round excellent functional exercise, great for building strength and endurance, it also provides a way to train posture in a normal upright position with the challenge of carrying heavy weights. The procedure is simple -pick up the weights, assume your long spine, head and shoulders back and arms slightly turned out- alignment, and walk. In the variation shown the weights are of different sizes to train the spine to to resist lateral flexion(bending sideways.)  Both weights can be the same, and if you try an offset load a lighter one half to two thirds the weight of the heavier one works well. Walk anywhere from 10 to 100 meters, switching the weights half way if they are unequal. Recheck that you have good alignment as you go- since walking is such a simple and familiar activity you can easily do this and make adjustments.

Other Exercises
One of the best exercises for building strength is the deadlift, and it can be very helpful for the upper back and shoulders if done correctly. However it is difficult to learn and easy unknowingly to do poorly, so get professional instruction before adding it to your workout. If you have pronounced kyphosis I wouldn't do it at all. Likewise kettlebell swings are good at working the same muscles and are easier to learn than the deadlift, but keeping good upper back alignment takes coaching and practice. The Crossfit, or American, swing, is very risky for the shoulders of anyone with a rounded upper back- do Russian style swings only.

The superman exercise, prone "T," and from yoga, cobra posture, can be helpful. Wall slides and forearms slides are also good. I don't discuss these and some other common exercises for t-spine mobility because they can't be progressed with more resistance, or they are not done in a functional, upright position. They aren't a bad start though.

Avoid crunches and situps. These train the body to move into exactly the alignment that you are trying to avoid. Bench presses and other chest exercises are also problematic- over-active and shortened chest muscles may be present already and you don't want to activate them even more. Another one I have seen pictures of is the use of heavy chains draped around the neck to work the upper spine extensors. Mechanically it makes sense, but even the instructors demonstrating it seemed unable to hold good form, so I don't recommend this method.

Forward head posture and kyphosis are not reason for alarm or necessarily a source of pain or dysfunction, but it may still be beneficial to decrease them. If choosing to address these conditions, a combined approach of increasing flexibility, strength, and movement training is suggested. Ultimately what will make the most difference is learning to incorporate the changes practiced in your training into your sitting, standing, and moving without conscious effort.

Thanks to Angie and Mimm(website) for their assistance. Photos were taken in Hoover and Heritage Parks in Palo Alto.

Further Reading and Viewing
(Caveat lector!)

Body Posture Affects Confidence In Your Own Thoughts, Study Finds
Standing Tall Is Key for Success: 'Powerful Postures' May Trump Title and Rank
Your Mother Was Right: Good Posture Makes You Tougher
Five Misconceptions About Posture
Three Essential Elements of Good Posture

Spine and Shoulder Mobility
Simple Thoracic Spine Mobility Exercises Everyone Can Perform
Improving Thoracic Mobility in Throwers

Tuesday, September 3, 2013

Fitness Articles of Interest

Here's a small sampling of the many interesting articles related to fitness over the past few months.

The 9 Workout Mistakes Women Make Most
Men, too.

Lift to Lose Weight
"If you want to get leaner, say the latest studies and the smartest trainers, it’s time to start strength training."
Fitness Playgrounds Grow as Machines Go
The single purpose, fixed motion machine is thankfully falling out of fashion. Moving your body and moving free weights is ticket to fitness. From the New York Times:
"Simple exercises with no-tech equipment (call them paleo or playground exercises, depending on how much fun they are) have long found disciples at niche gyms and in movements such as CrossFit. But in the last year and a half, major health-club chains have begun making hefting sandbags and shaking 25-pound ropes the standard, ditching the fancy weight machines that have dominated gym floors for more than 30 years."
Building Up Bones, With a Little Bashing
Another great NYT article, on maintaining bone density, with some points I've been making for a long time:
"So in combing recently through the professional literature on exercise and bone health, I was quite disappointed to learn that neither swimming nor cycling is especially good for my bones — at least, not the ones most susceptible to fracture. Swimming, in fact, might compromise the strength of those bones because it lacks the tug of gravity.

