The Best Postural Stretch?

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We talk a lot about posture and it’s effect on function and pathology on this site.  I think the above classic drawing says it all.  We are what I call an “anterior dominant” society.  Everything we do in our lives results in muscle length and stretch imbalances as a result of our daily posture.  Numerous injuries have been linked to these postural disturbances ranging from cervical headaches, to shoulder impingement, to bulging discs in your back., to plantar fasciitis.

I’ve talked about Yoga in the past and have included in my recommendations for the best home workouts.  But lately I started to think more about the Cobra yoga pose shown below and wondered, is this the best stretch of all time for postural issues in our society?  Take a closer look at the two pictures below, notice anything?

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The cobra pose is almost exactly the opposite of our standard sitting posture in our society.  If you go joint by joint, the entire body is almost reversed in this stretch position.  Take a closer look in this table:

  Sitting Posture Cobra Pose
Ankle Dorsiflexed Plantarflexed
Knee Flexed Extended
Hip Flexed Extended
Lumbar Spine Flexed Extended
Thoracic Spine Flexed Extended
Lower Cervical Spine Flexed Extended
Upper Cervical Spine Extended Flexed
Shoulders Forward Backward
Head Forward Backward

My only minor complaint is that people unfamiliar with the pose or that may have moderate stiffness will have a difficult time getting their shoulders retracted well enough.  But this is coachable and should be something that one can overcome. 

Extension exercises are no secret and large components of popular manual therapy theories, such as the McKenzie Method, or if you take into consideration the deep frontal line from the Anatomy Trains concept. But I openly wonder if we should be using this stretch on more of our patients other than those experiencing low back pain, perhaps our shoulder impingement patients, for example.  I know I feel better myself after performing this stretch.

Just like anything else, there are contraindications to this stretch and it isn’t for everyone, but I am starting to think it is grossly underused in our programs.  What do you think?

 

 

Yogo photo credit

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43 Responses to “The Best Postural Stretch?”

  1. I think you would have to specifically pay attention to where the movement comes from around the hips/lumbar spine.

    Serious stiffness in the hip flexors really limit the hip extension (first hand knowledge), and I feel like most people would compensate with excessive extension in their lumbar spine. Stretching the abdominals isn't something that would help in the long run.

  2. Ernie O'Malley June 21, 2010 at 10:25 am

    That's exactly what I think. Tried this pose as I actually have low back pain and I really felt it wasn't doing any good as I got the motion mainly from the low back. Rather stretched my hip flexors separately and extended my thoracic spine on a foam roller and so on.

    • I think it’s really important to make sure your transverse abdominus are turned on “low” and that your core can support you in this position or else you may find you get excessive extension in your lumbar spine. If this exercise is difficult or painful for you, it might be good to look into some Pilates-type exercises that encourage thoracic extension with core stabilizers turned on, before progressing to this exercise.

  3. What exactly is excessive lumbar extension? However you classify it unless your a former gymnist I'm willing to bet you don't have it.

  4. Couldn't the cobra just be modified to prone on elbows if this was too much of a stretch for someone? Then it could be progressed to cobra. I think it seems like a good postural stretch to think about for patients other than those who have back pain. Not only would it be a stretch, but it could also work on the endurance of the mid and lower trap in order to retract, downwardly rotate, and depress the scapulae to get into the correct cobra position.

    Someone mentioned that they have too tight of hip flexors to perform the cobra pose, but there is also a "resting pigeon" yoga pose (see picture here: .
    I was thinking that way you're focusing on one hip flexor at a time. It's similar to the cobra however only leg is extended in back and the other hip and knee is flexed in front. This may sound difficult but a yoga block(s) or firm pillow(s) could be propped up under the buttock of the leg that is flexed in front as shown in the picture. That way you don't have to be too uncomfortable if you're not that flexible. So, the pigeon stretch provides a hip flexor stretch of the extended leg and a piriformis stretch of the flexed leg, then the upper body is in the same position for the cobra providing a stretch to the anterior musculature. Possibly a little off topic but I figured I'd throw it out there for discussion. The resting pigeon is probably more for a younger or more active patient population.

  5. I agree that you could rely on too much back extension and starting on your elbows may be a good progression. I wasn't really thinking of this as a stretch where you would torque yourself to gain more motion, but more of a postural release by putting your body comfortably in this position (or modified) and sustaining. If you have to push into end range, that may be too aggressive. Not sure if that helps clarify my thoughts but great points by everyone so far!

