By Joshua Mayer, Rickey Blake and Sarah Hoover

Head is shifted 0.23” to the right

Right shoulder elevated

Shoulders are shifted 0.37” to the right

Right arm appears longer

Head is shifted 1.17” forward

Effectively making head weigh 29.7 lb

Shoulder’s protracted

Hips posteriorly tilted

Knees are shifted 2.80” forward

Forward head posture Increasing lordosis of cervical spine

Protracted shoulder girdle (right )

Pelvis is posteriorly rotatedDecreasing lordosis of lumbar spine

Upper Trapezius (right)

Levator Scapulae (right)

Pectoralis Major and Minor (right)

Hamstrings Pulling pelvis posteriorly

Janda’s Muscle Imbalance Upper Cross Syndrome

Neck flexors

Rhomboids

Serratus Anterior

Middle and lower trapezius

Iliopsoas

Janda’s Muscle Imbalance Upper Cross Syndrome

• Upper Trapezius is too tight

• Lower Trapezius and Serratus Anterior are over-stretched

• Poor upward rotation during shoulder flexion

• Upper Trapezius stretched

• Lower Trapezius and Serratus Anterior strengthened

• Healthy scapular ROM restored

Decrease lordosis of cervical spine

Retract and depress pectoral girdle (right)

Increase lordosis of lumbar spine (not too much!)

Restore more favorable center of gravity Decrease external forces

To stretch levator scapulae (and upper trap) Stabilize shoulder (hold

onto chair) Laterally flex the head to

the contralateral side (hold here to stretch upper trap)

Rotation of the neck (Look down like you are looking in your pocket)▪ Stretches levator scapulae

This would be beneficial because:

Stretching the upper trapezius and levator scapulae muscles will help to depress the resting position of the right shoulder back to normal

Stand in the center of an open doorway placing arm next to doorjamb

Step forward with ipsilateral leg and rotate to the contralateral side (in this case to the left, stretching the right shoulder)

Keep your hips facing forward while the shoulder is rotating back to maximize the stretch

This stretch will lengthen the tight pectoralis major and minor muscles

This will help to get rid of forward rolled shoulder Retract the resting right shoulder posture By stretching these overly tight shoulder muscles will

help to fix and further prevent a protracted, forward rolled shoulder

Lay FLAT on foam roller – support from head to tailbone Perform chin-tuck to

flatten neck against foam roller

Important to stabilize shoulder blades (retract & depress)

Arms OUT, palms UP

Chin-tuck helps to reverse forward head posture Also helps to strengthen overstretched neck

flexors

Light isometric contraction of overstretched rhomboids and middle trapezius to stabilize shoulders

Stretches tight pectoralis major and minor

To strengthen serratus anterior: Push up position – arms

straight and hands shoulder width apart

Go down until chest is a few inches off floor

Push back up, straighten arms, then push upper back toward ceiling.

This extra movement is minimal

Stabilize shoulders! DO NOT shrug shoulders toward ears

If unable to perform this exercise with good form, perform an easier version instead:

INCLINE Push-Up Plus

WALL Push-Up Plus (easiest)

Strengthening the serratus anterior will help to stabilize the scapula against the thorax, which will reduce winging of the scapula

The combination of stretching the upper trapezius (look-in-pocket stretch) and strengthening the serratus anterior will help restore proper functioning of the scapular upward rotation during shoulder abduction and flexion

Keep back straight, pull elbows back while squeezing shoulder blades down and together

Palms facing each other, exhale as you pull back keeping elbows close to torso

This rowing exercise mainly works the upper back muscles, specifically the middle trapezius and rhomboids

Doing this and other rowing exercises will help to strengthen those muscles to help stabilize (retract & depress) the scapula

Start with arms no higher than shoulders

Pull straight down to sides, squeezing shoulder blades down and together

This exercise will help to strengthen the overstretched middle and lower traps

Hamstring stretch andStrengthen iliopsoas

Decrease posterior pelvic tilt Increasing lordosis of lumbar spine

Stretching the hamstrings will also decrease knee flexion postural deviation

Help to bring knees closer to COG

Decrease lordosis of cervical spine

Retract and depress pectoral girdle (right)

Increase lordosis of lumbar spine (not too much!)

Restore more favorable center of gravity Decrease external forces

Still a slight forward head posture 0.74” forward shift

compared to 1.17” shift without brace

Making head weigh 23.9 lb. Compared to 29.7 lb without brace

Center of gravity closer to normal

Brace helps to retract and depress right shoulder

Hopefully, with time, doing these exercises will allow him to lose the brace and be able to maintain proper posture on his own

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