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drgroven@grahamrehab.

com
www.grahamrehab.com
206-622-9001

Standing

Sitting

Standing with good intention

Typical seated posture

Sitting with good intention

Postural Support Syndromes


Upper

Crossed Syndrome
Scapular Destabilization Syndrome
Lower Crossed Syndrome

Posture affects the Body and


the Brain
The

spine and musculature are affected


Organs are affected
Mood is affected
Chronic pain syndrome (UCS) can result in
the absence of other positive clinical
findings

Faulty Posture
Muscles

in slightly shortened positions tend


to be stronger
Muscles in slightly elongated positions
tend to be weaker than their opposers
If we can balance muscle groups there is
a sense that posture can self-correct

Patterns
Postural

or tonic muscles shorten while


phasic muscles weaken

Type

1 Postural fibers contract slowly

Burn O2 more efficiently than phasic


muscles
Allows them to work slow and steady over
time
Shorten in response to stress and overuse

Patterns

Phasic or Type 2 fibers weaken and lengthen


under prolonged stress

Type 2a fast-twitch fibers

Contract faster than type 1


Resist fatigue due to more mitochondria and
myoglobin

Walking and sprinting

Type 2b fast-twitch glycolytic depend more on


blood sugar for energy (strength training, weight
lifting)

Patterns
Tonic

or Postural Muscles tighten and


shorten

Pectoralis Major and Minor


Upper trapezius
Levator Scapulae
Sternocleidomastoid

Patterns
Phasic

muscles weaken

Lower and Middle Trapezius


Serratus Anterior
Rhomboid Major and Minor

Pain
Symptoms

are the product of too much


strain and the physiological changes that
happen to soft tissues over time

Altered Posture
Occ,

C1 and C2 hyper extend


Head translates anteriorly
Lower cervicals and upper thoracic are
now stressed

Altered Posture

Scapula rotates and abducts

Due to the upper traps and levator scapula


shortening and contracting

This inhibits the lower traps and serratus anterior

Scapula looses stability

Excess demand now put on humerus and the


levator scapulae, upper trapezius and
supraspinatus are called to maintain functional
efficiency

Upper Crossed Posture

Tight

Trapezius
Levator scapula
Pectoralis major and minor
Latissimus dorsi

Weak

Rhomboids
Serratus anterior
Deep neck flexors
Motor control loss is a central issue here

Upper Crossed Posture


Eyes

are looking forward


Excess Arch in the neck (tight sub
occipital)
Levator scapula sign (prominent)
Shoulders are rolled inward

Thumbs point toward hips rather than


forward

Upper Crossed Posture


As

head migrates forward there is less


ability to rotate
For each inch forward it doubles in weight
and applies more force to the cervical
thoracic junction
This causes increased potential for
degenerative changes

Upper Crossed Posture


Headaches

can appear due to upper


cervical involvement and can refer to the
frontal and temporal or vertex
There are correlations with
temporomandibular joint pain
TOS becomes more likely due to structural
tightening

Upper Crossed Posture


Shoulder

impingement can become


more likely as space under the acromial
arch is decreased due to the forward tilt
of the scapula
Upper back and mid back pain increase
due to chronic tension and overwheming
tissue capacity

Scapular Instability
Downward

rotation
Inferior border closer to the spine
May be depressed
Weak Serratus anterior
Musicians are at high risk

Scapular Instability
We

want to stabilize the scapula not


move it

Wrap
Decrease Upward rotation, posterior tilt,
depression

Lower crossed Posture


Tonic

or Postural muscles

Iliopsoas, Rectus Femoris, Tensor fascia


Latae and Erector Spinae
All tighten and shorten

Phasic

muscles

Abdominal, Gluteal and Quadratus


Lumborum
Weaken

Lower Crossed Posture


Pelvis

is tilted forward

Flexing hip and exaggerating lumbar


lordosis

L5-S1

Soft-tissue and joint distress


Pain and irritation

Lower Crossed Posture


In

the sagittal plane


Quadratus Lumborum
Shortens

Glute Maximus and Medius


Weaken

Lower Crossed Posture


Unstable

lower cross leads to

SI joint becomes unstable


Piriformis syndrome

Other Factors
Congenital

Misuse
Immobilization
Inappropriate

breathing
Chronic negative emotional
Reflexive influences such as Trigger points
and facilitated segments