  6. Mike, great thought! It's true that cobra is a reversal of the all-too-prevalent sitting posture. But it's actually quite a difficult posture to master. If you look around a typical yoga class you'll see rounded shoulders, hyperextended elbows, necks and yes, lumbar spines. (Path of least resistance). I personally prefer to teach 'mini-cobra' first, focusing on building up range, strength and endurance of the scapulo-thoracic region.

    Full cobra can be modified by using a folded blanket or block under the pubic bone. This allows for less hip extension and therefore less 'compensation' in the lower back. (@Todd – many people may not have excessive lumbar ROM as defined by normative standards but functionally, I would say anytime you stretch through the most relatively mobile parts at the expense of the tighter areas, it's excessive.)

    But yes, I do think this pose is under-appreciated and underused by PTs! And I think that we're in the position to make sure our clients are doing the best version possible.

  7. Christie Downing, PT, DPT, Dip. MDT June 21, 2010 at 6:51 pm

    Well, of course I cannot pass up this one, Mike! Certainly the "cobra" pose or repeated extension in lying is an essential part of managing a few conditions, and as you elude to, is often an appropriate "stretch" to do for MOST people. There are some studies that demonstrate that it can be helpful in reducing the risk of back pain in a military population. It's main applications, from a McKenzie standpoint, are in the treatment of a reducible derangement that is an extension responder or in the treatment of extension dysfunction.

    Part of the McKenzie process, however, is to tailor the exercise to meet the needs of the patient. Loaded vs. unloaded (I prefer to keep them standing when possible…better compliance), end range versus mid range, static versus repetition, getting "hyperflexible" patients to end range on books stacks, etc. In the treatment of the derangement syndrome, it's what ever construct allows the patient to experience a reduction and/or centralization of symptoms and/or a rapid increase in range of motion. Then, of course, sometimes lateral forces are required prior to pure saggital extension.

    In the treatment of extension dysfunction, the goal of the exercise is to stretch shortened and adapted tissues. The concept of "produces end range pain, but not worse afterwards" is the key. In these cases, the exercise SHOULD cause some discomfort at the central low back, but should subside shortly afterwards. It's our job to educate the patient and what they should be feeling (or not feeling)….

    of course in the end, you have to make sure you have the classification correct…

    What may surprise most non-McKenzie PTs, however, is that although MOST patients we see have derangement syndrome and that MOST of them require some form of extension, we actually treat more CONDITIONS with flexion than extension. Flexion is used to treat: anterior derangement, flexion dysfunction, adherent nerve root, nerve root entrapement, stenosis and is also used in the recovery of function and in reduction of fear/avoidance behaviors.

    Extension can be modified in many ways, and in the end, it's all about the patient. If they need extension, it's a very powerful tool. But we must also not forget flexion. In fact, we LEARN more about a patient's condition by flexion than we do by extending them.

    …in the MDT world, there's a little saying:

    "before you go to a McKenzie course, you flex everyone and extend no one"

    "after your first course, you extend everyone, and flex no one"

    …by the time we get to the 3rd and 4th courses, we learn how to use BOTH motions (and others) to tell us how the patient can make themselves better.

  8. Christie Downing, PT, DPT, Dip. MDT June 21, 2010 at 6:54 pm

    …oh, I forgot my point of where I was going with this. In the end, the point I wanted to make is that it CAN be used outside the normal orthopedic population. As an anecdote, a co-worker of mine who is an NCS and Parkinson's patient, finally sat through the McKenzie lumbar course. So many patients he was seeing were sacral sitters and had persistent LBP. Using McKenzie concepts, he's able to help these patients better manage their pain. Some are derangements, some have dysfunction…to a greater extent than the general population. He often has to use sustained midrange forces. In the end, using the concepts, he's able to modify the exercise to meet the needs of his patients.

