Rounded shoulder posture

Rounded shoulder posture (RSP), also known as “mom posture”, is a common postural problem in which the resting position of the shoulders leans forward from the body’s ideal alignment. Patients usually feel slouched and hunched, with the situation deteriorating if left untreated. A 1992 study concluded that 73% of workers aged 20 to 50 years have a right rounded shoulder, and 66% of them have a left rounded shoulder. It is commonly believed that digitalisation combined with the improper use of digital devices have resulted in the prevalence of sedentary lifestyles, which contribute to bad posture. Symptoms of RSP will lead to upper back stiffness, neck stiffness and shoulder stiffness. It can be diagnosed by several tests, including physical tests and imaging tests. To prevent RSP from worsening, maintaining a proper posture, doing regular exercise, and undergoing therapeutic treatments could be effective. If the situation worsens, patients should seek help from medical practitioners for treatments. If RSP is left untreated, chronic pain, reduction in lung capacity and worsened psychosocial health are likely to result.

Causes

Poor posture Poor posture can cause rounded shoulders because of the muscle imbalance and uneven weight distribution in our upper body. Long periods of time spent in positions that put undue strain on the shoulders and neck may wear out some of the muscles while weakening others. For instance, if an individual spends a long period of time in sitting positions without stretching, the chest and front arm muscles shorten and tighten, whereas the upper back and neck muscles weaken and lengthen. Due to this asymmetry, the shoulders may roll forward and the upper back may be rounded.

Genetics The development of RSP is often influenced by genetics, as certain inherited traits could possibly have an impact on bone structure, muscular strength, and connective tissue elasticity. For instance, some people naturally have a rounded upper back because of the way their spinal vertebrae are arranged. Others may naturally have muscles in their upper back and neck that are weaker and more prone to stretching, as well as with chest and front shoulder muscles that are more resistant to stretching. Connective tissue disorders, such as Ehlers-Danlos syndrome, could also alter the strength and elasticity of ligaments and tendons. The risk of joint hypermobility and instability will be increased.

Psychological stressors When the brain detects a threat, whether it is physical or psychological, the body will prepare itself to react against the threat (also known as the “fight or flight response”). Common responses include tensing one’s jaw, contracting the abdominal muscles, holding one’s breath and hunching one’s shoulders. Persistent psychological stressors such as career dissatisfaction, financial difficulties, or family problems may cause physical changes in the body like rounded shoulders, tension headaches and muscle tension.

Medical conditions

RSP could be a symptom of some medical conditions, such as kyphosis, scoliosis, forwarded head posture or ankylosing spondylitis. Kyphosis is a spinal disorder that contributes to excessive curvature of the upper back, leading to a hunched posture and RSP. Scoliosis refers to a condition where there is a sideways curve in a person's spine, causing our shoulders to become uneven and rounded.

Symptoms Symptoms of RSP include forward head posture, chronic shoulder and neck pain, as well as reduced mobility and flexibility in the shoulder; hindering the ability to perform daily activities.

Diagnosis The diagnosis of rounded shoulders involves a physical examination. Healthcare professionals will assess the patient’s posture, range of motion and strength during the examination. The following tests may be carried out:

Posture assessment Patients are instructed to stand normally with their hands by their sides. Their coracoid process (CP), sternal notch (SN), posterolateral angle of acromion (PLA), and adjacent thoracic vertebral spine (TS) are found and marked. The distance between the CP and SN, and the distance between the PLA and TS are measured with tape to calculate scapular index using the formula (CP to SN)/(PLA to TS) *100.

Range of motion assessment The ability of the patient to move their shoulders and upper back through their complete range of motion will be assessed by the medical professionals to check if there are any restrictions or limitations.

Muscle strength testing Muscle strength testing are also utilised to evaluate RSP. The following tests can assess the strength of muscles:

Shoulder External Rotation Test With this test, the strength of external rotators of the shoulders are examined, including the infraspinatus and teres minor muscles. Patients are instructed to keep their forearms bent at right angles while holding their arms at their sides. Resistance will be applied on patients while the patient rotates their shoulders.

Scapular Retraction Test The middle and lower trapezius, which are responsible for retracting the scapula, are evaluated in this test. Patients are instructed to pose with their arms at the sides. Resistance is applied as the patients try to pinch their shoulder blades together.

Shoulder Abduction Test Deltoid muscle strength is measured by this test. Patients are instructed to lift the arm away from the body. Resistance is applied when the patients attempt to raise the arm during the test.

Palpation The examiner will feel the patient’s upper back and neck muscles with their hands to check the tightness, tension or abnormalities of muscles.

Imaging tests Imaging tests such as X-rays, CT scans and MRI scans are used to determine the cause and extent of RSP.

The examiner will be able to identify areas of weakness, and provide patients with a targeted exercise regime for treatment to improve RSP.

Treatment

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