Rounded shoulders or hunch back, forward head posture or tech neck, whatever you call it, it’s all posture. Specifically posture in the upper body. And also, the posture that most people notice. As a posture specialist these are the biggest complaints that people have when they come in to correct their posture. If I ask a question like “What is it that you want to get out of our time together,” most people will say something along the lines of, “I want to stand up straighter” or “I don’t want to look so hunched over.” Again, these are important changes that people want to make, so we are going to tackle a couple things in this article.


  1. Why shoulder issues come about in the first place
  2. What can shoulder issues lead to
  3. How to tell the difference between kyphosis, rounded shoulders, and sway back
  4. What to do to test what you have

An Important Caveat

This article is written as a generalization. While it will pertain to different people more or less, this is just an accumulation of the knowledge that I have seen overlap within my community (clients and non-clients, alike). The goal of writing this is to bring some clarity to your situation and a better idea of your posture. If this article doesn’t quiet have all the answers you are looking for, free consultations are always a great way to get you pointed down the right path. So, without further ado. . .

Why Diagnosis Don’t Matter

I wrote about this in the first article of this series, but again want to briefly go over it. A diagnosis is just a name for a list of symptoms. There is something about getting a diagnosis, whether self-diagnosed or diagnosed by a professional, that puts us in a mental box. Suddenly our life becomes about fixing that diagnosis, those symptoms. Symptoms can be one of two things when it comes to posture. Either pain/tension or postural deviations, like rounded shoulders of forward head posture. But we need to remember that symptoms are sort of like magic tricks.

While the magician is doing something over here with one hand and making noise, he is really preforming slide of hand with the other hand. The symptom is the bunny coming out of the hat, the coin from behind your ear. But what set that up to be a success? Something we weren’t even looking at.

The same goes for symptoms in our bodies. We are so busy looking at the pain bunny and watching it jump up and down and go here and there. Now I get it. I had chronic pain as well. I was always aware of where the pain bunny was, and I would do anything to make sure it didn’t jump up. But now, looking back, I know that a better use of my time would have been to figure out what slide of hand was making my pain bunny come out of the hat in the first place. And that is what I am here to hopefully help you with today.

Where Do Shoulder Imbalances Start

Of the eight load-bearing joints (two ankles, two knees, two hips, and two shoulders) the shoulders are on top. What does this mean? That offsets and imbalances that happen below can have a large effect on what the shoulders are doing.

Think about it like this: a little twist in the ankle and knee may completely lop-side the hip and it’s up to the shoulders to counteract that imbalance. What’s more, our spine, that sits atop our pelvis, goes directly through our shoulders, giving our upper and lower body a direct line of constantly streaming information. Our bodies entire role is to keep equilibrium and to find balance. This doesn’t mean that all issues start from the bottom up. All imbalances come from repetitive movement patterns.

Our bodies adapt to whatever stimuli we give it, and rather quickly. If our body notices that we are in one position or doing one activity over and over again, it will adapt. By adapt, I mean that it will find a way to use the least amount of energy. Our bodies are all about using the path of least resistance. So, if we are sitting for extended periods of time, then there is the chance that we will slouch to save energy, potentially causing rounded shoulders. If we stand, we may find ourselves leaning up against something for no reason, potentially causing a rotation. If we are constantly carrying something and walking, we will favor a side to consistently take the brunt of the work, potentially causing an elevation.

Over time our posture will change to better support these tasks with ease. But most of the time this initially well intended change can lead to a heavy list of symptoms. Some that we can expect and those that we might not.

What Symptoms Can Shoulder Imbalances Lead To

What about all the other joints that aren’t load bearing? The jaw, the elbows, the wrist, the hand? A lot of those things rely directly on the shoulder to show them the way. If the shoulder is out of position, then the rest of the arm will follow. Purely because the shoulder socket is their own connection to what the rest of the body is doing. Our heads also count on the shoulders to stack well so they have something to stabilize on. If our heads cannot stabilize all sorts of things can go array.

Posture Symptoms

The most common and direct thing that can happen is the combination or rounded shoulders and a forward head posture. When we have rounded shoulders, the shoulder rounds forward within the socket creating an imbalance in muscles and leaning the shoulder shelf forward and moving the scapulae away from one another. This muscle tension can cause our upper spine to be forced behind the midline a bit. To counter this imbalance our head can find itself forward of the midline, which can cause other symptoms we will get to later. Rounded shoulders can also lead to issues in the arms and the hands. If we have rounded shoulders, it can be obvious that the next thing to round would be the arms and the hands.

Another common posture symptom people can notice is when one shoulder is higher than the other. This can look like a shoulder is closer to the ear lobe or like the muscles are more built on the top of one shoulder compared to the other. An interesting question to ask is if the shoulder that is elevated is the one that you use more or the one that you experience pain in? Just something to think about.

