It's fashionable nowadays to diagnose everyone with "dysfunctional" posture, movement and so on. My PT school courses spent a lot of time having us critique one another's posture, and a host of obscure and corrective exercises and stretches and foam rolling and so on then got prescribed. Physiotherapists are also fond of this stuff, and at $150 a session I don't blame them. "Here is one exercise, come in next week and I'll give you a second exercise."
Most of this is not very useful; it's certainly not harmful, but doesn't seem to do much. People do these little exercises for months, and they still look like Quasimodo and have sore backs. What I prescribe is to get stronger. Train movements, and the muscles will follow. Correct movement is the best corrective. .
In short: someone with postural issues gets mostly the same exercises as someone without it, except they'll get one or two more exercises and stretches to address their particular muscle imbalances. The general exercises are squat, push, pull and hip hinge. As correctives, side braces are common, as is one-legged work. Everyone needs to do their exercises with the best posture they can manage, someone with a back condition just needs to be more conscious of it.
The exercises are not necessarily barbell ones. But everyone needs to do these basic movements correctly to function usefully in everyday life: compound exercises with good posture and bracing.
Long version:
The exercises are not necessarily barbell ones. But everyone needs to do these basic movements correctly to function usefully in everyday life: compound exercises with good posture and bracing.
Long version:
In this I focus on scoliosis, because it is a condition I have, and while rarer than other postural issues, it has the most severe effects on quality of life.
What you have to realise is that many chronic health conditions are effectively just what everyone has from time to time, the difference is how severe it is and that it's long-lasting, and as I note in weakness and dysfunction, often people's ordinary weakness will be worse than a diagnosed medical issue or disability; consider Colin in The Secret Garden. Chronic conditions are really nothing special, the person is not some delicate invalid who needs to lie in bed all day with medication being walked around quietly and talked to in a soft voice and given endless cups of tea. They just have a severe and long-lasting version of stuff that happens to everyone.
For example, anyone can get light-headed if they've had little sleep and not eaten or drunk anything before their workout, but someone with low blood pressure is going to be light-headed more often and more predictably, in both cases we adjust diet and exercises to suit.
Anyone could have a day where one arm is tired or bruised or sore and can't be worked, but someone who's an amputee is without use of that arm every day. In both cases, we adjust the workout to suit.
As to scoliosis, almost everyone has some postural issues. The body doesn't just adapt to what we do in the gym, but what we do day-to-day as well. Commonly we see increased thoracic kyphosis, elevated scapulae and increased lumbar lordosis, with restricted range of motion in the right shoulder and a stiff leftside back. That's a fancy way of saying that people who sit hunched over desks holding a mouse all day tend to get stuck that way. That's our seated lifestyle, they have muscle imbalances.
So their lower back muscles, their chest muscles, the muscles at the tops of their thighs, these get short and tight; their upper back muscles, glutes and hamstrings are relatively weak. This leads to soreness and stiffness, which makes physical activity harder, which means the person is more likely to get overweight, and because they're overweight moving their body is harder, which makes them more overweight, and then their back and knees hurt because they're hauling extra weight around all day like a soldier in the field, and before you know it they're spending $1,000 a month at Jim-Quack Holistic Reiki Aromatherpeutic Naturopathy and getting a knee replacement at 50. This is less than ideal.
The solution is to strengthen the weak muscles, and stretch the short and tight ones. Now, what routines do I give normally? The same as everyone else: squat, push, pull and hip hinge. Everyone gets to do a deep knee-bend, a deep hip-bend, to pick something heavy up off the ground and put something heavy overhead. Everyone has to do this with good posture and bracing.
As personal trainers or coaches, our job is to teach correct movement. Part of this is posture. When doing a squat, someone might hunch over and bring their knees together - everyone must keep their chest up to straighten their spine, and put their knees out. When doing a cable row, the person might hunch their shoulders - so we teach them to bring their shoulders down and back while keeping their chest up. If the person can do it while pulling 40kg, they can do it just standing around. Their weak upper back muscles become stronger, their tight neck muscles get stretched out. Having a good posture under load lets them have a good posture without a load.
Now, the typical hunched over desk worker, or the person who's a bit twisted to one side because they've done years of rowing, in this case the issues are purely muscular, or in technical terms, "functional." That is, the person's muscles have adapted to the stuff they do day-to-day - well, they can adapt to what they do in the gym, too. So the imbalances can be completely resolved.
