International Journal of Industrial Ergonomics, 8 (1991 ) 3-15 3

Elsevier

Some fundamental aspects of posture related to ergonomics

R.S. Bridger
UCT Medical School and Groote Schuur Hospital, Observatory 7925, Cape Town, South Africa

(Received September 10, 1990; accepted in revised form December 21, 1990)

Abstract

This paper presents a broad review of some fundamental aspects of posture in terms of structure, function and control (including
dysfunction and postural behaviour) and attempts to derive implications for ergonomics. It begins by reviewing research on the
anatomical basis of the upright bipedal posture in man and its evolutionary development, based on recent fossil discoveries.
Relevant aspects of the anatomy of the spine, pelvis and hip are then reviewed together with some developmental aspects of
posture and a consideration of postural faults and muscle balance gleaned from the clinical fiterature. Further clinical aspects are
discussed to introduce the concepts of postural control, feedback and postural behaviour. Finally, some aspects of cross-cultural
postural variation are briefly reviewed.
It is concluded that empirical research on posture and effective workspace design can benefit from a consideration of these
fundamental aspects of posture. Much of modern design practice would appear to be built around a limited set of postural
stereotypes which are probably culturally biased and do not reflect the true limitations and possibilities of human anatomy. Whether
improved designs can be implemented on the basis of these fundamentals is both an empirical question and a challenge to the
ingenuity of designers.

Relevance to industry

Postural stress and occupationally-related musculoskeletal disorders have a high incidence in the industrially developed nations of
the world. Much research is currently underway to determine the reasons for this and provide designers with more effective
guidelines. This paper presents a review of fundamental aspects of posture to provide a wider conceptual basis for the investigation of
these problems.

Keywords

Posture, hip, pelvis, spine, hominids, bipedalism.

Introduction
C u r r e n t r e s e a r c h o n w o r k i n g p o s t u r e a n d its
r e l a t i o n to h e a l t h a n d i n d u s t r i a l e f f i c i e n c y is re-
v i e w e d in n u m e r o u s r e c e n t p u b l i c a t i o n s (see, for
e x a m p l e , C o r l e t t et al., 1986; G r i e c o , 1986;
K i l b o m , 1988). A k e y i n t e r e s t is the m e a s u r e m e n t
o f s t r a i n in m u s c l e s a n d j o i n t s in r e s p o n s e to
p o s t u r a l stresses i m p o s e d b y t h e d e s i g n o f a
w o r k s p a c e o r task. T h i s e n a b l e s d e s i g n a l t e r n a -
tives to b e e v a l u a t e d o n t h e b a s i s o f q u a n t i t a t i v e
d a t a c o n c e r n i n g p o s t u r a l stress o r s t r a i n a n d p r o -
v i d e s a r a t i o n a l , if s o m e t i m e s e m p i r i c a l , basis f o r
design guidelines.
It is n o t t h e p u r p o s e o f this p a p e r to r e v i e w this
r e s e a r c h , s i n c e this h a s b e e n d o n e e l s e w h e r e (see
C o r l e t t et al., 1986; G r i e c o , 1986; N a c h e m s o n ,
1976; A g h a z a d e h et al., 1989, for e x a m p l e ) . H e r e ,
s o m e f u n d a m e n t a l a s p e c t s will b e r e v i e w e d w i t h
the e m p h a s i s o n gross a n a t o m y a n d w h o l e b o d y

0169-1936/91/$03.50 1991 - Elsevier Science Publishers B.V.

 R.S. Bridger / Some fundamental aspects of posture

posture, its development, control and cross-cult-

ural manifestations. Some implications for ergo-
nomics will then be identified.

The upright posture: Its origins, antiquity and

anatomy

The upright posture and bipedal mode of

locomotion that characterises Homo sapiens has a
long evolutionary history. Charteris et al. (1982)
attempted to reconstruct the gait of Australo-
pithecus afarensis from 3.7 million year old fossil-
ized footprints found at Laetoli, East Africa. Their
estimates of stride length, cadence and velocity led
them to conclude that Australipithecus was fully
bipedal. Jungers (1982), however, questioned
whether the australopithecine adaptation to bi-
pedalism was fully m o d e m on the basis of an
analysis of limb lengths.
Research on physical anthropology in general
and hominid evolution in particular is of interest
since comparative analysis of the anatomy of early
hominids, Homo sapiens and modern great apes
can help specify the adaptations required for the
adoption and maintenance of the upright posture
and, indeed, clarify what is meant by the term
posture as it is used in Ergonomics.
Figure 1 depicts the bipedal posture adopted by
a human and by a chimpanzee. In the chimpanzee,
the center of gravity (C.O.G.) of the body lies
anterior to the lumbar spine and hip. In the hu-
man, it lies above the hip joint. This reduces the
mechanical disadvantage of the gluteal muscles in
keeping the trunk erect. Note also that the chim-
panzee has limited hip extension and cannot ex-
tend the hip to place the femur perpendicular to
the ground. This is due to length and position of
the ischium. In evolutionary terms, the main
anatomical adaptations to bipedalism can be sum-
marised as follows (see Robinson, 1972; Zihlman
and Brunker, 1973; McHenry and Temerin, 1979;
Tobias, 1982; and, for more popular treatments of
the subject, Napier, 1967 and Lovejoy, 1988):
- A lowering of the relative C.O.G. of the body
by means of a broadening and flattening of the
ilium and sacrum as well as a shortening of the
arms and a lengthening of the legs.
- A change in the function of the gluteal muscles
(figure 2). In apes, gluteus medius and gluteus
.~ C.O.G.
Fig. 1. The bipedal posture in m a n and chimpanzee - note the
location of the center of gravity (C.O.G.) of the body in
relation to the hip joint (Adapted from Zihlman and Brunker,
1979).
minimus are major hip extensors used for
locomotion while gluteus maximus is of minor
importance. These muscles are attached to the
iliac blades and the upper femur. In chimpan-
zees, the iliac blades are flat and lie across the
back of the torso in a single plane (figure 2b),
whereas in hominids (including H o m o Sapiens),
the ilium is rotated forwards around the body
(figure 2c). This displaces the anterior gluteals
into a lateral position on the body and converts
them to hip abductors. Gluteus maximus re-
mains posteriorly positioned but exhibits hyper-
trophy. In hominids, its function is no longer
locomotion but to stabilise the trunk and pre-
vent it 'jackknifing' forwards over the legs when
walking. The sacrum widens to leave room for
the viscera and birth canal.
For part of the bipedal gait cycle, the pelvis is
only supported on one leg. To stabilise the
upper body, the reorientated anterior gluteals
act as hip abductors. Viewed frontally, it can be
seen that the hip joint acts as a fulcrum with
the weight of the body and the unsupported leg
exerting a moment on one side which is coun-
teracted by the abductors on the other (figures
 R.S. Bridger / Some fundamental aspects of posture

