Neanderthal No More Part I
The complete guide to fixing your caveman posture!
by Eric Cressey and Mike Robertson


Do the Evolution, Baby

Evolution is defined as "a process in which something passes by degrees to a more advanced or mature stage." Think back to prehistoric times and try to envision your ancestors. You probably have an image conjured up of a Neanderthal wearing a loincloth, grunting at females, killing his own food, and hunching over a fire to stay warm. His DNA endured century after century, guaranteeing that you're equally hardcore, right?

Then again, you wear boxer briefs, utter cheesy pickup lines at every woman you see, hunt for your food at the local Stop 'N Shop, and hunch over a computer all day. In other words, the only trait you share with this prehistoric badass is your pathetic S-shaped posture: rounded shoulders, forward head posture, exaggerated kyphosis, anterior pelvic tilt, excessive lordosis, internally rotated femurs, and externally rotated, flat feet.

Well, it's time to once and for all to disassociate yourself from the Neanderthals by correcting these structural problems. We're here to help you do just that. This four-part series will outline the most common postural distortions and provide a comprehensive program to correct them.


The Length-Tension Relationship

First, let's talk about muscular contraction. You've heard of the sliding filament theory, right? No? You’re not a total kinesiology geek like us, huh? Well, here's a brief synopsis:

Actin and myosin filaments are found within the sarcomere (a contractile unit of skeletal muscle). The myosin cross bridges attach to the actin filaments, pulling them inward and leading to an overall shortening of the muscle fiber. When a bunch of fibers do this at once, we get a concentric muscle action (contraction or shortening).

With the sliding filament theory in mind, you can imagine that changes in the length of a muscle fiber can affect the ability of the muscle to contract optimally. For example, when a sarcomere is too short, it can't generate peak force because of the preexisting overlap of actin filaments. This overlap takes up valuable space that could otherwise be used for the myosin cross bridges to attach. Conversely, when the sarcomere is excessively lengthened, the actin filaments are too spread out for all of the myosin cross bridges to reach them for attachment.

So, we know that a muscle fiber (and, in turn, the entire muscle) is strongest when the sarcomeres are at their ideal resting length (usually resting position or slightly more lengthened). In all other positions, the sarcomere is outside of this ideal length zone and can't generate maximal force. Just consider how your strength varies in certain portions of the barbell curl and you'll understand what we mean.


Posture and the Length-Tension Relationship

The length-tension relationship isn't only important at the cellular level; training — or lack thereof — can alter a muscle's normal resting length. Simply put, the more you train a muscle, the shorter it wants to get.

Meanwhile, the response of the antagonist is to lengthen more and more over time to allow the agonist to shorten. If you need a visual, wrap an elastic band around your wrist. Pull on one side to loosen it (the antagonist) and note that the other side tightens (the agonist). This is how concentric muscle actions normally occur; the antagonist must relax to permit the agonist to shorten.

The problem herein lies when the agonists become chronically shortened due to poor training and/or lifestyle behaviors. Summarily, we get shortened (hypertonic or overactive) muscles and lengthened (hypotonic or inhibited) muscles opposing each another. Now, toss the length-tension considerations into the mix; do you think muscles (and their individual fibers) that are always outside of the optimal length zone will be able to generate maximal force? Is the Pope Hindu?

When discussing length and tension, you must also be aware that they're not one and the same. A muscle can have excellent length but still be excessively tight and vice versa (although it’s not as common). It's generally accepted that with length, more is better unless you have the flexibility of a circus sideshow freak. Muscle length is usually improved via stretching (static, dynamic, PNF, etc.)

On the flip side, tension is more of a bell-shaped curve. On one hand, excessive tension is problematic as stated above, but excessive laxity isn’t beneficial either. Tension is a true tight rope and something that should be evaluated frequently. Tension is best improved using modalities like massage, heat, muscle stim, or myofascial release.


The Caveman Look

It's time to apply the aforementioned principles to your caveman posture. Essentially, with the classic S-shaped posture, you have overactive and inhibited muscles from head to toe. The origin of such distortion is unique to each case. In some cases, these problems result from developmental or congenital structural abnormalities such as rear foot or forefoot varus, Scheuermann's disease, or spondylolisthesis (just to name a few).

However, these cases aren't the norms when it comes to screwy posture; rather, the Neanderthal look is usually a function of poor postural habits and improperly balanced training focus at multiple joints. Therefore, in weight-training populations without actual structural irregularities (read: you!), the most beneficial corrective programs will work to resolve the problem at each affected joint. Beginning with the core (a common source of postural problems), here's a depiction of how several joints interact in this common postural distortion:

• The core and glutes are inhibited; the hip flexors, hamstrings and erector spinae are overactive. This results in anterior pelvic tilt and exaggerated lordosis (swayback).

(Image from Medline Plus)

Now, this only refers to static posture. Just imagine what happens when someone with these postural afflictions actually tries to move around! Several injuries and/or conditions may result from each postural flaw:

Potential kyphosis/rounded shoulders manifestations: bicipital tendonitis, injuries to the glenoid labrum, subacromial impingement and resulting rotator cuff tears, injuries to teres major, scapular winging, decreased thoracic outlet space, degeneration of vertebral facets/acromioclavicular joints/sternoclavicular joints, and various elbow pathologies (due to compensatory overload).

Potential head forward posture manifestations: headaches, excessive dry mouth (over-reliance on breathing through the mouth), difficulty swallowing, anterior and posterior neck tightness, and irritation along the medial scapular border.

Potential lower body manifestations: low back pain, disc injuries, sciatica/radiating pain from the low back into the legs/feet, decreased low body power and strength production, lateral knee pain, medial collateral ligament tears/sprains, anterior cruciate ligament tears/sprains, excessive pronation of the foot (flat feet), ankle sprains, hamstring/lower back strains, sacroiliac joint dysfunction, piriformis syndrome, pain in the forefoot (metatarsalgia), bunions, and plantar fasciitis. Oh yeah, let's not forget the ever-popular incontinence.

Numerous muscles cross these joints and all of the actions of each muscle will be affected by alterations to optimal resting length. To give you an idea of how dramatic an effect these subtle distortions can have on every exercise you perform, consider the following muscles that may be affected and their functions:


Upper Body: Hypertonic/Shortened/Overactive

Note: The temporalis and masseter (facial muscles) also become overactive with forward head posture, as they must constantly contract in order to keep the mouth closed from this position (tension in the hyoid muscles of the neck forces the mandible posteriorly and inferiorly).


Upper Body: Hypotonic/Lengthened/Inhibited


Lower Body: Hypertonic/Shortened/Overactive


Lower Body: Hypotonic/Lengthened/Inhibited


Your Homework Assignment

And you thought poor posture wouldn’t affect your training! In Part II, we'll highlight several postural assessments and functional tests you can perform to give yourself a better idea of your structural flaws.

In the meantime, your homework assignment for the next week is to have someone take full body (head to toe) pictures of your normal standing posture from both sides and the front and back (preferably in just your underwear).

Don't chicken out! You absolutely have to take pictures of yourself to get an idea of how you stand (pun intended). You can also do this in front of a mirror, but it’s usually less effective because you'll want to fix your posture or subconsciously try to improve it. Moreover, it’s damn hard to take photos of your own back! Anyway, be sure to get those photos taken so that we can hit the ground running next week!

The Postural Analysis: Side Posture

After reading Part I you're probably thinking to yourself, "Maybe my posture isn’t so great after all, but how do I know?" Well, if you completed your homework assignment from last week, you should have been waiting for this week's update with a bunch of photos in hand. Time to put them to good use!

Essentially, we're looking for straight lines and 90-degree angles. Let’s start with your side photos. You should be able to draw a straight line between the middle of your foot and take it up through the knee, hip, acromion process (the "bump" where your superior scapula meets the clavicle), and mastoid process (the nub just behind your ear); ideally, this line is also perpendicular to the ground.

Below are the four most common side postures seen. Figure #1 depicts an anatomically ideal posture, whereas Figure #2 shows a posture with the same ideal spinal curves but excessive anterior weight-bearing (i.e. the weight is on the toes). In Figure #3, the anterior tilt has a semi-normal lumbar curve, but compensatory exaggerated kyphosis in the upper back.

Figure #4 is the "Caveman Look" to which we've been referring. It's highly prevalent in today's society; can't you just picture a computer screen right in front of that poor stickman with the club? In this fourth figure, you'll notice the exaggeration of the spinal curves, coupled with the compensations that manifest themselves throughout the rest of the body (excessive lordosis, excessive kyphosis and a head forward posture).

Now before you go on, take out a blank sheet of paper and make six columns at the top. The columns will be labeled as follows:

• Excessive lordosis (includes anterior pelvic tilt)

• Excessive kyphosis

• Internally rotated humeri (yes, that really is the plural of "humerus")

• Forward head posture

• Internally rotated femurs

• Externally rotated feet

Here’s a checklist of things to examine on your side-posture analysis, starting from the ground up:

1) Can you make a straight line between your feet, knees, hips, acromion process, and mastoid process? If so, is this line perpendicular to the ground? If you answered "yes" to both questions here, you're doing far better than most! You should still check to see if there's any exaggerated kyphosis or lordosis, however.

2) Examine your knees. Do they have a slight bend or are they locked? If they're flexed, give yourself a check in the internally rotated femurs and externally rotated feet columns.

3) Check out your skivvies. Is the waistband parallel to the ground or is the front pointed towards the floor? If it points down, give yourself a check in the lordosis column. If you see "skid marks," however, change your shorts.