However, some postural issues are not functional but structural. It's not just the way the person is sitting or carrying their bags or the sport they do, it's how their spine is structured. Put another way, in a functional issue the muscles are pulling the bones out of position, in a structural issue the bones are pulling the muscles out of position. We can resolve functional issues, but only mitigate structural issues.
Moderate and severe cases of scoliosis are typically structural. The spine is just built wonky. We can't resolve them by exercise. However, though we cannot resolve the muscle imbalances, we can mitigate them. We can't fix things up, but we can make them not so bad. As well, if the person is physically inactive, they will tend to lean to one side, and of course those muscles will get stronger and tighter - they're supporting the person's weight all day every day. And the other side's muscles get weaker because they're not being used. The short and tight muscles protest this by spasming and causing the person pain. Time for drugs.
If the person squats, pushes, hinges and pulls and uses the best posture they can manage, then the weaker side gets some work and the imbalance is mitigated. After hours in the gym being told "chest up! weight through heels! brace your abs! shoulders down and back, crush my fingers between your shoulderblades! push evenly with both feet/hands! you're leaning forward/sideways, stay straight!" and doing it with weight on them, doing it outside the gym becomes second nature.
Of course if the postural issue is big enough, the person may need specific exercises. Side braces are good for light and moderate scoliosis both functional and structural. And there are a host of others like clamshells, theraband side walks and so on, depending on the individual's particular issues. Lots of postural muscle stuff - or "core", as it's called nowadays, which is a word I hate because as Dan John says, the body is one piece.
It's important to remember that the "core" muscles are simply the postural muscles, the muscles that let us stand up straight without pain. Every exercise can be, is and should be a "core" exercise.. As I said earlier, the person who can squat with a straight back and 40kg on them will have a stronger "core" and better posture than the person who cannot.
Thus in general, the person with scoliosis - or increased thoracic kyphosis, or increased lumbar lordosis, or whatever - gets the same squat, push, hinge and pull exercises as someone without. Most people have to worry about their posture in the front-back direction, the person with scoliosis has to worry about it left-right, too. Lots of people will round their back when squatting or deadlifting, the person with scoliosis will lean to one side, too. In both cases the solution is to stand up as straight as possible.
For example, anyone can get light-headed if they've had little sleep and not eaten or drunk anything before their workout, but someone with low blood pressure is going to be light-headed more often and more predictably, in both cases we adjust diet and exercises to suit.
Anyone could have a day where one arm is tired or bruised or sore and can't be worked, but someone who's an amputee is without use of that arm every day. In both cases, we adjust the workout to suit.
As to scoliosis, almost everyone has some postural issues. The body doesn't just adapt to what we do in the gym, but what we do day-to-day as well. Commonly we see increased thoracic kyphosis, elevated scapulae and increased lumbar lordosis, with restricted range of motion in the right shoulder and a stiff leftside back. That's a fancy way of saying that people who sit hunched over desks holding a mouse all day tend to get stuck that way. That's our seated lifestyle, they have muscle imbalances.
So their lower back muscles, their chest muscles, the muscles at the tops of their thighs, these get short and tight; their upper back muscles, glutes and hamstrings are relatively weak. This leads to soreness and stiffness, which makes physical activity harder, which means the person is more likely to get overweight, and because they're overweight moving their body is harder, which makes them more overweight, and then their back and knees hurt because they're hauling extra weight around all day like a soldier in the field, and before you know it they're spending $1,000 a month at Jim-Quack Holistic Reiki Aromatherpeutic Naturopathy and getting a knee replacement at 50. This is less than ideal.
The solution is to strengthen the weak muscles, and stretch the short and tight ones. Now, what routines do I give normally? The same as everyone else: squat, push, pull and hip hinge. Everyone gets to do a deep knee-bend, a deep hip-bend, to pick something heavy up off the ground and put something heavy overhead. Everyone has to do this with good posture and bracing.
As personal trainers or coaches, our job is to teach correct movement. Part of this is posture. When doing a squat, someone might hunch over and bring their knees together - everyone must keep their chest up to straighten their spine, and put their knees out. When doing a cable row, the person might hunch their shoulders - so we teach them to bring their shoulders down and back while keeping their chest up. If the person can do it while pulling 40kg, they can do it just standing around. Their weak upper back muscles become stronger, their tight neck muscles get stretched out. Having a good posture under load lets them have a good posture without a load.