Other Factors
Laxity

of ligaments
Fascial tightness
Muscle tonus
Pelvic angle
Joint position and mobility
Neurologic outflow and inflow

Tissue distorters
Tight

and spasmed muscles


Inflammation
Scars
Proprioceptive loss
Ligament laxity
Loss of coordination
Muscle inhibition
Poor locomotor recruitment

Ideal

tissue shape and


tone are restored by
removing distorters from
the body

Considerations beyond
asymmetries or contracture
The

Autonomic Nervous System (ANS)

Soft tissue has sympathetic innervations not


parasympathetic
These regulate neuromuscular and
cardiovascular
Sympathetic produces more waste and
consumes more O2
Stress tightens soft tissue and causes
General Adaptive Response (Selye 1984)
Postural dysfunction results

Habituation

Adaptive demands on the musculoskeletal system


are exceeded
The capacity to absorb the load is overwhelmed
Elastic limits are exceeded resulting in structural ad
functional modifications
Repeated postural and traumatic insults over a
lifetime
Somatic effect of emotional and psychological
origin
Confusing pattern of tense, short, fatigued then
fibrous tissue.

Sensory awareness and


movement modalities
It

is a memory loss of how certain muscle


groups feel and how to control them
Thomas Hanna
Sensory motor-amnesia

Red light reflex


Green light reflex
Trauma reflex

Sensory awareness and


movement modalities
On

acting on the significant parts of the


body such as the eyes, the neck, the
breath, or the pelvis, it is easy to effect
striking changes of mood on the spot
Moshe Feldenkrais

Sensory awareness and


movement modalities
There

is no such thing as the right


position, but there is such a thing as the
right direction

You

come to learn to inhibit and direct


your activity F.M. Alexander

The Cure

Vitalism
The

historical concept of
vitalism proposes the idea
that our spirit animates and
operates the body
If our mood is depressed we
may slumpIf we slump we
may have a depressed mood

Postural Spirit

Put your Spirit up front rather than the ego


If ego is up front in posture it can drive it down
In our mind we have a body image of
ourselves that is internal in orientation but we
can get a sense of it when we look in the
mirror. We are seeing our body image but it is
better to look as if seeing someone behind
the mirror. That is look for your image. We
need to rebuild where the wound is in the
body image. Hubert Goodard

Gravity
There

can be a change in hormone


production due to the way that you hold
your body against gravity

Balance

reveals the flow of gravitational


energy through the body Rolf

Gravity
It

is when the gravity-combating active


subsystem of the huan organism becomes
deficient or defective in some way that
stress begins to be put on the joints and
passive subsystems of the body. Most
commonly, this takes the form of an upper
or a lower crossed syndrome. Leon
Chaitow

Natural posture
Learning

to push away from our support


pillars while sitting or standing
Helps us feel more open and connected
with our world
Often we can let Nature determine our
posture rather than dictate our posture to
nature

Pillars of structural support


Feet

Feel the contact points with the ground


and push away
Use a wall to measure HFP (head forward
posture)

Sitz

bones

Feel the contact on the ischium and push


away
If you arch your lower back a little it is
harder to slump

If uncorrected FHP will


continue to decline

It is very common to observe 2 inches of


anterior head placement in my patients.

Our heads weigh about 12 pounds. Would


you be surprised that your neck, upper back
or shoulders hurt if your neck had to hold up a
20-30 pound pumpkin all day ?

Uncorrected, forward head posture will get


worse and continue to decline.

One

study showed that the further a


persons head is away from the wall the
earlier they would die from any cause
death

In a nut shell this is a good reason to be


looking for FHP in our patients

For every inch your head moves forwards, it gains


10 pounds in weight, as far as the muscles in your
upper back and neck are concerned, because
they have to work that much harder to keep the
head (chin) from dropping onto your chest. This
also forces the suboccipital muscles (they raise the
chin) to remain in constant contraction, putting
pressure on the 3 Suboccipital nerves. This nerve
compression may cause headaches at the base
of the skull. Pressure on the suboccipital nerves
can also mimic sinus (frontal) headaches.
Kapandji (physiology of the Joints, Vol III).