4) Examine your lower back. Is there a minimal curve or is it exaggerated? (This one is more subjective, but chances are if you have an anterior pelvic tilt you also have an exaggerated lumbar curve). If it's exaggerated, give yourself a check in the lordosis column.

5) Examine your arms. Are they carried alongside or in front of the body? (Be sure to look at each side independently; sometimes one side is tighter than the other). If they're in front, give yourself a check in the internally rotated humeri column. If your knuckles are dragging the ground, give yourself a check in the "needs a full body wax" column.

6) Examine your upper back. Are your shoulders rounded forward? If "yes," give yourself a check in the internally rotated humeri column.

7) Can you see any of your upper back? If "yes," give yourself a check in the kyphosis column.

8) Finally, examine your head position. Can you draw a line straight up from the acromion process of your scapula to the mastoid process (anterior portion)? Or, is there a noticeable angle? If you answered "no" to the first question and "yes" to the second, put a check in the forward head posture column.


Front Posture

Now, let’s move on to our front photos. We'll be examining not only the position of the legs, but of the arms and hands as well. Below we have the two most common lower body postures: #1 represents our ideal and #2 the more common knock-knee or valgus position (imagine the kneecaps practically facing one another).

Here’s a checklist of things to examine on your front posture analysis, starting from the ground up:

1) Can you make straight lines between your feet, knees, and hips? If you answered "yes" here, awesome! Go through the last couple of steps just to make sure everything else is okay.

2) Do your feet have arches or are they flat (excessively pronated)? If they're flat, give yourself a check in the externally rotated feet column, and possibly one in the internally rotated femur column (correlate with #4).

3) From your knees down, do your lower legs and feet turn out? If "yes," put a checkmark in the externally rotated feet column.

4) From your hips to your knees, do your legs turn in and the kneecaps point inward? If "yes," put a check in the internally rotated femurs column.

5) Finally, examine the backs of your hands in the photo. Are they turned out to the sides or are they internally rotated and facing the camera? If they’re facing the camera, put a check in the internally rotated humeri and kyphosis columns.


Back Posture

Finally, let’s take a look at the photos of your back. This is usually the quickest test to perform because you’ve already examined the majority of the body. The most important thing we're looking at is the position of your scapulae.

Figure #1 shows us the ideal posture for our scapulae; the medial, inferior borders are both retracted and depressed. Figure #2 is an example of scapular winging, where the scapulae are "pulled" up and to the outside. Finally, Figure #3 shows us a classic example of someone with overactive/hypertonic upper traps coupled with weak and inhibited middle/lower traps.

Here’s our back posture view and what we need to examine. As a note, make sure to examine both sides in unison, as well as each side independently. For example, many people only have scapular winging or elevation on one side (typically their dominant one), so be sure to look for imbalances side-to-side as well.

1) Do the medial, inferior borders of the scapulae remain down and back (somewhat close together), or do they "wing out?" If "yes" on the second question, put checkmarks in the internally rotated humeri and kyphosis columns.

2) Do the superior scapular borders point upward or do they seem to "disappear" and point forward (anterior tilt)? If "yes" on the second question, put a check in the kyphosis column.

Now that you’ve completed the postural analysis, add up how many checkmarks you have in each column. This is pretty simple stuff; the more checks you have under each column, the more signs you have of that specific postural condition!


Additional Tests

If the results of the postural analysis haven’t already given you a pretty good idea of which postural afflictions you're battling, we have a few more tests that can help to answer any remaining questions you might have. Some of these tests require a partner.

Yardstick Test

You should be able to rest a yardstick across the clavicular portion of your pectoralis major without it touching the head of your humerus on either side. If the yardstick makes contact with your humeral heads first, you're dealing with internally rotated humeri and probably kyphosis.

Doorway Test

When you enter a room, which passes through the door first: the chest or head? If it's the head, you're dealing with forward head posture.

Supine Leg Lowering Test

This test is widely utilized, and Don Alessi described it in detail (including performance norms) in a previous Iron Dog. If you haven’t tried this before, check it out and see how your core strength stacks up. If you perform poorly, chances are you have anterior pelvic tilt and exaggerated lordosis.

Squat Test

This is an easy test that assesses the functional capacity of the lower body. Start with the feet at shoulder-width, toes pointing straight forward, and your arms held in front of the body. From here, perform a full squat (and yes, your thighs have to be at least parallel to the ground!) Look in the mirror if necessary; do any of the following occur?

• Do your heels lift? If yes, you have tight plantar flexors and/or poor posterior chain strength (especially glutes).

• Is there excessive arching of the low back? If so, it's indicative of overactive hip flexors.

• Do your knees come closer together at any point during the movement? If so, you have poor glute medius recruitment/strength, and this is probably coupled with tightness and overactivity of the TFL/ITB and adductor complex.

• Do the arches in your feet completely collapse at any point during the movement? If so, you have externally rotated feet and/or internally rotated femurs.

Hip Extension Test

Another test that's quite revealing is the hip extension test. This test will give you an idea of how your lower extremity is functioning, along with other muscle groups that may be trying to substitute for the prime movers.

Lay prone on a table or bed with the ankles hanging just off the end. From this position and keeping the leg straight, lift the leg up several inches. You’ll probably need someone to monitor you, but here are a few things they should be looking for:

• Is there a deepening of your lumbar curve when you initiate the movement? This deepening indicates tightness of the lumbar erectors and hip flexors.

• Does the leg stay straight or does it bend at the knee? Flexion at the knee (especially in the first 10-20 degrees of movement) indicates overactive hamstrings. This is usually coupled with the next question…

• Do the glutes fire immediately or is there a delay from the onset of movement? If they're delayed, your glutes are inhibited and/or weak.

Trunk Curl Test

This is just a basic sit-up test, but the results will give you an idea of how your trunk flexors and hip flexors are working. Lay on a table or the ground in a supine position with a slight bend in the knees. Place the arms out in front of the body and then curl-up slowly. Have your partner notify you if he or she sees any of the following:

• Are you unable to get your shoulder blades off the ground? This indicates weakness in the trunk flexors.

• Do you have to "rock" to get your body going (e.g. do you use body English to initiate the movement?) Again, this is indicative of weakness of the trunk flexors.

• Is there a deepening of the lordosis throughout the course of movement? If so, you have overactive/hypertonic lumbar erectors and/or hip flexors.

• Finally, do the heels rise or come up off the ground? Once again, this indicates overactive hip flexors.


Conclusion

If you took a close look at your photos and used the above tests, you're guaranteed to have some insight into how good (or bad) your posture really is. Next week, we'll show you how us anatomy enthusiasts (read: dorks!) apply these analyses to real-world situations.

 

After covering all the "what's" and "how's" of the most common postural problems in Part I, we focused on some self-assessment tools in Part II. Those self-assessments are certainly valuable tools, but they can sometimes be too subjective if you aren't accustomed to assessing these problems. With that in mind, use the results of those tests in conjunction with the cases studies featured in this article to really get an idea of how significant your problems are and how to correct them.

Before we get into the case studies, a brief discussion of the planes of movement is in order. Up until now, we've dealt almost exclusively with sagittal plane postural problems; this plane divides the body into right and left sides. Flexion and extension occur in this plane. Since kyphosis and lordosis occur in a "front to back" scheme, they're termed sagittal plane problems. 

Postural abnormalities may also occur in the frontal plane, which divides the body into anterior and posterior halves. Abduction and adduction occur in this plane. The most notable frontal plane postural affliction is scoliosis, which may be functional (a structurally normal spine that seems to be curved due to another factor, such as muscular tightness) or structural (a fixed curve resulting from a congenital birth defect, disease, infection, or tumor).

We'll use the term pseudo-scoliosis instead of functional scoliosis during this article simply because most gym-goers with some degree of lateral spinal curvature have slight problems at best.

Lastly, we can experience postural problems in the transverse plane. This plane, in which internal and external rotation occur, divides the body into top and bottom sections. Many people have difficulty visualizing transverse plane movements; your best bet is to think about the way the humerus and femur "swivel" at the shoulder and hip. Pronation and supination of the forearms are good examples, too. 

Frontal plane problems implicated in the typical Neanderthal posture include accentuated internal rotation of the femurs and tibiae, over-pronation at the subtalar joint, and excessive internal rotation of the humeri. 

With all that out of the way, let’s get to the real world case studies!


Case Study #1

Background

Nineteen year-old male with a training age of four years. During this four-year period, the primary focus has been training for aesthetics with a secondary emphasis on strength (but, unfortunately, none on structural balance!) The client has experimented with a variety of traditional bodybuilding training methods along with the occasional powerlifting and Olympic lifting programs, all of which were geared inevitably toward looking better.


Injury History

- Chronic on-and-off diffuse shoulder pain and joint soreness during and after all chest exercises.

- Acute "elbow tendonitis" (only once; no diagnosis was made).

- Chronic headaches (frequency has diminished greatly since initiation of an upper trap/levator scapulae stretching program).

- Most recently, bilateral pain in hip flexor/groin regions during quad dominant movements.  Pain is worse on the right, but present on the left as well. Pain has been severe enough to cut three consecutive squatting sessions short.


Performance Problems

The client has had difficulty making progress on the following lifts (client comments follow):

Squat: "I can make a lot of progress for a couple weeks, but it always seems too slow and even drops off soon after. I'm really slow on this lift, which I always assumed was wrong."

Bench Press: "I've struggled with the bench until recently. With all the extra work I've been doing for the scapula retractors, my bench is finally moving up."

