Analysis and re-education of posture

Define posture

Posture is the outcome of overall position of the joints adopted to balance the skeletal segments against gravity in a given position, serving as a basis for movement and non-verbal communication, maintained by the body’s connective tissue and muscles under control of the nervous system

i.e. Posture is the way one holds themselves during movement and when one is stationary

Static posture

• refers to the way one holds their body while standing, sitting or lying down

• its the position of the body’s joints and muscles when at rest, without any movement involved

• good static posture is important for:

  • overall health

    help to prevent musculoskeletal problems

  • reduce the risk of injury and promote efficient bodily functions

Things to consider (application):

• alignment (In static posture, the body segments are aligned in a way that optimizes balance and distributes the force of gravity efficiently. This helps minimise stress on muscles, ligaments, and joints)

• importance of ergonomics (Maintaining proper static posture helps prevent strain, discomfort, and musculoskeletal problems, especially during long periods in one position (e.g., desk work). Good ergonomics supports healthy posture

• individual differences

Prolonged static postures and the importance of movement

If the human body is immobile for long periods of time (static positions), there can be many adverse effects, such as:

• Muscle stiffness and fatigue

• reduced blood circulation

• joint discomfort

• increased risk of musculoskeletal issues

• impact on metabolism (can slow metabolism)

• stagnant lymph flow

• negative effects on mental alertness

Importance of good static posture

1. Musculoskeletal health

2. Comfort

3. Prevention of muscular imbalances

4. Spinal health

5. Efficient breathing and circulation

6. Functional movement

7. Positive body image

8. Injury prevention

9. Long-term well-being

10. Productivity and focus

Dynamic posture

• Dynamic posture = refers to the alignment and positioning of your body while you are engaged in various movements and activities for example: walking, running etcetera.

Importance

Common consequences of non-deal posture

• Physical consequences

  • Muscle pain and imbalances: Poor posture causes certain muscles to become overactive while others weaken, leading to chronic pain and tension.

  • Joint stress and degeneration: Misalignment places excess strain on joints and ligaments, increasing the risk of wear and tear.

  • Breathing difficulties: Slouching compresses the lungs and diaphragm, reducing respiratory efficiency.

• Functional consequences:

  • Digestive issues: Poor posture can contribute to constipation and acid reflux by compressing abdominal organs.

  • Incontinence: Slouching increases abdominal pressure, weakening pelvic floor muscles and contributing to stress incontinence.

• Mental and emotional impact:

  • Fatigue and mood changes: Poor posture is linked to increased fatigue and may negatively affect mood and mental health.

  • Reduced confidence: Slouched posture can influence self-perception and how others perceive you.

• Long term risks:

  • Spinal deformities: Conditions like kyphosis or scoliosis may worsen due to prolonged poor posture

  • Nerve compression: Misalignment can lead to pinched nerves, causing numbness or tingling.

What to observe for anterior view static posture

Anterior view

• Head carriage (neutral; rotation; lateral flexion) - Level of the shoulders (same level; one side more elevated/depressed)

• Symmetry of the clavicles (or asymmetrical)

• Rib cage and sternum configuration (if able to view - neutral; rotation; lateral flexion)

• Carrying angle of the elbows (greater; lesser) - Internal or external rotation of the upper extremities

• Iliac crest heights (same height; one side more elevated/depressed)

• Anterior superior iliac spines (same height; one side more elevated/depressed)

• Patella heights (same height; one side more elevated/depressed)

• Valgus or varus deformities of the hips, knees, or ankles

• Pronation or supination of the feet

Lateral view

• Ideally, this line passes through the following points: the external auditory meatus, the acromioclavicular joint, the greater trochanter, and a point just anterior to the lateral malleolus.

• Anteroposterior cervical, thoracic, and lumbar spinal curves - Neutral, anterior or posterior rotation of the pelvis (pelvic tilt)

• Flexion or hyperextension of the knees

Posterior view

• Head carriage (neutral; rotation; lateral flexion)

• Level of Shoulders (same level; one side more elevated/depressed)

• Level of inferior tips of the scapulae (same level; one side more elevated/depressed)

• Carrying angle of the elbows

• Iliac crests level (same level; one side more elevated/depressed)

• Spine alignment (are the vertebrae neatly stacked on each other or are there any curves visible)

• Posterior superior iliac spine (PSIS) level (same level; one side more elevated/depressed) - Level of Greater trochanters (same level; one side more elevated/depressed)

• Level of Gluteal creases (patients asked to cup their buttocks if able to unless this anatomical feature can be clearly seen)

