Superhuman Planks

Here's what you need to know...

• A plank should be a very intense, full body contraction that lasts only 8-10 seconds, not some bastardized version of a yoga pose you sustain for 10 minutes.

• Lifters and athletes who do planks tend to be a lot stronger and move better, plus they have better abs.

• Some exercises are direct representations of a plank position, so hitting up a plank beforehand is very helpful, such as planks before push-ups and side planks before lunges.

Planks are special. The more you do them, the more they seem to make everything else you do in the gym better. Whether you're trying to smash a PR in a big lift, recover from a back injury, get faster on the field, or simply get better abs, planks can help.

Unfortunately, planks get a bad rap for being a wussy exercise. All you do is hang out there, motionless, until you get bored. No big weights, no mind-numbing intensity, no big sex appeal for any hotties looking your way.

If this sums up your feelings on the exercise, odds are your planking skills are in need of a serious overhaul. Let's break down how to do a plank for maximum benefits; how planks can be used to increase your total weight lifted with compound movements; and how planks can be used to increase flexibility through the hips and shoulders.

Like I said, they do everything.

What a Plank Isn't

Poor plank position stems from poor spinal positioning through the movement, where the individual either excessively rounds his back or excessively sticks his butt out.

When the upper back is rounded, the main focus of the movement is on the neck and shoulders versus the abs. When the butt is sticking up, the main stabilizers are the lumbar erector spinae and hip flexor complex, not necessarily the entire core.

A 2010 study by Tse and colleagues showed that rounding of the back can increase abdominal activity and prolong the ability to do a plank without increasing the activity of the muscles. That, of course, makes perfect sense.

Most people treat the plank more as a marathon, seeing how long they can hold a position, most of the time topping out at a minute or three, all while exhibiting the same amount of intensity needed to casually flip through a magazine conveniently placed under their nose during the exercise.

If you can do anything other than focus on not blacking out while performing a plank, you're doing them wrong.

What a Plank Is

A plank is a perfect example of total body tension and co-contractive forces. It's a battle of near-maximal contractile strength from all areas (shoulders, abs, glutes, low back and quads) to produce a steel beam in human form,able to withstand any external forces.

About a year ago, I did a guest seminar in New York at Peak Performance, in which I had fellow T Nation contributor Dan Trink volunteer to demonstrate a plank. After altering his position slightly to get the most stable alignment possible, I had another trainer stand on his back to show how rigid he was, all while he breathed in a relatively comfortable yet tensed manner as instructed.

How did he do this? Is he some sort of Cirque du Soleil freak? Nah. A study by Maeo and his colleagues in 2013 showed that the bracing action of planking preferentially activated the internal obliques over the other core muscles, which is different from most other core-directed exercises that seem to preferentially activate the rectus abdominis. This utilization of deep core muscles thus helps to prevent the spine from deforming in the presence of external loads, as Dan can attest to.

To do a solid plank, lie down on the ground on your stomach and support your upper body with your elbows. Squeeze your shoulders in a kind of reverse shrug, pulling them tight to your ribs. Then, flex your glutes and straighten your knees as hard as possible, and lever up into a position where you feel you have balanced tension everywhere.

Now try to contract everything harder without changing position and focus on forceful inhalation and exhalation for the duration of the plank. Keep your neck neutral (no looking up or letting your head drop below your chest) and keep as tight as humanly possible.

This is a standard RKC plank, which shows the best example of maximal co-contraction of all elements that feed into core strength and spinal stability.

One underutilized aspect of the plank is breathing. Deep, forceful breathing plays as big of a role in total core activation as anything else. Martial artists use this principle to their advantage, with forceful grunts, yells, or Bruce Lee like noises during striking. This increases core activation and provides a stronger spine from which to produce power, which allows for stronger strikes.

This was confirmed in (2013) by Ha, et al., when they showed diaphragmatic deep breathing increases transverse activity and internal oblique activity during a plank. Likewise MacDonald et al., showed significant increases in muscle activity in the transverse and internal oblique during powerful singing in trained singers, proving an increased activation during forceful exhalation.

Planks for Lifting Big Weights

This increased utilization of core muscles to produce stability is awesome as a parlor trick to allow people to stand on your back, but it can also translate into increased strength and power development.

Using a front plank before heavy deadlifts or back squats as a part of an active warm-up can help increase core muscle activation and activity overall, which can help translate into bigger lifts.

Anecdotally, using this approach with my athletes has resulted in a noticeable increase in weight lifted from one set to the next in a fairly consistent manner. This could be from an increased neural firing rate into the core muscles to help hit higher thresholds during max lifts, increasing awareness of core firing, or simply warming the area up like warming up a car on a cold morning.

To use planks effectively to increase lifting capacity, use the following system:

• Do your normal warm-up, whether that means cardio, foam rolling, etc.

• Do progressive warm-ups with the main exercise, where you gradually increase the weight used over multiple sets before getting to your working weight.