Now, the typical hunched over desk worker, or the person who's a bit twisted to one side because they've done years of rowing, in this case the issues are purely muscular, or in technical terms, "functional." That is, the person's muscles have adapted to the stuff they do day-to-day - well, they can adapt to what they do in the gym, too. So the imbalances can be completely resolved.
However, some postural issues are not functional but structural. It's not just the way the person is sitting or carrying their bags or the sport they do, it's how their spine is structured. Put another way, in a functional issue the muscles are pulling the bones out of position, in a structural issue the bones are pulling the muscles out of position. We can resolve functional issues, but only mitigate structural issues.
Moderate and severe cases of scoliosis are typically structural. The spine is just built wonky. We can't resolve them by exercise. However, though we cannot resolve the muscle imbalances, we can mitigate them. We can't fix things up, but we can make them not so bad. As well, if the person is physically inactive, they will tend to lean to one side, and of course those muscles will get stronger and tighter - they're supporting the person's weight all day every day. And the other side's muscles get weaker because they're not being used. The short and tight muscles protest this by spasming and causing the person pain. Time for drugs.
If the person squats, pushes, hinges and pulls and uses the best posture they can manage, then the weaker side gets some work and the imbalance is mitigated. After hours in the gym being told "chest up! weight through heels! brace your abs! shoulders down and back, crush my fingers between your shoulderblades! push evenly with both feet/hands! you're leaning forward/sideways, stay straight!" and doing it with weight on them, doing it outside the gym becomes second nature.
Of course if the postural issue is big enough, the person may need specific exercises. Side braces are good for light and moderate scoliosis both functional and structural. And there are a host of others like clamshells, theraband side walks and so on, depending on the individual's particular issues. Lots of postural muscle stuff - or "core", as it's called nowadays, which is a word I hate because as Dan John says, the body is one piece.
It's important to remember that the "core" muscles are simply the postural muscles, the muscles that let us stand up straight without pain. Every exercise can be, is and should be a "core" exercise.. As I said earlier, the person who can squat with a straight back and 40kg on them will have a stronger "core" and better posture than the person who cannot.
Thus in general, the person with scoliosis - or increased thoracic kyphosis, or increased lumbar lordosis, or whatever - gets the same squat, push, hinge and pull exercises as someone without. Most people have to worry about their posture in the front-back direction, the person with scoliosis has to worry about it left-right, too. Lots of people will round their back when squatting or deadlifting, the person with scoliosis will lean to one side, too. In both cases the solution is to stand up as straight as possible.
What I find is that while everyone has imbalances, after a few weeks or months of doing correct squats, pushes, pulls and hip hinges, a lot of the imbalances shake themselves out, or are at least strongly mitigated. Absent an acute medical issue like sprained vertebral ligaments or herniated disc, the long-term back pain the person had is greatly reduced or disappears after 3-4 weeks, they usually wait another 2-4 weeks before telling me about it, since when it's just a week or so it might just be a fluke. In other words, getting stronger in the basic movements helps a lot.
Note that past about 30 years old, very few people change the appearance of their posture. If you were hunched over or twisted to one side for those three or more decades, you'll probably always be. It'll be reduced a bit with exercise but basically that's the way you are now. The ligaments holding the bones together have stretched out, and as anyone who's had a bad sprain knows, that's that, they're loose forever. But the pain and hindered movement can be removed or greatly mitigated. And you can certainly stop it getting worse, which it would if you did nothing.
Given time and practice, everyone will get stronger and can increase their range of motion in exercises. Someone with a back or other condition will just take a bit longer to do it. A trainer's job is to teach correct movement, which is why we can't get bored with the basics. Correct movement is the best corrective.
Note that past about 30 years old, very few people change the appearance of their posture. If you were hunched over or twisted to one side for those three or more decades, you'll probably always be. It'll be reduced a bit with exercise but basically that's the way you are now. The ligaments holding the bones together have stretched out, and as anyone who's had a bad sprain knows, that's that, they're loose forever. But the pain and hindered movement can be removed or greatly mitigated. And you can certainly stop it getting worse, which it would if you did nothing.
Given time and practice, everyone will get stronger and can increase their range of motion in exercises. Someone with a back or other condition will just take a bit longer to do it. A trainer's job is to teach correct movement, which is why we can't get bored with the basics. Correct movement is the best corrective.
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