• Level of fingertips (same level; one side more elevated/depressed)

• Level of Popliteal lines (same level; one side more elevated/depressed)

• Achilles tendons for lateral curvatures - Arches of the feet for flattened (ples planus) or high arches (pes cavus)

• Unilateral asymmetries in paired muscle groups, such as trapezius, erector spinae, gluteus maximus, hamstrings, or gastrocnemius etc. (describe muscle bulk as being lesser/greater)

Postural dysfunction definition

• Refers to the presence of significant and persistent deviations from the ideal or neutral alignment of the body’ skeletal structures. It encompasses a range of abnormal postures and movement patterns that may result from various factors, including muscle imbalances, structural anomalies, habitual postures, injuries and pathological conditions. The emphasis here is on the disruption of proper alignment and the resulting impact on overall function and well-being.

Causes of postural dysfunction

• Prolonged poor postural habits: Continuous adoption of incorrect postures over time can lead to adaptive changes in the muscles and soft tissues. These adaptations can result in imbalances, discomfort, and reduced mobility.

• Post-Surgical Contractures or Adhesions: After surgery, scar tissue can form and cause adhesions or contractures. Contractures involve the shortening and hardening of muscles, tendons, or other tissues, leading to rigidity and deformity of joints. Adhesions are bands of scar-like tissue that cause tissues or structures inside the body to stick together. Stress applied to these shortened and adhered structures can cause pain and further limitations in movement.

• Injury and musculoskeletal problems

Postural impairments

Postural impairment emphasises the negative effects and limitations caused by deviations from optimal posture. The term "impairment" often suggests a reduction in function or ability due to a particular condition or issue, which, in this case, relates to the impact of poor posture on movement, comfort, and overall health.

Impairments = Problems in body function and structure such as significant deviation or loss.

Factors associated with postural impairment

• Muscle imbalances: When certain muscles become tight or shortened while others become weak or lengthened, it creates muscle imbalances. These imbalances can pull the body out of its natural alignment, affecting posture. For example, tight chest muscles and weak upper back muscles can lead to rounded shoulders.

• Mechanical Stress and Tissue Breakdown: The concept you described about mechanical stress exceeding tissue capability leading to tissue breakdown is related to the idea that tissues (muscles, tendons, ligaments) have a certain capacity to handle load and stress. When this load surpasses a tissues capacity, the tissue becomes more prone to injury. Over time, repetitive stress on tissues in poor alignment due to muscle imbalances can lead to strain and pain.

• Prolonged end range loading: Applying excessive load at the end range of a muscle or joint can strain the tissues.

• Muscle Fatigue: Muscle fatigue can compromise your ability to maintain proper posture. Fatigued muscles are less able to support the body's weight and maintain correct alignment. This can lead to slouching or other forms of poor posture.

• Muscle endurance: Building muscle endurance is crucial to maintaining good posture. Endurance allows muscles to sustain their function over time without succumbing to fatigue. When muscles are endurance-trained, they can provide better support for the body's weight and maintain proper alignment.

• Compensatory Patterns: The body is quite adaptable, so when one muscle group is weak or inhibited, the body may develop compensatory patterns to maintain function. This can lead to altered movement patterns and posture, further exacerbating the issue.

• Lifestyle Factors: Sedentary lifestyles, improper ergonomics, and lack of physical activity can contribute to muscle imbalances and poor posture.

Common impairments

• Pain from Mechanical Stress and Muscle Tension: Poor posture can lead to mechanical stress on sensitive structures like nerves and blood vessels, causing pain. Additionally, muscle tension resulting from maintaining incorrect postures for extended periods can lead to discomfort and even headaches.

• Mobility Impairment: Muscle, joint, or fascial restrictions can limit the range of motion in joints, leading to mobility issues. This can affect everyday activities and may contribute to further postural problems.

• Imbalanced Muscle Length and Strength: Imbalances between antagonistic muscle groups (muscles that perform opposing actions) can lead to postural deviations. For

• Poor Muscular Endurance: Muscles that are essential for maintaining good posture need to have adequate endurance to support the body over time. Poor muscular endurance can lead to slouching or other postural deviations as muscles fatigue.

• Insufficient Postural Control: Stabilising muscles play a crucial role in maintaining proper posture and preventing excessive movement or misalignment. If these muscles are weak or improperly activated, it can contribute to poor posture.

• Decreased Cardiopulmonary Endurance: Posture can also affect cardiopulmonary (heart and lung) endurance. Certain postural positions can restrict breathing and affect overall endurance during physical activities.