Bent-over row: "Well, it's most kinds of rows, but bent-over rows especially. I don't ever seem to be able to progress and gain any measurable strength in them. On most other types of rows I can slowly gain strength, but the bent-over just seems to stay. And it tends to be a really low weight, which sucks, and can't be helping me in my goal of fixing all my problems."

Military Press: "The lift I've had the most problems with is the military press. No matter what I try, it never seems to improve. It's like that with a lot of my shoulder lifts. The only other thing I thought I should mention was that I've been doing my best to stretch my pecs and lats, and I've been using a roller a bit for self myofascial release, but it seems like no matter how much I stretch them, they go right back to being tight. So, I think I have some serious tightness or weaknesses in other places like the serratus anterior." 


Postural Analysis

Front View:  Client exhibits slight internal rotation of the humeri.

A "kneecaps out" appearance (to compensate for internally rotated femurs) is also apparent, and laterally rotated feet are noticed with apparent pronation.

Side Views: Client exhibits prominent anterior pelvic tilt, anterior weight bearing, moderate kyphosis, rounded shoulders, and internally rotated humeri.

Back View: Client exhibits anteriorly tilted scapulae, but no scapular winging. Internal rotation of the humeri and lateral rotation and pronation of the feet are confirmed.

No unilateral deficits (asymmetries) are apparent.


Impressions

The history of shoulder pain is consistent with anteriorly tilted scapulae, moderate kyphosis, and internally rotated humeri, each of which can contribute to decreased space between the acromion process and humeral head (primary subacromial impingement of the supraspinatus, and possibly the infraspinatus tendons). In other words, he's dealt with rotator cuff tendonitis. 

The acute "elbow tendonitis" may or may not be related to postural abnormalities, as the client related that it occurred during rugby season when lifting volume wasn't scaled down as it should've been. Conversely, this overuse could also have resulted from imposed overload on the musculature of the arms to compensate for weakness of the muscles acting at the injured shoulder. 

As an example, consider the pitching motion. The wrist extensors; biceps; infraspinatus, teres minor, and posterior deltoid; rhomboids and middle and lower trapezius; ipsilateral and contralateral core musculature; and contralateral glutes, hamstrings, and quadriceps are just a few of the numerous important decelerators of the throwing arm. If one link in this kinetic chain isn't doing its job, the others must pick up the slack.

The chronic headaches were definitely related to the forward head posture (compensation for the kyphosis). The forward head position and, in turn, headache frequency, have diminished since the introduction of stretching for the levator scapulae and upper trapezius.

The pain in the hip flexor and groin can be attributed to tight hip flexors and adductors, both of which contribute to the anterior weight bearing and anterior pelvic tilt. Unless he does something about this tightness, he's on the fast track to a strain, or lower back or knee injury.


Recommendations

The client is definitely in need of a complete kinetic chain overhaul! In other words, the corrections must address the core, lower body, and upper body. He's a prime candidate for doing the programs that’ll be outlined in Parts 4 and 5.


Case Study #2

Background

Twenty year-old male with a training age of 2.5 years, most of which was spent bodybuilding with programs that only trained what could be seen in the mirror. Long-term goal is to get involved in powerlifting.


Injury History

- Constant popping and cracking of the shoulders, but no pain.

- Chronic knee pain (since childhood), but never any diagnosed condition.

- More recently, sore ankles and lateral lower legs following "ass-to-grass" squats.


Performance Problems

None


Postural Analysis

Front View: Client exhibits slight internal rotation of the humeri. Moreover, the right iliac crest is raised when compared with the left. A knock-knee appearance is noted, and a "kneecaps out" appearance (indicative of tightness laterally and compensation for internally rotated femurs) is also apparent. Bilateral tibial internal rotation is also present.

Side View: Client exhibits classic exaggeration of the double S-curve posture. Forward head posture and chin protraction are evident. Rounded shoulders combined with an exaggerated kyphosis are apparent in the upper thoracic region. Significant anterior pelvic tilt with a concomitant increase in lumbar lordosis is also evident in the lumbo-pelvic region. Anterior weight bearing is difficult to determine due to the cropping of the photo, but still seems to be an issue of concern.

Back View: The client's left shoulder girdle appears raised when compared to the right. The elevated right iliac crest noted in the front view is confirmed in the back view. A right lateral listing of the thoracic region is also noted, and is evidenced by the elevation of the right iliac crest and depression of the right shoulder girdle.


Impressions

The client's chronic knee pain may or may not be related to the excessive anterior weight-bearing that's readily apparent. His anterior pelvic tilt and excessive lordosis shift the center of gravity forward and put a lot of pressure on the quadriceps and patellar tendon during weight-bearing activities, as the glutes are inhibited. 

If the knee pain occurs laterally, there are also implications for the vastus medialis. Given his internally rotated femurs, it certainly isn't functioning optimally as a knee stabilizer. Tightness of the ITB/TFL is highly likely if this is the case, too.

The pain in the ankles and lateral shins can most likely be attributed to tightness in the peroneals, which serve to evert the feet (a component of pronation) as compensation for internal rotation of the tibias.

Some of the problems may also result from the pseudo-scoliosis condition, although it's impossible to make such an inference from one photo alone. Nonetheless, it's a valuable point to make: an overactive quadratus lumborum (QL) is the primary cause of a functional scoliosis that originates with lateral flexion of the lumbar spine. 

• The QL has points of attachment on the last rib, pelvis, and L1-L4 vertebrae. If it's tight, the rib cage is pulled down, the pelvis is pulled up, and the lumbar spine is pulled laterally, creating a curve that initiates a chain reaction in two directions.

• Usually, this tightness of the QL is seen along with over-activity of the tensor fascia latae (TFL). The TFL, QL, and gluteus medius and minimus are functionally associated through hip abduction and lateral flexion (depending on whether the trunk is moving and the leg is fixed, or vice versa) and stabilization of the pelvis and femur in the frontal plane.

Often, these problems occur because the glutes are weak (also related to reciprocal inhibition from tight adductors, their true antagonist), so the TFL and QL become overactive through a process known as synergistic dominance.

• In order to counteract this lateral "lean" further up the spine, the contralateral erector spinae are constantly in action to realign the torso. As a result, a lateral curve of the thoracic spine emerges in the opposite direction of the lumbar flexion.

• The scapula on the side opposite the overactive QL also appears elevated and anteriorly tilted (recall that the rib cage is still depressed on the opposite side, too). 

• The cervical erector spinae on the same side as the tight QL then compensate for this thoracic curve, in turn, by contracting to keep the head upright. 

The end result? A double S-curve in the frontal planes to match the Neanderthal look that occurs in the sagittal plane! Furthermore, just as one can experience problems in the upper body from the unilateral pelvic elevation occurring with a tight QL, problems can occur in the lower body as well. 

If the pelvis is elevated on the side of the overactive QL, the leg on the same side as the irksome QL is functionally shorter, as the pelvis sits further up from the ground. The shorter leg always takes on the greater burden from both the force and speed of loading standpoints; the end result is over-pronation on this side. 

Suffice it to say, excessive pronation isn't something with which you want to deal. As we mentioned in Part I, it's a potential cause of chronic knee pain, not to mention problems at the hips, lower back, ankles, and feet.


Recommendations

By strengthening the gluteus medius, minimus, and maximus, he could likely shift some of the burden off of his quadriceps and patellar tendon, alleviating some – if not all – of his pain. Some extra work for the vastus medialis and dorsiflexors, coupled with stretching and myofascial release of the ITB/TFL, calves, and peroneals are highly recommended as well. Obviously, given his excessive anterior pelvic tilt, a lot of work needs to be done on strengthening the core and loosening up the hip flexors, hamstrings, and erector spinae as well.

Even though there's currently no pain in the shoulders, this may not be the case down the road.  Specific strengthening of the scapular retractors and depressors is needed, coupled with concomitant lengthening of the internal rotators (pectoralis major, latissimus dorsi, teres major, anterior deltoid and subscapularis) and scapular elevators (upper trapezius and levator scapulae). 

Even though the left clavicle and scapula are elevated, they appear otherwise symmetrical in shape/tonus to the right side. This indicates the problem is farther down in the kinetic chain. The forward head posture should be addressed using activation work for the deep neck flexors, coupled with stretching of the suboccipitals and sternocleidomastoid (SCM) (and the levator scapulae, as noted earlier).

Like our first client, he needs the whole package, as it's impossible to isolate within a kinetic chain with so many glaring dysfunctions. That said, the client's pseudo-scoliosis-like unilateral deficits merit special considerations that focus on unilateral training. 

In addition to the aforementioned focus on glute-strengthening/activation, these modifications should include right QL stretching (e.g. standing or seated side bend stretches), with QL activation work on the left hip side (e.g. side bridges and side hip thrusts). Specific focus in stretching should also be emphasized with respect to the left thoracic and right cervical erector spinae. 

Numerous other compensations occur, resulting in tightness and weakness through the kinetic chain from head-to-toe. As such, it's best to assess these functional decrements individually with tests of range of motion and strength. If conservative measures fail (and there is in fact a pseudo-scoliosis), the client would be wise to visit a qualified orthopedist to determine if:

A) an overactive QL is indeed the cause of the problems.

B) an actual structural leg-length discrepancy (possibly requiring an orthotic) is present (they're not as common as people think).

C) the curvature is structurally-based at the spinal level (i.e. vertebral shape or positioning).