  9. I got an email yesterday with a request for my opinion on Mike Reinold's post on the cobra pose, noting the Anatomy Trains reference and yoga. My first thought was the thread with Elitetack.com member the Muse bringing up yoga a few weeks ago. The intent of the email was not a set-up for some me to hammer a sarcastic response, but to create dialogue of the fact that some are back to using yoga again. It never left. The question was integration of various postures into training. One thing I liked about the post was Mike included a chart of how the posture could unwind the "front" line with those that are stuck in a hunched position. This was sort of a joint by joint approach to training shared by mike and it was a nice look to see what areas could be affected by the big back for your buck exercise. I think it has merit but for who? I find that overhead actions stretch out the front line more such as snatches but with his baseball populations that is a bad idea perhaps. I do think young athletes will benefit but an older athlete will need manual therapy. With guys like Curt Schilling playing videogames locked up for days the rate of change to his fascial system is likely to be months (18-24 according to Myers) that perhaps the cobra pose would be too long and slow. Here are some parting thoughts.

    Athletes sometimes like good manual therapy because they can just lay down and let people work on them. I do think therapy starts with training but the older the athlete the more likely therapy is the solution because it's much faster than training. The youth need more training and less therapy.I stand with Al Vermeil that sometimes manual therapy is necessary. Last, Mr. Glove like many coaches want to see how training and doing things better may help with some of the "PT" type needs and I attached one detail of why I do a lot of core barefoot. I saw divers training and like the fact that they had great plantar flexion abilities when they were doing core work, so I tried this with swimmers who were not gifted in the ankle flexibility and I saw measurable changes over a few months. The physioball and weight of the body did a nice stretch, so much of the needs in flexibility for athletes is done by indirect training.
    for photo

    http://www.elitetrack.com/blogs/details/5230/

  10. I love the dialogue, anytime I have a post with a question mark in it (i.e. "The best postural stretch?"), I know we are going to discuss a lot. I'm glad that so many people have shared their thoughts and experience. That is why I pose questions like this, realize I am not saying this is the best exercise for everyone, but rather questioning if it could be used more. Your responses help make it even better. I love everyone's comments on starting and/or performing in modified positions, makes great sense.

    @ Christie – when are you going to write up a multi-part post on Mckenzie for dummies for me??? Your responses are always a highlight and I would love to read more from you and share your thoughts with my readers. Email me!

    @ Carl – Good thoughts and good point on sharing Tom Myer's thoughts that any postural changes will likely take 18-24 months. That is a good point and should be noted. This isnt a quick fix but more of a postural release position to "unwind" you from the anterior dominant posture you have positioned your body in all day at work/play.

    That being said, have you ever had low back pain and did a few extensions and it felt better? Or have you had a headache and did a few shoulder retractions and it went away? This shows the promise of "reverse posturing." I just made that term up (I think) but I like it. Reversing the self-destructive anterior dominant posture that we all have in our daily activities.

    I really dont think we can make major changes in a persons posture, I just dont, its too hard. We use our body in these bad postures all day, why would a few exercises for a few minutes a day make any lasting changes? Rather than try to focus on changing posture, perhaps "reverse posturing" exercises, sore of like positional release positions, can be given to people to at least take some tension off the body throughout the day.

    What does everyone think about that thought???

  11. I just wanted to add that "cobra pose" as you have it pictured, is the final expression of this posture. Cobra begins on the forearms (AKA~sphinx pose) and progresses with time into full cobra. There are many preparatory steps before lifting the front body into this intense posture. Taught properly the low back is protected by engaging core muscles(as referred to in one of Mike's previous articles as the "abdominal brace") prior to initiating any movement of the upper body.

  12. Mike,

    I do think you can provide some major changes in posture and body alignment with people in their 30s. I have seen it with the sport of Athletics (track and Field) but most athletes that are involved with that environment live in a purist situation where every .01 counts. The culture of most sports don't allow for enough training and soft tissue therapy for change.

    I don't like corrective exercises as a primary solution but aggressive training and soft tissue done in the right sequence have done some nice things with sports that are more speed and power. I liked the rapid soft tissue therapy work I am seeing and the combination of program design, such as using a clean pull vs a deadlift for spinal changes. Big olympic lifters have some nice postures and yoga is not the primary stimulus.

  13. How ironic! I wrote a blog about the effects of sitting last week and considered incorporating my thoughts on the cobra pose into the blog. I decided not to write about it but I do believe in "reverse posturing" and taking tissues into opposite ranges to prevent adaptive shortening and the host of negative consequences that follow. Obviously for some you'd need to regress the pose. Great post Mike!