• Neuromuscular Control and Kinaesthetic Sense: Poor postural habits can disrupt the body's neuromuscular control and the sense of where the body is in space (kinaesthetic sense/proprioception). This can make it difficult to recognise and correct faulty postures.

• Lack of Knowledge of Spinal Control and Mechanics: Many people lack the awareness and understanding of how to maintain a healthy spine and practice proper posture. This lack of knowledge can contribute to the development of poor postural habits

Factors a physiotherapist should consider in managing postural impairment

• Postural Alignment, Balance, and Gait: Assessing physically how an individual aligns their body while sitting and standing, as well as their ability to maintain balance and walk smoothly, is crucial. Correcting any postural imbalances in any position and improving gait can help prevent discomfort and injuries.

• Range of Motion, Joint Mobility, and Flexibility: Evaluating the range of motion in various joints helps identify any limitations or restrictions. Joint mobility and flexibility exercises can address these limitations and improve overall movement quality.

• Muscle Strength and Endurance: Evaluating muscle strength and endurance is important because muscles play a significant role in maintaining proper posture. Strengthening weak muscles and improving endurance can contribute to better postural support.

• Ergonomic Assessment: Ensuring that the environment and equipment we use are ergonomically designed is crucial for maintaining good posture and preventing discomfort or injuries. This applies to both workspaces and other environments where we spend a lot of time.

• Body Mechanics: Understanding and practicing proper body mechanics during daily activities can reduce the strain on muscles and joints. This includes techniques for lifting, carrying, bending, and other movements.

Postural misalignment

Postural misalignment refers to a considerable displacement or deviations from the ideal alignment in a kinetic chain resulting in abnormal biomechanical stress that can compromise the body’s ability to deal with these forces. These malignments may result in several postural faults. These faults can occur at any point in an individual’s life (across the lifespan) due to a range of causative factors that may impact the individual’s quality of life and movement.

The influence of postural misalignment on body structures

• Poor posture can have significant and widespread effects on the musculoskeletal system. The musculoskeletal system includes muscles, bones, joints, tendons, and ligaments, and it plays a vital role in supporting the body, facilitating movement, and protecting internal organs. When posture is consistently compromised, it can lead to various negative effects:

  • Muscle Imbalances: Poor posture often leads to uneven distribution of muscle tension. Some muscles become overused and tight, while others become weak and lengthened. This imbalance can result in discomfort, pain, and a decreased ability to move efficiently.

  • Strain and Overuse: Poor posture places additional strain on muscles and joints that are not designed to bear that load. This can lead to muscle fatigue, pain, and even repetitive strain injuries.

  • Strain and Overuse: Poor posture places additional strain on muscles and joints that are not designed to bear that load. This can lead to muscle fatigue, pain, and even repetitive strain injuries.

  • Spinal Curvature: The spine is particularly vulnerable to poor posture. Rounded shoulders, forward head posture (tech neck), and excessive curvature of the spine can develop. These deviations from the spine's natural alignment can lead to discomfort, pain, and spinal issues like herniated discs.

  • Compression and Nerve Impingement: Poor posture can compress nerves, leading to tingling, numbness, or shooting pain along the affected nerve pathways. For instance, nerve impingement in the neck due to poor posture can result in radiating pain down the arm (radiculopathy).

  • Reduced Range of Motion: Over time, poor posture can cause muscles and connective tissues to become stiff and less flexible. This can result in a reduced range of motion and difficulty performing everyday activities.

  • Muscle Fatigue: Muscles that are forced to work against their natural alignment and support the body's weight in compromised positions can become fatigued more quickly. This fatigue can lead to discomfort and impact overall movement quality.

  • Breathing and Digestion: Poor posture can compress the chest cavity and abdomen, making it more difficult for the lungs to expand fully and for the digestive organs to function properly. This can contribute to breathing difficulties and digestive issues.

  • Body Mechanics: Poor posture can alter movement patterns and mechanics, which can lead to inefficient movement, decreased athletic performance, and an increased risk of injuries.

Common faulty postures

• Postural faults: (A)

• Thoracic hyperkyphosis. (B)

• Forward head. (C)

• Swayback. (D)

• Increased lumbar lordosis. (E) Scoliosis.

