Here is a list of common structural and Postural concerns, and exercises to help correct them. This is from a list of guidelines that I have from when I was working at a NYC Sports Medicine Clinic along with a team of Physical Therapist, Athletic Trainers, Strength & Conditioning Coaches, Exercise Specialist, and Massage Therapist. Please note that this is only a very basic hit list of items for general reference. Not all corrective exercises are mentioned but I wanted to share it with everyone anyway.
Listed below is each concern followed by exercises to do or avoid for each condition.
Forward Head: strengthen all areas of the upper back; stretch scalene and monitor anterior neck activity. Minimize recruitment of neck flexors with exercise keeping head neutral and relaxed.
Protracted shoulders: Focus on scapular retraction exercises and posterior deltoids. Perform upper back exercises such as overhand pulling activities. Perform oscillation exercises to help teach scapular stability. Use a 2:1 or 3:1 pull/push work ratio.
Stiff Thoracic Spine: (decreased normal lordosis or kyphosis) Strengthen mid /low trapezius and rhomboids. Perform unilateral work, reciprocal work and stretch latissimus dorsi muscle group.
Sway Back: Strengthen abdominal musculature, oblique and core. Stretch hamstring muscle group and strengthen hip flexors.
Flattened Lordosis: Strengthen lumbar extensors and abdominal group. Stretch hamstrings and hip flexors.
Immobile Thoracic Spine: Perform reciprocal upper body exercises such as quadrupeds, single arm rows, funky chickens, and Upper Body Ergometer (UBE).
Structural Scoliosis: This is an irreversible condition, but the effects can be minimized by doing upper body reciprocal movements, strengthening core, and all back musculature. Consulting a Physical Therapist is highly recommended.
Functional Scoliosis: This is a reversible condition that is caused by repetitive unusual body positioning from daily activity. Balance and increase flexibility along spine. Look at asymmetries of flexibility of legs and stretch accordingly. Try and identify what is causing the imbalance and change/modify daily activity leading to this.
Herniated Disk: (Lumbar) Avoid active hyperextension of back, but this can be individualized and passive extension can be used such as prone press-ups and knee to chest stretch. Incorporate lower body flexibility and lumbar stabilization exercises. Neck should always be in neutral position and when in prone position, head should be supported by a rolled towel at forehead.
Lower Back Pain: Maintain neutral spine in all exercises (five point contact rule) and avoid unsupported weighted squats if client can’t maintain neutral spine.
Meniscus Tear: Typically avoid deep squats beyond 80 degrees as this can compress meniscus in joint space. Weighted leg extensions are usually contraindicated.
Patellofemoral Pain: Seated, weighted leg extensions are contraindicated. High step-ups and running should be avoided. Increase VMO strength with compound lower body motions and standing TKE’s. Increase flexibility as tight musculature and tendons can contribute to compressing forces on knees.
Ligament laxity in Knees/ Tears/ Absence: Strengthen surrounding musculature of knee (quadriceps, hamstrings, abductors, adductors, core). Avoid quick lateral pivots and motions with absent cruciate ligaments.
VMO Weakness/VLO Dominance: Increase VMO strength by performing leg extensions with ankle dorsi flexion, step down with good eccentric control, straight leg raises with external hip rotation, adduction with leg press, dumbbell squats and ball squats.
Ankle Ligament Laxity: Strengthen everters, invertors, plantar flexors, dorsi flexors and include proprioception exercises (lateral and forward step ups, BAPS board, Bi and Uni Calf raises, single leg standing hip flexion and extension, trampoline work) Avoid running until stable.
Pronated / Flat feet: Pronated feet are less stable and can change alignment of the patellofemoral joint which can contribute to lower back pain and knee pain, by increasing repetitive forces along the lower kinetic chain. Avoid running and ballistic high impact movements.
High Arches / Rigid Arches: High arches are poor shock absorbers and arch supports in shoes can be beneficial to avoid overstretching of plantar fascia. Kinesiology taping aids as well.
Shoulder Impingement syndrome: Avoid chest and triceps dips, pull-ups, bench press, shoulder press, and deltoid lateral raises. Use an underhand grip for most pulling activities and work on strengthening middle and low trapezius, rhomboids, serratus anterior, and latissimus dorsi.
Cervical / Trapezius Tension: Avoid upright rows, and abdominal crunches until discomfort is minimal or absent. Focus on scapular stability exercises, and minimize trapezius recruitment with all pulling exercises. Re-teach correct shoulder mechanics if traps are being used excessively during exercise.
Lateral Epicondylitis: Avoid chest and triceps dips, chin / pull-ups, push-ups, lateral shoulder raises, and strong gripping exercises. Perform a strength-based program utilizing cuff weights and manual resistance until pain free. Maintain a neutral wrist extension and flexion and monitor for progression.
Carpel Tunnel Syndrome: Stretch wrist extensors and flexors before and after workouts, and maintain a neutral wrist position. Perfeorm oscillation exercises and utilize ice massage.
Joint Hyper mobility: Avoid end range of motion where full extension occurs at joint, and overloading with heavy weight. Teach client to maintain a slight bend in joints and not to lock joints out.
Jon Torerk, CSCS