Sacrum
Ilium

Anterior
Gluteals

(a)

(c) (d)
Ilium
Fig. 2. The hip and pelvis related to posture. (a) Frontal view of a human pelvis and hip joint. The joint acts as a fulcrum during
walking. The anterior gluteals, acting as hip abductors, counteract the moment exerted by the upper torso and unsupported leg. (b)
Top view of the pelvis of a chimpanzee. Note that the iliac blades lie almost flat, in a single plane. The gluteal muscles act as hip
extensors in the chimpanzee. (c) Top view of a human pelvis. Note the curved ilia which provide lateral attachment points for the
anterior gluteals, enabling them to abduct the hip. (d) 'Trendelenburg' posture. Weakness of the fight anterior gluteals causes
deviation of the pelvis to the right and lateral tilting to the left. The spine exhibits compensatory scoliosis. This type of posture can
also be observed when people stand on an uneven surface to work. (Adapted from Lovejoy, 1988, and Kendall et al., 1971.)

2a and 2d). In hominids, the femoral neck is
lengthened and the ilium is flared outward,
away from the body to increase the lever arm of
the hip abductors. People with weak or para-
lysed hip abductors exhibit the 'Trendelenburg'
gait in which the pelvis tilts towards the unsup-
ported leg and the upper body bends towards
the supported leg (figure 2d).
- T h e ilium expands posteriorly, bringing the
C.O.G. of the body closer to the hip joint in the
sagittal plane.
- In order to stand erect, the spine must be
repositioned from horizontal in the quadrupedal
posture to vertical in bipedal posture. This can-
not be achieved by simply rotating the pelvis on
the vertical femur by 90 degrees until the trunk
is erect, because the extension of the femora
required for walking (i.e. extension past the
vertical by the trailing leg) is then impeded by
the ischium (figure 3). This is one reason why
the great apes cannot walk on two legs effi-
ciently (figure 3b). Further, the sacrum cannot
be rotated backwards with respect to the ilium.
Although this would help to place the spine in a
vertical position, while using less than 90 de-
grees of hip extension, the birth canal would
then be obstructed by the coccyx. Somewhat
counterintuitively, the evolutionary solution
seems to have been to rotate the sacrum for-
wards on the ischium and increase the exten-
sion of the lumbar spine. This is the origin of
the lumbar lordosis which is of so much con-
cern to researchers in seating. According to
Farfan (1978), the posterior lumbar (supra-
spinous) ligaments and the zygapophyseal joints
of the fourth and fifth lumbar vertebrae are
specially adapted in man to resist the lumbo-
sacral shear force which is brought about by the
tilt of the sacrum and which is exacerbated
when objects are lifted.
The pelvis can be seen as the base on which the
spine is supported. Many muscle groups which,
in other species, provide locomotive power take
on new roles in the bipedal posture. As de-
scribed above, the anterior gluteals now stabil-
ise the pelvis. The iliopsoas muscles initiate
'swing-through' of the trailing leg in walking
and the hamstrings decelerate it prior to heel
strike. Only the quadriceps and the plantarflex-
ors (gastrocnemius and soleus muscles) are left
to provide a ground reaction force for locomo-
tion in walking.
6 R.S. Bridger / Some fundamental aspects of posture
(a) (b) (c)
Fig. 3. Orientation of the ischium with respect to the hip joint.
(a) Man standing erect. (b) Chimpanzee standing erect. (c)
Chimpanzee in normal quadrupedal posture. In (b), the ischium
prevents extension of the thigh past the vertical. Comparison
of (a) and (c) reveals the fundamental nature of the lumbar
lordosis as an adaptation to erect bipedalism. (Adapted from
Robinson, 1972.)
- Alterations in foot morphology.
- A decrease in hip and knee joint mobility.
The fossil record provides considerable insights
into the evolution of the upright posture over time
and the anatomical adaptations which bipedalism
requires (interestingly, as Kapandji, 1970, points
out, the true physiological position of the hip in
man corresponds to the position on all fours. In
standing, the head of the femur coincides imper-
fectly with the acetabular cavity. This is used to
argue in favour of man's evolution from quadruped
ancestors). According to Farfan (1978), the lumbar
lordosis and other adaptations provide an over-
abundance of power for attaining the upright pos-
(a)
Erector Spinae
Anterior Superior / Abdominals
Iliiac Spine ~ . /
k / Posterior Superior
Rectus Femoris t (-""'--'-'J
--%:+
I~liopsoas ~ I JJ
Pubic Body Ischial Tuberosity
Fig. 4. Conceptual model of the sagittal pelvis.
ture. The erection of the trunk has been achieved
only partly by the backward rotation of the pelvis,
the rest by the inversion of the normal quadrapedal
lumbar curve (concave anteriorly) into a lumbar
lordosis (concave posteriorly).
The hip and pelvis: S o m e a n a t o m i c a l a s p e c t s re-
lated t o p o s t u r e
In erect standing, as has been described, only
part of the erection of the trunk is accomplished
by extension (posterior pelvic tilting) of the hip
joint from the quadrupedal posture, the rest oc-
curs as extension (lordosis) of the lumbar spine.
This means that the pelvis is tilted anteriorly,
relatively speaking, in normal standing.
The antero-posterior tilt of the pelvis has a
major influence on the posture of the body since it
co-varies with the angle of the sacrum from which
the lumbar lordosis arises. An understanding of
factors influencing tilt of the pelvis is therefore
essential for the analysis of posture and postural
load.
In figure 4, the pelvis is represented sagittally
with the hip joint regarded as a fulcrum. The tilt
of the pelvis is the equilibrium position of the