• Between each of these warm-up sets, hit up 3 "reps" of an 8-10 second max effort plank, spending some focus on getting deep forceful inhalation and exhalations.

• Rest for about 5 seconds between reps and go into the next one.

• Start your workout.

Can you hold a plank for longer? Sure. You can also run farther than a 100-meter sprint, but probably not at the same intensity, and the results will be somewhat different depending on how long you decide to do it. For strength, stability, and force production, keep them short, hard, and repeated.

Planks for Improving Mobility

An area that's unstable will steal stability from other areas to prevent damage. For example, if the low back is unstable, the hips will tense up to provide some level of stability through fascial interconnections with the tissues of the low back. The hip will have limited mobility until the stability is restored to the lumbar spine.

Here's a video of the process in action. The main complaint of the trainee shown was chronic low-level low-back pain and hip flexor tension with pretty much everything.

From working with a few hundred clients in similar situations, I've found that reductions in hip external rotation tends to correlate to anterior core instability, while reductions in internal rotation tends to correlate to lateral core instability. Front and side planks, when used appropriately, seem to provide fairly immediate results in these situations.

So how do you know if you have a restriction in either direction? Think about your deadlift position, specifically during a sumo stance setup. If you stand with your toes under the rings on the knurling and you can't get your knees to form a straight line without your hips and feet versus caving into a valgus position, you may be restricted through external rotation.

Another way to check is to see if you can do a Cossack squat to any real depth, with the leg extended and both toes and knee pointing to the sky.

If this is the case, try some additional sets of front planks and see if your mobility improves. Some people will show very dramatic and immediate improvements while others will show just minor improvements, depending on what the cause of the restriction is and if there are any structural alterations from injury or degeneration.

For internal rotation, you could use a simple squat mobility drill I use with my clients, focusing on dropping one knee to the ground while in a squat position.

You can pair this with external rotation (as shown) as well.

If the internal rotation is limited, try hitting a few sets of side plank before re-testing to see if it improved anything. Focus on alignment so that your feet, knees, hips, chest, and head are all in a straight line – not rotating back or forward – and so that you can breathe deeply and forcefully.

Planks for Accessory Movements

Some movements are direct representations of a plank position, and therefore hitting up a plank beforehand is very helpful. A push-up is essentially a moving plank. One major downfall a lot of people have during their push-up is a lack of lumbar stability (often seen in a sick low back arch), or an upper back rounding that would make Quasimodo feel a bit better about his condition.

A plank can help learn the positioning required to correct both of these issues, which will then allow you to feel the push-up where you should: the triceps, pecs, and delts. If you do a set of push-ups and feel your neck or low back doing all the work, you're doing something wrong.

Lunges are another accessory movement that benefit from side plank work before your set. Since most people tend to have stability issues in the frontal plane during a set of lunges, throwing in a set of 3 (10 seconds per side) can have a big impact on how well the core fires up during the point of contact with the floor after the step, which then keeps you from having to explain to everyone in the gym why you just fell down and can't get up.

Get Your Plank On

Strength training is all about increasing your ability to generate force. Using an exercise like a plank before high force exercises can help to warm up the muscles, nervous system, and stabilization system to help you produce more power through your extremities.

Use this system of planking – hard, forceful contractions paired with forceful inhalation and exhalation for reps of 8-10 seconds – and see what happens with your main lifts. It may make all the difference in the world.

References

Ha et al (2013). "A Normal Breathing Pattern is Important for an Effective Abdominal Hollowing Maneuver in Healthy People: An Experimental Study."J Sport Rehabil. 2013 Aug 12.

MacDonald et al (2012). "An investigation of abdominal muscle recruitment for sustained phonation in 25 healthy singers." J Voice. 2012 Nov;26(6):815.e9-16.

Tse et al (2010). "Trunk Muscle Endurance Tests: Effect of Trunk Posture on Test Outcome" JSCR: December 2010 - Volume 24 - Issue 12 - pp 3464-3470.

Scientific Analysis of the Kettlebell Swing, Snatch, and Carry

Becca Borawski Jenkins

Managing Editor

Kettlebells are gaining popularity as a method of training strength and conditioning. There are a lot of claims as to what can be accomplished with kettlebells, but what muscles do they really activate?

A recent study published in The Journal of Strength and Conditioning Research examined a series of basic kettlebell movements. Researchers wanted to learn more regarding two aspects of kettlebells:

1. Muscle activation involved in kettlebell movements.
2. The effects of kettlebells, positive or negative, on loading the lower back.

In the study 3D imaging, electromyography, and ground force measurements were gathered for of all the movements performed by the test subjects. Subjects in the main study were chosen at random from a university and screened for injury. A single case study was also conducted on Russian kettlebell master Pavel Tsatsouline, performing the same techniques.