That’s what researchers have found when they measured bone mineral density in young athletes who swim or cycle, and even in some who run. There are two reasons for this. One is the continuous nature of these activities. Bones, it seems, don’t like constant pressure. They respond better to exercise that involves forceful muscle contractions, occurring in starts and stops and with some variety — as happens, for example, when playing tennis or training with weights.

To maintain strength, bones also need the stress of gravity, which is lacking in cycling and swimming and not as powerful when walking as it is when running. Being suspended in water is like floating in space for a short time: once they leave Earth, astronauts lose bone."

Strong Vs Toned: The Truth About Gender-Specific Workouts
"When you talk about "toning," "enhancing," or "shaping" certain areas of your body, what you're really talking about is muscle. Muscle creates the shape of your body, and therefore more muscle equals more muscle tone. You can't build a perkier, rounder, or sexier anything without building muscle."
Fat Loss Guide: A Hierarchy of Exercise Choice
"There is a common belief that “you can’t lose weight without cardio”. This just couldn’t be further from the truth. Low intensity, long duration exercise is not your ticket to quick weight loss. In fact, the very opposite may be the case.

I’m not saying steady state cardio doesn’t have it’s place. It can definitely serve a

John Salley on veganism in the NBA
Former Detroit Pistons big man John Salley has spent a lot of his retirement advocating for veganism. He does so at a time when the lifestyle’s gaining powerful advocates in Bill Clinton and Serena Williams.
Selecting the right shoe? – By Simon Bartold
Excellent read for anyone interested in running footwear, esp. the barefoot/minimalist debate.

Sunday, August 11, 2013

Fall Fitness in the Park

Exercise Warm Up
Exercise Warm Up
Fall Fitness boot camp in Palo Alto begins soon! Small group training outdoors in the park is great way to add variety and fun to your regular workouts or sports.

You will use your whole body and combine mobility, strength training, and cardio work to become leaner, stronger, and moving more freely. Unlike the frenzy of a typical boot camp, these workouts will have less running and jumping, and more strength building and attention to good exercise form. Class size is limited to 6 people, so there is plenty of personal instruction and programming for everyone.
Playing on the Swingset

The workouts are fun and challenging with exercises including lifting, swinging, carrying, pushing, pulling, throwing, running, and jumping. Use your own body, kettlebells, dumbbells, suspension straps, elastic bands, medicine balls, and sandbags.

Some of the Equipment

Class starts Tuesday September 3rd and goes until November 26th, meeting from 5:00 to 6:00 at Mitchell Park. The series costs $240 in advance. There is a 3 person minimum signed up to hold the class, then drop-ins will be available at $25 for the hour if there is space. Additional class times will be added if there is enough interest. Private or semi-private personal training is also available.

View Larger Map

Saturday, July 6, 2013

Using Apps for Video, Intervals, and More in Personal Training video capture and annotation is now available for my personal training clients. Often a video can quickly show what is difficult to explain verbally, and can also be used for later review. The videos can give detailed feedback of your exercise, slow motion viewing, zoom in and out, and side by side comparison of exercises from different workouts or people. Personal bests and other moments of epic achievement can be easily shared. The app is Coach's Eye

Here's a marked up example of a dumbbell power snatch:

At different points in the lift the video is paused or put in slow motion to show good spinal alignment, good vertical lift and leaning the body backwards, but bad position of the dumbbell, not getting the body low enough to receive the weight, and not having the arm fully extended on the catch.

This split screen video shows good and poor form of a lunge for comparison:

In the left frame, note how the left knee collapses inward on landing. The torso rounds forward, and the medicine ball is never lifted fully overhead as on the right.

While these examples are finished edits, the video can be annotated and the playback speed manipulated on the spot. This gives immediate feedback for optimal learning and the opportunity to practice better technique.

The other app to help with your training is an interval timer, complete with bells and whistles:

No more will a forgetful trainer make you repeat an exercise! The interval name, time remaining in the interval, intervals left, etc. are shown, and there are audible tones to begin and end each interval. Remember, it's not the trainer making you work so hard, it's the app.

