Hermione Halman

Slouching – “To sit or stand in a drooping bearing”. Cambridge Dictionary (2019).

Slouching is something many, if not all of us experience. As an osteopath, it is important to understand why a patient presents with a certain posture. There are many reasons why someone might fall into a slouched position: muscle imbalance, pain, antalgic postures, deconditioning of supporting musculature, workspace compromise or habit in the subconscious, to name a few.

This post highlights and explains some of the effects slouching has on the musculoskeletal structures.

The following presentations are more often observed in patients who have a desk-based or seated jobs, such as office workers or drivers. These presentations can also occur independently for various reasons.

Figure 1 and 2- Illustrations demonstrating global differences between upright and slouched sitting postures (H Halman, 2019).

1. Forward head posture

Protraction in the cervical spine (neck) creates extension through the upper segments leading to shortening and tightness of the upper posterior cervical musculature. Forward head postures also create elongation or strain of anterior cervical muscles, lower posterior cervical, and upper thoracic (mid-back) musculature. These elements can lead to a couple of issues we see in the clinic.

A. Myofascial trigger points– Areas of tightness in the muscles that refer pain to different areas of the body- when located in the neck the pain refers to the head and down into the shoulder or arm.

B. Facet joint irritation – Irritation of the small joints in the spine, either the joint surface or ligamentous capsule being placed unusual strain.

C. Cervical or upper thoracic restriction – reduced segmental articulation through the spine, which may lead to discomfort.

D. Generalised muscle strain – lengthening and or tightness of the muscles also causing local pain and discomfort. (This can occur throughout the body).

E. Headaches– The above-listed components may contribute to headaches. These are usually caused by, facet strains and myofascial trigger points in the upper cervical muscles (cervicogenic headaches).

*I’ll do a further post on different types of headaches

2. Protraction of shoulders

When in a slouched position, shoulders commonly roll forward. This position shortens and tightens muscles in the front of the chest and can limited range of motion in the shoulders. Shoulder protraction can also impact the range of motion through the cervical and thoracic spine.

A. Thoracic Outlet Syndrome (TOS)– Pain and tightness around the lower anterior and posterior cervical spine, accompanied with pain traveling down into the arms and hands. Pins and needles, numbness, weakness in the hands and temperature changes may also be reported.

TOS is the compression of nerves (brachial plexus) and blood vessels (subclavian artery and vein) that travel between the clavicle (collar bone) and first rib to supply the arms and hands. Slouching predisposes patients to the development of TOS due to the following consequences. Tightness in the pectoral musculature (front of chest), raised first rib, hypertonicity (tightness) in scalenes (muscles in the front and side of the neck).

B. Periscapular muscle strain– When shoulders are held in a protracted position, the scapulae (shoulder blades) elevate and abduct (move away from the mid-line). The muscles surrounding the scapulae elongate or shorten often causing discomfort.

C. Scapula winging– Identified by a flaring of the shoulder blades. This can be caused by deconditioning and strain in the periscapular muscles.

3. Rounded thoracic spine (hyperkyphosis)

As a result of the head and shoulders protracting, gravity increases the natural curvature of the thoracic spine. This action limits several functions, as mentioned, restriction of the thoracic joints, shoulders as well as muscle and ligament compromise.

A. Restriction of ribs- The ribs attach to the thoracic vertebrae and sternum (breast bone). When in a flexed position, the range of motion at the costotransverse and sternocostal joints may be limited, creating discomfort with breathing, more so with inhalation.

B. Compression of the diaphragm– In an upright position, the ribs and diaphragm have optimal space to expand and contract, allowing efficient breathing cycles. With increased flexion through the spine, there is less space for the ribs to expand and compression of the diaphragm. This limits its ability to contract and relax for breathing.

*Both A and B can lead to breathing disorders, I will expand on breathing mechanics and disorders in a further post.

4. Reduced curvature of the lumbar spine (lower back)

In a slouched position the lumbar spine straightens, in comparison to its usually curved position. The curves in the spine allow optimal weight bearing throughout the body. Any changes in this may stress certain structures.

A. Annular strain/ lumbar disc prolapse- Prolonged flexion in the lumbar spine predisposes the intervertebral discs to strain and, or eventually lead to disc prolapse. There are many grades of prolapse severity and presentations seen in the clinic: asymptomatic, or localized pain in the lumbar spine. Others may involve nerve root irritation or impingement which can present as pain into the leg, pins and needles, numbness or weakness.

B. Sacroiliac irritation/ restriction– Slouching has an effect on the movement between the pelvis and the sacrum. When in a slumped seated position, the pelvis rolls into a posteriorised position (backward), if this is prolonged, one or both sacroiliac joints they can become restricted and uncomfortable due to muscle and ligament tension.

Your osteopath can help you address seated and standing postures, guide you with exercises to maintain treatment aims and reduce any work-related discomfort.

Take care,

Hermione