How upper back and shoulder posture influence each other and cause pain

10/27/2017

Continuing my series of blog posts about how the body works as a unit and how posture deviations in one area cause reactions throughout the body, today I'm going to focus on the relationship between the upper back and shoulders.

Here are the first three blog posts in this series:
Part 1: Introduction to how the body works as a unit
Part 2: Foot and leg posture
Part 3: Hip and spine posture

The upper back or thoracic spine is intimately related with the shoulder complex including the scapula, clavicle, and humerus and any injury or pain symptom in this area can only be effectively treated by looking at the entire upper body as a unit.

Basic anatomy lesson

In order to understand the relationship between the upper back and shoulder and how dysfunctional relationships cause pain and injury, let's start with a simple anatomy lesson. We each have 12 thoracic vertebrae (named T1 through T12) and each thoracic vertebrae has a rib attached to it (numbered to match the associated vertebrae). The shoulder joint is made of of three bones, the humerus (upper arm bone), the clavicle (collarbone), and scapula (shoulder blade).

Back view of the thoracic spine, ribs, and scapula.

Front view of the shoulder complex of the scapula, clavicle, and humerus.

Does spinal posture affect shoulder position?

The position of the thoracic spine (the degree of flexion) has a direct effect on the position and function of the shoulder complex. Increased thoracic flexion will cause the scapula to abduct and tilt forward (which changes the position of the glenoid fossa) and compresses and depresses the clavicle (causing compression of the acromioclavicular (AC) joint). These changes combined put the entire shoulder complex and shoulder joint into a less efficient position and one that can cause rotator cuff impingement, bicep tendon injury, thoracic outlet syndrome, tendonitis, bursitis, frozen shoulder, and osteoarthritis.

This image shows the major nerves and blood vessels that run through and around the shoulder joint. You can easily understand how any change in the position or movement of any of these bones has the potential to compress, pinch, or otherwise impede normal function of these nerves or blood vessels. The shoulder is designed perfectly and is a very resilient joint, but it must be kept in good postural alignment and maintain normal range of motion to continue to work pain free.

How shoulder range of motion is affected by spinal posture.

Increased thoracic flexion or thoracic kyphosis changes the position of the scapula and clavicle and puts them in a position where they cannot go through their normal range of motion which decreases arm range of motion and increases stress on the tissues of the shoulder joint.

The imagine on the left shows normal thoracic flexion which allows the scapula, clavicle, and humerus to move through a normal range of motion. The image on the right shows increased thoracic flexion or thoracic kyphosis which limits the ability for the scapula, clavicle, and humerus to move through a normal or full range of motion.

Thoracic kyphosis not only decreases range of motion but also increases stress on the tissues of the shoulder joint leading to injury and pain over time or with repeated use.

As the shoulder joint flexes the scapula has to rotate to allow smooth pain free movement. Thoracic kyphosis limits the rotational ability of the scapula and causes increased stress on the rotator cuff increasing the chance of tendonitis, bursitis, and tears.

During normal shoulder flexion the clavicle tilts to allow normal joint mechanics. Thoracic kyphosis decreases the ability for the clavicle to tilt freely and this can cause AC joint impingement, rotator cuff impingement, and frozen shoulder.

Does shoulder posture affect spinal position?

Just as upper back posture will affect shoulder posture and function the opposite is also true. If your shoulder rounds forward that will automatically change scapular tilt which then changes thoracic spine position.

Forward rounded shoulders tilt the scapula and then that causes the thoracic spine to change position.

Rounded shoulders will turn normal thoracic spine posture into excessive thoracic flexion or thoracic kyphosis.

What happens if one shoulder rounds forward more than the other shoulder?

Great question! When one shoulder rounds forward more than the other shoulder, one scapula will move into a different position than the other scapula, and this pulls unilaterally on the thoracic spine. The thoracic spine will usually start to rotate but also can laterally flex because of the shoulder imbalance.

Her right shoulder is less rounded forward than her left.

Her left shoulder is more rounded forward than her right shoulder.

The increased right shoulder rounding has caused her thoracic spine and torso to rotate left side forward.

As the left shoulder rounds forward it changes the position of the glenoid fossa tilting the joint surface forward and in. This change in the glenoid fossa position means the head of the humerus has to rotate to still fit in the joint correctly. This causes the entire arm to internally rotate as seen above.