Besides these, normal communication and productively apps make it easy for me to base my training business outdoors. Here's my office at the Steven Rice Fitness International Headquarters in Mitchell Park Palo Alto:

Monday, May 6, 2013

Summer Fitness in the Park

Steven Rice Fitness begins an exciting new Palo Alto outdoor exercise class in June.                 Get out of the gym and get fit while enjoying the summer weather.

The class will meet at Mitchell Park on Tuesday afternoons from 5:00 to 6:00, starting June 4th and ending August 6th.
Slosh Pipe, half filled with water
You will use your whole body and combine mobility, strength training, and cardio work to become leaner, stronger, and moving more freely. Similar to a boot camp, but with less running, more strength building, and better exercise form. This once per week class is a great way to supplement your regular gym workouts, or add variety to training for your sport.

Suspension training
The workouts are fun and challenging with exercises including lifting, swinging, carrying, pushing, pulling, throwing, running, and jumping. Use your own body, kettlebells, dumbbells, suspension straps, elastic bands, slosh pipes, and sandbags.

Outdoor training equipment
Class size is limited to 6 people. The first meeting on the 4th is free, the remaining 9 session series costs $180 in advance. There is a 3 person minimum signed up to hold the class, then drop-ins will be available at $25 for the hour if there is space. If there is enough interest other times will be added. Private or semi-private personal training in the park is also available. Contact for more information and to reserve your spot.

Wednesday, January 2, 2013

Selecting Strength Exercises with Five Examples

Picking the best exercises for yourself is one of the most obvious and fundamental choices to make in creating a resistance training program, or just a workout. There is an enormous variety of possibilities, most of which are good in some circumstances but not others. There is no ideal set to give you, but I will offer five which combined offer a fairly complete program. My real point though is not this particular group of exercises, but describing the reasons why I would select them.

The exercises are chosen to improve the fundamental movements of strength, develop a foundation for sports, aid in activities of daily life(ADL), and counteract typical movement and posture problems. Exercises that work the left and right sides of the body separately(unilateral) are preferred in order to include more muscles and coordination demands, and for some exercises to prevent forcing the joints into possibly injurious positions. In an actual program with more than 5 exercises though I will often use both the unilateral and bilateral versions to gain the advantages of both.

Strength can most basically be exerted as pushing, pulling, lifting, and rotating. All of these can involve either movement or resisting movement, and any movement can be with the body fixed and an external object moving(eg. standing still while lifting a weight) or with the body moving relative to a fixed object(eg. pull-ups on a bar.) A generalization is that a weight is held in the hands, moved, the core transmits the force to the lower body without twisting or bending, and the legs support and possibly also move the body. (This is a huge simplification.)

From Integrate Performance Fitness in Mountain View, here is my example five exercise workout, with very brief descriptions of how each should be done.

Goblet Squat
Not much more fundamental than rising from a crouch holding something heavy. Works the legs and hips primarily, and holding the weight in the 'goblet' variation loads the arms, shoulders, torso, and to a degree that will surprise you, the core. More weight can be lifted in a back squat, but at the loss of including arms and shoulders.

A bilateral stance is used here to enable lifting more weight and develop more strength in the larger muscles.
Exercise Tips: Keep the knees wide, and your weight on the heels.

Single Leg Deadlift
The deadlift works many similar lower body muscles as the squat, but puts the emphasis more into the glutes and the back of the legs. It continues the load up the back in what's known as the posterior chain, a major area of weakness for most people. The back of the shoulder is included, and again holding the weight in the hand means the arms are part of the lift. Standing on one leg while moving a heavy weight is excellent for developing the muscles in the lower leg and hips needed for stability. Because the hand opposite the working leg holds the weight, there's a large rotational force(transverse plane) to work against in lower range of the lift, and a lateral bending(frontal plane) to resist at the top of the lift. Correct form is essential for the Single Leg Deadlift.
Exercise Tips: Don't let the spine round at all. Push the hips backwards. Keep the weight close to the body, and have something beneath to tap the weight against.

With these first two exercises, lifting is well covered, resisting pushing and pulling are included, and good anti-rotation accomplished. But the hands do need to move things, and the next three exercises cover that.

