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Posture is usually defined as the relative arrangement of the parts of the body. Normal or standard posture is the state of muscular and skeletal balance that protects the supporting structures of the body against injury or progressive deformity. Forward shoulder posture (FSP) or “rounded shoulders” is one of the numerous deviations from the normal posture. Kendall et al1 describes FSP as abduction and elevation of the scapula and a forward position of the shoulders. In addition to abducted scapula, FSP also include winging of the scapula and medial rotation of the humerus.2 The aetiology of FSP has been attributed to several factors. Kendall et al1 state that posture and relative alignment of body segments are affected by muscle shortening and weakness. They describe FSP as the result of the shoulders being pulled by shortened or tight anterior shoulder girdle muscles, such as the serratus anterior, pectoralis major and minor, upper trapezius and intercostalis muscles. Additionally, FSP may be caused by weakness and lengthening of the muscles that function to pull the scapula toward the spine, such as rhomboids and the middle and lower trapezius muscles.3 4 According to Knudsen,5 FSP can be attributed to the presence of excessive and habitual flexion of the back, which will eventually cause the pectoral muscles to shorten and fix the shoulders in this forward position. Muscle length changes in FSP may result in abnormal scapulohumeral rhythm, impingement of rotator cuff tendons,6 acromioclavicular joint degeneration, bicipital tendonitis3 and painful trigger areas.7
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