  14. Phil Page PhD PT ATC CSCS June 22, 2010 at 12:55 pm

    The 'flexed' posture often results from tightness-prone and generally overactive tonic flexor muscles: pectoralis, SCM, suboccipitals. Dr. Alois Brugger (Swiss neurologist) described the "Brugger Relief Position" in sitting to reverse flexed posture. He then described a 'postural reset' exercise using light Thera-Band resistance that simultaneously activates all the tonic extensor muscles, theoretically inhibiting the tight flexor muscles. This is one of my favorite exercises and applicable for anyone, particularly those at a computer all day, or those who can't assume a cobra position on the floor like me. Here's a link with the exercise and video: http://www.thera-bandacademy.com/exercises/showExercise.asp?exID=426

  15. Hi Mike
    I completely agree with your analysis of the postural distortions associated with long term sitting and with the benefit of stretches. I think it is also useful to see those postural distortions in other contexts though.

    Many of the slumped sitters I see show the "upper crossed" muscle imbalance (as described by Janda)along with a posteriorly rotated pelvis on sitting. Stand them up though and a whole other picture emerges.

    Suddenly the "upper crossed syndrome" is balanced with either a "lower crossed" pattern or a "swayback/layered" posture. in both cases the lumbar spine goes into an extension pattern with an anteriorly tilted pelvis. What these people seem to be demonstrating is not a posteriorly tilted pelvis but an unstable pelvis and lumbar spine. I'm therefore cautious about recommending a stretch like the cobra, that is really easy to do badly, particularly if you have an unstable pelvis/lumbar spine. This is despite being a long term yoga practitioner myself.

  16. Another thought-provoking post, Mike. I appreciate the diverse comments and do agree with a number of views about the cobra pose. The illustration on man's evolution is cool too. Looking forward to your next question.

    Rick Kaselj
    http://www.ExercisesForInjuries.com

  17. Lance "Gerkin" Goyke June 23, 2010 at 7:21 am

    @Todd, I would classify any extension past neutral excessive (for me, in the very least). It just doesn't feel good.

    @Mike, I have extension-based back pain, so extensions have never helped my back feel better.

    On posture changes, it seems to be possible with proper education and effective correctional programming. I know some days I have better posture than others based on what I've been doing in the gym lately. I also agree that the older the person is, the harder it gets.

  18. @ Bretcontreras – I checked out your post, great job, good info.

    @ Phil Page – great info as well and thanks for the link! I do like the Brugger Relief Position, though think we need to incorporate the lower extremity more as well. Good thoughts on also incorporating activation of all the extensor muscles.

    @ AndrewP – I agree, I often comment on how and upper body cross position sitting can easily be modified by simply anterior tilting the pelvis, you magically sit upright! That is why sitting on a physioball helps with your posture. I try to sit on the edge of a chair to help this as well.

  19. Christie Downing, PT, DPT, Dip. MDT June 23, 2010 at 4:06 pm

    Lance…you state "extensions never make my back feel better"…does it leave you feeling worse, or just hurt while you do it? Are you having pain at times other then when you extend your back? The answer to these might help classify whether you would have a possible derangement syndrome or an extension dysfunction. It's quite possible you need a different loading strategy before working on your extension.

  20. Lance,

    I couldn't agree more with Christie when talking about loading strategies, what your describing is not normal and can be helped by the right person. Lumbar Extension is essential to every day function and deficits in this area if not treated only worsen with age.

  21. I think that a lot of people who get pain with lumbar extension are not getting proper gliding of the sacral base on L5. This will create pain and limited mobility. Quickly assessing sacral glide during an active cobra stretch will clue you into the potential need for work focused on this area. This is the same for intervertebral movement. Some good ol' PA's have surely seen quick but lasting changes in lumbar extension. Then there's the case of thoracic mobility restrictions that will place a lever arm of torque into the lumbar spine.
    Overall a great stretch that has been used for thousands of years.
    Leon Chaitow has a great postural stretch in his MET book- the Brugger relief position- basically sternosymphseal distraction, level chin, shoulder ER w/ elbow extension and thumbs out. Slight shoulder retraction and a series of a few deep breaths. This can quickly be performed at work/school/etc.

  22. Christie Downing, PT, DPT, Dip. MDT June 28, 2010 at 8:27 pm

    …I know there are probably several dozen "todds" on this site, but any change the above "todd" is "montclair" todd? If so, good to see you "here-y"

  23. Mike,

    What is your opinion of this exercise for someone with lordosis? Is the implementation of further extension based exercise a no-no for someone in this circumstance.