moments and countermoments exerted by the
muscular-ligamentous system which fixes the pelvis
on the hip joint. The iliofemoral ligament lies
anterior to the hip joint and the ischiofemoral
ligament lies posterior to the joint. In standing,
(b)
~ ~ 1 ~ Spinae
Erectr
Hip
Flexors
sor8
 R.S. Bridger / Some fundamental aspects of posture
these ligaments are in moderate tension, during
extension of the hip all of the ligaments become
taut whereas in flexion they relax. In standing, the
iliofemoral ligament prevents the pelvis from tilt-
ing posteriorly i.e. it prevents the trunk from
'jackknifing' backwards over the legs.
During lateral rotation of the hip (to stand with
the toes pointing outwards, for example) the ante-
rior ligaments become taut and the posterior liga-
ment slackens. The opposite occurs during medial
rotation (Kapandji, 1970). This may explain why
Cyriax (1924) held that walking with the toes
turned out too much was a cause of excessive
anterior pelvic tilt in children (and hence excessive
lumbar lordosis). This would slacken the posterior
ligament and tense the anterior ligaments resulting
in a net increase in the anterior moment acting on
the hip joint and a more anteriorly tilted equi-
librium position of the pelvis. This illustrates why
an analysis of foot position is essential to the
analysis of posture and the improvement of the
design of workspaces.
Pelvic tilt is not the only determinant of spinal
curvature. Kapandji (1970) describes how the
articular facet of the sacrum is subject to wide
variation in humans. In the more horizontally
aligned sacrum, the spinal curves are pronounced
- Kapandji regards this as an overadaptation to
the biped state. When the spinal curves are less
pronounced, the sacrum tends to lie more verti-
cally on the ilium. This may explain why measure-
ments of pelvic tilt do not always correlate with
measurements of lumbar curvature (Walker et al.,
1987), whereas measurements of sacral tilt do
(Bridger et al., 1989a; 1990). Although the more
vertically aligned sacrum with flatter spine does
occur in adults, it is more usually seen in children
and closely resembles the sacral orientation found
in primates (Kapandji, 1970).
In neonates, the spine exhibits a single, anteri-
orly concave curve and vertical sacrum. This
kyphosis of the lumbar spine disappears at about
13 months of age and is replaced by a lumbar
lordosis of increasing severity after the third year.
By ten years, the adult state is assumed. When an
adult stands, the lumbar lordosis supports the
upper body so as to minimise the bending moment
on the spine and the line of gravity of the superin-
cumbent body parts passes through the facet joints
of L4 and L5 (Klausen and Rasmussen, 1968).
7
Development of the bipedal posture in children
suggests a recapitulation of phylogeny in ontog-
eny. The young child is physically unable to stand
at first, partly because of an inability to fully
extend the knee and hip and the absence of a
lumbar lordosis. Crawling is a precursor to stand-
ing in which hip extension in the quadrupedal
position is used for locomotion. (Raft, 1962, re-
garded premature standing as a cause of maldevel-
opment of the feet in children).
The muscles of the hip and trunk and the
maintenance of posture
The importance of the anterior gluteals in the
lateral stabilisation of the pelvis has already been
noted. Figure 4 presents a sagittal view of the hip
and pelvis. The flexor and extensor muscles of the
hip and trunk play a major role in the mainte-
nance of the erect posture. As described above,
the pelvis is fixed on the hip by a system of
muscles and ligaments. The tilt of the pelvis de-
pends on the equilibrium of the moments and
countermoments exerted by the antagonistic
muscles in this system. The one and two joint hip
flexors (iliopsoas and rectus femoris) and the one
and two joint hip extensors (gluteus maximus and
the hamstrings) are of relevance to ergonomics as
are the abdominal and erectores spinae muscles of
the trunk. Contraction of the hip flexors (on a
fixed femur as in standing) and the erectores spinae
tends to tilt the pelvis forwards and exaggerate the
lumbar lordosis whereas tension in the hip ex-
tensors and the abdominals tends to tilt the pelvis
posteriorly and reduce the lumbar lordosis.
The spine itself lacks intrinsic stability.
Nachemson (1966, 1968) notes that an isolated
ligamentous spine can only support a load of 2 kg
placed on top of the first thoracic vertebrae. Klan-
sen (1965) held that the short, deep muscles of the
back supported the individual joints of the spine.
The long back muscles were responsible for the
stabilisation of the spine as a whole when the line
of gravity of the upper body parts passed ventrally
to the lumbosacral joint. The anterior abdominals
stabilised the spine when the line of gravity was
dorsal to the axis of movement of the joint.
Nachemson (1966, 1968) investigated the role
of the vertebral portion of the iliopsoas muscle
(psoas major) in the extrinsic stabilisation of the
 R.S. Bridger /Some fundamental aspects of posture
spine. He concluded that, in addition to its func-
tion as a hip flexor, the psoas muscle was involved
in the stabilisation of the lumbar spine particu-
larly in upright standing and unsupported sitting
(i.e. without a backrest). Psoas activity decreased
when the trunk was inclined forwards while activ-
ity of the sacro-spinalis muscles simultaneously
increased. Taken together and recalling the com-
ments made previously about the function of
gluteus maximus, the muscles of the hip and trunk
can be seen as a system of synergists and
antagonists which influence the shape of the spine
in erect standing and sitting through their effects
on the tilt of the pelvis as they act to stabilise the
