When dealing with patients, as Therapists,we need to view the body as a whole. Our perspective should be modified to incorporate a complete picture from head to toe including an appreciation of its component parts.
By becoming aware of our own posture, and of ways to correct it, we are often able to give advice to all those who are open to receive it.
Posture’ means simply position or alignment of body-parts. It means:
Good posture in standing position, for example, means head and chest held high, chin, abdomen and buttocks pulled in, knees bent slightly and feet planted firmly on the ground slightly apart.
Thanks to gravity, the only way the body can be kept upright is through muscles exerting a continuous pull on the bones in the opposite direction to gravity.
The muscles are able to do that thanks to their property of tonicity.
Tonicity or muscle-tone refers to the constant readiness of the muscles to react. Our muscles are never completely at rest. They can lose their tone through illness, old age, accident and lack of exercise, and become flabby.
Massage is an excellent way to restore muscle-tone.
If we were to drop a line down the side of the body and line it up with the Lateral Malleolus (aka ankle bone), on the way up, it should pass slightly to the front of the midline of the knee.
Progressing higher, it should pass through the centre of the hip joint… higher and through the shoulder joint and through the lobe of the ear.
Slightly posterior to the apex of the normal surface.
Mans basic instinct is to prevent himself falling forward, consequently his muscle maintain the original stance.
The muscles that hold man erect against gravity are called postural muscles.
These muscles have a majority of slow twitch (red) muscle fibres, which can hold a contraction for a long time before fatiguing. If posture is not balanced, postural muscles are required to function more like ligaments and bones. Postural muscles tend to shorten and become hypertonic when under strain.
In contrast the phasic muscles, which have a majority of fast, twitch (white) muscle fibres and will tire out fast. It is more common to find muscular tendinous junction problems in phasic muscles. The four most common problems are micro tearing of the bursitis. Phasic muscles will weaken in response to postural muscle shortening. Phasic muscle can become hypertonic. This almost always results from some sort of repetitive behaviour and is a common problem in athletes.
Imbalance between these muscles leads to postural abnormalities, which need to be corrected by an exercise program that stretchs thePpostural muscles and strengthens the Phasic muscles.
Many people try to solve their slouching problem by telling themselves to “Stand Up Straight!” … and if they didn’t correct themselves, their parents or teachers did. These people take on a military-style posture. But in reality, military-style posture causes just as many problems as slouching.
The phasic muscles are purposely being used to maintain the military-style posture and these muscles will fatigue quickly. This is why when most slouchers try to correct their posture they can only maintain the “correct” posture for a few minutes and then they collapse back into their comfortable slouch.
In this ‘military type’ position, the chest is elevated and the pelvis is tilted forward putting the rectus abdominis in a somewhat elongated position. The lower back and the hip flexor muscles are in a shortened position. Due to the anterior pelvic tilt, the hamstrings are in a slightly longer position than in ideal alignment.
Although this posture is not one of the four main types of postural alignment, the Military type posture can occasionally be observed.
With this “military type” position, the chest is elevated and the pelvis is tilted forward putting the rectus abdominis in a somewhat elongated position. The lower back and the hip flexor muscles are in a shortened position.
It is characterised by an increased curve in the lumbar spine of lower back and an anterior pelvic tilt.
The client shows a posture in which the chest is pushed forward.
This image shows the typical posture of someone with an increased Thorax (Kyphosis) and an hyper extended lower back (Lordosis).
This position places stretch on the anterior hip joint ligaments, the one-joint hip flexor muscles and the external oblique abdominal muscles. These muscle groups usually show stretch – weakness. The lower back and hamstring muscles are likely to be strong and somewhat short. In the upper trunk, the opposite conditions prevail. The upper back muscles show stretch ’96 weakness and the upper abdominals are likely to be strong.
Kyphosis is usually associated with an increase curve of the thoracic spine. Along with this, a slightly posterior pelvic tilt is seen along with a reduced lumber curve and a forward head position. The client will show a hunched over posture with a depressed chest.
We speak of Lordosis when there is an increased curve in the lumbar spine of lower back. Often there is also an increased pelvic tilt. This posture shows the stomach and head are pushed forward.
Lordosis is defined as an excessive inward curve of the spine. It differs from the spine’s normal curves at the Cervical, Thoracic, and lumbar regions, which are, to a degree, either Kyphotic (near the neck) or Lordotic (closer to the low back).
The spine’s natural curves position the head over the pelvis and work as shock absorbers to distribute mechanical stress during movement.
Lordosis is found in all age groups. It primarily affects the lumbar spine, but can occur in the neck (cervical). When found in the lumbar spine, the patient may appear swayback, with the buttocks more prominent, and in general an exaggerated posture. Lumbar Lordosis can be painful, too, sometimes affecting movement.
Not every Lordosis requires medical treatment. However, when the curve is rigid (fixed), medical evaluation is warranted.
The term ‘flat-back’ describes a faulty posture where the spine appears straight. It doesn’t have the normal curves of a healthy spine. A ‘flat-back’ posture has a forward head, or excessive extension of the cervical spine. He has increased flexion of the upper portion of the thoracic spine while the lower portion of the thoracic spine is straight. His lumbar spine is flexed. As a result, his pelvis is tilted backward and his hip joints are extended. His knees may be extended as well.
People who have flat-back posture often have strong abdominal muscles, though the positioning of the pelvis indicates that the hip flexors are weak. The hamstrings will be tight also, pulling the pelvis into a backward or posterior tilt. Weak neck flexors and tight neck extensors contribute to a forward head.
In flat low back posture, generally the hamstring muscles are tight, which brings the back side of the pelvis closer to the thigh. As the pelvis moves forward, it has a straightening effect on the curve of the lower spine.
Along with tight hamstrings, the flat low back posture will also show strong lower abs, back muscles and weak quadriceps muscles.
While it is good for your back to have strong abdominal muscles, a flat low back posture is a deviation from ideal alignment, and affects posture and balance.
Occasionally due to the position of the hip it can be difficult to fully straighten the knees when standing.
A Sway back posture can be seen with a neutral or posterior pelvic tilt with the hip almost rolled upward to the front. The client shows a relaxed posture, leaning backwards with the upper body.
A Sway-Back posture has several characteristics.
The head is forward. There is increased flexion in the upper back.
A person that has the sway-back posture has weak hip flexors and external obliques. The muscles that extend the back are weak also. The forward head position makes for weak neck flexors, and the low back can be very tight, requiring stretching. The hamstrings and internal obliques may also be tight.
With this condition, we have a lateral or sideways curve in the spine that is apparent when viewing the spine from behind. It can be genetic or due to abnormalities or diseases of bone, muscle or nerves. A mild degree of Scoliosis is common, occurring in up to 50 per cent of the population.
Scoliosis generally does not require any specific treatment. However, severe scoliosis does indeed need treatment. Scoliosis occurs mainly in the thoracic and thoraco-lumbar regions.
Between the ages of about nine and fourteen, children bones grow rapidly and can in some children form excessive bony deposits in spots of the skeletal structure. At this time the backbone or spine may show signs of developing Scoliosis.
There are two basic types of Scoliosis.
Structural and Functional.
In the structural Scoliosis the mechanics of the curve are such that rotation of the vertebrae occurs in combination with lateral curvature, and this usually produces a protruberance of one side of the rib cage, seen best when a person bends forward. This is the worst type of scoliosis, and it can be progressive.
In the functional Scoliosis, fixed rotation does not occur, and the curvature is usually non-progressive. This type of Scoliosis is classified into postural, and most commonly due to a short leg.