Figure 6 . Holding the smart phone down low in front predisposes the client to rounded shoulders characterized by protracted scapulae and medially rotated humeri
6 . Rounded Shoulders
Rounded shoulders is a postural distortion pattern in which the scapulae are protracted and the humeri are medially rotated . Therefore the shoulder girdles and arms are rounded in , hence the name . The client with rounded shoulders has scapular protractors ( pectoralis minor and major ) and humeral medial rotators ( subscapularis , pectoralis major and teres major ) that are locked short and tight , accompanied by scapular retractors ( middle and lower trapezius and rhomboids ) and humeral lateral rotators ( teres minor and infraspinatus ) that are weak and also likely locked long and tight . Using a smart phone often predisposes the client to this condition because so many people hold the smart phone down low in front of them ( Figure 6 ). As with other overuse conditions , occasional rounded posture with a smart phone is not detrimental , but when this posture is assumed for long periods of time , the effects can become very chronic and severe .
7 . Rounded Upper Back
Rounded upper back is defined as hyperkyphosis of the thoracic spine and almost always accompanies rounded shoulders . As the client ’ s shoulder girdles and arms round and collapse forward and down , their thoracic spine also rounds and collapses into flexion , in other words , hyperkyphosis . As with rounded shoulders , rounded upper back is caused and / or exacerbated by prolonged use of the smart phone down in front of the body ( see Figure 6 ).
8 . Forward Neck
Also accompanying rounded shoulder girdles and rounded upper back is forward head . When the thoracic spine is hyperkyphotic , the neck naturally projects forward with a hypolordotic lower cervical spine . The upper cervical spine then becomes hyperlordotic as a compensation to bring the eyes and ears back to level ( see Figure 6 ). The posture of the head ends up being forward ( protracted ) with its center of weight anterior to the trunk and imbalanced over thin air ; therefore , it should fall with gravity into flexion until the chin hits the chest . The only reason it does not is that the posterior cervical extensor musculature isometrically contracts to hold the head in this postural distortion pattern against the flexion force of gravity ( Figure 7 ). Due to the prolonged isometric contraction of the posterior cervical musculature , it often fatigues , tightens , and becomes strained / injured and painful . Long-term chronic tightness of this musculature can also cause a tension pulling force ( enthesopathy ) upon its cranial attachments on the scalp , possibly resulting in tension headaches .
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Figure 7 . Forward head posture results in the center of weight of the head being anterior to the trunk .
Having the center of weight of the head forward of the trunk requires constant isometric contraction of the posterior cervical extensor musculature . How forceful the posterior cervical musculature must work is dependent upon the leverage force of the weight of the head .
The average head weighs approximately 10-12 pounds . However , as the head and neck are further flexed , the center of weight of the head moves increasingly anterior , increasing the leverage force of the weight of the head against which the cervical extensor musculature must work . It has been estimated that when the neck is flexed to 45 degrees , the head weighs the equivalent of 45 pounds . And if the neck is flexed 60 degrees , the head weighs the equivalent of 60 pounds !
Upper Crossed Syndrome
The sum postural distortion pattern of rounded shoulders along with rounded upper back and forward head is often termed as the upper crossed syndrome . This name is used to describe the characteristic crossed pattern of overly facilitated / tight / locked short muscles with the overly inhibited / weak / locked long muscles .
78 | vol29 | no2 | JATMS