upper body.
The abdominal muscles (rectus abdominis and
oblique) and the thoracic (intercostal) muscles play
a major role in stabilising the spine when a weight
is lifted or carded (in relaxed standing, they are
electromyographically silent) according to the
cantilever analysis of Morris et al. (1961). The
contraction of these muscles pressurises the con-
tents of the thorax and trunk and converts them
into a p p r o x i m a t e hydraulic and p n e u m a t i c
'splints' or cylinders capable of resisting some of
the flexor moment on the spine and therefore
reducing tension in the extensors of the spine.
Aspden (1989) proposed a new mathematical
model of the spine based on arch mechanics. In
this model, intra-abdominal pressure is essential
for lifting heavy weights in conjunction with
lumbar lordosis. Empirically, Ortengren et al.
(1981) have demonstrated high positive correla-
tions between measures of intra-abdominal and
intra-discal pressure and back muscle activity. This
does not necessarily imply that intra-abdominal
pressure exerts an extensor moment about the
spine, however. Aspden proposes that it applies a
compressive stress to the convex surface of the
lumbar lordosis which acts to stiffen the lumbar
spine and therefore increases its ability to with-
stand loads.
Postural faults and muscle balance
Kendall et al. (1971) present analyses of pos-
tural faults which illustrate the role of the muscles
of the hip and trunk in the maintenance of pos-
ture. They make considerable use of the concept
of 'muscle balance' in the analysis of posture.
!I
(a) (b) (c)
Fig. 5. Alignment of the spine, pelvis and hip in standing. (a)
Normal posture. (b) Excessive anterior pelvic tilt and hyper-
lordosis. The hip flexors and low back muscles are shortened
and the abdominals are lengthened and often weak. (c) 'Flat-
back' posture caused by excessiveposterior pelvic tilt (hyperex-
tension of the hips). Sometimes caused by weak hip flexors.
(Adapted from Kendall et al., 1971.)
When a muscle is weakened and its antagonist is
not, a state of imbalance is said to occur. The
stronger muscle then shortens and the weaker
elongates resulting in a deformity of the posture of
the joint. Figure 5 illustrates this using examples
of imbalance in the hip and trunk musculature.
The alignment usually seen in healthy subjects is
depicted in figure 5a. The lumbar lordosis and
thoracic kyphosis are easily discerned. In figure
5b, the pelvis is tilted anteriorly (this may be
caused by an imbalance between the hip flexors
and low back muscles on the one hand and the
abdominal and hip extensors on the other). A
compensatory increase in the lumbar lordosis oc-
curs to maintain the trunk in an erect position. In
figure 5c the pelvis is tilted posteriorly and com-
pensatory reduction of the lumbar lordosis occurs
accordingly.
Generally speaking, weakness results in a lack
of support about a joint and permits a state of
deformity whereas shortness creates the deformity.
Deformities can also occur if weak muscles are no
longer able to adequately oppose gravity.
In a clinical study, Fisk and Baigent (1981)
found that young patients with back pain fre-
 R.S. Bridger /Some fundamental aspects of posture
quently had stiffness in the lower thoracic spine
and this was related to 'tight' hamstring muscles
(i.e. in these patients, hip flexion with the knee
extended was limited to about 30 degrees due to
passive stretching of the hamstrings which pre-
vents further flexion). They hypothesised that the
tight hamstrings, by limiting hip flexion when the
knees are extended, would increase the stress on
the spine when bending (i.e. flexion of the spine
would need to be increased to compensate for the
lack of hip flexion when activities involving bend-
ing were carried out).
A small number of studies have been carried
out to investigate the anthropometry of the hip
and trunk musculature and the pelvis and spine as
a linkage in healthy subjects. Toppenberg and
Bullock (1986) carried out multiple regression
analyses of thoracic and lumbar angles (of stand-
ing subjects), pelvic tilt and indices of muscle
length (obtained by measuring ranges of passive
flexion and extension of the hip joint and trunk)
of adolescent females. They found some signifi-
cant relationships between these variables, in par-
ticular, a negative correlation between the index of
hamstring length (range of hip flexion with the
knee extended) and the lumbar lordosis. This sug-
gested that individuals with short ('tight') ham-
strings had more pronounced lumbar lordoses than
those with long hamstrings - somewhat surprising
since the hamstrings cause posterior pelvic tilting
which flattens, rather than accentuates, the lumbar
lordosis. This finding was replicated by Bridger et
al. (1989b). They suggested that it was a statistical
artifact, the result of a positive correlation be-
tween the measures of hip flexion and extension
(the indices of hamstring and iliopsoas length).
Theoretically, in standing, short (or 'tight')
iliopsoas muscles would tend to tilt the pelvis
forwards and accentuate the lumbar lordosis. The
hamstrings are not stretched in standing and would
therefore not be expected to influence the tilt of
the pelvis. Similar findings were reported by
Bridger et al. (1990). Their data further stresses
the role played by iliopsoas in determining stand-
ing posture and postural adaptation to different
working positions.
This provides a clear theoretical justification
for the inclusion of footrests or footrails in the
design of workspaces for standing operators. When
one foot is placed on an elevated footrail, the
9
corresponding hip joint is slightly flexed and its
iliopsoas muscle shortened. This tilts the pelvis
posteriorly and slightly reduces the lumbar lordo-
