Tuesday, July 02 2019

Extension can offer improved outcomes that carry over to daily life. Just because we’re born in a fetal position doesn’t mean we have to return to it. Extension is vital for maintaining a healthy posture and yet so many of our exercises are focused on flexion.  We focus on flexion for hips, backs, knees, elbows, shoulders, necks, etc. when we might provide clients with better function if we offered some focus on extension. 

As we move forward in life, it is common for the head to move forward and the shoulders to round, which can cause chronic back and neck pain. Our once swift and sure stride is replaced with a sort of shuffle (Griegel-Morris et al. 1992). Sadly, this kyphotic posture (characterized by extreme convex curvature of the upper spine) can increase the risk of falling.

Inattention to how the head and shoulders are positioned can lead to tight pectoral muscles and weak upper-back and neck muscles, which can result in postural kyphosis. At the same time, the Achilles tendons and hamstrings become tight.  Fortunately, you can help to set straight what has become crooked! By incorporating extension stretches and strengthening exercises into your clients’ routines and instructing clients on proper posture, you decrease their risk for debilitating pain.

Here’s an example of extension in the water:
Begin walking backwards as you inhale for a few counts and exhale for a few.  Each time you inhale, lift the crown of your head (your chin should push back and up, you’ll feel a stretch on the back of your neck).  Relax your head/neck when you exhale.  Continue lifting on the inhalation and relaxing on the exhalation.

Next, press your shoulder blades down during the inhalation and head lift.  Relax everything during the exhalation.  Continue for at least 6 reps.

Why should we promote extension?
Thoracic kyphosis and forward spinal flexion are extremely common musculoskeletal imbalances brought on by prolonged time in some postural positions learned through exercise and/or activity choices, environmental factors, myofascial dysfunction, pain, and psychological stress.

Health issues (minor to major) from forward flexion include:

musculoskeletal aches and pains

breathing problems

limited function

impaired athletic performance

gastrointestinal upsets

increased mental stress

vision issue

decreased organ function

joint instability


inability to move away from midline

Extension in the Water Research Walking backward in water, when compared with walking forward in water, resulted in higher EMG activation of the paraspinal muscles or erector spinae (61%), the quadriceps (83%), and tibialis anterior (47%). Investigators suspect that the higher activation of the paraspinal muscles is caused by using the arms to assist with locomotion, and greater use of the quadriceps is linked to the higher propulsion force required to move through water, especially when done against a current. Walking backward most likely contributed to the greater use of the tibialis anterior. (Masumoto 2005 and 2007)

Poor Posture and Its Effect on Breathing
Di Bari (2004) documented that kyphosis is associated with dyspnea (discomfort or difficulty breathing, shortness of breath) and ventilatory dysfunction (abnormal breathing or oxygenation of the blood), as measured by pulmonary-function test data.

“A head that is positioned forward and shoulders that are rounded decrease the space in the chest cavity and restrict lung function,” says Debra Jensen, PTA, e-RYT, CHC, of Southampton, New York, who provides physical therapy and yoga for individuals with cervical kyphosis and a shuffling gait. She adds, “Persons with poor posture may be unable to breathe deeply, resulting in shallow breathing. Continued shallow breathing can cause general fatigue and shortness of breath.”

Posture, Gait and Chronic Disease Individuals who suffer from chronic disease have an increased risk of developing posture and gait abnormalities. Research has found a strong correlation between severe chronic obstructive pulmonary disease (COPD) and walking abnormalities, concluding that severe COPD causes compromised gait (Yentes et al. 2010). People who have had coronary artery bypass surgery often assume a hunched-over posture to protect the roughly 6-inch-long surgery incision carved into their chests. Similarly, people who suffer from chronic conditions that require prescription medication are at an increased risk of tripping or falling (Lipsitz et al. 1991).

Interestingly, research finds no relationship between flexed posture (of which kyphosis and a forward head are measures) and osteoporosis. Balzini et al. (2003) found that the severity of flexed posture in elderly female patients (without apparent co-morbid conditions) was directly related to the severity of vertebral pain, emotional status, muscular impairments and motor function, but not to osteoporosis.

Awareness Remind clients that posture awareness is paramount when it comes to straightening up. All the stretches and strengthening exercises in the world, even with proper form, won’t lead to improved posture if new habits don’t replace old, bad ones. Give your clients these encouraging reminders—all helpful in promoting healthy cervical posture:

·       Always sit and stand tall.

·       Let the rhomboids pull the shoulders back and together.

·       Hold the chin above the chest.

·       Check that the ankles are dorsiflexing and plantar flexing during walking, with the heel of one foot striking the floor as the ball of the other pushes off.

I hope that this article provides you some inspiration for adding more extension into your exercise.  Check out the video, Extension for Function on Fitmotivation.com


This article was written by Ruth Sova.  Ruth is the president of the Aquatic Therapy & Rehab Institute (ATRI), served on the Wisconsin Governor's Council on Physical Fitness, received the Governor's Entrepreneurial Award, the IDEA Outstanding Business Award, the first Presidential Sports Award in aquatic exercise, and AEA's Contribution to the Industry Award.  She has authored eighteen books and over 50 DVDs and CDs.   At the 2017 International Aquatic Fitness Conference (IAFC), Ruth was honored with the Elizabeth Burg Global Award for Lifetime Achievement. Read a featured article/interview on Ruth’s 30 year history in the industry. 

Author: Mark Grevelding is the founder of Fitmotivation. He is also a training specialist and consultant with the Aquatic Exercise Association’s (AEA). Mark has been active in the fitness industry for 22 years as a group fitness instructor, personal trainer, international presenter and a continuing education provider for AEA, AFAA & ACE.