Pilates for the treatment of Rounded Shoulders

Nicola Heweston

September 2015

Wimbledon UK, January 2014

Abstract

Rounded shoulders is a description of a common posture abnormality whereby the

shoulders appear further forward, often accompanied by a hunching or bending

forward of the upper spine and head (kyphosis). The rounded shoulder posture is

often associated with and contributes to non-optimal function of the shoulder complex.

This paper outlines the BASI Pilates conditioning program used, to help correct

rounded shoulders, in a 33-year old and otherwise healthy individual. It concludes

that with regular Pilates sessions, improved body awareness and accompanied

lifestyle changes, the muscular imbalances and holding patterns that cause rounded

shoulders can be addressed, and the posture of the individual improved.

Table of Contents

Title 1

Abstract 2

Table of Contents 3

Anatomy of the Shoulder 4

Introduction 7

Case Study 7

Conditioning Program 8

Conclusion 12

Bibliography 13

Anatomy of the Shoulder

The bones of the shoulder complex consist of the humerus (the upper arm bone), the

scapula (the shoulder blade), and the clavicle (the collar bone).

The clavicle is the only bony attachment between the trunk and the upper limb

(sternoclavicular joint). It forms the front portion of the shoulder complex and runs the

entire length with a gentle S-shaped contour. The clavicle articulates at one end with

the sternum (chest bone) and at the other end, with the acromion of the scapula (bony

structure on top of the scapula). This articulation between the acromial end of the

clavicle and the acromion of the scapula forms the roof of the shoulder

(acromioclavicular joint).

The scapula is a large, flat triangular bone that forms the back portion of the shoulder

complex. The flat blade of the scapula glides along the thoracic wall (back of rib cage)

allowing for extended movement of the arm, encased by 17 muscles that provide

control and stabilisation (sometimes referred to as the scapulothoracic “joint” however

there is no bone connection).

The scapula also has a shallow cavity (glenoid cavity) where the head of the humerus

connects to the shoulder joint (also known as the glenohumeral joint). This ball and

socket joint of the shoulder allows arm movement in every direction.

The lack of bony and ligamentous support in the shoulder complex means that the

shoulder is muscle dependent, relying heavily on the muscular for good shoulder

function and shoulder stability. These muscles can be divided into three groups:

Fig 1 – Joints of the shoulder girdle

Global stabiliser – muscles that connect the scapula to the surrounding bones (head,

spine, ribcage) but with no direct connection to the humerus (upper arm). The primary

function of this group is to stabilize or move the scapula in accordance to needs of the

arm: trapezius, rhomboids, levator scapula, serratus anterior and pectoralis minor.

Local stabilisers – the rotator cuff is a group of small muscles that connect the

scapula to the proximal humerus, essential for providing shoulder stability and

facilitating correct shoulder mechanics: supraspinatus, infraspinatus, teres minor and

subscapularis (Fig 2).

Global mobilisers – large muscles that function to produce gross movement of the

arms: pectoralis major, latissimus dorsi, deltoid and teres major.

Fig 2 – Rotator cuff muscles

Good alignment of the trunk, as close to the plumb line as possible, is key to achieving

correct shoulder mechanics. Conversely, without good body alignment, good

shoulders mechanics are not achievable and faulty shoulder mechanics can lead to

shoulder problems. Rounded shoulders can lead to impingement (when the bony

structures of your shoulder begin to compress the bursa and the underlying rotator

cuff tendons), impingement can lead to rotator cuff inflammation, inflammation to

tearing and potential incapacitation.

Correct shoulder mechanics also involves a co-ordinated, linked movement of the

scapula and humerus termed scapulohumeral rhythm. To this there are two key

components, the first is abduction of the glenohumeral joint (primarily produced by the

supraspinatus and deltoid muscles) and the second is upward rotation of the scapula

(serratus anterior, upper, middle and lower trapezius – includes scapular depressors

to prevent excessive elevation). If this linked movement is properly co-ordinated,

there will be a 2:1 ratio of movement in the glenohumeral joint to that of the

scapulothoracic articulation.