Overhead Press
Picking up things and holding them overhead is an important ADL, and strengthening the shoulders is helpful any time holding something is heavy is needed. The overhead press can help maintain shoulder mobility that is often lost with aging, however this also means that adequate shoulder and upper spine mobility is required to press at all. Injuries in the front of the shoulder are common, and the press can help prevent them if done correctly. Pressing with one hand at a time means more muscles are engaged to keep the weight in proper alignment, and since the hand can be rotated a healthy angle relative to the shoulder is possible. Doing the lift while standing will develop stability in the body down to the floor.

Exercise Tips: The weight should travel straight up and end above the shoulder blade. At the top the palm should rotate partially or completely facing inward. Don't lean back or arch the spine. NB: It may be necessary to improve shoulder and upper spine mobility to correctly perform this exercise.

Dumbbell Row
Pulling the shoulders back(scapular retraction) and straightening the upper spine(thoracic extension) are a major shortcomings for most people, so an exercise that improves these is important to include. In the deadlift the upper back muscles work to hold a static position, here they actively create movement. I like doing rows in a lunge so that the body is somewhat supported but not entirely. Make certain the upper spine is held straight and not rounding forward.
Exercise Tips: Let the shoulder drop forward but not hang, then pull the shoulder up toward the ceiling and in toward the spine, without hunching toward the ear. Keep the elbow close to the torso. On each rep try to straighten the upper spine even more.

The push-up is last on the list because it is the least important. Still, it is a great exercise. While it fulfills the need to include pushing in the program(along with the overhead press), the best part of the push-up is the strong core it promotes when done correctly. The first priority is to hold the body straight with a neutral spine, as in a plank, then bend and straighten the arms to lower and raise a straight body. Pushups progress mainly by changing the angle of the body. They can be done at first with the hands elevated(a barbell rack works great for this), to hands and feet on the floor, to feet elevated. There are many variations, including doing each rep with one leg off the ground or picking up one hand for a moment at the top of each repetition. These will both add a anti-rotation element to the exercise.
Exercise Tips: Start with your body in a straight plank, but with one knee on the floor to hold your weight. Now really straighten your plank by contracting the abs as if you're doing a crunch, and pull your shoulders and head back. Elbows point out about 45 degrees from the torso. At the bottom touch with your chest(because you're keeping your head and shoulders pulled back so well.) At the top push the torso up through the shoulders toward the ceiling(scapular protraction.)

Honorable Mentions
  • Lunges and Step Ups: Moving between one leg forward and one leg behind is the foundation of running and carrying. Some variation of this really should be part of a strength training program.
  • Turkish Get-Up plus Kettlebell Swing: Between the two you get up, down, back, front, slow and fast.
  • Dumbbell Snatch: One thing the five exercises above don't include is developing power, which is exerting force with speed. A dumbbell(or kettlebell) snatch covers lifting a weight from the ground to overhead and adds power development.
  • Suspended Row: Hanging with the feet on the ground under gymnastic rings, TRX, or even a racked barbell while rowing requires the body to work to maintain alignment as you pull. Like an inverted push-up.

General Tips
  • Think in terms of general movements and directions first, then pick a set of exercises that includes all of them.
  • It's good to involve as much of the body in an exercise as possible, but make sure you're not limited anywhere but the target movement or area. For example, you can squat far more than you can curl, so a "squat curl" is useless.
  • Always use proper form. This reduces chances of injury, makes the exercise more effective, and improves the ability to have good form.
  • Kettlebells work just as well as dumbbells for these exercises.
  • Use enough weight or resistance to challenge yourself. If you can do around 8-10 clean reps, make the exercise harder. If you're not getting winded and sweaty,  make the exercise harder. If you can talk to someone or watch TV while doing the exercise, make the exercise harder.
  • Don't be afraid of exercising on your own, but consider professional instruction.

In closing, remember that a real program has more than 5 exercises. Some variety is good to insure nothing is missed or overdone, and just to keep your workouts interesting. Keep in mind the principles I have described, and whatever exercises you pick will likely help you get stronger and improve how you move.

For more about picking exercises, see my earlier article Gravity, and the Ups and Downs of Weight Training