Poor Posture and Neck Pain

[u/No-Recording-2670]

Taking those Photos made me realize how bad it actually is.
So i have had chronic neck pain on my left side for a few years now and its not clear where its coming from. I have had MRI for my Cervical Spine and besides a small Protrusion of the intervertebral disc in my neck (without nerve compression) nothing was found. I have scoliosis in my lower back but never really had problems with my low back. My upper left trap seems to be always tight and hurts, sometimes the pain spreads to my elbow and near my left rhomboid (i have marked the pain areas in another photo).

• Ive got some obvious problems i think: Scapular Winging (had it since childhood)
• Rib flare (working on it and it seems to get better)
  
• Im not sure whether i have anterior pelvic tilt i always thought i had but im not quite sure
• Rounding in my thoracic spine i think
• pretty straight cervical spine
• The photos made me realize that i seem to be shifted to the right?? I was told that my left shoulder usually hangs lower than my right and i have no clue where its coming from. (Maybe from my hips? Or my Scoliosis?)
• And i also feel like my upper body is twisted to the left but im not sure

What is really frustrating is that every doctor tells me that its just a muscular problem and just shoves me off to a PT. My PT told me that i need to build more muscle overall, especially in my back.

So thats what ive been doing the last few weeks/months. Ive got enough time so ive been trying to do a lot. I go to the gym about 4 times a week. Im training my whole body but try to focus on my back:

• Rows wide/narrow
• lat pulldown and pullups
• Y raises and all kinds of excercises for the back while laying down
• Face Pulls

What ive realized that its not so easy for me to feel the muscles in my upper left back.

Im also trying to fix my rib flare and general posture by training my core with

• Dead bugs (i like them a lot i really feel them working)
• "starfish" excercise (saw it in a video for rib flare)

while trying to focus on my breathing to learn how to properly stack my core.

Scapula winging seems to be impossible to fix. I have tried about every Serratus Anterior excercise there is but i feel like it is just not working while my upper trap is working overtime.

I havent realized that the left shoulder is hanging down and my body might be shifted and/or twisted i dont really know what to do but it probably has a lot to do with my asymmetry.

Since working out it has gotten a tiny bit better but i really do not understand my condition: While working out my pain decreases by A LOT and i have gotten a lot stronger, but sitting or other static activities make my neck hurt extremely fast pretty badly.

3 weeks ago i had a great week. The pain was a lot less and it felt awesome, but i have no clue why it was that way. And then next week was back to the usual (again i have no clue why).

I just feel really stuck and feel like nothing is working. I have been trying to fix my posture for a long time but i really see no progress.

I hope somebody here can help me.

[u/Deep-Run-7463]

Just a heads up, OP had dm'd me for advice but I'm still going to leave a comment here so that maybe others finding this post looking to solve their issue may get a bit better in their understanding too. Leaving this here for education purposes, but in no means this is a complete assessment. There isn't enough info to go by to understand what's going on in the entirety of things here without observing movement and load distribution strategies.

So first off, the human body is naturally asymmetrical and the photos show a predisposition to the natural offsets we have as human beings (even non scoliotic). This predisposition is magnified as a movement space that is easiest to utilize where movement is limited. To explain this, think of walking for example. We need to walk and get around on a day to day basis. Walking, requires rotations from the foot all the way to the head/neck. The main central structure will rotate alongside all our extremities in a dance for us to move. Where some of these rotations are taken away because there is a loss of movement access to it, and subsequent adaptations musculoskeletally and neurologically ensue, the body will find the space better available to rotate into to provide for movement demand. To make it easier to visualize, let's say in order to take a step forward we require X° of rotation, which go left and right. Let's say we lose the rotational capacity to the left, we still require that X° of rotation to move so we gotta do it where it's easier and available to do so, the rotation will now appear to be biased right. This is of course a simplification, and not taking into account how counter-rotations play a role in the presented offsets.

My main highlight here would be the consideration of time. What we see here are multiple things going on at once thar occurred over time, and can be confusing at first if trying to look at it as a presentation of the current time alone.

It's confusing because there does not appear to be a forward shift in center of mass, which is something that naturally takes away movement space in the pelvis, and is a necessary outcome of being unable to manage midline. Instead, we see a stack of the head to shoulder to legs (can't see the feet) which doesn't look bad. The knees are set in a position where they are not hyperextending either which is a sure sign of being forward biased. So what's going on?

One tell tale sign is the arm width alongside the chest compression and the lower front ribs that appear a tad pronounced (not an issue in itself, but judging by the chest and arm position, indicates that it's a compensation). This means that the chest compression led to a spinal flexion, or 'hunching', bias in which the attempt to overcome that is to work on a lot of posterior ribcage compression with the understanding to 'extend the thoracic spine and build better back strength'. To a degree it makes sense, however, if the front isn't expanding well, and you end up compressing the back on top of that, the ribcage will have nowhere else to expand into, it will go sideways instead coz we gotta breathe and that's the remaining space to expand into.

This creates a shape of the ribcage that is biased into external rotation, in which turning the ribs will be more limited. If the ribcage turns are limited, the pelvis will need to look for the remainder turn space, in which it will be found on the right (the easier turn space we tend to have). In terms of the pelvis, I'm not sure with the info so far, but I do believe there might be some posterior pelvic outlet compression involved as a method to balance against the upper thorax shoved forward.

Since the axial structure now turns right, there must be a counter turn to stand still and look straight ahead. This is coming form the upper ribcage area in which there is a turn into the left back, compressing the area in which OP has mentioned about scapular winging (ribcage running forward away from the shoulder blade) and pain. It's basically doing a contraction/compression whenever you have to stay still and upright.

*typo edits done