People with Asthma have


decreased lung capacity

Head in forward posture can add up to thirty pounds of abnormal


leverage on the cervical spine. This can pull the entire spine out of
alignment. Forward head posture (FHP) may result in the loss of 30%
of vital lung capacity. These breath-related effects are primarily
due to the loss of the cervical lordosis, which blocks the action of
the hyoid muscles, especially the inferior hyoid responsible for
helping lift the first rib during inhalation. Rene Cailliet M.D.,

Persistent forward head posture also known as a hyperkyphotic


posture puts compressive loads upon the upper thoracic vertebra,
and is also associated with the development of Upper Thoracic
Hump, which can evolve into Dowager Hump when the vertebra
develop compression fractures (anterior wedging). A recent study
found this hyperkyphotic posture was associated with a 1.44 rated
of increased mortality.

Parkinsons

patients
benefit neurologically
from physical medicine,
posture control and
rehab therapy

Implications for the spinal joints


Phase

1 Initial sprain.

Phase 2 Beginnings of fibrosis.


Phase 3 - Complete fibrosis. Complete
fibroses and the beginnings of fibrosis are
not reversible, leading to permanent
spinal biomechanical impairment.

Implications for the spinal joints

Hypomobility: Abnormal restriction of joint


motion
Hypermobility: Abnormal increase in joint
motion
Compensation reaction: Long term
hypomobility causes the joint above the
hypomobile area and occasionally the joint
below to become hypermobile.
Positional dyskinesia, dynamic misalignment:
Joint misalignment throughout the entire
range of motion of the involved joint

Golf Posture

One of the fundamentals of golf is posture.


Many golfers have muscle imbalances which prevent them from physically
getting into the posture and positions that their PGA or LPGA instructor is
recommending.
The two most common postural distortions are:
Upper Cross Syndrome or C-Posture
Lower Cross Syndrome or S-Posture
The Upper Cross Syndrome is often developed by people who are used to
sitting over a computer or desk. It is a forward shoulder posture where the
pecs become over contracted and the muscles in your shoulder blades get
weak. The C-Posture has an excessive rounded curvature in the back which
limits ability to rotate in the back swing.
The Lower Cross Syndrome is often the result of extensive sitting whereby the
hip flexers are shortened. Since the brain thinks the hip flexers are contracted,
the abdominals get relaxed. Often it causes a Reverse Spine angle swing fault
and leads to back injury. The S-Posture has excessive curvature which looks
like a sway back or S shape.

UCS Evaluation

Stand next to a wall


Sit in a chair

Watch

them as you are doing


their first interview

Take a photo
Phone or computer apps

Computer Physical Performance


testing

Hands on
Evaluate

ROM
Palpation

Evaluate

tightened and shortened muscles

weakened and lengthened muscles

Strength testing
Computerized

Physical Performance Testing

ROM Testing

Extension strength

Flexion strength

Strength ratio

Cervical extension strength should be stronger


than flexion strength
Stretch flexors prior to working with
strengthening extensors
When treating patients with UCS, Sherrington's
Law proposes that the shortened muscles
must be restored before embarking on
training of the weakened muscles. The basis
for this is reciprocal inhibition when one
muscle is shortened or tightened its opposite
muscle relaxes.

Treatment Goals

Restoring energy-efficient and strain-free


movement

Ideal body movement and fitness are the end


points of care.

The quality of movement produces the actions


that make our dreams real and give life value.