Sometimes what can come across as rounded shoulders or an elevation can actually be a rotation in the shoulders. Rotations are always interesting because it usually passes through multiple joints in some way. The ever amazing body is keenly aware of these types of nuances and will usually correct the head so that it is not also rotating with the shoulder.

Rounded Shoulders Look-A-Likes

Kyphosis can commonly be mistaken for rounded shoulders, or vice versa, based on appearance. It is when the curve of the upper spine is over exaggerated. Someone who is kyphotic can have a hunch back that is relatively immobile. We will get into this with the testing below. It can look like rounded shoulders because the shoulder blades do move away from each other, but unlike rounded shoulders, which has more to do with the shoulder socket itself, kyphosis has to do directly with the thoracic spine.

Another rounded shoulders look-a-like is swayback. Unlike kyphosis which deals with the upper spine, swayback is in response to what to lower body is doing. In this scenario the lower body is moving forward of the midline, whether it be a slight lean from the ankle to the hips, or the hips dumping forward into an anterior pelvic tilt, or the lower back is lordotic. In response, the upper body will move to counter this imbalance. It will literally sway back. This causes the upper spine to move behind the midline. The arms and head will usually move forward to keep some weight in front of the midline, leading to the look of rounded shoulders.

Pain Symptoms

The Obvious

The obvious pain symptoms are going to be those related to the muscles that are located around the shoulder joint and the scapulae. Especially with rounded shoulders you can feel tension between the shoulder blade and the spine. When dealing with rotation there is usually pain more on one side of the body then the other. The same goes for elevation. This is because we have one side that is off balance, creating a different type of tension and pull in one side of the body then the other.

The Less Obvious

Less commonly associated symptoms are those in the elbow, wrist, and hand. When our shoulders are out of place, we deal with a different muscle tension when creating movements with out arms. Whether it is carpal tunnel in our wrists, tennis or golfers elbow, or loss of grip in our hands it can all lead back to the shoulders.

The Nerves

Our shoulders are a very complex joint that deal with not just tendons and ligaments but nerves as well. Numbness or radiating pain in the arm or face can also be contributed to the shoulder position. Rounded shoulders can change the freedom that our nerves have to move and do their job. The little canals and tunnels that they call home can be seriously impinged because of the diverse and dramatic changes that take place with postural changes like rounded shoulders.


The Head

Even less associated with shoulder position are issues with the sinuses, headaches and migraines, ear issues, and eye strain. Shoulder position, and therefor head position, play a large role in the ability for our ears and sinuses to release pressure and drain properly. I once met a man who used to have to get his sinuses drilled because the mucus could not drain. Because of it he had sinus headaches, massive ear aches, and a constant throbbing that he said did not feel like a headache, but more of a pressure in his brain. Because of his job he had hip and lower back pain that also made his leg go numb every once in a while.

As we were descending from the plane ride his ears couldn’t pop which helped the situation none. I went with him and his wife to the baggage claim and there preformed a 10 minute static hold that released his ears, completely dissipated his hip pain and reduced his sinus headache and the pressure in his head completely.

Tests to Figure Out Your Imbalance

These are very simple tests to give you a better understanding of what exactly is going on in your body joints wise. If any further explanation is needed please feel free to schedule a free consultation with me to go over your results and get next steps.



Rotation/rounding/swayback –

All you need for these tests is a wall.

  1. Place your heels up against the wall so they fit snuggle.
  2. Relax the rest of your body, totally and completely.
  • What to feel for:
  1. Does one shoulder push into the wall more than the other shoulder? Rotation.
  2. Does it feel like your calves or butt are barely touching or not touching the wall, but your shoulder are pretty firmly planted on the wall? Swayback.
  3. Do you feel that the tips of your shoulder blades are barely touching or not touching the wall but you can feel your mid back/spine touching the wall more? Rounded shoulders.

Kyphosis check –

  1. Place your heels up against the wall so they fit snuggle.
  2. Relax the rest of your body, totally and completely.
  3. Now bring your arms up into a “T” position.
  • What to feel for:
  1. Do your shoulders flatten out against the wall and you feel yourself standing up a bit straighter? Not kyphosis.
  2. Is it hard for you to bring your arms up -or- does it now straighten you up or change your shoulder position at all? Kyphosis.

Elevation –

You will need a mirror and additionally a ruler or something with a straight edge and a dry erase marker.

  1. If not using a dry erase marker skip to step 2. If using a dry erase marker, draw a line across the mirror at a place where when you stand back your shoulders can line up to.
  2. Stand back and either line up with the line on the mirror or just look. See if one shoulder is higher than the other.

This is a simple way to see if you have an elevation of not.