When we started to play our sport of Croquet, we were appropriately told to stand a mallet head’s length behind the ball and to forward bend our torso until the tip of our nose was directly over the mallet handle. Although this advice has led to countless hours of fun, competition, success, and the occasional missed clears and wickets, it can, over time, exacerbate the confluences that aging has on our bodies. How many times on the croquet lawns do you see our friends and club members with rounded shoulders, slumping postures, and the development of an exaggerated curvature of the upper spine? Probably far too often as, even without croquet, osteoporosis, slipped discs, previous trauma, weakened glutes and abdominal muscles, fallen arches, the ravages of arthritis, and joint replacements can all contribute to these, even without the added hours of forward flexion that our sport requires.
The medical term used for this condition is Thoracic (the portion of your spine below your neck but above your kidneys) Kyphosis or an increase in the forward curvature of the spine. Laymen’s terminology often includes “hunchback” or “slouching posture”. The natural history of kyphosis is not exactly well known; however, an increased amount of curvature in the thoracic spine is seen starting at the age of 40 years old, with women having a more rapid rate compared to men. The condition increases with age, and the prevalence is about 20%-40% in adults 60 years or older.
In addition to the cosmetic deformity that this can cause, people will also commonly complain of back pain from mild to severe, fatigue, increased forward posture of the head, and, if it becomes severe, then one might experience shortness of breath, weakness, and/or loss of sensation.
Following a diagnosis, which is typically made by x-ray analysis of the spine, conservative management usually includes physical therapy and NSAIDs (Motrin, Aleve, etc.) for the pain. Underlying conditions, such as osteoporosis, also need to be treated, obviously, but often do not correct the thoracic kyphosis itself. Physical therapy will be used to strengthen the back and abdominal muscles, which can relieve the pressure on the spine, helping to improve posture and reduce discomfort. Stretching exercises and cardiovascular activities are also prescribed to help alleviate back pain and fatigue.
Let’s get specific. If you already have a very pronounced thoracic kyphosis or if your back pain is of acute onset, seek medical advice before doing any exercises. If you are otherwise a healthy individual with mild to moderate kyphosis or if you are intent on preventing curvature of the spine, consider these exercises, which can all be found on YouTube with specific instructions:
1. Back Extensions
Lying on your front, preferably on the floor or otherwise firm surface, raise your torso onto your forearms, gently arching your back. Hold this position for up to 90-120 seconds. Start slowly at lower duration intervals, as stiffness/soreness may occur when first starting these maneuvers. As you progress, also lift your head, which helps to accentuate your extension.
2. Foam Roller Thoracic Extension Rolling
Place a foam roller under your back while lying on your back with your knees bent at 90 degrees. Start with the roller below your neck, optimally underneath the shoulder blades. Slowly roll your spine over the foam roller, and you will feel the “push” of the foam roller into your back. Rollers come in different sizes and configurations, and you may wish to start with a smaller roller, e.g., 4 inches, and progress to a bigger one e.g., 6 inches. It is not uncommon to feel or hear a “pop” as you roll, which is akin to “cracking your knuckles,” allowing gases to escape from the joints in your back. Not only does this exercise improve your posture but may also diminish your pain and improve the spine’s range of motion. Do this for approximately 5 minutes/session.
3. Lying Over an Exercise or BOSU Ball
You can start by sitting on an exercise ball and then rolling the ball under your back so that your back is now flat on the ball. The ball contours to the shape of your spine if the pressure in the ball is appropriate. Extend your back over the ball and let your arms extend over your head or out to your sides. Hold for one minute and then return to the starting position and repeat as tolerated. Repeat this extension exercise for up to 3 times.
4. Thoracic Extension Using a Chair
Kneel on the floor next to a chair or bench. If you have “bad knees,” consider using a pad or cushion under your knees to absorb the pressure. Extend your elbows over your head onto the seat of the chair in front of you. Slowly extend your back, creating an arch, and add extension to your spine. Return to the start position and repeat as necessary. As above, try to hold the extension for one minute and try doing three repetitions.
5. Sitting Extensions
Sit upright on a chair with a solid back. Support your neck by interlacing your fingers and placing your hands behind your neck. Round your lower back slightly, and now focus your attention to your upper back (thoracic region) and bend backwards to tolerance. Consider 15 to 20 repetitions for this maneuver.
Resistant Band Upper Back stretches:
https://youtube.com/shorts/mwGtsKu325Q?si=JXjpCysOKLTGIIuT
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