Subjects performed the following exercises with a 16kg kettlebell:

• Kettlebell swing to chest height
• Kettlebell swing with Kime (abdominal pulse at the height of the swing)
• Kettlebell swing to snatch
• Kettlebell carry – racked on the back of the arm
• Kettlebell carry – bottoms-up style

Kettlebell Swing Analysis

According to the research, the kettlebell swing uses the back muscles (latissimus dorsiand erector spinae) throughout the movement, but they are the main muscles engaged in the initiation phase of the swing. The abdominal muscles are primarily activated at precisely the halfway point and the gluteal muscles engage for the second half of the swing. Shear and compression forces were determined to be highest at the beginning of the swing.

Average range of flexion and extension in the swing:

• Lumbar spine – 26º of  flexion at beginning to 6º of extension at peak.
• Hips – 75º of flexion at beginning to 1º of extension at peak.
• Knees – 69º of flexion at beginning to 2º of extension at peak.

Adding “Kime” to the swing did essentially nothing other than engage the abdominals to a greater degree at the peak of the swing. The swing to snatch was very similar to the swing except for a general increase in the activation of all muscle groups. Overall spine loads, compression and shear, were determined to be low for swing, swing with Kime, and swing to snatch.

Kettlebell Carry Analysis

The main finding in the kettlebell carry analysis was the increase in muscle activation in the “bottoms-up” position. The average muscle activation was much higher in the bottoms-up carry than it was in either the racked position or regular unloaded walking. As a result, joint compression and shear forces were also much higher in the bottoms-up position. Researchers determined the bottoms-up position required higher degrees of core and grip strength.

Case Study: Pavel Tsatsouline

Researchers also performed a case study on the kettlebell swing of Russian kettlebell masterPavel Tsatsouline. Tsatsouline swung a 32kg kettlebell for the tests. It was noted that Tsatsouline powerfully tightened his hip at the top of each swing resulting in tremendous forces, but also based on the research a technique not recommended for those with lower back issues given the speed at which his spine moved.

Conclusion

Researchers concluded that the relationship of compression to shear forces on the spine are significantly different in the kettlebell swing than they are in more traditional strength exercises like the deadlift or squat. The kettlebell swing has much higher shear forces and therefore athletes with inadequate movement patterns or bad habits of allowing their spine to move while under load could find the kettlebell swing to be more painful than traditional lifts.

On the other hand, researchers noted the fast cycles of muscle activation and relaxation required to perform the concentric and eccentric phases of the swing repeatedly could have benefits in a variety of sports.

In their final words, the researchers noted:

This unique exercise may be very appropriate for some exercise programs emphasizing posterior chain power development about the hip. In contrast, the exercise also appears to result in unique compression and shear load ratios in the lumbar spine that may account for the irritation in some people’s backs, who otherwise tolerate very heavy loads…Thus, quantitative analysis provides an insight into why many individuals credit kettlebell swings with restoring and enhancing back health and function, although a few find that they irritate tissues.¹

 

TACFIT FOR LIFE

 

 

This tactical fitness methodology from world-champ MMA fighter Scott Sonnon emphasizes precision over power, recovery over exhaustion.

Peer into some fitness classes and you’ll see knees caving toward each other, elbows flailing and backs rounding as participants struggle to keep up with the instructor.

And yet they just keep going.

You know the type — you might even be the type: valuing effort over technique; doing workouts more than a little beyond your limits; adhering to the well-tread, often wrong-headed maxim No pain, no gain.

“That whole you-gotta-push-through mentality is destroying people,” says Scott Sonnon, world-champion mixed-martial-arts (MMA) fighter and creator of the TACFIT (tactical fitness) training system, which takes a gentler approach to circuit training. “People think they should get their butt kicked and feel awful the next day. But we should feel better at the end of the workout than at the beginning.”

In his career as a martial artist and trainer of U.S. military and law enforcement personnel, Sonnon has discovered that the ability to move precisely during exercises and to recover quickly is more important than how much weight is lifted. Beyond that, focusing on technique and recovery minimizes injury and maximizes performance. So he created TACFIT to emphasize people’s exercise form and technique to help them deal with physically challenging, high-stress situations.

You don’t need to be involved in hand-to-hand combat to benefit, says Sonnon. The challenges you face outside of the gym can include anything from chasing your 5-year-old in the park to carrying groceries to your third-floor condo.

All TACFIT workouts incorporate high-intensity interval training and proactive periods of recovery. Workouts consist of strength and mobility drills, often done in circuit style, and include heart-rate recovery strategies between exercises. (See “Heart-Rate Recovery How-To,” below.) This makes the system challenging, but not so grueling that you wake up the next morning feeling as though you’ve been hit by a bus. On the contrary, you’ll notice that you’re moving, feeling and looking better day by day.

GET TACFIT 

The structure of this workout involves 20 seconds of work followed by 10 seconds of rest, repeated eight times per exercise (for a total of four minutes). You cap each four-minute round with one minute of recovery. During each round you’ll focus on one exercise only. Between rounds, you’ll practice recovery strategies to slow your heart rate. Perform this workout two to three times a week, taking 24 to 48 hours to recover between workouts.