sis. Essentially, intermittent use of a footrest by a
standing operator may help to prevent postural
fixity of the lumbar spine and therefore reduce
fatigue or backpain. Grieco (1986) suggested that
postural fixity in sitting may be a hazard since it
degrades nutritional exchange in the intervertebral
discs.
The conceptual model or the hip/pelvis/spine
linkage presented in figure 4 is not new.
Forrester-Brown (1930) emphasised the clinical
importance of the tilt of the pelvis in determining
the posture of the spine. In ergonomics, Keegan
(1953) used this conceptual approach in his quali-
tative radiographic analysis of posture related to
seating. It is noteworthy that Keegan believed that
the application of a knowledge of physiological
factors to chair design was important and an
improvement over the 'traditional trial and error
and anthropometric measurement methods of de-
signing seats' (Keegan, 1962). Mandal (1981, for
example) extended this work in advocating the use
of chairs with forward sloping seats over the con-
ventional flat or rearward tilted seats. Recently,
Bridger et al. applied a similar approach to the
analysis of nine working positions, including sit-
ting in a variety of ways. They concluded that
postures can be analysed not only in terms of joint
angles and depth of spinal curves but also in terms
of the constraint imposed on the pelvis and lumbar
spine by the degree of hip and knee flexion (i.e.
the functional lengths of the one and two joint
muscles of the hip and knee, their resting tone and
the extent to which they can be further lengthened
in a particular working position).
Disturbances of muscle balance result in pos-
rural deviation. Initial weakness or tightness of a
muscle may cause faulty alignment of a joint and
vice versa. Cause and effect may be difficult to
distinguish except where some clear precipitating
factor such as paralysis or trauma is extant. It is
less certain that incorrect workplace design and
postural fixity can lead to postural faults, al-
though immobilisation of muscles in a shortened
position has been shown to cause structural short-
ening and stiffening of muscles over time (Her-
bert, 1988). Although workspace redesign using
ergonomics is an appropriate approach to the pre-
10 R.S. Bridget / S o m e fundamental aspects of posture
vention of postural faults at work, the detailed
knowledge of functional anatomy possessed by the
occupational physiotherapist is essential at an idi-
opathic level for the diagnosis and treatment of
individuals and the redesign of their workspaces.
Postural reflexes and posturai control
The erect human body is a tall structure with a
narrow base of support - its C.O.G. lies at more
than half its total height. In terms of physics, the
body is at the mercy of environmental perturba-
tions. In terms of physiology, however, an adult
with fully-developed postural reflexes is very sta-
ble (given that movement is not restricted).
According to Martin (1967), posture is an active
process, its control depends on the existence of a
system of reflexes which are neurologically sep-
arate from the system which supports the trans-
mission of impulses for voluntary movement and
from the anti-gravity reflexes which cause auto-
matic bracing of a limb when it is loaded by body
weight.
The anti-gravity reflexes are centered in the
hind brain (pons and medulla, Martin, 1967). Al-
though they are essential for the maintenance of
the upright posture, they do not assist in the
maintenance of equilibrium. A second set of pos-
tural reflexes (dependent on the basal ganglia of
the mid brain) control the posture of the various
body parts in relation to each other (postural
fixation of limbs, for example) and the posture of
the whole body itself. The cerebellum is also in-
volved in posture in the co-ordination of body
movements.
The reflex control of posture (as distinct from
both low level reflex arcs such as the 'knee jerk'
reflex and voluntary movement) depends on both
intrinsic and extrinsic feedback. The labyrinthine
reflexes seem to be concerned with protection
against mechanical instability. Martin (1967) notes
that people devoid of vestibular function exhibited
little apparent disability provided they were on a
stable base and obtained visual feedback. Postural
reflexes dependent on visual feedback are mostly
supplementary to proprioceptive or labyrinthine
feedback (except the reflex reaction to an obstacle
in the path of motion). However, people with
impaired somatic and or labyrinthine feedback
exhibit particular disabilities when their vision is
impaired (e.g. inability to maintain the head erect
when blindfolded) and in some cases can only
function normally when additional cues are given
(e.g. they can only walk when white lines are
painted on the floor or when guided by the little
finger, Martin, 1967).
Extrinsic and intrinsic feedback are essential to
the maintenance of stable posture. Some quad-
rupedal animals can 'lock' their limbs to achieve
stability at little energy cost (presumably, this is
one reason why horses can sleep standing up). In
humans bipedal stability is achieved dynamically.
In the sagittal plane, the anterior and posterior
muscles act as antagonists to keep the C.O.G. of
the body within the small base of support defined
by the position of the feet. Postural reflexes act
such that, for example, forward flexion of the
trunk anterior to the base is accompanied by
posterior projection of the buttocks (the ankle
joints plantarflexing accordingly). Loss of balance
posteriorly is accompanied by forward thrusting
of the pelvis (hyperextension of the hip joints) and
the arms to restore the C.O.G.
Postural stability and postural sway
In healthy subjects under less drastic cir-
