Rounded Shoulders or Flat T-spine?

Hi guys, I’m Mai-Linh Dovan, Certified Athletic Therapist and Founder of Rehab-U Movement and Performance Therapy. 

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In this week’s video, we’re going to talk about rounded shoulders. 

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I’m going to tell you a little story about rounded shoulders. A recent client of mine motivated me  to do this video about rounded shoulders. Unfortunately, I don’t have him here with me, but fortunately, I have Carolane who’s likely going to get more views than my client. 

Carolane is also one of our therapists at Rehab-u here at Missfit Laval. So if you ever have a little problem, make sure you come see her. 

All right, so the story I want to talk about, about rounded shoulders is, and it’s a bit like when you hear me talk about how we get into kind of cues, and we get into things that we see and and we kind of have a tunnel vision of what we need to do for this thing that we’re seeing, that’s kind of a story with rounded shoulders where you know you’ll see someone with rounded shoulders or people with rounded shoulders are going to say, well how would I correct my posture and they get told that it’s about a rounded back that they need to straighten up their posture. 

But some people have rounded shoulders, but actually have a flat T-spine. Okay. So it isn’t the case with Carolane she is not, well, she’s kind of flat. She doesn’t have the winging and all of that, but sometimes people will have a shoulder that’s rounded but a T-spine that’s really flat. And what are the cues that these people are getting, they’re getting cues like squeeze your shoulder blades to clean up your posture. This particular client of mine, what he had been told was imagine there’s a little string pulling the top of your chest up. 

Now, here’s the thing about a flat t-spine. A flat t-spine is already in a lot of extension and it tends to be like a rigid stick. So if you’re driving them into more extension and telling them to bring their chest up they’re likely jamming those facet joints closed. This particular client of mine would complain about pain between the shoulder blades,  pain in the upper back, which likely may have been because of that miscue he was getting and he said to me, no matter how much I try to bring my chest up, it really wouldn’t bring my shoulders back. My shoulders were still forward. 

And the reason for that is that a flat T spine is a really poor foundation for the scapula to move on. So, typically what you’ll see with people who have a very flat t-spine, is, you’ll see scapula that are winging. So they’re internally rotated and typically, they’re also anterior tilted. And what that does is it brings the glenoid facing anteriorly and that’s why the shoulders are rounded. No matter how much they try to bring their chest up and bring their T-spine into extension, that’s not going to change that plane of the scapula. Okay? Now it’s also classic for people with those flat T-spine, and winging scapula, to kind of have pain in that mid upper back area. And in my experience, they’ll often get pain with things like, carrying a heavy backpack or carrying a purse, like a heavy purse on one shoulder.  In the case of my client, he’s a firefighter, so what would really trigger his pain is if it he was out long with the equipment on and all that pressure on his shoulders 

That being said with a flat T spine and and rounded shoulders, AKA scapulae that are winging, that are anterior tilted and bringing that joint forward, what we really want to do, there’s a couple of things we want to do. We want to get them into some flexion. Remember they’re flat and that’s rigid and it’s not going to be a good foundation for the scapula to move on. So we want to give them some flexion because that will usually relieve a lot of their pain and tension, and then the second thing we want to do is we want to get that scapula moving on that flexed spine. 

Okay, so we’re going to look into what we can do to get them into some flexion and then what we can do to get the scapula moving on to that flexed T-spine.  So one of the things that are really effective for getting the T-spine into flexion, getting some mobility in that rigid stick,  that flat T-spine is using breathing.  And you’ve heard me talk about breathing as being the most powerful tool for mobilization. If you haven’t seen that video, check it out on our channel. 

All right, so here we’re going to go into quadruped breathing but we’re going to bias flexion, so she’s going to get into a quadruped position and then she’s going to get into a flexed position and she’s going to push the ground away. She gets nice flexion and she breathes from this position. So as she inhales, she wants to maintain that flexion and especially as she exhales, because naturally as she exhales is going to pull that rib cage down. So you can focus on getting even more flexion. So breathing in this position breathing through the nose. Five-second, inhale, 5 second, exhale, and maintaining that flexion bias.  

This is going to be really relieving for those people you find who are flat T-spine, winging scapula, and complain to you about pain and tension between the shoulder blades or rhomboids area, that kind of stuff. 

I typically program for at least three minutes, that would be optimal for me. Now again, if you’re programming this at the beginning of a warm up, or something like that, and you’re concerned about time, then 2 minutes is a good compromise, but it’s pretty much the minimum that I would give.  In my ideal world, it would be at least three minutes. 

Another really great exercise to bias some flexion is a quadruped reach through. So, when we think about thoracic mobility and thoracic rotation mobility, when we want to get movement in the T-spine, we’re off and doing rotation extension stuff, think about going into rotation and extension. But because the client I was referring to is a flatter T-spine, we want to get some flexion rotation instead, so we’re going to use quad reach through where she can really focus on getting that rotation element. She’s getting that movement element. She can bias into flexion and she’s reaching through. So she’s getting flexion-rotation as opposed to the classic extension-rotation exercises that we typically will go to for thoracic mobility. So again opening up those facet joints and relieving that tension from that flat rigid T-spine.  Another exercise that you can do for time, I would stick this in a mobilization sequence and go for about 1 minute on each side. 

So the second thing we want to do after we got that flexion is we want a couple that flexion with scapular movement. So again we’re going to go to our quad position or oour quadruped position, and now we’re going to do quadruped rock backs with a flexion bias and protraction. So, what we’re trying to do is we’re trying to get the scapula to come up and around that rib cage up and around that flexed T-spine. So Carolane is pushing the ground away, getting protraction, and then she’s not just dropping her hips towards her heels,  she’s actually pushing with that hand on the ground to push herself away, to push herself back. So really getting that serratus activation, getting that protraction, and then as she pushes away and that arm is coming over head, that scap is moving up and around the rib cage. 

Now, couple ways you could do this, I really like the reset on each rep. So she really gets a feeling for that, and then as she gets comfortable with it, she could maintain her position and rock back and forth. This again is an exercise that I might do for time or for reps. 

Another great exercise: forearm wall slides. So again here, we’ve got a soccer ball. You could have a yoga block, something that allows her to reach a little bit with the elbows, so she’s getting a little bit of that roundedness and then she’s going to slide the arms up and out and again, we’re getting that scapula to come up and around the rib cage to keep the forearms on the wall and then back down. 

So the bigger the object in front, the more rounded you’ll be here in the T spine, so you could do even more than this. And then slide the forearms.  It is going to limit how high she can lift her forearms, but it’s really going to get her into that flexed position and then the scapula moving around that rib cage. 

So there you have it guys, remember that just because you see rounded shoulders doesn’t mean that the upper back is round and that people need to lift the chest up and clean up their posture. Sometimes they’ll have a very flat T-spine and having them try to bring the chest up is really going to irritate them. So remember that for a flat rigid T-spine, we need to work on flexion and then we need to work on the scapula to come up and around. 

And then there are other exercises which you can find again on our channel to come and work on that scapula staying close to the rib cage and doing its posterior tilt. 

So hopefully that helps you deal with the next client who comes to you with the rounded shoulders problem and the pain potentially related to that. 

And on that note will see you next week!

Mai-Linh Dovan M.SC., CAT(C)
Certified Athletic Therapist
Founder of Rehab-U