“My middle back is tense and hurts almost all the time,” said the young man slumped in my office chair. “I’d like you to show me how to stretch it out.” He was quite surprised when I told him his back needed to be strengthened, not stretched, and he needed to stretch his front body, not his back.
I see an epidemic of slumping all around me, and it contributes not only to problems in yoga poses but also to back pain and other significant medical problems. Happily, you can use a well-balanced yoga practice to help correct the muscle imbalances that cause you to slump, at the same time relieving midback pain and creating a beautiful, upright posture.
The muscle imbalance that causes slumping may begin to develop early in life, when as children we have to round the spine to reach the back of a chair. Eventually, the muscles of the front body become short and tight and the muscles of the back body become weak and overstretched, causing the spine to curve backward and the head to poke forward. This slump of the midback—the thoracic spine—is called a kyphosis.
The thoracic spine is prone to excessive kyphosis for several reasons. First, a normal thoracic spine has a mild amount of backward curve, which balances the normal forward curves of the lower back and neck. Second, the rib cage tends to limit the mobility of the thoracic spine. The 12 ribs attach to the 12 thoracic vertebrae in back and to the breastbone in front, forming a protective cage around vital organs. But when the thoracic spine begins to curve excessively, the rib cage’s natural tendency to immobility can result in a “stuck” midback.
The third reason for excessive kyphosis is our everyday movement and sitting habits. If you spend a lot of time with your head and arms forward, the natural curve in the thoracic spine will increase. And if you sit slumped, your weight hangs on the ligaments of the spine. The back muscles are in a lengthened position and not engaged; eventually, they become weak and overstretched and lose their ability to hold us in an upright position. As the back muscles weaken, the soft tissues of the front body—including the front spine ligaments, the tiny muscles between the ribs (intercostals), and the abdominal muscles—begin to shorten. Shortening of the abdominals can be exacerbated by a fitness regimen that overemphasizes abdominal strengthening exercises, like crunches, without balancing them with back-strengthening exercises.
While bad posture habits can cause a mild to moderate kyphosis to develop, more severe kyphosis can indicate significant medical problems that require expert professional attention. Conditions such as osteoporosis, extreme scoliosis (spinal curvature), and ankylosing spondylitis, a painful form of rheumatoid arthritis that attacks the spine, can cause severe and painful kyphosis. If you have one or more of these conditions, the careful, therapeutic application of yoga asanas can help, but it would be a good idea to get advice from a medical expert and an experienced yoga teacher first.
The Cost of Slumping
Once established, hyperkyphosis contributes to a variety of health problems. As the kyphosis increases, the head migrates forward, causing chronic neck tension. Increased kyphosis can also limit our ability to breathe freely. The collapsing chest compresses the diaphragm at the base of the rib cage, and the tightness of the intercostals restricts the lungs’ ability to expand. This limitation is a liability in daily life as well as in any yoga practice, especially pranayama, but it is even more troubling for anyone with a lung problem such as asthma or chronic obstructive lung disease.
While the severe kyphosis associated with diseases like osteoporosis, scoliosis, and ankylosing spondylitis can cause severe health problems, as well as significantly limit overall mobility, even mild to moderate postural kyphosis can get in the way in yoga. It’s especially problematic in backbending poses, when the whole spine should share in the curve. If the thoracic spine is stuck in a forward bend, then the lower back and neck, which are naturally more flexible in backbending, tend to overwork. The resulting localized excessive backbending, or hyperextension, contributes to compression and pain in the lower back and neck.
Because of the decreased mobility of the rib cage associated with increased kyphosis, the ability of the spine to twist can also be restricted. Limited rotation can cause difficulty in most standing poses but is especially problematic in pronounced twists like Parivrtta Trikonasana (Revolved Triangle Pose) and the many seated twists.
The Slumping Antidote
A well-rounded yoga practice will gradually reduce excessive kyphosis, but you might like to include some poses in your practice that will hasten the process. The most valuable poses to include are supported backbends, which stretch out shortened chest and abdominal muscles and the front spine ligaments. In all these poses, it’s important to focus the stretch on the thoracic spine, or midback, stabilizing the lumbar and cervical regions so they don’t overwork and hyperextend.
To focus a proper stretch on the thoracic spine, lie on your back on the floor with a rolled blanket under the midback, just below the shoulder blades but not as low as the lower ribs. To stretch the pectoral muscles, open your arms to the sides, creating 90-degree angles at the elbows and shoulders. Alternately, you can sit on the floor with the edge of a chair seat pressing into your midback, and then lean back. Let your head move toward the back of the chair, but be sure to support your head with firm pillows or your hands so you don’t hyperextend your neck.
In both of these positions, keep your knees bent so that you don’t over-arch your lower back. Hold each of the supported backbends for two to five minutes and be sure that you can breathe normally. Some studies have shown that longer stretches, at least one-and-a-half to two minutes, are the most effective way to stretch connective tissue. If you can’t breathe or you’re in pain, you won’t last more than a few seconds in these important poses.
Now that you’ve stretched the front body, it’s time to strengthen the back body. The muscles that hold us upright are called, appropriately, the erector spinae. They are the large muscles that lie on each side of the spine and extend from the pelvis to the upper back. When they contract, they pull the spine from a forward bend to a backbend.
Salabhasana (Locust Pose) is a simple exercise that strengthens the erector spinae. Lie face down on the floor with your arms by your sides. Lift your nose and breastbone three to four inches from the floor: You are now using the erector spinae to raise the weight of your head and chest. Keep your pubic bone pressed into the floor to protect your lower back from overarching. To further guard against lower back discomfort, it’s best not to lift your head higher than a few inches from the floor. Protect your neck from hyperextension by keeping your gaze on the floor rather than on the wall in front of you. Over time, build your endurance so you can hold the pose for 30 seconds and repeat it three or four times.
Now it’s time to integrate your kyphosis awareness into the rest of your practice. Standing in Tadasana (Mountain Pose), feel your legs extending down into the earth and your spine lengthening up into the heavens. Remember where the rolled blanket or edge of the chair seat pressed into your midback, and lift up from there. Feel your breastbone lifting up and space opening in the upper lobes of your lungs. That lift will engage the erector spinae so that you feel vitality, not hardness, in the midback muscles.
Practice your new kyphosis awareness several times throughout the day, at home, at work, and in your yoga practice. If you find yourself constantly slumped down in your chair, perhaps it’s time for a new one. Can you keep your chest open in your yoga poses? Be especially careful with forward bends, as it’s easy to collapse into an excessive kyphosis. Learn to pause for a moment as you begin each pose, to feel the vitality of the support muscles of your back, the spaciousness of your lungs, and the openness of your heart. Over time, this practice of opening your heart will contribute not only to changing your posture but also to the development of compassion. In just this way, the physical practice of asana changes our outlook on the world and the way we interact with other beings.
Extra: For a simple sequence to promote better posture, see Don’t Be a Slouch.