Conditioning programs that focus on achieving good shoulder mechanics must start

with attaining good alignment of trunk, followed by the inclusion of strengthening

exercises for the rotator cuff and muscles involved in scapular stabilisation.

Introduction

Rounded shoulders is a description of a common posture abnormality whereby the

shoulders appear further forward, often accompanied by a hunching or bending

forward of the upper spine and head (kyphosis). There are many lifestyle factors in

modern day society that contribute to this posture; sitting at a desk working on

computers, bending over whilst using a mobile phone and sitting for hours to eat, drive

or watch TV. All these activities involve forward flexion and typically lead to weak

back extensors and shoulder external rotators; tight pectorals, hip flexors, hamstrings,

and shoulder internal rotators; and an overactive levator scapula and upper trapezius.

Fig 3 – Head and shoulder muscle imbalance pattern “upper crossed syndrome”, often found in individuals with rounded shoulders and desk-workers

Case Study

Name: Claire Age: 33

Lifestyle: Desk-worker who has practiced Pilates regularly for last 2 years.

Goals: To achieve correction of forward head, rounded shoulders posture and improvement in shoulder stability and range of motion (current restriction observed when raising arms overhead).

Conditioning Program

8 week programme, 2-3 sessions per week

Objectives: Strengthen the abdominals, back extensors and neck flexors to achieve

improved head and trunk alignment. Strengthen the rotator cuff muscles and muscles

involved in scapular stabilisation (rhomboids, serratus anterior, lower and mid

trapezius), stretch the pectoralis minor and major to lengthen and open out the chest.

Encourage awareness of unhelpful movement patterns (e.g. over-activation of the

levator scapulae and upper trapezius), as well as holding patterns (e.g. habitually

holding shoulders / arms in a hunched position).

WARM UP

Roll Down

Mat: Pelvic Curl, Spine Twist Supine, Chest Lift, Chest Lift with Rotation

Cue client to slightly tuck chin when required, to correct the habitual forward head and train the head to retract to plumb line position.

Chest Lift and Chest Lift with Rotation performed on a Step Barrel to increase the range of motion from spinal hyperextension to spinal flexion. Added benefit of significant stretch for the chest (thoracic region).

FOOTWORK

Reformer: Parallel Heels, Parallel Toes, V Position Toes, Open V Heels, Open V Toes, Calf Raises, Prances, Single Leg Heels, Single Leg Toes

Footwork performed lying on a half foam roller, taking arms out to sides with the palms facing up, allowing the pectoral muscles to open and stretch.

Week 5-8:

Chair: Parallel Heels, Parallel Toes, V Position Toes, Open V Heels, Open V Toes, Calf Raises, Single Leg Heels, Single Leg Toes

Progressed to Chair to further develop trunk and pelvic stabilization. Hand positions selected to stretch chest, varying between a) hands near rear of seat resting on fingertips, with elbows bent and reaching back and b) arms outstretched into a T.

ABDOMINAL WORK

Step Barrel: Overhead Stretch, Teaser Prep

Week 5-8:

Chair: Standing Pike Reverse, Full Pike, Torso Press Sit

Progressing to Chair to further develop abdominal control and scapular stabilization. Full Pike to further strengthen the shoulder girdle. Torso Press Sit to strengthen the back extensors and abdominals, stretch the chest and shoulders, and develop hip flexor control.

HIP WORK

Cadillac: Basic Leg Springs Series - Frog, Circles Down, Circles Up, Walking, Bicycle

Week 5-8:

Avalon Chair: Frog, Circles Down, Circles Up, Openings, Helicopter

Progressed to Avalon to leverage the hand position to open out the chest further (hands holding levers, elbows reaching out to sides). Plus Helicopter is a good for a functional hamstring stretch.

SPINAL ARTICULATION

Chair: Pelvic Curl

Week 5-8:

Reformer: Semi-Circle

Semi-Circle selected as has the added benefit of arms overhead for a chest/shoulder stretch and in comparison to other repertoire, an increased range of motion to take lower back from flexion to extension.

