Set it Straight: How to Identify and Address Posture Problems

By Billy Polson

Postural deviations lead to improper joint wear, arthritis, muscle imbalances, trigger points and often to injuries and surgery. And that's not to mention how they physically affect the way you present yourself and the degree of confidence your body displays. Therefore, postural corrections should be the primary focus in any workout program. It's no good getting big if you're not carrying yourself correctly.

There are many versions of postural deviations, however, and each will need to be addressed in a different way. So first you will need to test yourself for the most common problems, and then select exercises and stretches that can take on the issue. Below I have listed the most common posture deviations I see, along with a test you can use to determine whether you have this deviation, and exercises you can use to address it. Here's the thing—by just dedicating a portion of your workout to correcting these problems, you can keep yourself safe and strong for all your future workouts, not to mention daily life. It's really worth the time investment.

Here are the most common posture problems, with tests and exercises:

Forward Head Posture Test
Stand with your back against a wall with your feet about a foot from that wall and try to touch the wall at three points of contact: 1) where your lumbar spine meets your sacrum (that is, right at your waist band); 2) your shoulder blades; 3) the rear base of your skull. Then, stand off the wall while maintaining this vertical body alignment to hold the ideal posture state. People with very kyphotic posture (rounded shoulders) may not be able to attain this posture on the wall at all.
Exercises for Forward Head Posture
Do your standing upper body exercises while holding this posture (i.e. bicep curls while leaning against the wall, maintaining these 3 points of contact). Or, have a workout partner hold a wooden dowel or stick on your spine during cable rows, push-ups, cable presses, etc. (You can persuade someone at your gym by offering to return the favor!) In your car or when seated anyplace where you have a head rest, always have the base of your skull on the head rest.
Forward-Rounded Shoulders Test
Stand facing a mirror in a relaxed stance with feet square side-by-side. Note where your hands hang naturally. Ideally, your hands should hang at your sides with palms facing in towards the sides of your legs and your middle finger along the mid-seam of your pants. If your hands are hanging in front of your body with your palms rolled inwards facing your front pockets, this is a great sign that you have shoulders rolled forward.
Stretches and Exercises for Forward-Rounded Shoulders
First, I recommend checking that your chest is not overly tight and that tension is in fact causing the rounded posture. Since maintaining shoulder posture is an endurance activity, the best way to strengthen these areas is doing endurance work. I recommend upper-body-only cobra stretch for holds up to two minutes, making sure you are only using your upper body to hold and no glutes. I also recommend doing dual cable lat pull-downs and holding the low end of the movement for five seconds each time in order to build up the endurance strength in your lower-middle trapezius.
Unilateral Shoulder Hike Test
This is actually one of those things that even clients who have a major shoulder hike on one side don't seem to notice until it is pointed out to them. To check for this, stand in front of a mirror with no shirt on (or for females, in a jog bra). Take note of the levels of your shoulders. Also take note of the levels of your armpit creases, your nipples, and where your fingers hang down and hit your legs. All of these observations will help you figure out if you have a unilateral shoulder hike.
Stretches and Exercises for Unilateral Shoulder Hike
First, I recommend doing some stretches and breathing to try and get your upper traps to relax. Try sitting tall on a bench and letting your arms hang down low at your sides as you slowly drop your head to the left and take a deep breath (inhale and exhale) and then return to start. Repeat for the right side. If one side is much tighter then repeat that side for three times. Secondly, I recommend upper-body-only cobra for holds up to two minutes, making sure you are only using your upper body to hold and not your glutes. I also recommend doing dual cable lat pull-downs and holding the low end of the movement for five seconds each time in order to build up the endurance strength in your lower middle traps. If one side tends to be the problem, then try doing single cable lat pull-downs on that side to try and strengthen that side's shoulder retractions.
Kyphotic Spine Curvature Test
This is not an easy one to test on your own, but frequently if you have forward head posture and rounded shoulders, then you also have excessive forward rounding of the thoracic spine. This can often come from improper work-posture on the computer, or even from standing over a sink/stove and cooking for too long. If you have neck tension or even trigger points around your shoulder blades, often they are caused by this.
Stretches and Exercises for Kyphotic Spine Curvature
One of the best things for this is to take a four-inch foam roller (six-inch also works, but not as well) and lay the foam roller on the floor perpendicular to your spine. Lie across it so that the roller is just under the lowest edge of your shoulder blades. Place your hands on your head and lay back across the roller so that you open your chest and your head lays back. Take three deep breaths here, then for the next three breaths, with each exhale bring your head and shoulders up to a flat spine position and with each inhale lay back over the roller. After these three movement breaths, roll the foam roller up your spine to the next vertebrae level and start the process of the three breaths holding and three breaths moving at that level. Move up until you reach the base of your neck with the roller.