Case Study #3

Background

Thirty-five year old male with a training age of 21 years. The first 17 years were geared toward athletic performance in a variety of sports and the Marines, and the last four have been exclusively devoted to bodybuilding for vanity. The client has experimented with everything from Heavy Duty to high volume to Olympic lifting. Prior to devoting himself completely to weight training, the client was involved in teaching aerobics and competing as a triathlete and distance runner for fifteen years.


Injury History

Current

- Primary subacromial impingement in left shoulder.

- Left biceps tendonitis (elbow, not shoulder).

- Arthritic left knee (chronic), especially painful with impact.

- Chronically tight hamstrings and calves.

Previous

-Torn left vastus lateralis.


Performance Problems

- "My main concern is my weight shift onto the left leg when squatting; my right knee falls inward at the same time. In fact, the right knee does that all the time, regardless of whether or not I'm squatting!"

- "I also feel my pelvis rotate laterally when I deadlift."

- "My shoulder turns to junk almost every time my bench weight gets close to 250 pounds!"

- "I've noticed I have tightness more on one side than the other, but in different places. For instance, my left pec and left upper trap are really tight, yet my right lat is, too."


Comments

- "Personally, I attribute the knee to having been a long jumper in my youth and having had to run miles and miles carrying heavy loads when I was in the Marines."

- "The biceps tendonitis is generally brought on by anything heavy with a pronated grip (e.g. weighted chins). It first came on when I was big into rock climbing and has come and gone over the last five years." 

- "I initially hurt the shoulder arm-wrestling a few years ago, and it's been on-and-off pain ever since. I think it has altered my benching technique."


Postural Analysis

Front View:

The left shoulder girdle is clearly elevated in comparison to the right, and, as evidenced by the hands pointing backward with resting posture, both humeri are internally rotated. The feet are slightly externally rotated, and are likely pronated, although it's tough to clearly determine degree of pronation from this distance.

Side Views:

Kyphosis, lordosis, and forward head posture are slightly accentuated, but not overly significant.  The left humerus is held further in front of the body than that right, indicating that it's more internally rotated.

Back View:

The left hip is slightly elevated, and the elevated left shoulder girdle is confirmed, especially in light of the fact that the right hand is closer to the ground. Lateral rotation of the feet is also confirmed.


Impressions

As with Cases #2 and #3, there appear to be both sagittal, frontal, and transverse plane components to this client's problems. The impingement problems will likely resolve with the implementation of a program to lengthen the internal rotators and scapular elevators while strengthening the external rotators and scapular retractors and depressors. Obviously, reduction of inflammation through therapeutic modalities and avoidance of overhead activities is the first step.

The elbow is likely a compensation for the shoulder injury, as weakness in one area will usually lead to overuse at another joint. Obviously, biceps tendonitis is a function of overuse of the biceps; one role of the biceps is to decelerate elbow extension (as occurs with a bench press).  Likewise, at the glenohumeral joint, the external rotators serve to decelerate the internal rotation of the humerus during movements such as overhand throwing and – you guessed it – bench pressing! 

So, if our external rotators are weak, and we still need to decelerate the same load, the biceps (along with a few other muscles) are going to be working overtime. The end result is two half-ass sets of decelerators; one is weak because it never received any attention in the first place, and the other is weak because it received too much attention and is just beaten up! We're going to go out on a limb here and assume that this might alter one's benching mechanics to some extent!

The client is also likely dealing with a pseudo-scoliosis. Based on the photographs provided, a tight left QL is the culprit, and leads to the following compensations and problems:

• Tight right thoracic erector spinae.

• Tight left cervical erector spinae, upper trapezius, and pectoralis major.

• Tight right lats, relating to the depression of the right shoulder girdle.

• Possibly a functional leg length discrepancy (left is shorter).


Recommendations

The client would be wise to approach these problems from both a sagittal and frontal double-S posture perspective. Important measures to undertake include:

• Stretching the levator scapulae, upper traps, and cervical erector spinae with particular emphasis on the left side.

• Stretching the internal rotators of the humerus, with a particular emphasis on the left side pectoralis major and right side latissimus dorsi.

• Stretching the left QL and right thoracic erector spinae.

• In the case of muscles that are unilaterally tight, in strength training, the same muscles – only on the contralateral side – should be given slightly more volume to take care of the imbalance.

• Stretching the hip flexors, adductors, IT band, calves, and peroneals.

• Strength training should focus on the neck flexors, scapular depressors and retractors, humeral external rotators, glutes, core (comprehensively), and dorsiflexors.


Final Notes

We've outlined the corrective modalities that directly apply to our disciplines and educational backgrounds. That's not to say, however, that other disciplines wouldn't be excellent complements to our recommended initiatives. Most notably, Active Release Techniques (ART) are incredibly effective in breaking down soft tissue adhesions, reducing pain, promoting healing, and getting you back on the road to proper movement patterns.  In many cases, a single session can make a world of difference. 

Likewise, myofascial release and massage may be suitable implements in the correction of your problems. Remember, it’s necessary to address not only the length of the muscle through flexibility training, but also to address and adjust the tonus of the muscle through modalities such as ART, massage, and myofascial release. All of these modalities should be used in addition to intelligent training protocols designed to correct existing imbalances. Plus, it's important you learn how to effectively balance a wide variety of movement patterns in future programs. 

Lastly, you might spend three to ten hours per week training; that's a miniscule amount of time in comparison to the time you spend sitting at your desk and car, or just walking around in your daily life. Very simply, the training recommendations we've made in this article must be accompanied by a constant focus on proper postural habits all the time, so sit up straight!

Hopefully, taking a look at these folks gave you a great appreciation for how you stack up.  Don’t think we’re going to leave you hanging, though; if you're one of those people whose posture closely resembles that of a knuckle-dragger, our next two parts will give you specific training programs that'll help you kick your postural afflictions and return to the world of the upright!

We'd like to extend a special thanks to those T-forum [link] members who were gracious enough to pose for the photos in this article; we really appreciate your help!

 

After reading Part 1, Part 2, and Part 3, you've probably come to grips with the fact that you have a greater resemblance to Cro-Magnon man than you previously thought. Now, what are you going to do about it?

The program outlined below is designed to keep your current strength levels intact while correcting the muscle imbalances holding back your strength and physique. We have two primary goals: 

1) Hit the global muscles hard and heavy with a four-day per week program.

2) Hit the local muscles daily (or at the very least on off days) to take advantage of the motor learning effects produced by frequent, low-intensity training.

What are "global" and "local" muscles? Local muscles (also known as the deep muscular system) are extremely important when we're discussing posture improvements. The primary roles of the deep muscular system are motor control, segmental stabilization, and fine-tuning of movements. 

On the flip side, you have the global (or superficial) muscle system. The primary role of the superficial muscle system is to produce movement, power, and torque. As a general rule, when you have significant postural issues, your global or superficial system is overactive and the deeper system is inhibited or weak.


Hitting the Iron 

We'll give you the fun stuff first. However, before we do, it's important we emphasize that this is a PRE-habilitation program; it isn't meant to be a corrective protocol for someone after they've suffered the consequences of chronic poor posture. In other words, if you have primary subacromial impingement or a herniated L5-S1 disk, for example, lots of these exercises are contraindicated for you (you'd be better off with a true physical therapy program).

You'll notice that the actual number of exercises is fairly low. The purpose of these workouts isn't for you to see huge, immediate gains in your strength or physique (although some of you will!), but rather to balance out your body and relearn proper recruitment patterns in preparation for more optimal training efficiency in the next training phase. 

Always keep in mind that your body is smarter than you are! Think about it like this: if you're always training chest and you never work your back, eventually your posture is going to go down the drain; that's just a given.  Beyond that, however, your body is also going to halt any further progress with regards to your chest training until you bring up the muscle imbalance. 

In Achieving Structural Balance, Charles Poliquin talked about how an elite hockey player put 51 pounds on his bench press in six weeks simply by adding in training for the external rotators! What makes this fact even more amazing is that Coach Poliquin didn't even have this guy bench pressing for that entire time! (1) Now we're not saying just by correcting your posture you'll put 60 pounds on your bench, but the fact of the matter is that by attempting to correct the imbalances in your body, you're improving the future level at which you can train.

You'll also notice the sequence of the exercises in this program is probably very different from what you're currently doing. Squats and benches are put at the end of the training week, and have a fairly low total volume.  Now we're all for developing strength in the major muscles groups, but all too often these exercises are always at the beginning of the training week, promoting muscle imbalances and increasing the risk of injury by not giving priority to their antagonist muscle groups/exercises. 

If you follow Ian King's work for preventing injury and developing balance within the body, he'd bury the most-often trained exercises at the end of the week and at the end of the workout, but our goals are slightly different here. We want to try and correct our muscle imbalances on the fly, without losing much (if any) of our hard-earned strength in the process.

Now, we're giving you a program geared to meet your needs in the gym, but that still leaves roughly 23 hours per day for you to screw up with your posture! No matter how diligently you follow this protocol, you won't get optimal results unless you keep a close eye on your posture throughout the day. So, unless you want to remain a caveman, sit up straight! And put down the club, too; it's such an office faux pas. You can, however, continue to scratch yourself and grill dead animal flesh at your cubicle. In fact, we encourage it.


The Plan

One of our main goals is to make these workouts time effective, but we also want to derive the most benefit from the exercises. Many of the exercises in the program will be coupled with stretches for the antagonist muscle groups. Not only will this allow for a stronger contraction by inhibiting the antagonist, but it'll also save time in the process!

Note: After we lay out the program, we'll provide descriptions and pics of the exercises at the end of the article.