STRETCHES

Reformer: Hamstring Stretch Group - Kneeling Lunge

Step Barrel: Shoulder Stretch Lying Side

Week 3-5:

Ladder Barrel: Shoulder Stretch 1, Shoulder Stretch 2

Cadillac: Shoulder Stretch

Week 6-8:

Pole: Pole Series – Shoulder Stretch, Overhead Stretch, Side Stretch, Spine Twist

FULL BODY INTEGRATION F/I

Selected 1-2:

Reformer: Up Stretch Group – Long Stretch, Up Stretch 2, Down Stretch Group – Down Stretch

Cadillac: Push Through Group – Cat Stretch Kneeling, Sitting Forward, Side Reach

ARM WORK

Selected 2-3:

Chair: Shrugs, Triceps Press Sit

Cadillac: Push Through Group – Shoulder Adduction Single Arm, Shoulder Adduction Double Arm, Sitting Side Prep

Week 5-8:

Avalon Chair: Arms Sitting Series – Chest Expansion, Biceps, Rhomboids, Hug-A-Tree, Circles Up, Circles Down, Salute

Selected Arms Sitting Series on Avalon Chair oppose to Reformer for 3 reasons a) removes constraint of tight hamstrings, b) has the addition of Circles Up and Circles Down that have a wider range of motion, and c) addition of back support to help client keep a broad back and scapulae stabilised throughout (oppose to Reformer Arm Kneeling Series).

FULL BODY INTEGRATION A/M

Week 7-8:

Reformer: Balance Control Front

To develop trunk and scapular stabilization and to strengthen the shoulder extensors.

LEG WORK

Reformer: Long Box Group – Hamstring Curl

Selected over other leg work repertoire as the position of lying prone, hugging the front of the box with the upper back extended is advantageous to opening out the chest.

LATERAL FLEXION / ROTATION

Selected 1:

Cadillac: Butterfly

Reformer: Mermaid

Week 5-8:

Reformer: Short Box Group – Side Overs

BACK EXTENTION

Step Barrel: Swan Prep

Week 5-8:

Cadillac: Prone 1, Prone 2

COOL DOWN

Rest Position, Roll Down

Conclusion

Claire is pleased with her progress to date from her BASI Pilates program. Her

shoulders look visibly less rounded and internally rotated, and her chest feels more

open with a greater depth of breath.

Claire has gained more awareness of faulty movement patterns, such as bending over

to reach for an object by folding at the chest (oppose to bending at hip joint). Claire

has also made lifestyle changes such as sleeping on her back with one pillow

(previously slept on two pillows) and using a backpack when possible (oppose to

holding a handbag over one shoulder).

Lifestyle changes alongside increased strength in her abdominals, back extensors and

neck flexors have resulted in Claire’s head retracting and spine aligning closer to the

plumb line, key in achieving good shoulder mechanics. Her shoulder stabilisation has

also improved and the abduction / adduction range of motion of her scapulae

increased.

Claire plans to continue with the BASI Pilates program to work on fine tuning her

shoulder mechanics, increasing her overhead range and incorporating the principles

of Pilates into her everyday life.

Bibliography

http://www.chrisreynoldspractice.co.uk/rounded-shoulders.asp

http://chrisreynoldsosteopathyphysiotherapy.blogspot.co.uk/2012/01/correcting-round-

shoulders.html

https://breakingmuscle.com/mobility-recovery/why-does-the-front-of-my-shoulder-hurt

http://breakingmuscle.com/mobility-recovery/the-dynamic-duo-of-shoulder-impingement

https://breakingmuscle.com/strength-conditioning/how-to-unlock-your-athletic-potential-through-

good-posture

Study Guide Comprehensive Course, Body Arts and Science International, 2000-2013

Movement Analysis Workbooks, Body Arts and Science International, 2000-2012

Pilates, Rael Isacowitz, Human Kinectics, 2006

Pilates Anatomy, Rael Isacowitz and Karen Clippinger, Human Kinetics, 2011

http://www.sportsinjuryclinic.net/anatomy/shoulder-anatomy

https://www.shoulderdoc.co.uk/article/1177

http://www.fitnessprofessionalonline.com/articles/exercise-science/the-shoulder-understanding-the-

science-behind-both-movement-and-dysfunction/

http://www.crankhf.com.au/improve-rounded-shoulders/