Scoliosis is an example of the relationship between the thoracic spine posture and shoulder posture and what happens when the body does something much different on one side of the body than the other. Scoliosis can be caused when one shoulder is positioned much differently than the other shoulder and this imbalance causes the spine to rotate that starts the whole cascade of imbalance. Scoliosis can also be started by a spinal rotation that throws one shoulder into a much different position than the other shoulder. The third main cause of scoliosis is a pelvic or hip imbalance that causes the spine to rotate as I talked about in the earlier article about how hip and spine posture influence each other and cause pain.

The great thing in any case of scoliosis is that you can balance out the posture of the hips, spine, and shoulders with specific posture exercises that target the underlying imbalances and restore symmetry. The key to becoming pain free is looking at the body as a unit and remembering that the human body is a stimulus response organism and can heal itself.

8 Comments

kim

11/4/2017 03:10:48 pm

Awesome info as always. Do you address the posture/body the same (ie prescribe same E-cises) whether the persons shoulder rounds forward due to muscular imbalance, as opposed to structural damage causing the rounding (ie broken clavicle healing in an overlapped position) ?

Doesn't structural 'damage' now dictate a new compensation that needs to be considered?

Much appreciated :-)

Matt Whitehead link

11/6/2017 12:47:07 pm

Thanks Kim, I'm glad you found this info useful.

Yes, posture imbalance is treated differently depending on if it is functional or structural. Structural imbalances or limitations do create dysfunction that often can't be changed with exercise therapy and the goal of the therapy in these cases is mitigating the compensation that arises from the structural imbalance.

All structural imbalances (spinal fusion, actual leg length difference, ankle fusion, torn ACL, torn rotator cuff muscle, clavicle that doesn't heal correctly as you said) will lead to compensation and the compensation is often what causes wear & tear, injury, and pain, not the original structural imbalance.

Of course some "structural" imbalances can be improved or corrected over time with appropriate exercise therapy like spondylolisthesis, scoliosis, valgus/varus knees, Dowager's hump, pes planus, etc.

David

7/23/2018 07:09:59 am

thanks for this article, i think this can help me!
"if one shoulder rounds forward more than the other shoulder"
how can i get rid of this?

5/5/2019 10:33:50 am

You say The great thing in any case of scoliosis is that you can balance out the posture of the hips, spine, and shoulders with specific posture exercises that target the underlying imbalances and restore symmetry. My right shoulder is more internally rotated and I have right thoracic scoliosis (and kyphosis) and my right back hurts very bad. How can I correct this?

Matt Whitehead link

5/10/2019 04:23:26 pm

Hi KF, I think your right shoulder position has a lot to do with the right thoracic scoliosis but also think about what your left shoulder is doing or not doing. The imbalance between your shoulders and shoulder blades is playing a big role in your spinal position and getting them balanced will help your spinal posture improve. If you'd like, I'd be happy to give you a free posture evaluation to see exactly what is going on throughout your body.

Michael Treloar link

11/12/2019 07:02:57 am

the facts have been discussed is really important. Thank you so much for sharing a great post.

JoAnn Marucci link

1/19/2022 09:32:12 am

If you have a damaged shoulder , will your Thoriac spine compensate ? How do you know if the Thoriac spine is compensating for the Shoulder or if the the spine is compensating for the shoulder? I had shoulder surgery years ago, I was left in bad pain. in shoulder, I also have neck pain which is on the side of my affected left shoulder. I later developed Kyphosis and some pain in the spine, Is my spine compensating for my shoulder? I have been to Neurosurgeons who said that my shouldr is the problem . Orthopedics have sent me to Neurosurgeons. I recently went to Shoulder specialist at a major hospital. He wants to do surgery, . He says I need new shoulder but my range of motion is still good. . He wants to do a debridement , and possible capsular release and clean out scar tissue, I supposedly had frozen shoulder after surgery., I need to know if My spine is causing shoulder problems or vice versa. Before shoulder surgery, I had no back issues, After surgery I have problems , Could lack of treatment for my shoulder have caused my Kyphosis? Do not want to undergo surgery for nothing. .

Matt Whitehead link

4/21/2022 11:42:56 am

Hi JoAnn, Great questions. I would be happy to do a free posture evaluation/consultation with you and we can look at your body and help figure out what is happening and why and how you can fix it. Email me to request a free evaluation.