Monday         

Precede this session with a dynamic warm-up emphasizing ballistic stretches for the hip flexors, hamstrings, erectors spinae, and IT band.  If you have access to mini bands, perform side-steps with them around your ankles to activate the hip abductors.

A1) Supine Bridges

Sets: 3

Reps: 15

Tempo: 1011 (squeeze at the top for a count of one)

Rest: 45 seconds, during which time you should perform A2

A2) Warrior Lunge Stretch: 15 seconds per side

B1) Snatch Grip Deadlifts

Sets: 6

Reps: 6-8

Tempo: 20X0

Rest: 2 minutes, during which time you should perform B2

B2) IT Band Stretch: 15 seconds per side

C) Barbell Step-Ups

Sets: 4 per leg

Reps: 10-12

Tempo: 20X1 (squeeze the glutes at the top)

Rest: 60 seconds between legs

D1) Dead Bug Twists

Sets: 3

Reps: 15

Tempo: 1010

Rest: None, go immediately to D2

D2) Side Hip Thrusts

Sets: 3

Reps: 15 per side

Tempo: 1010

Rest: None, return immediately to E1 to repeat superset

Tuesday

Precede this session with a dynamic warm-up emphasizing ballistic stretches for the lats, chest, and anterior delts.

A1) Pronated, Medium Grip Row

Sets: 6

Reps: 10

Tempo: 30X1 (retract the scapulae for a count of one)

Rest: 2 minutes, during which time you should perform A2

A2) Pec Stretch: 15 seconds

B1) Face Pulls

Sets: 3

Reps: 10-12

Tempo: 3010

Rest: 60 seconds before B2

B2) Decline Barbell Extensions

Sets: 3

Reps: 10-12

Tempo: 30X0

Rest: 60 seconds before repeating superset

C1) Rear Delt Fly

Sets: 3

Reps: 10

Tempo: 1010

Rest: None; go immediately to C2

Ideally, this will be performed on a rear delt machine to prevent cheating with the upper traps.  If you don't have access to such a machine, perform bent-over lateral raises with the head supported. Be strict and don't shrug the weight up!

C2) Low Pulley External Rotations

Sets: 3

Reps: 12

Tempo: 1010

Rest: None; go immediately to C3

C3) Dip Shrugs

Sets: 3

Reps: 15

Tempo: 1010

Rest: 60 seconds before repeating triset

D) High-to-Low Cable Woodchops

Sets: 3 per side

Reps: 10

Tempo: 20X0

Rest: 15 seconds between sides

Thursday

Precede this session with a dynamic warm-up emphasizing ballistic stretches for the hip flexors, hamstrings, erectors spinae, and IT band. Again, if you have access to mini bands, perform side-steps with them around your ankles to activate the hip abductors.

A1) Heels Elevated, Rock Bottom Front Squats

Sets: 6

Reps: 3,2,1,3,2,1

Tempo: 20X0

Rest: 3 minutes, during which time you should perform A2

A2) Warrior Lunge Stretch: 5 seconds per side

B1) Walking Lunges

Sets: 3

Reps: 8-10 steps per leg (16-20 total steps per set)

Tempo: Just worry about controlling the descent

Rest: 2 minutes, during which time you should perform B2

B2) IT Band Stretch: 15 seconds per side

C) DB Split Squat Isometric Holds

Sets: 1 per leg

Reps: 1?lasting 60 seconds!

Rest: 30 seconds between legs, 60 seconds before D1

D1) Pull-throughs

Sets: 4

Reps: 12

Tempo: 30X1

Rest: None; proceed immediately to D2

D2) Pulldown Abs

Sets: 4

Reps: 12

Tempo: 30X1

Rest: None, return immediately to D1 to repeat superset

E1) DB Dorsiflexion

Sets: 2

Reps: 20

Tempo: 1011 (hold at the top for a count of 1)

Rest: 60 seconds, during which time you should perform E2

E2) Calf Stretch: 15 seconds per leg

Saturday

Precede this session with a dynamic warm-up emphasizing ballistic stretches for the lats, chest, and anterior delts.

A1) Decline Close Grip Bench

Sets: 6

Reps: 3,2,1,3,2,1

Tempo: 20X0

Rest: 90 seconds, then perform A2

A2) Chest Supported T-Bar Row

Sets: 6

Reps: 6

Tempo: 20X2 (hold at the top for a count of two)

Rest: 90 seconds, during which time you'll perform A3 and then return to A1 to repeat superset.

Note: If you don't have access to a T-Bar machine, do these with dumbbells and a pronated grip. Retract the scapulae at the top.

A3) SCM/Upper Trap and Suboccipital/Levator Scapulae Stretches: 15 seconds per side

B1) Single Arm Low Pulley Cable Row to Abdomen

Sets: 3 per side

Reps: 10

Tempo: 20X2 (again, retract the scapulae for a count of two, this time with thoracic rotation)

Rest: 30 seconds between arms, during which time you should perform B2 for the side to be trained next.

B2) Pec Stretch: 15 seconds

C1) DB External Rotations, elbow supported at 90 degrees

Sets: 3

Reps: 10-12

Tempo: 2010

Rest: None; go immediately to C2

C2) One-Arm Prone Lower Trap Raises

Sets: 3

Reps: 10-12

Tempo: 2011 (squeeze at the top for a count of one)

Rest: None, repeat superset with opposite arm

Note: As you may have inferred, you'll be performing these exercises in succession one arm at a time. In other words, do C1 with your right arm, and then C2 with your right arm. Then, repeat the superset with the left arm.

D) Saxon Side Bends

Sets: 4

Reps: 6 per side

Tempo: Don't sweat it. These are killers; just worry about controlling the movement and surviving!

Rest: 60 seconds

Wednesday, Friday, and Sunday: Postural GPP (To be done at home)

Chin Tucks

Sets: 2

Reps: 20

Theraband External Rotations

Sets: 2 per arm

Reps: 25

Prone Cobras

Sets: 2 ? one at 10 & 2 and one at 9 & 3

Reps: 1 ? hold for 60 seconds in retracted position

Single Leg Knee-to-Chest on Foam Roller

Sets: 2 per leg

Reps: 15

Supine Bridges

Sets: 2

Reps: 25

Prone Bridges

Sets: 1

Reps: 1-60 second hold

Side Bridges

Sets: 1 per side

Reps: 1-30 second hold

Scap Pushups

Sets: 2

Reps: 25

Applicable Stretches

Those included in program along with the good morning and lat stretches (pictured below).


Exercise Descriptions

Supine Bridge

Lie on your back with your legs bent to approximately 90 degrees and the feet flat on the floor. From the starting position, squeeze the glutes like you're trying to pinch a quarter and raise your vertebrae off the ground one at a time. Hold and squeeze at the top, then return under control to the starting position. Added bonus: Do this rapidly to music and girls may stick dollars in your shorts!

Warrior Lunge Stretch

Go into a lunge with the arms outstretched overhead.  Keeping the head and chest up, let the hips sink down and shift your weight forward so you get a stretch in the front of the hip on the "down" side.  Don't place your hands on your knee or lean too far forward or arch the back to increase the stretch; just let the hips sink and shift forward.  Hold for 15 seconds, and then switch sides. Repeat as necessary.

Snatch Grip Deadlifts

The emphasis on this exercise isn't using maximal weights, but making sure you perform the exercise properly.  Assume a shoulder-width stance and take a snatch grip; the weight should be on the mid-foot or shifted slightly toward the heels. 

Now here's the most important part. Really work to lift the chest and retract/depress the scapulae. You should work to keep this position throughout the movement, and there should really be no movement around the upper torso after you're locked in.

From the starting position, shift the weight to the heels and think of simultaneously pushing your heels through the floor and pushing the knees back. Not only will this really tax your upper back, but it'll also roast your hammies if you're pushing the knees back properly.

IT Band/Tensor Fascia Latae Stretch

Lie supine with the knees flexed to 90?. To stretch the right side, cross the right leg over the left so that the lateral aspect of the right ankle is in contact with the left quadriceps. Next, reach through (with the right hand) and around (with the left hand) to grasp the left hamstring. Pull the left leg toward your face, thus applying pressure on your right ankle to move in the same direction (don't let the knee move, though; you can actually push away on it). You should feel a stretch along the lateral aspect of the right thigh, particularly where the glutes begin.  Perform the opposite steps to stretch the left ITB and TFL.

Barbell Step-ups

Most of you probably already know how to do step-ups; we just want to offer a few reminders:

• Keep the chest high, head up, and scapulae retracted throughout the movement.

• Position your foot so that the heel is on the step or bench, and the back leg is on the floor with the toes dorsiflexed (pulled up, like an elf shoe). Positioning your trailing leg toes like this will prevent you from pushing off with the back leg.

• Drive the heel of the lead leg into the bench as you would with initiating the deadlift, and forcefully contract the hamstrings and glutes to pull yourself up onto the bench. Don't worry about going out of your way to consciously fire the quads; they'll come along for the ride, we promise!

• As you reach maximum height, squeeze the glutes. Step back with the trailing leg and repeat for reps. Don't alternate legs; do all your reps on one leg, rest, and then move on to the other side.

Dead Bug Twists

Lie supine with your legs bent to approximately 90 degrees and extend your arms as shown. Draw your navel towards your spine, pressing your low back into the ground. While keeping the stomach tight and back flat, rotate your torso slightly from one side to the other.

Another note:  If at any point during the movement the back comes off the floor, stop the movement and return to the starting position.

