Case Study - Postural Complaint

Written By Holly Hunt

Client Profile

Age: 34
Occupation: Office-based professional (8–10 hours/day at a desk)
Activity Level: Walks occasionally, no regular strength or mobility training
Primary Complaint: Ongoing neck and upper back discomfort, worse at the end of the workday

Presenting Complaint

They report:

  • Dull, aching pain through the neck, upper back, and shoulders

  • Occasional headaches starting at the base of the skull

  • Stiffness when turning her head, especially after long periods of sitting

  • A feeling of “tightness” across the chest and shoulders

  • Symptoms worsen with prolonged computer use and improve slightly with movement or stretching

No red flags, trauma, or neurological symptoms reported.

Key Postural Features:

  • Forward head posture

  • Increased thoracic kyphosis

  • Rounded shoulders

  • Mild anterior pelvic tilt

  • Reduced thoracic extension

  • Shallow, upper-chest dominant breathing pattern

Likely Contributing Factors/Possible Conditions

Overactive / Tight Structures:

  • Eg. Upper trapezius, Levator scapulae, Pectoralis major & minor or Suboccipital muscles

Underactive / Weak Structures:

  • Deep neck flexors

  • Lower trapezius

  • Serratus anterior

  • Thoracic extensors

  • Deep core stabilisers

Pilates-Based Exercise Program

Primary Goals:

  • Improve postural awareness

  • Restore thoracic mobility

  • Strengthen postural support muscles

  • Reduce neck and shoulder tension

  • Improve breathing mechanics

Watch Points

  • Neck and head positioning

  • Breath holding/shallow breathing

  • Mobility

  • Abdominal activation

Suggested Program Focus

1. Breathing & Awareness

  • Supine diaphragmatic breathing: Focus on rib expansion and reducing upper chest dominance

  • Head nods/chin tucks (deep neck flexor activation)

2. Thoracic Mobility

  • Cat–Cow

  • Thoracic extension over a foam roller, barrel or ball

  • Seated mermaids, twist

  • Adding thoracic twists to lunges, seated work or standing work

3. Scapular & Upper Body Strength

  • Arm openings / chest expansion (supine or seated)

  • Scapular work - chariots, setting or upper back work (eg. fly or row)

  • Wall angels

4. Core & Postural Integration

  • Dead bug or tabletop variations (eg. arms in straps or matwork)

  • Four-point kneeling (eg. bird dog, kickbacks or reverse knee tucks)

  • Standing posture integration exercises (eg. stacking the spine, head positioning, adding back work to standing leg series)

5. Stretching & Release

  • Chest opening stretches

  • Upper trapezius and levator scapulae stretches

  • Gentle cervical mobility work

Holly Hunt
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