1. Set a timer for four minutes.
2. Perform the first exercise for 20 seconds, working at a steady pace you can maintain. Your focus should be on technique. If you are unable to complete the exercise with perfect form, stand up to recover until it is time to begin the next set. Take a controlled inhale, followed by a deep exhale. Shake out your arms, legs and torso.
3. Rest 10 seconds.
4. Repeat steps 2 and 3 with the same exercise, continuing for eight sets (four minutes total).
5. Record the total number of repetitions completed (it helps to jot down reps after each set during your 10-second break). You will use this number to measure progress as you repeat this TACFIT workout in the future.
6. Rest 60 seconds or until your heart rate recovers to below 80 percent of your maximum heart rate. (See “Heart-Rate Recovery How-To,” next page.)
7. Begin the next exercise. Repeat steps 1 through 6.

SCORE YOURSELF

Add up the lowest number of repetitions completed in a set for each of the six exercises. For example, if your reps for an exercise look like this: 8/8/8/6/6/7/5/5, add only the 5. You will be adding six numbers (one for each exercise). The final total will be your score for the workout. Strive to increase your score over time.

TIP: Make sure you’re not trading reps for recovery. See “Heart-Rate Recovery How-To,” below.

WORKOUT

1. Suitcase Deadlift

  

• Stand with your feet hip-width apart, arms extended at your sides. Hold a kettlebell in your right hand, palm facing inward.
• Push your hips backward as you bend your knees to lower the kettlebell toward the ground. Your back should stay in its natural arch.
• Drive your weight through your midfoot and slowly rise to standing, exhaling as you rise.
• Switch arms each 20-second interval.

2. Plank Pull

  

• Kneel with your toes gripping the ground. Fold forward and push your hips back. Extend your arms and place your palms and forearms on the ground at shoulder width.
• Keeping your elbows in, pull forward with your forearms.
• Tuck your tailbone and lift your elbows, moving your body as far forward as you can while maintaining a strong core and shoulders. Exhale.
• Place your elbows down and sit back to the starting position.
• Continue in 20-second intervals.

3. Sit-Through

  

• Start on all fours, weight balanced between your hands and feet with your hands on
• the ground directly below your shoulders.
• Lift your left hand, pulling your elbow straight up, and rotate your left shoulder back. Keep your right shoulder stable and press your right hand into the ground.
• With your right knee bent, bring your right leg between your right hand and left leg so that your right glute touches the ground and right thigh comes parallel to the ground. Keep both feet on the ground and keep your gaze downward. Exhale as you sit through.
• Rotate back to the starting position, placing your left palm down.
• Switch sides each 20-second interval.

4: Kettlebell Bench Press

  

• Lie flat on your back with knees bent.
• Hold the kettlebell an inch above the middle of your chest, cupping the bell portion with your hands. Keep your elbows as close to your ribs as possible.
• Press the kettlebell upward until your arms are straight.
• Slowly lower the kettlebell to the starting position.
• Continue in 20-second intervals.

5. Spinal Rock

  

• Sit on a mat with your arms at your sides. Tuck your tailbone and roll backward so your lower back comes in contact with the ground.
• Lift your hips and extend your lower legs toward the ceiling. Exhale. Keep the weight of your body on your shoulders. There should be no tension in your neck. Ideally, your spine should be perpendicular to the ground and your knees and toes should be above your head, but don’t worry if you can’t get your legs this high.
• Grab the outsides of your knees and inhale as you roll back to a seated position, bringing your ribs to your inner thighs.
• Continue in 20-second intervals.

6. Table Lift

  

• Start seated with your knees bent and feet hip-width apart. Position your hands below your shoulders, just outside of your hips, fingers facing your heels.
• Press down into your palms to extend your elbows and drive through the middle of your feet to lift your hips. Exhale as you extend. Your hips should be as high as possible, knees directly over your feet. Keep your shoulders pulled down. Gaze skyward.
• Pull in your navel to lower your hips between your hands and come to a seated position, legs extended.
• Continue in 20-second intervals.

More Effects of Slouched Posture: Muscle Imbalances, Spinal Stresses, and Into Old Age

 

Slouched posture "caves" in the chest and restricts breathing. Taking a deep breath stretches the opposing front chest muscles that may have shortened and tightened, and helps bring back the shoulders and straightens the mid back.