Side Hip Thrusts

Position yourself so that your body is sideways and perpendicular to bench. Rest the bottom elbow on the bench and the feet stacked on top of one another on the floor. Keeping your body in a straight line and the head facing straight forward, thrust the hip toward the ceiling. Hold for a count of one, descend to the bottom position, and reverse the movement. Once you've completed your reps, flip over and work the other side.

Pronated, Medium Grip Seated Row

This is just a normal seated row, but we want you to use a wide-grip lat pulldown attachment and an overhand grip (this grip reduces involvement of the subscapularis). Keep your chest high and don't round over; focus on initiating the movement by retracting the scapulae. Your arms should just "come along for the ride" as you bring the bar to the lower abs.

Shoulder/Pec Stretch

Using a doorway, post, etc., firmly grab with one hand at about shoulder level. With a "soft" elbow, twist from the hips away from the arm until you get a mild stretch in the chest and shoulder. Hold for 15 seconds and then repeat with opposite arm.

Face Pulls

Face a lat pulldown or low pulley machine and grab the rope with an overhand grip. Pulling through the elbows, take the middle of the rope in a straight line towards the bridge of your nose, forehead, or throat (the higher you pull, the higher on your back you'll target). The key is to make sure you fully retract the shoulder blades at the midpoint, squeeze, and then return to the starting position.

Rear Delt Fly

Get on a rear-delt fly machine (to prevent cheating) and use a neutral grip. Keep your chest against the pad throughout the movement.  If you can't understand the directions on the machine, give up on postural correction training and go play in traffic.

Alternate Exercise: Bent-over Laterals

Bend over at the waist, placing the weight on the heels and keeping the chest up. From the starting position, squeeze the posterior deltoids and raise the dumbbells to a point parallel to the ground.  Squeeze at the midpoint and then return slowly to the starting position. Don't use the upper traps; this isn't a shrug!

Low Pulley External Rotations

Set the handle on a low pulley at slightly above knee height and stand with your non-working side toward the weight stack. Grasp the handle with your working arm and pull it across your body until it's at upper thigh level on the opposite side. This is the starting position. The elbow should be flexed to approximately 90? with the upper arm held as close to the side as possible. To execute the concentric portion of the movement, externally rotate the humerus (all the motion should be at the shoulder) while keeping the elbow close to the starting position. A good trick is to pin a towel in between your elbow and side to prevent cheating; if the towel drops, you're abducting, which indicates recruitment of the supraspinatus and deltoid (not the external rotators).

Dip Shrugs

Set yourself up as if you had just completed a dip with bodyweight; keep the body as vertical as possible (minimizing forward lean). With the elbows locked, shrug your shoulders so that all the movement occurs at the scapulae. It's very important that you attempt to keep your scapulae held tight against the rib cage throughout the movement; do not let them wing! If you don't have access to a dip stand, you can do these off a bench (as shown below).

High-to-Low Cable Woodchops

With the knees slightly flexed, stand with one side facing a cable set-up with a D-handle attachment set above your hairline. Reach across your body and grip the handle with only a slight bend in the elbow.

Using the core musculature (especially the internal and external obliques), forcefully rotate your upper body to pull the cable across your body to a point below the opposite hip. Slowly return to the starting position and repeat for reps. Try to avoid excessive hip flexion by focusing on keeping the chest high. You should also get some activation of the hip abductors with the body weight shifting that occurs throughout the exercise.

Walking Dumbbell Lunges

You've probably done these before, so there's no need for an elaborate description. Make sure to keep your chest high and scapulae retracted; don't round over!

Dumbbell Split Squat Isometric Holds

Position yourself as if you're going to do a dumbbell split squat with the back leg elevated. However, instead of descending all the way to the bottom, we want you to hold at a position where the front leg is slightly below the 90 degrees knee flexion position. 

Drive your front heel into the floor and squeeze the glutes and vastus medialis hard, keeping the chest high and scapulae retracted. Since the loading is pretty significant, you should fatigue, relaxing into a stretch for the hip flexors on the back leg. All in all, you'll want to hold the position for one minute before moving to the other side. You may find it helpful to find some way to "fix" your back foot. The point between the back pad and seat on an incline bench works well, as do benches with built-in gaps (for switching from flat to incline). Or, you could just have someone hold your foot.

Pull-throughs

Position yourself with your back to a low pulley with a rope attached. Reach back between your legs and grab the rope with a neutral (palms facing each other) grip; be sure to take a step forward to ensure that the weight stack doesn't touch down on the eccentric portion of the lift. With a slight knee-bend, keep a tight arch in your lower back, the chest high, and the head up. Drive your heels into the floor (as in a deadlift or good morning) and fire your hips forward. Focus on contracting the glutes as you pull through.

Pulldown Abs

Facing away from a lat pulldown machine, pull a rope attachment down behind your neck. From the starting position, flex the abs down until you can't contract them anymore.  Note: Make sure you only use your abs, not your hip flexors! Come up under control to the starting position. Think of rolling your shoulders over onto your lower abs instead of your entire torso going to your knees.

Dumbbell Dorsiflexion

Sit on a bench with the legs close together and the ankles and feet dangling off the end of the bench with a dumbbell held between the feet. With the knees locked to prevent the quadriceps from assisting with the movement, raise your toes toward your face (dorsiflexion). Hold for a count at the top, and then lower the toes and repeat for reps.

Note: If you have access to a dynamic axial resistance device (DARD), use that instead.

Calf Stretch

This one isn't rocket science.  Either do this on the edge of a step, or from a semi-pushup position.

Chest Supported T-Bar Row

This is a normal T-Bar row; we just don't want you to cheat it up with hip extension! Be sure to retract the scapulae to initiate the movement and hold the retraction for a count at the top. Use a pronated (overhand) grip and be sure to keep the chin tucked.

Alternate Exercise: Prone, Pronated Grip, 45? Incline Dumbbell Rows

This is just a makeshift T-Bar row. Follow the same guidelines as before: scapulae retraction and tucked chin.

SCM/Upper Trapezius Stretch

In a seated position with good erect posture, place your right hand on the bottom of the chair and your left arm on the opposite side of your head. Gently pull on the right side of your head with your left hand to assist the stretch; hold for 15 seconds. Reverse all these steps to stretch the left side.

Suboccipital/Levator Scapulae Stretch

From the same starting position as the SCM stretch, tuck the chin in and bring it towards the chest. Place the left hand on top of the head to assist the stretch and hold for 15 seconds.

Single Arm Low Pulley Cable Row to Abdomen

Set the pulley at mid-shin and face the weight stack with a shoulder-width stance, knees slightly bent, and lower back slightly arched. Hold the handle with a neutral grip (thumbs facing up), and initiate the rowing movement by retracting your scapula on the same side as the handle. Then, bring the handle to alongside the hip. Think of this as a seated row/one arm row hybrid.

Dumbbell External Rotations, elbow supported at 90 degrees

Sit sideways on a preacher bench and support your elbow while holding a dumbbell. In the starting position, there will be 90? angles at both the shoulder and elbow joint; in other words, it'll look like you're waving to someone with your elbow propped up. 

From this position, lower the dumbbell forward (internally rotating the humerus) so that your palm faces toward the floor while maintaining the 90?/90? shoulder/elbow angles. Once the dumbbell has reached the pad, reverse directions by externally rotating the shoulder to return to the starting position. Keep the chest high and chin tucked throughout the movement.

One-Arm Prone Lower Trap Raises

Ideally, this exercise is performed face-down with your chest-supported on an elevated flat bench (i.e. longer legs, so that you're higher off the ground). However, if you don't have access to such a bench, you can do it bent-over; just make sure that your upper body remains parallel to the floor at all times (no cheating!)

Hold a dumbbell in one hand with a supinated group (the thumb points up at the top of the movement). Begin with the arm dangling below you on the bench. Horizontally adduct (think reverse fly) your arm while maintaining the thumb-up position. At the top, your arm should be at the 9 (left) or 3 (right) positions, and the upper arm and torso should form a 90-degree angle. Throughout the movement, concentrate on retracting the scapulae while keeping it tight to the rib cage (no winging).

Saxon Side Bends

Suffice it to say that we love and hate Coach John Davies for popularizing this movement; it's extremely effective, but hurts like hell (in a good way, of course)! Stand with the feet slightly wider than shoulder-width apart with a dumbbell held in each hand and the arms directly overhead and together. Laterally flex (bend) to one side, with the motion coming at the waist, not the shoulder girdle and arms. Return to the starting position, and repeat on the opposite side. Be sure to keep the dumbbells close together throughout the movement.

Chin Tucks

Lie supine with the head flat on the floor. From the starting position, tuck the chin towards the chest, but keep the head on the ground (e.g. don't let the suboccipitals and SCM take over the movement!)  Hold, relax, and then repeat as necessary.

Theraband External Rotations

These are performed exactly the same as the low pulley external rotations, but with a theraband instead.

Prone Cobras

Lie face down on the floor with your arms lying next to your torso with the thumbs up. Initiate the movement by squeezing the shoulder blades together and raising your upper chest a few inches off the floor.

A key point: as you come up, externally rotate your arms so at the midpoint your palms are facing down. Hold and squeeze at the top, then lower under control to the starting position. You'll be doing a set of these at two positions: 9 and 3 (arms directly out to the sides) and 10 and 2 (arms slightly forward of the previous position?kind of like Superman).

                                                                                                                          

9&3

10&2

Scap Pushups

This exercise is also known as a "Pushup Plus." Basically, it's a pushup without any movement at the glenohumeral or elbow joints. Get set up as if you were going to do a pushup, and then just allow your shoulder blades to retract without bending your elbows. You should drop about two inches toward the floor. 

