Before I get into helping you answer that question, I want to preface this article by saying that everyone is asymmetrical, but not always in the same ways. Let’s face it, we’re asymmetrical beings – most of us write with one hand, are stronger on one side, and habitually move and operate in ways that emphasize using one side more than the other for different tasks. It is not the presence of asymmetry that is a concern, it is the degree of asymmetry that we have to look at. This is true of posture as much as it is of movement and I would like to start this series of postural articles looking at a very common postural asymmetry: shoulder tilts.
Let’s begin by having you stand in front of a mirror and wave your arms up and down a few times. Doing this loosens you up a little bit and helps interrupt your natural tendency to want to artificially “straighten up” when looking at yourself (yes, we all do this and no it doesn’t mean you’re an egotist). Now with arms hanging loosely by your sides, immediately look at your shoulders in the mirror and see how level they are with each other – we’re looking for the outer edge of the shoulders where they begin to slope down. If they line up perfectly then congratulations! You don’t have a shoulder tilt and the rest of this article does not pertain to you (at least for now – our postures do change over time and can even vary day to day).
However if you see one shoulder is higher than the other, you have a shoulder tilt. Is this a bad thing? Not necessarily, for remember that asymmetries are normal – but we need to look at the degree of asymmetry to determine if this is something that needs to be addressed. A very minor tilt will be barely noticeable – perhaps a millimeter or two off between your sides. These minor tilts should be watched over time but there’s typically no cause for concern. Any difference that looks like a half-inch or greater is very pronounced (you’ll probably be surprised when you see it) and may indicate something postural or muscular that should be examined. Not addressing this could potentially lead to overuse, uneven spinal loading, and orthopedic issues later on.
So what causes one shoulder to tilt higher than the other? There are many, many factors that can account for this and it is impossible without going through a full postural analysis involving the whole body to even begin to deduce what could be going on. For example, someone who has a very tight quadratus lumborum muscle in the lower back (this is the muscle that is responsible for elevating your hip) could be tilting one side of the torso down which would explain why one shoulder could be lower than the other. Or (and this is very common, especially with women who tend to hold a lot of tension around the neck and shoulders) one trapezius muscle in the upper back/neck could be “hypertonic” or tight due to excessive tension and that can hike one shoulder up. Scoliosis, even of the mild variety, can cause the same thing to be observed as well as a number of other possibilities.
Even if we don’t yet know the cause of a tilt, we can still take a couple of simple steps to help reduce any tension in the neck and low back area – such stiffness is very common in today’s stressful and sedentary world and these two stretches can help:
1. Gentle Neck Stretch – I call this “gentle” to emphasize that when stretching the neck in particular it is very important to go easy and not strain it. Slowly lower your chin to your chest and then tilt the head to one side while keeping your head bent forward. You should feel a mild stretch on one side of your neck/shoulder area. Hold this for anywhere from 15-60 seconds and then slowly tilt the head to the other direction to stretch the other side. When done, turn your head back to center and bring it back to an upright position without hunching your shoulders.
2. QL Stretch – Go to a stairway and step up onto one step, facing the railing. Holding the railing in both hands let one foot hang off the edge of the step. Allow the weight of your leg & foot to pull your hip down and hold that for 15-60 seconds. If you don’t feel a stretch, try pulling the toes of the hanging foot back toward your shin (dorsiflexion). When done, turn around and repeat with the other leg.
Our goal is not necessarily to “fix the tilt” (there can be many variables that go into why it is there in the first place, including genetic), but to take appropriate steps to address it should you have one. A more detailed approach would require a book-length manuscript to address, so if anything here is unclear or unhelpful I urge you to contact a movement specialist or fitness coach who is schooled in postural work to give a more complete screen.