Sometime slouched posture with forward head leads to the tendency of the entire body to lean forward of the center of gravity—as the head goes, so does the body. The pelvis rotates backward, almost as if trying to pull the trunk erect, and in the process pulls back on and flattens the lumbar spine. Hip flexors (front thigh and hip muscles) elongate and weaken, and hip extensors (gluts, and hamstrings at back of thigh) shorten and tighten. With loss of the normal lumbar lordotic curve ( "Flat– back Syndrome") the body tends to lean forward when sitting, walking or standing. As with forward neck/head, the added weight of the out–of–balance upper body requires more force applied by the back extensors to keep the upper body from falling forward—causing them to be in a constant state of tightness. The muscles that bend the back forward—not back muscles at all but front (anterior) abdominals—have little to do and become weakened. See Fix the Posture

Slouched Sitting Posture: Many of us spend more time sitting than standing. Some of us work leaning forward, our heads craned toward the computer screen. Some of us curve our backs into a big "C" so that we sit on our lower backs, pelvis rotated back, which rounds the lower back into kephosis, reversing the normal lordotic curve. 
For the sake of keeping the neck and head erect, neutral sitting posture in a chair with lumbar support is best. Interestingly, Dr. Bashir et al did a study using a positional MRI machine to image the spinal discs of subjects in three sitting postures:
1. Hunched forward (kephotic lower back)
2. Upright at a back–thigh 90 degree angle with knees bent and feet flat on the floor,
3. Upright at a 135 degrees back–thigh angle (pelvis boosted up with a wedge–shaped bolster) and feet flat on the floor (tilts pelvis forward increasing lumbar lordosis).
    The authors found that intervertebral discs showed less compression with increasing lumbar lordosis. "Slouched posture" showed the most disc compression. The 135 degree "position was shown to cause the least 'strain' on the lumbar spine, most significantly when compared with an upright 90 degree sitting posture." (But how do you stay in the chair without sliding off? You'd have to be strapped in.) They do not make clear if the 90 degree sitting position was with a lumbar support, which helps maintain the lumbar lordotic curve effectively as long as one sits back in the chair against the lumbar support.

The Aging Disc: Even a lifetime of balanced posture and moving in posturally healthy ways will result in normal wear and tear of the spine over time. The shock absorbers of the spine, the intervertebral discs, lose water content, going from 90% down to 65% water, which causes loss of disc height. Body weight becomes increasingly borne by the more delicate rear vertebral facet joints, which over-stresses them and leads to new bone growth (bone-spurs, arthritic changes) in the body's attempt to thicken and stabilize them. Acceleration of this spinal aging process may occur from an acute injury as in a car accident or from the many small stresses of poor posture. Chronic hyperextension (hyperlordosis) or hyperflexion (round backed), eventually accelerate arthritic degeneration of the spine. "Repeated eccentric* (Force in a direction the spine is not designed to accept) and torsional (twisting) loading and recurrent microtrauma result in tears in the annular fibers" (tough outer layer of the disc) and lead to the gel-like nucleus losing water content faster. See emedicine article: Low Back Pain and Sciatica

(Roef, 1960. A Study of the Mechanics of Spinal Injuries), Mechanical stress tests done on spinal sections from human cadavers, both young and old.
— The disc of normal height and fluid content is very resistant to compression. The nucleus does not alter in shape or position on compression or flexion. The annulus bulges very little. On increasing compression the vertebral body breaks before the disc does.
— If the nucleus pulposus has lost fluid pressure, as in the aged spine, there is abnormal mobility between vertebral bodies. On gentle compression or flexion the annulus protrudes on the concaveside—not on the convex side as is commonly thought.
— Disc prolapse consists mainly of the outer layer (annulus); and occurs only if the nucleus pulposus has lower fluid pressure and the annulus is lax and protrudes easily.
— In the normal disc, hyperextension or hyperflexion do not easily cause rupture of spinal ligaments but rotation forces can easily cause ligament rupture and dislocation.
— A combination of rotation and compression can produce almost every kind of spinal injury.

Effect of Faulty Lower Back Posture on Vertebra:
— If the pelvis tilts forward, the low back is brought into excessive extension or hyper-lordosis, which shifts more of upper body weight onto the relatively delicate rear vertebral joints making them prone to damage. Also the excessive curve crowds the rear vertebral joints, and the spaces (foramina) through which nerve roots travel become narrowed (see middle picture of illustration below); nerve impingement is risked if pre-existing disc degeneration has caused loss of disc height, bone spurring and stenosis (narrowing) of foramina through which nerve roots leave the spine. The large central canal containing the Cauda Equina (or spinal cord in thoracic and cervical spine) may also be narrowed.

Illustration 4. Effect of Extension and Flexion of Lumbar Spine on Vertebral Anatomy

Effect of Extension and Flexion on Intervertebral Discs: If the pelvis tilts backward, bringing the lumbar spine flat, weight is borne more by the discs—a good thing up to a point—but as the forward curve (flexion, see right picture of illus. 4 above) increases, such as when bending forward, slouched sitting, or any sit-up type exercises, all the weight of the upper body is borne on the discs, increasing their internal pressure up to two-fold (during sit-ups). The worst maneuver for increasing intradiscal pressure and also increasing the risk of a disc tear or herniation, is to lift weight with a curved forward/flexed spine. Direct measurements of intradiscal pressure showed 2.75 times the pressure compared to standing in neutral posture. And the heavier the weight, the greater the load on the disc. See "The Lumbar Spine: An Orthopaedic Challenge" by Alf L. Nachemson. (However, bending forward enlarges the nerve root foramina, which is the reason patients with severe nerve root compression may get relief walking or sitting with their backs rounded in flexion.)

