Posture & Pain; Neck, Upper Back and Shoulders

We are often told that rounded shoulders are bad posture and the reason for shoulder pain.

We are often told that rounded shoulders are bad posture and the reason for shoulder pain.

Rounded shoulders are one key feature of the postural pattern clinicians will sometimes refer to as 'upper cross syndrome'.

Once the above observations have been made (upper cross pattern), correcting these 'postures' is often the target of therapy to alleviate a host of complaints including neck, upper back and shoulder pain. 

The really interesting thing however is just how common these faulty postures occur in people who don't have pain. Researchers have also been unable to find any evidence that these muscle imbalances were in anyway causative for shoulder impingement2. Another study assessed whether these postures had any effect on repetitive strain injuries at the shoulder. There was no difference in shoulder or shoulder blade posture between those that got an injury and those that did not3.

Similar finsings were observed in a 2016 systematic review regarding the effect of a 'hunched' upper back. This posture we intuitively tell people to avoid by 'standing up straight' is certainly good advice for increasing our overhead shoulder range of movement. While this is important perhaps regarding training, the hunched posture itself is seen just as commonly in people without pain as those with pain, questioning its role as a potential cause4.

We are often told that a forward head position and arched neck are the reason for our neck pain.

We are often told that a forward head position and arched neck are the reason for our neck pain.

Forward head position and an arched neck (as seen above) have also been identified as a faulty posture and part of upper cross syndrome.

If this posture is truly a cause of neck pain then it would be fair advice to avoid these postures. To test this premise researchers compared 54 people with neck pain and 53 without. They measured the curvature of the spine to see if those with pain had more of an 'arched' neck. On average, the angle for those suffering neck pain was 6.5 degrees compared to 6.3 in those without - in other words the neck posture was nearly identical whether we are talking about the group who has pain or those who don't5.


The important takeaway from this article is that postural variations of the upper back, shoulder and neck are a completely normal part of being human and do not seem to be a problem in and of them selves with regards to causing injury or pain. Furthermore, studies have shown that efforts to 'correct' or improve these postures with corrective exercise or correct postures have proven fruitless. For example even though shoulder pain may improve after a course of care, the resting posture of the shoulder blade did not change or correlate with the improvement in symptoms6.

Your best posture is your next posture. Keep on moving
— Luke R. Davies

Data is also lacking in demonstrating strengthening exercises for successfully changing posture. It is likely that any conscious position or intervention would be of unsufficient duration or frequency to actually change postions in every day lives7.

Pain is a complicated phenomenon and it seems clear that to suggest any one posture is causing your pain is inaccurate. Whilst slouching may not look particularly attractive, it is no worse for your pain than a tall upright military position. With that being said, either slouching or military alignment are likely to become a problem if they are adopted for long periods. Your best posture is your next posture, keep on moving.

But what about the low back and pelvis? Surely there is a correct posture in those body parts? See the follow on article for the research. 

Luke R. Davies :)