Are rounded shoulders just a shoulder problem?

Key points in 30 seconds

1. Rounded shoulders are often not just a shoulder problem.
2. The chest muscles in front have shortened, and the back muscles behind have weakened.
3. We first work out whether it comes up from the feet or down from the jaw.
4. If the starting point isn't treated too, the shoulders stay open only while you're in treatment.
5. If you can't raise your arm or pain wakes you at night, imaging comes first.

What we often hear

• "In the mirror, my ears are in front of my shoulders."
• "Even when I try to pull my shoulders back, they soon curl forward again."
• "Is it enough to just loosen up my shoulders?"

Are rounded shoulders just a shoulder problem?

Looking only at the shoulders often doesn't solve it. That's because the shoulders are often just where misalignment pushed up from below or down from above shows on the outside.

Many people think shoulders that curl forward are only a matter of weak shoulder muscles. But in the clinic, we often see shoulders curl forward again a few days after we've opened them up, no matter how much. That's because what made the shoulders that way lies somewhere other than the shoulders.

In medicine, this shape is called "rounded shoulders."

What is happening in the shoulders?

The muscles in the front of the chest have shortened, and the back muscles that pull the shoulders back have weakened. The pull from the front has gotten stronger, and the hold from behind has gotten weaker.

When this lasts a long time, strain builds up in the shoulders and neck and shows up as stiffness and pain. So it's common for someone to come in with shoulder pain, and when we examine them, the shape of the shoulders is the first thing we notice.

But sometimes balancing the front and back muscles isn't the end of it. The question of why that balance broke down remains.

What do you mean by pushed from below or above?

We look at two paths: one coming up from below and one coming down from above. One starts at the feet and comes up through the pelvis; the other starts at the jaw and comes down through the neck.

Here's how it comes up from below. If the arches of your two feet are different heights or one has collapsed more, your knees and pelvis twist slightly differently while you stand and walk. When the height of the pelvis changes, the spine resting on it tilts, and the shoulders take up that tilt.

Coming down from above, it's the jaw. If you chew with your jaw shifted to one side, uneven strain keeps going to the top of the neck. When the neck twists, the shoulders below it move along with it.

That's why just opening up the shoulders tends to wear off. We first need to sort out which direction it came from to decide what to treat.

What do you check?

We look at your standing posture and left-right height differences, and check how your feet press on the ground and how you walk. We also look at how your jaw opens and closes.

Where we work is completely different depending on whether it came up from the feet or down from the jaw, so we settle this before treating the shoulders. If needed, we check imaging in partnership with the radiology clinic in the same building.

How do you treat it?

We loosen what has shortened and get the weakened parts working. We use Chuna on the misaligned areas, and give you exercises so you can hold that position.

If the starting point is the feet, we treat the feet too; if it's the jaw, we treat the jaw too. If we only treat the shoulders, they feel better only while you're in treatment and then curl forward again. We tell you this up front.

When should I see another doctor first?

If you can't raise your arm, pain wakes you at night, your arm feels weak, or numbness runs down to your fingertips, get checked before treating it as a posture problem.

It could be a torn shoulder tendon or a pinched nerve in the neck. When there are signs like these, we recommend imaging first.

What are the limits of this assessment?

How rounded the shoulders are and how much they hurt don't go hand in hand. Some people have very rounded shoulders with no pain, and the reverse also happens.

One more note. We can't say that working on posture will definitely make the pain go away. What we do is reduce the conditions that concentrate strain on one side, and how much that changes things differs from person to person.

We don't look only at the shoulders; we follow it through the upper back and neck. Rounded shoulders usually come as a result of a hunched upper back.

If your shoulders keep going back to rounded even when you try to straighten them, come see us. The place that needs straightening may not be your shoulders.

Results differ from person to person depending on the starting point and how stiff things have become.