Slouched Posture into Old Age: With time and arthritic degeneration, spinal flexibility is lost and all the varieties of poor posture result in fixed spinal changes—essentially permanent deformities.
— A fixed, excessive kyphotic thoracic curve can't be changed without serious surgery. The resulting forward head and neck can only be minimally improved by standing as erect as possible and maintaining optimal lumbar lordosis. But even a little improvement is better than slouching, which over time causes progression of the curvature.
— Forward head posture causes the head's weight to press unevenly on the cervical spine. Uneven pressure hastens disc degeneration as one side of the containment structure wears out (cracking, thinning, allowing moisture loss) more than the other. The bulge worsens, eventually desiccating and hardening. See link to Dr. Bookspan's article.
— Straightening of the cervical lordotic curve also becomes permanent with time; see below: "Loss of normal lordotic curve in the cervical spine." (In my case, because of arthritic degeneration, my cervical spine has minimal flexibility. I can barely bend my neck to the sides, and the lordotic curve is almost nonexistent. Thankfully my upper back is still flexible. I can reduce the kyphosis so my neck straightens.)
— In the lower back also, loss of the normal lumbar lordotic curve can become permanent. (I had believed my lumbar lordotic curve was lost to arthritic degeneration, which in an MRI looked almost as bad as my cervical spine, but then discovered that my pelvis was "locked" in a back-tilted position due to tightness of back hip extensors (hamstrings). Doing a "dead lift hamstring stretch" during chores helped me regain a somewhat normal lumbar curve. Definitely there's lack of flexibilty as I can't "overextend" my lower back, but that's not necessary for balanced posture.)
— If lower back surgery is ever considered, preservation and/or return of the normal lordotic curve should be insured. Back surgeries often fail without this step. See Flat Back Syndrome — Dr. Justin Paquette Interview.— Same goes for cervical spine surgery. Outcomes are much better with preservation and/or return of the normal cervical lordotic curve.

Loss of normal lordotic curve in the cervical spine seems to be common in neck pain sufferers—I have it. (see my MRI) Several factors may be involved: 1–neck extensors too weak from injury or overuse atrophy to both pull the head back and bend the neck into extension (lordosis), 2–laxity of spinal ligaments because of injury, or shrinkage of disc height (Degenerative Disc Disease), 3–wedging of vertebral bodies from congenital causes, compression fracture or low bone density.
Long term forward head posture aggravates all the preceding, and "the (off-balance) weight of the head can cause progression of the curvature." (See "A Patient's Guide to Cervical Kyphosis" from U. Maryland Spine Program.) Without a cervical lordotic curve the only alternative to reducing pain from stressed back neck extensors is to maintain a posture where the neck is as straight as possible, which entails reducing thoracic kyphosis and maintaining a normal lumbar lordotic curve.

The Connection Between Slouched Posture and Pain

 

Discovered by Serendipity: the accident of finding something good or useful
without looking for it. Pek van Andel described serendipity as: "to look for a needle
in a haystack and get out of it with the farmer's daughter." — Wikipedia

— The Main Cause of My Neck Pain – Habitual Slouched Posture
— Chronic Pain and Posture
— Pain in Neck, Shoulder and Upper Back muscles
— Worsening of Radicular Pain Through Neck Muscle Tightness and Spasm
— Cervicogenic Headaches
— Shoulder Pain: Rotator Cuff Tears and Frozen Shoulder
— Thoracic Outlet Syndrome – Numb Fingers, Hands and More
— Aggravation of Big Toe Pain and Arthritis

The Main Cause of My Neck Pain – Habitual Slouched Posture After years of pain, disability, failed treatments, and sporadic searches through books and internet websites, I made a serendipitous discovery that ended my chronic neck pain. Surprisingly, the main cause was not the bad neck strain in my early 20's, or the accelerated degenerative disc disease that followed, but the decades of habitual slouched posture that had profoundly weakened some muscles (neck flexors, thoracic extensors, shoulder blade stabilizers), while tightening, spasming and inflaming others (neck extensors, shoulder blade suspensor muscles — upper trapezius and levator scapula). At the worst of it, my shoulder blades were so unstable that even the smallest task involving my arms such as loading the dishwasher or pulling on my jeans caused spasms at the sides of my neck. And my neck flexors were so weak I couldn't even lift my head from the pillow when lying on my back in bed.

And with time, my posture was only getting worse. Poor posture feeds on itself because slouching forward stretches and weakens the back muscles (back extensors) needed to keep the body erect against gravity, while the muscles that curl the upper body inward tighten and strengthen. As we age and lose muscle mass and strength (unless we deliberately keep active and exercise) slouched posture slowly worsens, and may accelerate with illness or chronic pain. The only way to end the vicious cycle is to decisively and mindfully correct poor posture until balanced* posture feels right and slouched does not, and even then constant vigilance is needed.

