Bones Says…”Counteract Clinician Kyphosis!”

The daily demands of being a physician are daunting. From managing patient loads and charts, to handling insurance claims and complaints, workday stressors abound. And don’t forget about the physical stress: standing for hours on end; white-coat with heavy, overstuffed pockets weighing around the neck; reading X-rays with your head in forward flexion; eating less-than-optimally and using M&M’s as energy supplements… the list abounds.

Holistic Primary Care believes that we as physicians are most effective when we keep ourselves healthy and can model healthy living for our patients. To that end, we’re happy to present the “Bones Says” column, to help you restore your well-being while on the wards, in your office, or wherever it is you spend your time caring for others. We need to take care of the care-takers, too!

“Bones Says….” is adapted from its original home at living anatome, a website that helps medical students practice what they preach, by promoting conversations and curriculum concerning self-health. Bones represents voices from a variety of holistic healthcare fields such as yoga, naturopathy, Pilates, energy management, to give you specific recommendations for how to ease the physical and emotional stressors of medical practice.

What is Clinician Kyphosis?

skeleton_MrBonesHarken back to your days in residency: you wore a white labcoat with pockets full of pocket guides, pens, and patient lists, while a stethoscope hung around your collar. This large burden on your neck and shoulders likely had a predictable, postural result: a flexed upper back, slouched shoulders, and a head jutting forward. It is likely that you continued this posture… labcoat or not! Whether you spend your days bending over an examining table, stooping to write patient notes, or sitting in front of a computer viewing medical images, odds are good that you’re suffering from a case of Clinician Kyphosis.

With any postural misalignment, muscles are misused over long periods of time; in response, some muscles will tighten, while others weaken. With Clinician’s Kyphosis, the muscles of your anterior chest wall (e.g. pectoralis major) become short and contracted, as they are forced to maintain chronic flexion of the thoracic spine. In contrast, the deep muscles of your upper back (e.g. erector spinae) become weak and elongated, as they, likewise, conform to the kyphotic position.

Counteracting CK

When working with postural misalignment, it is important to stretch the muscles that arebhujangasana_cobra_pose tight, and strengthen those that are weak. A simple yoga pose, Cobra pose (Bhujangasana) stretches those tight anterior thoracoappendicular muscles (e.g. pectoralis major) and strengthens the weak thoracic extensor muscles (e.g. erector spinae) to counteract the kyphosis, and add breadth and expansion to your anterior chest.

How to do the pose:

o Lie prone on the floor, with your forehead flat on the floor.
o Place the palms of your hands on the floor, directly under your shoulders. Keep your elbows against your sides.
o Your legs, extended straight behind you, should be engaged, but not gripping. Press the dorsum of your feet into the floor for a gentle engagement.
o While inhaling, start straightening your elbows, raising your chest from the floor. Your pelvis (and lower extremities) should remain on the ground.
o Raise your chest as far as you can while still maintaining a connection between your pubic bone and the floor. If your pubic bone lifts off the floor, bend your elbows until it is back on the ground.
o Once you find the appropriate height for your chest, ensure that your elbows are still hugging your sides, your scapulae are stable against your back, and your shoulders are lowered away from your ears.
o In this position, your back is in extension. Make sure that the extension is even throughout, e.g. your cervical spine should follow the extension of the rest of your spine (be careful not to extend the head back too far!)
o Hold the pose anywhere from 15 to 30 seconds, remembering to breathe… and maybe even smile!
o While exhaling, slowly release your chest to the floor.

Counteracting Clinician Kyphosis with the Cobra pose can be done in any space that approximates the length of your body. Your bedroom, living room—even the physician’s break room is fair game. Performing 3 sets of Cobra won’t take more than 5 minutes, so the hardest part will likely be remembering to do it!

Stephanie Pieczenik Marango, MD, RYT is a practitioner of Mind-Body Medicine in New York City. She merges the movement and medicine worlds in her private practice, as co-founder of living anatome, as co-Director of the Functional Anatomy for Movement and Injuries (FAMI) Workshop, and through Yoga Teacher Trainer programs. Find out more, participate, or contact her at

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