Unilateral Hip Hike Test
The best way to measure this on yourself is to do a visual check in the mirror wearing just your underwear or briefs. On each side of your body, find the bony part of your hip called the ASIS (Anterior Superior Illiac Spine) and place your index fingers on it. Now note in the mirror if one of them is higher than the other. If they are way off level then I definitely recommend working with a professional to get some information about what could be the cause for such a malalignment. A large difference in your hip heights will definitely lead to some rough times on all your lower body joints and length-tension relationships, so definitely check it out (especially if you are a runner or impact athlete).
Stretches and Exercises for Unilateral Hip Hike
Your goal for exercises on this is to try and realign how your pelvic stabilizer muscles are working. I recommend trying to lie on your side across a stability ball to try and release the higher hip. For example, if your left hip sits higher than your right, you want to lie with your right side on the stability ball so that your left side is up and stretched across the top of the ball. Lie across the ball for 30-60 seconds. Then immediately go to the floor and, lying on your back with your knees bent and feet on the floor, squeeze a yoga brick or ball between your knees for five second holds, five times repeated, to relock your pelvis. Then try the mirror test again to see if you can notice any change. If there is no change I recommend working with an experienced DPT, chiropractor or massage therapist with experience dealing with misaligned hip issues.
Lordotic Spine Curvature/Flatness Test
This is again a tough one to test without the assistance of a professional, but some key signs you can look for are the following:  (1) excessively tight hip flexors and weak lower abs tend to lead to a dramatic anterior tilt of the pelvis; (2) When standing against the wall with the three posture points of contact (base of skull, shoulder blades and base of spine at waist band), you should have just enough space at your lower back to slide your hand between your spine and the wall.
Stretches and Exercises for Lordotic Spine/Lumbar Flatness
For lordotic (excessive curvature) of lumbar spine, the best things your can do are to stretch your hip flexors and strengthen your lower abs. For a flat lumbar spine, the best thing you can do is to lie across the middle of the stability ball with the center of your back at the peak of the ball for a minute of deep breaths before each workout. I also recommend doing upward-dog yoga pose (aka Mckenzie press-up stretch) for 10 reps and a 10 second hold with deep breaths before each workout.
Flat Arches Test
When standing with your feet square and toes forward, place a straight edge (i.e. a credit card) on the inside of your foot so that it is straight up and down and touching the medial malleolus of your tibia at your ankle (that's the bony protrusion on the inside of your ankle). Ideally, this straight edge should also be touching the fleshy part of the top of your arch as it goes straight down from the malleolus. The bigger the space is between the card and the skin of your arch, the flatter your foot is.
Stretches and Exercises for Flat Arches
Again, lots of things can lead to flattened arches, but one of the main culprits I have found with my clients is that their glutes (specifically their gluteus medius) are extremely weak on the flat foot side. Therefore, by strengthening their gluteus medius their legs will again return to a proper alignment from the hips down and therefore slowly raise their arches back to correct levels. The most basic of glute med strength exercises is to lie on your side about six inches away from a wall with both legs straight. Keep your lower leg on the floor and, keeping your top leg straight, drive your heel into the wall. Keeping the pressure of the heel into the wall, slowly raise your leg up as high as you can while maintaining the pressure and straight leg, then maintain pressure as you return the leg to the low position. Repeat for 12-15 times on the side where the glutes are weak. You should feel this work your 'back pocket' on the top side leg. I also recommend lying on your back and doing single-leg hip raises, using a single leg to drive through your heel and raise your lower body up and down using your glutes on that single leg. As your glutes strengthen you should begin to feel a gear switch in terms of where your body finds strength in running and moving.

I know this seems complicated, but take one of your gym days off as the opportunity to try out these tests, and to form a plan for addressing what you find. You can work on this within the context of your existing workouts, and thereby build a foundation for your continued good health and fitness.

About Billy Polson: Billy Polson is co-founder of the award-winning Diakadi Body personal training gym and creators of RealJock's 12-week Workout Programs. Billy was recently named by Men's Journal Magazine as one of the top 100 Trainer's in America and is a certified Level 1 Practitioner and Holistic Lifestyle Coach through the Paul Chek Institute as well as a Certified Personal Trainer through The National Academy of Sports Medicine. He and Diakadi co-founder Mike Clausen can be reached via email at