*Instead of the terms ideal or neutral posture, I like the term, balanced posture, because spine and pelvic extensors and flexors should be in balance. When one muscle of an antagonist pair that operates a joint is too weak, it allows the faulty alignment; while the other relatively stronger muscle createsthe faulty alignment. The musculoskeletal system is least stressed during rest and activity when antagonistic pairs of postural muscles are balanced. The same goes for all antagonistic pairs of muscles. Care must be taken in strength training to avoid overworking one member of an antagonistic muscle pair. Only working the biceps to get that great bulge of anterior upper arm muscle, but ignoring the triceps at the back of the arm, predisposes to elbow and shoulder pain. Concentrating on the pectorals to get a great chest, but ignoring back extensors, causes shoulders to round forward, and mid to upper back extensors to elongate causing kephotic posture.

Chronic Pain and Posture: It's not only poor posture that begets worse posture. But any chronic pain, especially in the core areas of spine, shoulders, chest, and abdomen, seems to protectively tense up the front of the body, curling it into flexion (fetal position). Don't most of us just want to huddle on the couch or in bed when we are in pain or feeling unwell? So the observation by Professor Jull that neck pain patients when simply rising to a standing position can't "shape" their lower back/pelvic area into a normal (lordotic) curve, (which requires activation of extensors) and don't use their deep stability muscles well (such as the spinalmultifidus), may apply to all chronic pain patients. 

      Prior to the worst of my neck pain, I had developed a chronic stomach condition called post-viral gastroparesis (partially paralyzed stomach), which is like bad stomach flu but lasts for 6 months to forever. Soon I looked skeletal and had profound fatigue from the medication as well. I remember how carefully I moved as rounds of nausea, heartburn and stomach cramps knocked me down day after day; how stiff and out of balance I felt, how all I wanted to do was huddle on the couch and watch of all things, reruns of CSI (Crime Scene Investigations). No wonder my posture suffered, and my neck pain, spasm and weakness ramped up worse than ever. A total nightmare. Eventually I wasn't able to do household chores or drive. How did I let myself get so weak? Avoidance of pain and my depressed mood (whether cause or effect?) limited more and more my everyday activities until I could barely do anything. And I didn't even notice how slouched I'd become, and no one said anything because I was so ill. 

An important lesson: When chronic illness and pain limit physical activity, making the effort to use good posture helps keep postural muscles strong and reduces the risk for increased neck, shoulder and back pain.

1. Pain in Neck, Shoulder and Upper Back muscles. Slouched posture causes Forward Head and Destabilization of Shoulder Blades, both of which, predispose to spasm, pain and inflammation of the neck, upper back and shoulders. These are chronic muscle strain symptoms (not generally nerve compression symptoms) and even though attributed to a previous neck injury and/or existing degenerative disc disease and spinal osteoarthritis, slouched posture may likely be the root cause even though these other disorders are present.(see How Slouched Posture Causes Neck Pain: 1. Forward Head and 2. Destabilized Shoulder Blades...)

2. Slouched Posture Causes Worsening of Radicular Pain Through Neck Muscle Tightness and Spasm Radicular Pain is pain that radiates down the arm (or leg in the case ofsciatica) in a specific pattern (see sensory dermatome). Radicular pain is often caused by irritation of spinal nerve roots coming off the spinal cord. The nerve roots area off-shoots of the spinal cord that travel through openings (foramina) formed by vertebral facet joints. Those openings can become narrowed, and the nerve tissue irritated by bone spurs and/or bulged–out hardened disc material caused by degenerative disc disease (spinal arthritis) or when the inner shock-absorbing gel of discs herniates from acute injury.

In slouched posture, the excessive kephotic curve of the upper back is balanced by an excessive lordotic curve of the neck/cervical spine (unless the cervical lordotic curve is lost) in an effort to balance the weight of the head without overworking the back neck muscles (neck extensors). Excessive cervical lordosis forces vertebral facet joints closer together, narrowing the foramina, and can irritate the nerve roots all by itself or further irritate nerve tissue already impinged on by bone spurs. Muscle spasms at the back of the neck can also narrow foramina by clamping together the vertebral facet joints. Improving posture takes some of the pressure off nerve roots by straightening the neck and easing muscle spasms. And if nerve roots aren't already inflamed there may be no symptoms even with severe foraminal narrowing, as long as posture is optimal and muscle spasm is absent. (see my MRI report—In spite of moderate to severe narrowing in several nerve root foramina I now have no radicular pain; also see Johnson).
Very importantly, do not ignore numbness and/or weakness of arms or legs. "Persistent pressure upon a nerve root of three-months duration may not recover when the pressure is relieved."(Cailliet) This means surgical decompression must be done before damage is permanent.