cumstances, erect posture is accompanied by pos-
tural sway. This can be measured using a force
plate and used to evaluate function in a variety of
medical complaints (e.g. strokes). Passive testing
can be supplemented by active methods in which
destabilising forces are dehberately applied at the
feet or waist (Duncan et al., 1990). An 'ankle
strategy' is used to counter small perturbations of
the C.O.G. and a 'hip strategy' to counter large
perturbations or when the support surface is nar-
row (when working in a confined space or on a
narrow plank for example). For posterior displace-
ments, tibialis anterior and then quadriceps
femoris contract in the ankle strategy and the
paraspinal and hamstring muscles in the hip
strategy.
Losses of balance (including slips, trips and
falls) are a major cause of work-related injury
(Porritt, 1985). A summary of some of the factors
which influence postural sway and stability is
therefore appropriate.
Several factors influence postural stability and
 R.S. Bridger /Some fundamental aspects of posture
sway in healthy subjects (see Ekdahl et al., 1989).
Age has been found to be related to sway in some
studies but not in others. Vision is known to be an
important stabilising factor in maintaining the
erect stance whereas severe hearing loss has been
shown to correlate with increased sway. Of the
various balance tests investigated by Ekdahl et al.,
standing on one leg while blindfolded was the
most difficult (impossible for subjects over 55
years) and standing on one leg without a blindfold
was more difficult than standing with the feet
together with a blindfold.
These results are not surprising in view of the
reduction in the size of the base of support, in-
creased muscle coordination (recruitment of the
hip abductors to maintain the C.O.G. over a single
foot) and loss of visual feedback brought about by
this test. Some interesting practical implications
are, for example, that operating foot pedals in a
standing position would be contraindicated, par-
ticularly under poor lighting. Ekdahl et al. also
observed that female subjects had better balance
than men, possibly attributable to a lower C.O.G.
Postural sway analysis may be of use in ergo-
nomics to assist in the design of loads for manual
materials handling and in workspace design gener-
ally, particularly where there is a lack of space for
the feet and hence increased demand on the pos-
tural control system.
Finally, posture may vary according to the level
of neural activation. Marek and Norowol (1986)
investigated changes in sitting posture depending
on the level of stimulation by the task. Overstimu-
lation was accompanied by a decrease in head and
trunk inclination and understimulation by an in-
crease in trunk and head inclinations during the
first two hours of work. They attributed these
findings to differences in muscle tone due to
changes in neural activation (facilitation via path-
ways in the reticular formation).
Behavioural aspects of postural control
Dempster (1955) viewed the body as an open-
chain system of links. Each joint of the body has a
freedom for angular motion in one or more direc-
tions. A complex linkage, such as that between the
shoulder, arm and hand has m a n y degrees of
freedom of movement and power transmission is
impossible without accessory stabilisation of joints
11
by muscle action. For example, supination of the
wrist may be required to turn a door handle but
this is only possible if the elbow and shoulder
joints are stabihsed and can counter the reaction
at the hand-handle interface. When analysing the
workload or onset of fatigue associated with the
performance of a task, an attempt to distinguish
between the load imposed by the work itself and
the load imposed by the requirements for postural
stabilisation may be appropriate - m a n y in-
dustrial tasks involve the manipulation of objects
whose mass is negligible compared to the mass of
the operator and his main body segments.
Postural reflexes exist for the complex control
of joint forces which occur during almost all of
our daily activities. Nachemson (1966) believed
that the psoas muscle was involved in posture
maintenance quoting Dempster's view that when
the body forms a closed-chain system of links to
exert forces on its environment, the trunk and
limb muscles do not directly exert forces, rather
they maintain joint postures such that body weight
exerts an effective moment. This mechanism un-
doubtedly makes possible those activities in which
the body produces very large forces on its environ-
ment or in which joints or external objects un-
dergo rapid acceleration through 'pivoting' ac-
tions (as in throwing a javelin, or swinging a golf
club).
Branton (1969) used the body-link concept to
evaluate the comfort of train seats using observa-
tional data on sitting behaviour. An open-chain
system of body links can behave in unpredictable
ways when subject to internal and external forces.
The prime function of a seat is to support body
mass against the forces of gravity. A second func-
tion, which was emphasised by Branton, was to
stabilise the open-chain system. In the absence of
external stabilisation, tonic muscle activity is re-
quired which leads to discomfort. Behaviours such
as folding the arms and crossing the legs are
postural strategies which turn open-chains into
approximate closed chains, stabilised by friction.
The comfort of a seat, therefore, depends on the
extent to which it permits muscular relaxation
while stabilising the open-chain of body links.
Branton's analysis remains novel (in the
author's opinion) and is of value in posture analy-
sis since the physical workload of m a n y tasks can
be reduced if the operator stabilises a b o d y part
12 R.S. Bridget / S o m e fundamental aspects of posture
