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If there’s one thing that I see and treat pretty much every single day of the week, it’s terrible posture.  What is difficult for me to deal with is the elderly population with terrible thoracic kyphosis and decreased hip extension.  Some of the most common issues I see in these populations:

It makes sense that having a tremendous forward head posture from a resulting thoracic kyphosis will lead to neck pain.  We also know that treating the thoracic spine can be beneficial for this population.

Having a huge thoracic kyphosis is going to lend to scapular anterior tilt and internal rotation, both of which are implicated in shoulder pain.

Having a combination of thoracic kyphosis and osteoporosis also increases our risk of having compression fractures, something that causes additional pain and even worse posture.  Sounds like a pretty viscous cycle aye?  Aging sucks.

Side Note: Interestingly, increased lumbar extension correlates with shoulder pain (tsunoda 13 j orthop sci) (Straker Manual therapy 09).

Looking down the chain we tend to lose hip extension as we age.  Coming with this are slower walking speeds and subsequent increased risk of having falls (Falls are incredibly dangerous for the elderly population).  Although patients with spinal stenosis tend to have a flatter lumbar spine, they also tend to feel better in this position (even better when flexed).  If they’re lacking hip extension then they’ll compensate with lumbar extension with gait and when standing (One of the reasons standing and walking are painful for these patients).

The point I’m trying to make is that if you’ve spent 70+ years developing poor posture, it’s going to be incredibly difficult to try and dig yourself out of that hole.  It’s actually pretty sad to see.  I’m hopeful for these patients but am frustrated with how …read more

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I picked this one up from 2 time olympian and 8 time national champion olympic weight lifter Chad Vaughn at the Power Monkey Camp this past fall.

As described earlier, adequate tibial internal rotation is important for achieving a deep squat.  If you’re lacking tibial internal rotation you might find your feet spinning out at the bottom of a squat or just having trouble getting your knees out over the toes in general.

I like to put this in either my warm-up, cool down or between sets of a strength exercise.  Give it a shot and let me know what you think.  Works for Chad Vaughn, works for me.

Can’t argue much with olympians,

Dan Pope DPT, CSCS

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