Rounded shoulders

Rounded shoulders describes a position in which the shoulders—more precisely, the scapulae and the heads of the upper arm bones—sit forward of the trunk's midline and roll inward. Korean terms for it also mean rounded shoulders or rolled-forward shoulders. In English, it is called rounded shoulder posture or forward shoulder posture. It describes a visible posture rather than a diagnosis.

How far forward the shoulders sit varies from person to person, and even within the same person it changes throughout the day depending on activity and fatigue. It therefore makes more sense to view it as a postural characteristic on a continuum rather than something that is either present or absent.

It often occurs alongside forward head posture and thoracic hyperkyphosis. Head position is described as forward head posture, shoulder position as rounded shoulders, and the curve of the thoracic spine as thoracic hyperkyphosis, but in everyday conversation the three are often grouped together as “slouched posture.”

In terms of the scapulae, the position is described as sliding forward (protraction), tilting forward, rotating downward, and rotating inward.

Several factors work together.

• Spending long periods with the arms held forward — The shoulders are more likely to roll forward when you spend a long time with both arms in front of your body and your head bent down, such as when using a keyboard and mouse, using a smartphone, driving, breastfeeding, or caring for children. Posture and daily habits are also discussed in Visual display terminal syndrome and Sedentary lifestyle.
• Balance between the muscles at the front of the chest and in the upper back — In Janda's upper crossed syndrome model, the pectoralis major and pectoralis minor at the front of the chest and the upper trapezius are considered prone to shortening and tension, while the rhomboid muscles, middle and lower trapezius, and serratus anterior are considered prone to weakness. The idea is that the shoulders roll forward when the front pulls and the back cannot provide enough support.
• The role of the pectoralis minor — The pectoralis minor attaches to the coracoid process of the scapula and pulls the scapula forward and downward. The serratus anterior holds the scapula against the rib cage and acts in opposition.
• The connection with the thoracic spine — When the upper back rounds, the surface on which the scapulae rest tilts forward, making the shoulders more likely to roll forward as well. This is also considered in relation to movement of the thoracic vertebrae.

Many people have rounded shoulders without any discomfort. When discomfort is present, it generally takes these forms:

• Aching or stiffness at the front and top of the shoulders.
• A feeling of heaviness at the back of the neck and medial scapular border pain.
• A feeling of restriction at the front of the shoulder when raising the arm overhead.

When the scapula is tilted forward, the space beneath the bony projection of the shoulder blade (the acromion) may narrow as the arm is raised, so this posture is sometimes discussed alongside shoulder impingement syndrome. It is also mentioned in discussions of thoracic outlet syndrome because of the nerves and blood vessels that pass beneath the pectoralis minor. Research has also reported that shoulder pain in volleyball players was associated with sensitivity to pain rather than forward shoulder posture itself. The degree of visible postural change and the level of discomfort vary from person to person, so it is helpful to consider how your body feels rather than judging by posture alone.

There are three simple ways to take a look using a mirror or a photograph.

• Side-view reference line — In a photo taken from the side, check whether your earlobe, the tip of your shoulder, and your pelvis lie roughly along one line. Look at whether the tip of your shoulder sits noticeably in front of this line.
• Direction of the backs of your hands — Stand comfortably with your arms hanging naturally and check whether the backs of your hands face forward. When the shoulders roll inward, the whole arm rotates inward, making the backs of the hands more likely to face forward.
• Standing against a wall — Stand with your back against a wall and check whether the backs of your shoulders touch it comfortably or feel as though they roll forward and lift away from it.

These methods are not tests that measure angles and use numerical cutoffs. They are simply ways to get a rough sense of your postural tendencies and become more aware of your usual shoulder position. Taking photos in the same place and the same position at one-month intervals can make changes easier to see.

• Change positions often — Rather than holding a good posture for a long time, getting up every 30–40 minutes to circle your shoulders and stretch your arms overhead is more comfortable. Avoiding long periods in one position matters more than finding a perfect posture.
• Stretch the front of the chest — Rest your arms on a doorframe and gently lean your body forward to stretch the front of your chest for 20–30 seconds. Go only far enough to feel a stretch.
• Use the upper-back muscles — Movements such as spreading your arms out to the sides and drawing your shoulder blades together and releasing them, or holding a resistance band and pulling backward, can help. They are useful for learning the feeling of keeping the scapulae against the trunk.
• Check your work setup — Keeping your monitor at eye level and your elbows close to your body helps the shoulders roll forward less. Try positioning your keyboard and mouse so that your arms do not reach too far from your shoulders. Getting into the habit of lifting your smartphone to eye level is also helpful.
• Take deep breaths — Opening your chest and breathing in deeply may let you feel your rolled-forward shoulders briefly straighten. Try it a few times during work.
• Move in different directions — Activities that use your arms forward and backward, up and down, engage the muscles around the shoulders in a balanced way. Swimming, yoga, and Pilates are examples of exercise that involve large shoulder movements.

• When you feel a sharp, catching sensation at the front of your shoulder as you raise your arm
• When numbness, tingling, or a feeling of weakness in your arm or hand persists
• When shoulder pain wakes you at night
• When only one shoulder is noticeably rolled forward or the shoulders are at different heights

If you notice these changes, consult a professional who can assess both your shoulders and neck.