It has been said that : The better you can move


the better your life will be

Remove the obstacles to cure


2

very important interferences to remove


Postural Distortion
Loss of movement control

Treatments

General Wellness
Neuro approach versus simple structural changes

Postural, functional and sensorimotor training


ROM exercises

Naturopathic spinal manipulation can be very


corrective
Reverse joint fixations
Reinvigorate the muscles that retract the head
Stretch the muscles that pull the head forward

General Wellness for the Body

Cardio Training
Strength training
Nutrition
Lifestyle
Cleanse Diet

Creates homeostasis and a new relationship with food


3 weeks

Weight Loss

Hormones

Men convert testosterone into estrogen

Get the right and enough dietary fat to provide hormone precursers
Eat cruciferous vegetables to remove estrogen at the level of the
liver

Cardio
Interval

running or spinning

Walk or cycle slowly for 2 minutes to warm


up

20

seconds on at medium fast speed


(8mph at 10% incline)and 10 seconds off.
Repeat 5 x

This is a time efficient work out that takes


less than 10 minutes and compares to
about 2 hours of jogging
Build up intensity appropriately over time

Strengthening Creates
Improvement

in Function
Causes a faster metabolism
Added power to movement
Enhanced flexibility
Aging well

Nutrition

Cleanse Diet for inflammation reduction


Healthy and sane diet that is learned over time

Add in healthy goals once about every 2 weeks

Eat more slowly and stop at 80% full


Change focus to good Protein, Vegetables, Good Oils
Avoid simple Carbs, processed and GMO
Avoid high carb and additive Beverages

Grass fed organic meat


Seafood
Olive oil
Fish oil
Grape seed oil
Nuts and seeds
Filtered Water, Green tea, Coffee
Drink the weight of your brain (2L) in water every day to improve
memory

Nutritional Treatment
The

model of inflammation

Fish oils EPA and DHA versus Parent Omega


3s
How are GMO foods affecting our bodies
and our environment

Lifestyle

Standing correctly
Sitting correctly
Breathe into abdomen
Sleep

Create a bedtime ritual

Turn off lights and TV 30 minutes prior to bed


Have a therapeutic bath, Peat and epsom salts
Mg, Zn
Phosphatidylserine serine to decrease night cortisol
& support brain health

Wait for about 30 minutes in the morning before


exercise loading to preserve disc health

Physical Medicine Treatments

Balance
Manual Therapy

Stretching, Myofascial release, active release

Strengthening
Spinal Adjustments
Neuromuscular Re-education
Hydrotherapy
Modalities

Cold Laser
Stim
Ultrasound

Balance
Stability

(Swiss ball)
Pulse Flex
Wobble boards
Foam Roller

Squat test

Bird dogs

Superwoman pose

Pelvic bridge

Letting gravity help

Alternating arm flexions

Field goal on foam roller

Wobble board

Manual Therapy
Stretching

Muscle

energy stretching
Myofascial release
Active release of musculature
Post isometric resistance

Stretching
PIR

or MES

Sub occipital
SCMs
Upper traps
Levator Scapula
Pectoralis minor
Pectoralis major
Upper rectus abdominus

Strengthening
Deep

cervical flexors
Supra and infra hyoid
Middle and lower traps
Rhomboids
Serratus anterior
Thoracic errectors

Scapular stability

Strengthening Exercises
Birddogs

Neck

extension machine

Use thoracic extension with cervical extension

Inverted row with TRX straps


Swiss ball crunch for abdominals
Reach Roll and Lift
Bent over row with dumbells

when your posture starts to fail you are done

Strengthening Exercises
Static

wall lean
Neck rotations
Cable reverse flys
Barbell upright rows
Foam roller
Wall stretches upright diamond
Wall angels

Wall Angels

Lat Test

Note arching of mid back

Strengthening Exercises
Scapular

stabilization exercises

Single arm pull backs with opposite scap


stabilized
Double arm alternating pullbacks
Wrap
Taffy pulls

Stabilized scapula opposite


arm row

Strengthening Exercises
Swimming

Naturopathic Spinal
Manipulation
Improvement

in hypomobile joints
Imrovement in neurological compression

Neuromuscular Re-education
Establish

correct patterns of muscle


movement
Kinesio-tape methods

The Nervous system is the


conductor
Retraining

proper neural
patterns in conjunction with
organic healing of the tssues
In neuromusculskeletal
medicine there are
interference patterns that can
be removed

Hydrotherapy
Hot

bath
Contrast hydrotherapy
Balneotherapy

Peloid packs
Additive bath

Low Level Laser


Myofascial

release
Muscle stretching
Scar sensory imput
Architecture faults
Facilitation of locomotor patterning with
therapeutic exercise
Brain balancing