Stop slouching

The Pediatric Insider

© 2010 Roy Benaroch, MD

A question from Mark: “I’m worried about my daughter’s posture. What can I do about it other than constantly nagging her to stand up straight?”

You’re probably talking about “kyphosis,” which is the rounded-shoulders, hunched forward kind of posture common in children and many adults. It’s often called “postural kyphosis” because it can be corrected if the child tries to stand straight up. Rarely, there’s a genuine spinal deformity, called Scheuermann’s Kyphosis or Scheuermann’s Disease, which cannot be corrected voluntarily. If you’re not sure if your daughter can correct the slouch even if she tries, see an orthopedic specialist.

The majority of slouching children don’t have any kind of deformity. Their posture is probably caused by a mixed bag of habit, rapid growth, social pressures, poorly balanced muscle tone, and perhaps a dash of childish rebellion.

The scientific literature is very scanty on effective therapy, with very few decent published reports. I searched both the traditional medical literature and some osteopathic and chiropractic journals, and found nothing that really shows what modalities are genuinely effective. There’s an overall impression (in reviews like this one) that postural training and exercises might help, and a few studies support the use of pilates or similar exercises in adults, but there really isn’t any proof that they help in children.  Zero studies have looked at the effectiveness of nagging (which, by the way, didn’t work for my mom. Maybe you’re better at it.)

Even though there isn’t much scientific support, some ideas are probably worth trying. Is your daughter especially tall, or an early developer? Some tall girls are shy about towering above their peers, and deliberately shrink down to they don’t stand out. Girls who develop early or are well-endowed sometimes try to minimize the appearance of their chest by hunching forward—not to mention the physical effect of the weight on the front of their chests. Talk to your daughter if you think there is some deliberate slouch going on to support her own self-esteem and pride in her body.

Exercising can only help. Building strong core muscles and back extenders ought to pull back the shoulders and straighten posture. Stretching, pilates, or even light resistance work would all be helpful. Some specific exercises to strengthen the back include:

Back flys: Sit in a chair, holding two cans of soup. Bend forward at the waist so your head is just about at the level of your knees, and lift the soup cans up as if you’re using your arms to fly. Flap your “wings” slowly, staying in control both on the down-flap and up-flap, several times. Try to hold the soup up at the top of the flap for several seconds before the next down-flap.

Shoulder blade squeeze: sit up straight in a chair. Draw your shoulder blades together, imagining that you’re holding a little box between them. You can also do this exercise standing, or leaning over.

An exercise bonus: more time active means less time slouching in front of the computer or TV!

Try to build “muscle memory” by maintaining good posture all the time. Pay attention to how you’re sitting in front of the computer, or watching TV, or talking on the phone. Slouching is a habit that has to be “broken” by creating a new habit of sitting up and standing up straight. The good habit will get more firmly established by doing it all the time.

And if this doesn’t work, there’s always more nagging. Or, as a last resort, this medical device, which was somewhat more popular during the middle ages:



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