3. Cervicogenic Headaches — Tight back neck muscles due to Forward Head and Neck (seeHow Slouched Posture Causes Neck Pain: 1. Forward Head...) can irritate the occipital nerve, which runs through the upper trapezius and another neck extensor, the semispinalis capitis. The nerve may be compressed and irritated by spasms of those muscles high at the back of the neck near the base of the skull (see occipital neuralgia). (Kendall)

4. Shoulder Pain: Rotator Cuff Tears and Frozen Shoulder — Slouched posture causes weakening of the muscles supporting the shoulder joint, which predisposes to shoulder problems like torn rotator cuffs and frozen shoulder (adhesive capsulitis). In particular the downwardly tilted scapula can't create enough space for the topmost tendon of the rotator cuff (which is already slack from lateral drift of scapula) when the arm is lifted overhead, causing it to be pinched and damaged by the bony process of the shoulder blade called the acromion. (Fitzgerald) (see illustration)

5. Thoracic Outlet Syndrome – Numb Fingers, Hands and More. Several nights a week, I would be awakened from sleep with numb fingers and hands. I would sit up in bed and shake my hands until the feeling came back. This was one of was one of the seemingly unrelated symptoms along with headaches and big toe pain that disappeared when my posture improved. Night–time numbness and tingling in hands and arms are symptoms of a Thoracic Outlet Compression Syndrome (TOS).





The thoracic outlet is a narrow passageway between collarbone (clavicle) and ribs that the subclavian artery and vein, and the brachial plexus (a network of nerve fibers formed from the lower 4 cervical and first thoracic nerve roots) must travel through to get to the arm. The nerves of the brachial plexus control most arm and hand muscles, and receive sensory input from most of the skin and muscles of the arm
Slouched posture and resulting tightness in front shoulder muscles and downwardly tilted shoulder blades, narrows the thoracic outlet in the shoulder, which may compress thebrachial plexus and/or subclavian arteryrunning through it. Symptoms include waking from sleep with numbness, tingling, weakness, coldness of hands and arms. The neck and upper trapezius may be painful. Most patients improve with therapy for posture and muscle imbalance. See Medscape article:Thoracic Outlet Syndrome Treatment & Management. Kendall et al, discuss a similar syndrome, Coracoid Pressure Syndromewhere the brachial plexus is compressed by the Coracoid Process of the shoulder blade, which is pulled forward and down by a tightpectoralis minor. Symptoms are pain down the arm with slight pressure on the area of the coracoid. Also pain that worsens with weight on the shoulders from a backpack or purse, or when carrying something heavy with that arm. The upper trapezius is often in "protective spasm" from trying to lift the shoulder girdle off the nerve bundles. First line of treatment is realign posture and shoulder blade position. See Fix the Shoulder Blade Exercise... 
In Depressed/Droopy Shoulders, the clavicle (collarbone) is horizontal or slopes down to end of shoulder. The acromion process of the shoulder blade is also held too low. There are two areas of possible nerve and blood vessel compression in the thoracic outlet: 1. between clavicle and first rib, and 2. between coracoid/short tight pectoralis minor and the 3rd through 5th rib. The upper trapezius is stretched and weakened, but protectively spasms to lift the clavicle off compromised structures. Weight-bearing by the arms worsens the compression and stress on upper trapezius.

Another possible cause of arm pain originating in the thoracic outlet area may be an "Elevated First Rib" which would predispose to compression under the collarbone. The first rib elevates (within the relatively rigid structure of the ribcage) by action of the anterior and middle scalene muscles. 
Scalenus Syndrome (Scalenus Anterior or Anticus syndrome) — The anterior and middle scalenes are also involved in a third possible area of thoracic outlet compression. Between them is a narrow area that the brachial nerves and subclavian artery (not the subclavian vein) go through before passing under the collarbone. Turning the head enough to twist the neck narrows the passage even more. Other factors that predispose to nerve compression between the scalenes include a cervical rib (additional rib-like structure extending from the C-7 vertebra) or enlargement of the scalenes from exercise. (see abstract: Exercise-Induced Scalenus Syndrome)

6. Aggravation of Big Toe Arthritic Pain and Arthritis — For over 25 years I've had an enlarged, arthritic first big toe joint on my right foot. This is called Hallux rigidus or rigid big toe, which has caused limited movement of my right big toe and pain while walking. (Try walking without bending your big toe. It's difficult.) Fifteen years ago I had surgery to remove the bone spurs, but within 6 months much of the excessive bone had grown back, though the worst of the bone spurs didn't return. But I still had chronic pain and inflammation and used an insert to stiffen the sole of my right shoe to limit bending of the painful big toe. 

...But then I improved my posture and somehow my toe pain began to improve. I discovered that poor posture had a lot to do with my toe pain. Apparently I had always been leaning forward from flat back posture and putting too much pressure on my arthritic big toe. With improved posture and awareness that my weight should be distributed evenly between heel and forefoot, my big toe pain improved greatly...even to the point that I don't need the sole stiffener and can go without shoes if I want to.