    Please enlighten me. I'm only in first year Kin.

    Best,
    Tavis

  24. I just wrote a long reply and lost it!!! Here is the quick version:

    1) to give a potential "position of relief" for patients with severe kyphosis I have them passively lie supine over a towel roll. If pec minor tightness is an issue, which is almost always is, they can outstretch their arms as well if tolerated.

    2) In response to the physician who was asking about education and lifestyle coaching ideas. I focus on "proximal stability before distal strength" and get this in the mind of the patient early. I describe the Tranverse abdominus as a corset that must "turn on" miliseconds before "every movement that you make". I believe there is evidence that suggests that the underlying issue with activation of the TvA is a timing problem rather than a muscle dysfunction problem. Once they have that knowledge and you cue them how to turn it on they seem to do quite well.
    Lifestlye is a totally different subject…I was actually wondering how people address the issue of obesity as many people with posture impairments also have weight concerns.

    Keep up the awesome work Mike. Your site keeps it real!

    JP, DPT

  25. Cobra pose is such a good stretch. Even though it’s in almost any yoga practice, not everyone gets the best stretch they can. Yoga guru Leeann Carey has a free yoga video on the best way to do cobra. I thought your readers might want to check it out.

  26. Great site!

    I've always liked the Cobra stretch for my own personal workouts. Great comparison too.

  27. All good points here pertaining the cobra position. I am more of a fan of teh Mc>kenzie extension position than the classic Cobra as that also involved neck extension. Besides that this position has a mechanical effect on the involved tissues as well as a fluid transition effect (JOPT) I think there is more involved here. I believe that this position can help to restore neutral in the involved joints of the spinal segments as they interlock on each other in a closed packed position, potentially shutting off hihibitory respnonses (Janda). Also in my opinion the position release effect cannot be ignored from a neurologic standpoint. As a big fan of neurology I also believe there is an effect to be considered around the concept of rhythm and repetition. In fact rhythmic movements is a form of actively introducing our brain to oscillatory timing, its fundamental organizer of neural information. Examples are PROM, PNF patterns and so forth. Maybe neural synchronization is at play here as well.
    What do you think?
    http://www.facebook.com/kineticintegrations?ref=ts

  28. I have experienced coaching the cobra with an active gluteus maximus contraction going into the stretch and holding the stretch shifts fra fosut from the lower back to the abs and thoracic spine. Works great for a hyper kyphotic (scheuerman) person as myself.

  29. Keep these articels coming as they\’ve opened many new doors for me.

  30. Yes for the Cobra stretch, I completely agree! As a movement analyst I also know that we need to recuperate from living predominately in this forward relationship to the world. Our bodies craves full dimensional movement. I find many students with lower back problems complain about this pose until they realize they need to turn on the support from the front.

    As an exercise instructor I incorporate this stretch in my classes and include gentle back extension exercises as well. I do not cue to retract the shoulders (people tend to pinch them together)but to externally rotate the humeral head and gently draw the shoulder blades down. Teaching someone to rise in Cobra while maintaining the integrity of the shoulder girdle and support from the deep abs is not complicated but then again I consider myself a professional nagger.

    I also work a lot, a la Eric Franklin, with visualization. Students are asked to imagine one smooth curve upwards. It helps in keeping excessive pressure out of the areas where there would be more flexion naturally. I was also taught to cue students to visualize more flexion in those too stable areas, sometimes by placing a finger on the spinous process and cuing it to move forward. Seeing the shift is always very rewarding and students report great relief/sense of wellbeing as well.

  31. Each to their own but I agree with what others have raised regarding dysfunctional back and hip mechanics causing an issue.
    I personally don’t think the ankle rest in dorsiflexion when seated. Perhaps in ideal seated posture where the ankles are kept at 90 + degrees, but most people extend legs far more distal from their COM which leaves their ankle plantarflexed.

  32. I like to stand up in front of my computer desk chair at work, grab the inside of the arm rests behind me, and really stick my chest forward while going into a little extension but mainly in the thoracic spine all while keeping my neck packed as best I can. It’s almost like an exaggerated no-money drill where I continue the motion to grab onto the arm rests for a nice static stretch. Feels great to me! What do you think about that in comparison, Mike?

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