by forming temporary closed chains with his
workspace (e.g. upper body weight can be used to
stabilise a forearm, hand and component resting
on the worksurface while the other hand uses a
tool to work on the component). Many postural
strategies for relaxation are culturally determined.
A famous example is the 'stork-like' stance of the
nilotic herdsmen of East Africa (standing on one
leg with the sole of the opposite foot resting on
the knee of the weight-bearing leg). A brief con-
sideration of some cross-cultural aspects of pos-
ture is therefore in order.
Cross-cultural variation in postural habits
Man is capable of approximately 1000 comfor-
table static postures (Hewes, 1957). In most cul-
tures, however, only a subset of these are practiced
due to tradition, climate and terrain, clothing de-
sign and the methods of work. The most widely
researched posture is undoubtedly standing fol-
lowed by the western '90-degree' sitting posture,
as well as its reclining variants and the furniture
used to support it (see Mandal, 1981, for a critique
of 90-degree sitting). The bipedal, upright stance
is universal across cultures and can be regarded as
fundamental in an anatomical sense. The same
cannot be said for sitting in chairs. This has its
origin in Ancient Greece and Egypt as a high
status posture. The rest of the population appears
to have sat on the floor or on low, sloping stools
(Mandal, 1984). A common posture, worldwide, is
the deep squat (regarded as vulgar by the Ancient
Greeks, which may explain why it is not practised
in countries influenced by hellenistic culture).
However, millions of people in many parts of
Asia, Africa, Latin America and Oceania custom-
arily work and rest in this position - the C.O.G.
of the body is low and over the feet, the hips and
knees are almost fully flexed, the hamstrings and
quadriceps muscles are towards the middle of
their range, the iliopsoas are shortened and the
gluteals are lengthened. The trunk is flexed and
inclined anteriorly towards the thighs. This pos-
ture is similar to the habitual resting position of
the chimpanzee and is easy for young children of
any culture to adopt. Adults not accustomed to it
find it difficult however - one reason being that
they lack sufficient dorsiflexion at the ankle to get
the C.O.G. of the body over the feet and therefore
tend to fall backwards.
Cross-legged sitting is found in North Africa,
the Middle East, India, South East Asia and In-
donesia and also Korea, Japan and Polynesia. It is
depicted in ancient Mayan sculptures and in the
pottery of many tribes of North and South
America. Convention, clothing and cold, damp
floors restrict its use in western culture (although
it is a common posture in schoolchildren), but
most people are able to sit in this way. The hips
are flexed, abducted and laterally rotated with the
knees resting on the foot of the opposite leg. The
two-joint muscles of the hip are relaxed as is
iliopsoas and body weight is born by the ischia
and not the coccyx. (In India there are many
variations of this basic position. Sen, 1984, sum-
marises some of the benefits.)
Long sitting (on the floor with a ninety-degree
trunk-thigh angle and knees extended) is a com-
mon working and resting posture among women
in Africa, Melanesia, South East Asia and Indian
North West America. Bridger et al. (1990) demon-
strated that this posture is extremely stressful for
westerners unaccustomed to it (particularly males)
because of hamstring tightness, which causes ex-
treme posterior pelvic tilting and lumbar flexion.
Sitting on the heels with the knees resting on
the floor is a formal sitting posture for both men
and women in Japan. It is the position for praying
in the Islamic world. In Africa, Mexico and parts
of South East Asia it is mainly used by women.
Most adults in western culture can attain this
posture even if unpractised, except those with
overdeveloped or tight quadriceps muscles or knee
injuries. Of the nine sitting and standing postures
investigated by Bridger et al. (1990) this was the
posture of least constraint of the hip joint with the
lumbar spine and pelvis in the middle of their
ranges. Sitting on the floor is generally unaccepta-
ble in western society and it is interesting to
observe that kneeling has recently been imple-
mented in a more acceptable form (the 'Balans'
chair) - as a piece of furniture which hfts the user
off the floor to desk height (for evaluations of this
concept see Drury and Francher, 1985; Frey and
Tecklin, 1986; Bridger, 1988).
Postures for lifting and stooping also vary across
cultures. In Africa, women traditionally stoop to
pick up objects and to carry out activities such as
 R.S. Bridger / Some fundamental aspects of posture
gardening. The knees remain extended and the
trunk-thigh angle of over 90 degrees is achieved by
flexing the hips. Little lumbar flexion seems to
take place. Most westerners are unable to stoop in
this way probably due to tight hamstrings. Floyd
and Silver (1955) and Kippers and Parker (1984)
observed that in trunk flexion from standing, the
erectores spinae muscles exhibit electrical silence
at 60% of the total hip and 90% of the total
vertebral flexion required to stoop, body weight
being supported by the posterior ligaments of the
vertebral column. The stoop method of lifting is
generally regarded as hazardous since it imposes a
greater moment at the lumbosacral joint than the
preferred squat lift (Grieve and Pheasant, 1982). It
is difficult to understand why the stoop method is
habitually used in Africa if it is hazardous, unless
the ability to avoid lumbar flexion when the hips
are flexed confers some protection. (It may be that
with the head below the hip joints and straight
spine, the component of force along the direction