To reverse the motion, protract the scapulae until you're back in the starting position. This exercise activates and strengthens the serratus anterior, a muscle that is crucial in holding the scapulae tight to the rib cage, thus preventing scapular winging.

Single Leg Knee to Chest on Foam Roller

Lie supine with a foam roller positioned directly underneath your spine (parallel to it) between your back and the floor. Posteriorly tilt the pelvis utilizing abdominal hollowing; this should flatten out the lower back (neutral spine) and allow you to maintain contact with the roller with your lumbar spine. 

Raise one knee to the chest while maintaining the flat back position. For most individuals, the actual movement approximates 90-135 degrees of hip flexion. A good trick is to place your hand on your abdomen during the movement to develop a better awareness of abdominal firing (as opposed to hip flexor firing).

Note: If you don't have access to a foam roller, you can pick up one of those pool noodles children use in swimming pools to stay afloat. You'll probably have to cut it in half, but it's important to have one of these items in place for sensory feedback.

Prone Bridge and Side Bridge

For the prone bridge, bend the elbow so your upper and lower arms make 90-degree angles, and make sure the elbows are placed directly underneath the shoulder. Brace your entire core area and keep your hips up and in-line with your legs and torso. For the side bridge, you'll only be bracing with one arm at a time. "Stack" the feet and keep your body in a straight line.

Additional Stretches (to be performed daily)

Lat Stretch

Again, using a doorway or post, keep the hands just above hip level. Keeping the chest up and your back flat, push the butt back until you feel a stretch along the sides of your back. Hold for 15 seconds.

Good Morning Stretch

This is an excellent technique that focuses the stretch on the hamstrings rather than the low back. Stand up straight with the chest held high and the hands on the hips. From the starting position, push the butt back until you feel a mild stretch in the hamstrings. Remember to keep an arch in your back throughout the stretch! Hold for 15 seconds and repeat as necessary.

Seated Side Bend (Quadratus Lumborum) Stretch

From an upright, seated position place the fingertips behind the head. From this position, try to let the left shoulder/elbow lower down to the hip. Don't twist the spine! Make sure the trunk is erect for the entire duration of the stretch. Hold for 15 seconds, and then repeat on the opposite side.


Concluding Remarks

We designed this program for the average Joe Weightlifter to iron out imbalances; there's nothing particularly fancy-schmancy, sport-specific, or "functional" about it. As such, the core exercises included at low volumes may not be applicable for everyone's goals. Some of you may need Olympic lifts, for example.

That said, you may wish to modify some of the exercises utilized. Just make sure the overall integrity of the program remains virtually the same in order to "undo" the damage that's accumulated from years of unbalanced training approaches and poor daily posture. If you do choose to modify the program and aren't sure if you've done so appropriately, feel free to post your version of our program on the T-Forum [link] and we'll do our best to stop by and offer critiques and suggestions for improvement.

You'll want to follow this program for four weeks, dropping the overall in-gym volume for the fourth week.  Rather than going overboard to calculate a 38.9756% reduction in volume, simply drop a set off of each exercise in the program. Start up the following week with the program we'll outline soon in Part V! 

 

It's been a while since Part IV so those of you following this program are probably chomping at the bit for the conclusion. Chomp no more, because this is it!

The program contained in this article is designed to reintroduce more of the traditional exercises that you've grown to love while still maintaining the emphasis on postural corrections through appropriate prioritization and volume manipulation. Essentially, it's one step closer to the balanced training programs you should seek to create. Remember, we shifted the balance in the opposite direction to start to take care of the problems created by lack of balance in previous programs.

This program will last three weeks (and is meant to follow the first program outlined in part IV), after which you'll want to have a back-off week consisting of markedly lower volume. Oh, and even if you're not following the entire "Neanderthal No More" program, you'll still learn some new exercises you've probably tried before.

Here are the goods:


Monday

Pre-workout: Normal dynamic warm-up, but include 3x10 side steps (per leg) with the ankle band. (Descriptions and pics to follow.)

A) Rack Pull with exaggerated scapular retraction
Sets: 8
Reps: 3
Tempo: 21X3 (two seconds to lower, one second pause on the pins, explode up, three second scapular retraction at the top)
Rest: 90 seconds between sets and before B

B) Rack Pull with exaggerated scapular retraction: back-off (feeder) set
Sets: 1
Reps: 15-20
Load: 70% of working weight from A
Tempo: 21X3

C) Lunge off 6" box
Sets: 3 per side
Reps: 8
Tempo: 20X0
Rest: 45 seconds between sides

D) Kneeling Squats
Sets: 4
Reps: 12
Tempo: 10X1
Rest: 60 seconds, during which time you should stretch your hip flexors

E) Full Contact Twist
Sets: 3
Reps: 6
Tempo: 30X1
Rest: 30 seconds between sides


Wednesday

A1) Chest Supported Row
Sets: 5
Reps: 6-8 (week 5), 5-7 (week 6), 4-6 (week 7)
Tempo: 20X2
Rest: 60 seconds before A2

A2) Incline Dumbbell Press
Sets: 5
Reps: 6-8 (week 5), 5-7 (week 6), 4-6 (week 7)
Tempo: 20X0
Rest: 60 seconds before return to A1 and A2

B) Chest Supported Row: back-off (feeder) set
Sets: 1
Reps: Max
Load: 75% of A1 working weight
Tempo: 10X1

C1) Bent-over Laterals with 10-second iso-hold on last rep
Sets: 3
Reps: 8
Tempo: 20X2
Rest: None; proceed immediately to C2

C2) Prone Lower Trap Raise with 10-second iso-hold on last rep
Sets: 3
Reps: 12
Tempo: 20X2
Rest: None; proceed immediately to C3

C3) Dumbbell Cuban Press
Sets: 3
Reps: Max
Load: 7% of 1RM Bench Press
Rest: 2 minutes before repeating tri-set

D) Bar Rollout
Sets: 5
Reps: 10
Tempo: 30X1
Rest: 90 seconds


Thursday

Pre-workout: normal dynamic warm-up, but include 3x10 side steps (per leg) with the ankle band.

A) High Bar (or safety squat bar) Low Box Squat
Sets: 5
Reps: 10
Tempo: 21X1
Rest: 2 minutes, during which time you should stretch your hip flexors and calves

B) Seated Good Morning
Sets: 3
Reps: 8-10
Tempo: 20X1
Rest: 90 seconds, during which time you should stretch your IT band

C) Extended ROM Bulgarian Squat
Sets: 3
Reps: 6-8
Tempo: 21X1
Rest: 45 seconds between sides

D) Reverse Hyper
Sets: 3
Reps: 12-15
Tempo: 2012
Rest: 60 seconds

E) Uneven Barbell Side Bend
Sets: 3 per side
Reps: 8
Tempo: 20X0
Rest: 30 seconds between sides


Saturday

A1) Double D-Handle Seated Row
Sets: 6
Reps: 10
Tempo: 20X2
Rest: 60 seconds before A2

A2) Weighted Dip
Sets: 6
Reps: 6
Tempo: 20X0
Rest: 60 seconds before returning to A1 and B

B1) 1 1/4 Inverted Row
Sets: 3
Reps: 8
Tempo: 20X2
Rest: None; proceed directly to B2

B2) Band Retraction
Sets: 3
Reps: 12
Tempo: 3012
Rest: 2 minutes before return to B1

C) L-Lateral Raise
Sets: 3
Reps: 8
Tempo: 20X2
Rest: 90 seconds

D) Single-Arm Dumbbell Protraction
Sets: 3 per side
Reps: 15
Tempo: 11X1
Rest: None; alternate back and forth between sides

E) Prone Bridge
Sets: 2
Reps: 1 really long one!
Rest: 120 seconds

Note: No tempo here. This is the same exercise we used in the GPP portion of Part 4, but you're just going to do two sets for maximum duration. If you find that you can hold this position for more than 60 seconds, have someone add a 45-pound plate or two to your back. Keep the abs as rigid as possible.


Exercise Descriptions

Side Step with Ankle Bands: We’ve used variations of this exercise with others and ourselves pre-training, during training, and on off-days. As girly as they may seem, you really can't go wrong with them, as the hip abductors need constant stimuli in order to counteract the tightness that almost everyone has in the TFL/ITB, iliopsoas and adductors. Loading isn’t all that important here; you're just working on activation.

Basically, you’ll need either bands with Velcro cuffs on each end that allow you to wrap them around each ankle, or regular bands that you can double wrap to get around your feet. When doing side steps (or other variations), you have to concentrically work with the lead leg abductors and eccentrically with the trailing leg abductors (provided that you control the movement speed and don't let your feet get too close together in between reps).

Rack Pull with Scapular Retraction: Set the pins in a power rack to a point about an inch below your kneecaps. From here, just do a top deadlift: fire your heels into the floor, thrust your hips forward, and lock out the bar with a glute squeeze.

Here’s the kicker: when you’ve locked the bar out, pull the shoulder blades together forcefully and maintain this retracted position for three seconds. This is a phenomenal exercise for upper back thickness, forearm and grip development and deadlift lockout strength.

Lunge off 6" Box: Place an aerobic box in front of you (yes, they really are good for something), just short of where you'd normally land for a regular dynamic lunge. With your chest up, take an exaggerated step forward, landing on your left heel. Sink into the lunge until your right knee is very close to or lightly touches the ground. Drive back off the heel to the starting position. The extended ROM (range of motion) will really blast your VMO and glutes, two important determinants of knee stability.