Forward head posture (muscles involved)

How to correct the muscle imbalances in forward head posture:

• Strengthen prevertebral muscles (cervical flexors)

• Stretch suboccipital (cervical extensors)

Anterior pelvic tilt

Characteristics of an anterior pelvic tilt:

An anterior pelvic tilt describes the position of the pelvis deviated from the neutral position. It is characterised by pelvis being tilted forward, causing the front of the pelvic bone (anterior superior iliac spine) to move downward and forward, while the back of the pelvis (posterior superior iliac spine) moves upward. This creates an imbalance between the front and back of the pelvis. There is also an associated increase in the lumbar lordosis.

Muscles surrounding the pelvis and hips are affected by APT: The hip flexors (e.g., iliopsoas) and erector spinae (lower back muscles) can become chronically shortened due to the forward tilt, while the gluteal muscles and abdominal muscles might become lengthened and relatively weaker.

How to correct the muscle imbalance of the anterior pelvic tilt:

• Strengthen rectus abdominus and gluteus maximus

• Stretch/lengthen erector spinae and iliopsoas

Posterior pelvic tilt

Characteristics of a posterior pelvic tilt:

Muscles around the pelvis and hips are impacted by posterior pelvic tilt. The hip flexors and abdominal muscles can become lengthened and relatively weakened due to the backward pelvic tilt, while the hamstrings and gluteal muscles may become chronically shortened. The muscles responsible for extending the lower back (erector spinae) may become lengthened and relatively weakened in individuals with posterior pelvic tilt. Hip flexors, such as the iliopsoas, can become lengthened and weakened in posterior pelvic tilt. This can impact hip flexion strength and coordination.

How to correct the muscle imbalance of the posterior pelvic tilt

• Strengthen the hip flexors and abdominals.

• Stretch hamstrings and gluteal muscles.

Postural pain syndrome

• This occurs when an individual maintains a faulty posture for an extended period, leading to mechanical stress on the body.

• The result is pain, which is usually relieved with movement or activity. This type of pain arises due to the stress placed on muscles and other tissues when the body is held in a poor posture for long durations.

• It can be alleviated by correcting the posture and engaging in movement.

• The pain from any sustained position results from ischemia of the isometrically contracting muscles, localised fatigue, or excessive mechanical strain on the structures. Intramuscular pressure can compress the blood vessels and prevent the removal of metabolites and the supply of oxygen, either of which can cause temporary pain.

Ergonomics definition

Ergonomics is defined as “an applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely.”

Why should a physiotherapist consider ergonomics as part of treatment?

• Injury Prevention: Physiotherapists often work with individuals who have musculoskeletal injuries or conditions. Ergonomics helps prevent these issues by designing workspaces and environments that reduce the risk of strains, sprains, and other injuries caused by poor posture or repetitive movements.

• Posture Correction: Ergonomics focuses on maintaining proper posture, which is crucial for preventing and treating many musculoskeletal problems. Physiotherapists can recommend ergonomic adjustments to support their patients' postural needs and provide exercises to reinforce healthy alignment.

• Rehabilitation: When individuals undergo physiotherapy for injuries or surgeries, ergonomics can aid in the rehabilitation process. Properly designed workstations and environments can support the recovery process and prevent re-injury during the healing phase.

• Pain Management: Ergonomics can alleviate chronic pain by optimizing the way individuals interact with their surroundings. Physiotherapists can provide ergonomic recommendations to reduce pain and discomfort associated with conditions like back pain, neck pain, and repetitive strain injuries.

• Education: Physiotherapists often educate their patients about healthy movement patterns and body mechanics. Integrating ergonomic principles into these educational sessions empowers patients to make informed decisions about their daily activities, leading to better outcomes and reduced risk of injuries.

• Holistic Approach: Ergonomics takes a holistic approach to human well-being by considering physical, cognitive, and emotional factors. Physiotherapists recognize the importance of this holistic perspective and use ergonomics to address multiple facets of their patients' health.

• Workplace Health: Many musculoskeletal issues are work-related. Physiotherapists collaborate with employers to create ergonomically optimised work environments that support employee health and reduce the likelihood of work-related injuries.

• Customised Care: Every individual has unique physical needs and limitations. Ergonomics provides a framework for customizing recommendations based on an individual's body type, abilities, and tasks. Physiotherapists can tailor their advice to each patient's specific requirements.

Examples of ergonomic equipment

Office ergonomics

• Ergonomic chair

• Adjustible desk

• Ergonomic keyboard and mouse

• Footrest

Healthcare ergonomics

• Laptop stand

• pillows

Common exercises for improving posture

• Finding neutral pelvis

• Cat-cow stretch

• Chin tuck (deep cervical flexors)

• suboccipital stretch

• pectoralis minor muscle stretching