of the spine exerts traction on the spine and
reduces disc pressure.)
Several cross-cultural investigations of the inci-
dence of spinal pathology have been carried out.
Fahrni and Trueman (1965) compared the inci-
dence of disc space narrowing and hypertrophic
change in North Americans and Europeans and a
jungle-dwelling tribe in India. In all groups, lumbar
degeneration increased with age, but the trends
were steeper for the western groups than the In-
dian tribe. The incidence of disc space narrowing
was much less amongst the Indians and was hardly
age-related at all. Fahrni and Trueman noted that
the spines of horses, cows, dogs, camels and
giraffes degenerate at levels where the mechanical
strain is greatest (the cervico-thoracic region of
camels and giraffes, the lower thoracic level in the
basset hound and dachshund dog and the apex of
the lumbar spine in humans). They observed that
the Indian tribe habitually squatted, avoiding pos-
tures in which a lumbar lordosis was retained, and
suggested that the habitual lordotic postures of
western culture contributed to disc degeneration.
Findings such as these are difficult to interpret
because of the number of factors involved. Spinal
pathology is not always found to be lower in
non-western cultures (Tower and Pratt, 1990, ob-
served a higher incidence of spondylosis and
spondylolisthesis in rural Eskimos than in urban
13
Eskimos or black or white populations). Clearly,
the cross-cultural study of posture and postural
habits is potentially of immense value in under-
standing the high incidence of occupational
musculoskeletal disorders in the industrialised
world.
Some practical implications
The lowering of the C.O.G. of the body was an
important stage in the evolutionary development
of bipedalism. In ontogeny, it is accompanied by
increased postural stability and development of
adult gait. Although a great deal of research has
been done on lifting, less attention has been paid
to carrying. Grieve and Pheasant (1982) argue that
holding a weight close to the body is advisable to
minimise the moment about the lumbo-sacral joint.
There would appear to be theoretical support for
the notion that the C.O.G. of the body plus load
should not be raised when an object is carried or
held because an increase in the height of the
C.O.G. increases the load on the muscles (such as
the gluteals), which stabilise the trunk and may
increase postural sway and hasten the onset of
fatigue. It may be hypothesised that the C.O.G. of
the load should be no higher than the hips, par-
ticularly when walking or standing on uneven
ground. A yoke carried over the shoulders with the
load suspended symmetrically can satisfy this re-
quirement but it increases the flexor moment on
the trunk as reflected by increased erectores spinae
activity (Klausen, 1965). Modern rucksacks trans-
mit the load through the iliac crests via a hip
strap. This method of load carriage increases the
extensor moment on the trunk, which is opposed
by the iliopsoas muscles (Klausen, 1965). It is
noteworthy that in Klausen's original paper, pho-
tographs of the above two carrying methods show
almost identical bodily postures, electromyo-
graphical analysis being required to disclose the
biomechanical difference between them. In Africa,
women traditionally carry young children low on
their backs.
The lumbar lordosis is fundamental to erect
standing, but it depends on the angle of the sacrum
and the tilt of the pelvis. This, in turn, depends on
the equilibrium of moments and countermoments
14 R.S. Bridger /Some fundamental aspects of posture
exerted on the pelvis by the musculo-ligamentous
system which controls movement of the hip and
therefore on the angles of hip and knee flexion
(see Brunswic, 1984). A lumbar angle of 20-30
degrees is normal in European subjects when
standing but is beyond the range of voluntary
movement of the hip and pelvis of males in 90-de-
gree sitting and is at the extreme of the voluntary
range of both males and females in sitting pos-
tures which do not constrain the pelvis (e.g. kneel-
ing and sitting in forward sloping chairs, Bridger
et al., 1990).
Postures other than standing are not funda-
mental in an anatomical sense. Societal factors
such as tradition and technology can shape the
development of postural reflexes and joint mobili-
ties through their effects on habitual activities.
The '90-degree' sitting posture, long used as a
model for the ergonomic design of workspaces,
has received much criticism recently (Mandal,
1981, for example). In view of the above discus-
sion, this posture would appear to be atavistic
(figure 1) and has been replaced by anatomically
more sophisticated alternatives (Corlett and Ek-
lund, 1984 and Gregg and Corlett, 1988, for exam-
ple). A young child has the ability to attain all of
the resting positions practiced throughout the
world, but usually practises only a subset. In the
present author's opinion, the attainment of a wider
postural repertoire in youth may be of benefit in
later life. The ergonomics literature contains infor-
mation on anthropometry and workspace design
much of which is based on a limited set of pos-
tural models - those which are found amongst
people who grew up in a western industrial milieu.
Whether other postures would be more ap-
propriate, particularly for implementation in de-
veloping countries, is worthy of further investiga-
tion which should lead to a better understanding
of the true limitations and possibilities of human
anatomy.
Acknowledgements
The author would like to thank the Medical
Research Council of South Africa, Professor M.
Henneberg, Mrs. D. Orkin, Professor G.G. Jaros
and Dr. H. Goldberg for their support.
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