Kneeling Squat: Set up some padding on the floor at the base of a power rack and position the bar so that it's slightly below shoulder level when you're on your knees on the padding. From a kneeling position, slide under the bar as if you're going to squat it and unrack the weight. At this point, you'll be upright with a 90-degree angle at your knees.

From here, simply push the butt back while looking straight ahead or slightly up. When your butt makes contact with your calves, fire your glutes in order to push the hips forward. You'll really be able to feel the glutes working at lockout (as they should with the lockout of a deadlift). You'll not only be surprised about how much weight you can use on this, but also with how sore your posterior chain is the next day!

Full Contact Twist: Take a barbell and position one end of it in a corner. You’ll want to load plates on the opposite end for resistance. Using an alternate grip, grasp the barbell at the weighted end with the arms extended and your back to the wall. Using the core musculature, rotate the torso until you face toward the wall. On the eccentric portion of the movement, lower the barbell under control to the starting position.

Chest-Supported Row: You’re probably familiar with this exercise already, so a full description is unnecessary. However, remember a few important components:

1) Initiate the movement with scapular retraction; the arms should just come along for the ride.

2) Keep the chest pushed out against the pad. Never lean back to move the weight with "body English," as doing so will just recruit the hip extensors.

3) Keep the neck vertical and chin tucked. In other words, you should be able to tuck the chin without staring down at the floor.

Incline Dumbbell Press: Nothing too exciting here. Grab a pair of dumbbells and lie on your back on an incline bench. Before pressing the dumbbells up, make sure to retract and depress the shoulder blades. This will not only give you a more stable surface to press from, but it'll also keep your shoulders healthy and allow you to use more weight! Drive the dumbbells up in an arc to a point just over your chest, then lower under control to the starting position.

Bent-over Lateral: You may have used this in the last program due to lack of a rear delt flye machine. If so, don't sweat it, we've changed the recommendations enough to allow you to keep it in there for a few more weeks.

Bend over at the waist, placing the weight on the heels and keeping the chest up. From the starting position, squeeze the posterior deltoids and raise the dumbbells to a point parallel to the ground. Squeeze at the midpoint and then return slowly to the starting position. Don't use the upper traps; this isn't a shrug!

Prone Lower Trap Raise: This is the same exercise that we used in Part IV; however, now we’re going to do it with both arms at the same time. Whether you do it bent-over or prone with your chest supported on a bench is up to you; just make sure that you’re getting plenty of scapular retraction, keeping the thumbs pointing up, and raising the arms to 9 and 3.

Dumbbell Cuban Press: Perform an upright row until the dumbbells are just below your armpits. At this point, hold the elbows steady while externally rotating the humeri. At the completion of this movement, there should be 90-degree angles at both the shoulder and elbow. Then, simply press the dumbbells overhead, curse our names, and lower along the same path to repeat for reps.

Bar Rollout: Load a barbell with a plate on each side and set it on the floor. Kneel down in front of it with your hands just outside shoulder-width. Make the abs as rigid as possible and let the bar roll out in front of you. Go out to a point where your lower back wants to sag, and then squeeze the abs to return to the starting position.

High Bar Low Box Squat: Again, Louie and Dave have written extensively about how to box squat properly, so we’re not going to beat a dead horse here. The only difference between the standard version and our version is that we're putting an emphasis on depth to increased glute and VMO recruitment. Key points to remember here include sitting back as far as possible, keeping the chest up, squeezing the glutes, and forcing the knees out to explode off the box. For full details, see Dave Tate's article HERE.

Seated Good Morning: In a power rack, get under a bar so that it’s resting across your upper traps. With a wide grip and the upper back tight, sit down on a bench that puts your knees at 90° of flexion. Make sure that you have a relatively wide stance to allow for appropriate range of motion. Maintain your lordotic curve, tight upper back and chest-up position while lowering the upper body until your torso touches your inner thighs.

At this point, forcefully drive the head back as you dig the heels into the floor and allow the hip extensors to fire your torso upward. When the trunk is upright, reverse the directions to begin the next rep. Focus on feeling the hamstrings and glutes — not just the lower back.

This exercise can do wonders for individuals that have a hard time coming out of "the hole" when squatting, and obviously has a carryover to core hip extension movements (e.g. deadlifts, standing good mornings, Olympic lifting).

Extended ROM Bulgarian Squat: This exercise is identical to the version we described in Part IV, with the only difference being we're increasing the ROM to further blast our VMO and glutes. Set-up and performance of the exercise are identical, but this time you'll put an aerobic or low box where your foot would go. This adjustment makes the exercise much more difficult, so you should consider reducing the load until you get acclimated to the movement.

Reverse Hyper: Louie Simmons and Dave Tate have talked for years about the benefits of this exercise, so if you aren’t incorporating them, now is the time.

Lie facedown on a reverse hyper machine with your arms grabbing the bar in front of you. Squeeze your glutes and swing your legs back to a point where they're in-line with your torso, making sure to keep your legs as straight as possible and lead the movement with your heels. Squeeze your glutes, hamstrings and lower back at the top, and then lower under control to the starting position.

I’m sure many of you are thinking, "What if I don’t have a machine?" Be creative and improvise! John Davies has talked about doing them off the back of a pick-up truck. Another viable option is to jack up the front and back of a Roman chair or glute-ham machine, and lie backwards on it so your hands can grab the back and your hips are hanging off the front end. For added loading, have someone place a dumbbell between your ankles.

Uneven Barbell Side Bend: This one will make you hurt for a few days, so consider yourself forewarned. Position a barbell in a rack as if you’re going to do squats. Instead of loading plates on both sides, though, put the weights on one side only (you might want to double up on clamps just to be safe). Position the bar across your upper traps with a relatively wide grip; be sure to keep the scapulae retracted and upper back tight.

With the feet shoulder-width apart, do a side bend to the weighted side. Don’t allow the knees to bow inward or the opposite hip to "slide" out; the legs should remain perpendicular to the floor the entire time. Perform the desired number of reps and then switch over to the other side.

Double D-Handle Seated Row: This is a normal seated row, except you’ll be using two D-handles as your attachments. These handles allow you to supinate your forearms as you row. Begin the movement with the handles at arm’s length and a neutral grip (palms face one another). As you row, supinate so that the palms are facing up when your scapulae are retracted. This supination will also give rise to a fair amount of humeral external rotation, which certainly bodes well for your cause, hunchback.

Weighted Dip: If you’ve been training for more than a week, you know what a dip is. If possible, perform these with weight, making sure to keep the chest up and squeeze the triceps throughout.

One and One-Fourth Inverted Row: Also known as the "fat-boy pullup," this is an upper back exercise with a good carryover to the bench press.

Set a barbell up on the pins in a rack (or just a Smith machine; scary that they actually have a good use, huh?) at about mid-thigh. Now, position yourself on the floor under the bar with your hands positioned as if you’re going to do a bench press. Instead of pressing the bar, pull yourself up until your sternum touches the bar. In order to modify resistance, change the position of your legs and feet. The progression from easy to difficult is as follows:

1) Knees flexed, feet on floor

2) Knees extended, feet on floor

3) Knees extended, feet elevated on bench

4) Knees extended, feet on bench with weight plate on chest

You want to keep your entire body in a straight line; don’t allow the hips to sag. Remember that we’re doing one and one-fourth reps, so after touching your chest to the bar and retracting the scapulae, you’ll drop one-quarter of the way down and then go back up to the bar before returning to the floor. That’s one rep. Enjoy.

Band Retraction: This is a simple exercise that doesn’t quite provide us with enough loading to make it a primary movement, but it works perfectly as a follow-up to a bigger exercise.

Loop a mini-band around the post of a power rack so that the middle of the band is in the middle of the post. Put your elbows in the ends of the bands, and just try to squeeze your shoulder blades back and together. You don’t have to worry about your arms taking over the movement here, but make sure to keep the movement nice and controlled so momentum doesn’t take away its effectiveness. Note that the chin is tucked in the photos; this is important, as we don't want you to reinforce that protruded chin/forward head posture.

L-Lateral Raise: With a dumbbell in each hand and the elbows flexed to 90°, perform a lateral raise to 90° of humeral abduction. Once your upper arms are parallel to the floor, externally rotate your humeri so that your forearms are perpendicular to the floor (as in the mid-phase of a military press).

Single Arm Dumbbell Protraction: Set up as if you’re going to do a one-arm dumbbell bench press. With the dumbbell in the up position, simply protract your scapulae. Think of punching the dumbbell through the ceiling without flexing the elbow or significantly moving at the glenohumeral joint (we’re looking for scapular motion only here). Hold at the top for a count, and then allow the scapulae to retract.

This exercise helps to strengthen the serratus anterior, which holds the scapula tight to the posterior aspect of the rib cage. You'll be able to use some decent weight on this exercise, but don't get caught up in adding pounds if it's compromising your form. Holding the protraction is far more important than the weight utilized here.


Conclusion

Well, it's been fun, but you're on your own now. Where you go from here is entirely up to you. You can either continue the trend we've sought to establish with positive daily postural habits and a balanced training approach, or you can go back to a life of slouching at your desk and training only what you can see in the mirror.

Hopefully, we've set the record straight: a few sets of lat pulldowns and leg curls simply won't cut it and will actually make the problems worse in many cases! For those of you who have stuck with the entire program, we encourage you to post some "before" and "after" photos to show the stubborn Neanderthals what they're missing!