What is Posture?

z Position of the body, or relative alignment of body parts; in

particular the musculo-skeletal system; but has an effect
on every system of the body
z COG over base of support
z Posture should fulfill 3 functions (Martin, 2002):
Assessing Posture z Maintain the alignment of body segments in all
positions; standing, sitting, quadruped, prone & supine
z Anticipate change to facilitate engagement in goal-
directed movements such as reaching & stepping
Paul Taylor & Oliver Scott z React to unexpected disturbances in balance
z Not just a static state – it is important during movement
and has an impact on balance
z Sitting
z Standing
z Moving

What is Posture? Good And Poor Posture

z Understanding the principles of posture Æ better z Good posture is the state of muscular and skeletal
exercise prescription balance that protects the supporting structures of
z Optimal posture Æ body requires minimal energy to the body against injury or progressive deformity
maintain its position and movement is more efficient irrespective of the attitude (eg erect, lying,
z We use multiple sensing references squatting, stooping) in which these structures are
working
z Visual
z Somatosensory
z Poor posture is a faulty relationship of the various
z Vestibular parts of the body, which produces increased strain on
z Neural component cannot be understated the supporting structures and in which there is less
z Basis of motor control efficient balance over its base of support
z Connective tissue is active in posture
z Fascia & Ligaments z Posture Committee of the American Academy of
Orthopaedic Surgeons

Implications of Poor Posture Implications of Poor Posture

z Impaired movement
z Pain
z Body will compensate if one or more segment/s of
the kinetic chain is not in proper alignment z In poor posture, the postural muscles are more
active, with greater energy expended
z Repeated movements and sustained postures
associated with daily work and recreation activities z Muscle ischaemia – the level of contraction of a
are the main culprit (Sahrmann, 2002) muscle is inversely proportional to blood flow through
it: at 50-60% peak contraction, blood flow is almost
z Computer analyst / office worker
zero (Sjogaard, 1988)
z Supermarket checkout assistant
z Can lead to pain, dysfunction and breakdown in
z Golfer / Soccer player numerous systems of the body (compensatory
z Inappropriate exercise prescription can exacerbate effects)
faulty movement patterns
z Pattern overload – machine VS free weights
 Importance of Posture Muscle imbalance

z Forward head posture:

z Average head weighs around 7% of BW
z Activity of neck extensors increase dramatically
z Reduced blood flow and build-up of waste products
z Leads to reflex muscle contraction & trigger points
z For every inch the COG of the head moves forward, lower
cervical spine is subjected to compressive forces equivalent to
an additional single head weight (Zohn, 1988)
z Chronic pain develops
z Traditional viewpoint:
z Occurs when a muscle shortens and its antagonist
is stretched and lengthens
z Both disadvantaged biomechanically
z Length-tension relationship not optimal
z Can displace the bones where they attach
z Kinetic chain response

Muscle Fibre Types & Actions Implications of Muscle Shortening

z Fibre type z Pseudoparesis (Janda, 1986):

z Fast-twitch: for powerful, gross movements
z Slow-twitch: low-level endurance activities (posture)
z Tonic, phasic and mixed musculature
z Tonic: resist gravity, so are strongly involved in
posture. Slow-twitch dominant and react to faulty
loading by shortening
z Phasic: main function is movement. Predominantly
fast-twitch and react to faulty loading by lengthening
z Mixed: majority of muscles are mixed. React to faulty
loading by either shortening or lengthening
z Muscle imbalance is identified where there is a lack of
balance between tonic and phasic muscles (Spring et al,
1991)
z Tight or overactive muscles may hinder or inhibit the
opposing muscle (antagonist)
z Reciprocal inhibition
z The hypertonic muscles become active in movements
they are not normally associated with
z Tonic muscles are innervated by smaller type 2 motor
neuron
z Lower excitability threshold than phasic muscles
z Can inhibit antagonist
z Direct affect on movement patterns, range of motion
and posture

Implications of Muscle Lengthening Muscle Classifications

z Stretch weakness (Kendall et al, 1993)
Predominantly Tonic Predominantly Phasic
z Result of altered length-tension relationship (lengthening)
(shortening)
z Reduced contractile force as actin and myosin
Pectoralis major Rhomboids
filaments are pulled apart
z Increase in Serial Sarcomere Number
Shoulder Levator scapulae Lower trapezius
z Stretched muscle adds more sarcomeres in an attempt Upper trapezius Mid trapezius
to move actin & myosin filaments closer together Girdle
(Norris, 2000)
Biceps brachii Triceps brachii

Neck extensors Neck flexors

Trunk Lumbar & cervical Thoracic extensors

erectors
Quadratus lumborum Abdominals
Adapted from Spring et al, 1991
Muscle Classifications Tensegrity

Predominantly Tonic Predominantly Phasic

(shortening) (lengthening) z Spine not stabilised by compression forces alone
Biceps femoris z Vertebral bodies do not bear all forces transmitted to
Semitendinosus Vastus medialis the spine
Pelvic Semimembranosus Vastus Lateralis
z Neural arch assists in transmitting force
Girdle
Iliopsoas Gluteus maximus z Spinal erectors form guide-wires for stabilising spine
Rectus femoris Gluteus mimimus z Help resists flexion & reduce forces on vertebral
Gluteus medius body & discs
Adductors z Spinous & transverse processes provide framework
Piriformis for guide-wires
TFL z Pain & forces can refer throughout kinetic chain
Lower Gastrocnemius Tibialis anterior
z Beauty & complexity of Human design
Leg Soleus Peroneals
z Need to view dysfunction globally
Adapted from Spring et al, 1991

Development of the Muscle and

Fascia Correcting Faulty Posture

z Myofibril z Consider main myofascial line(s) involved

z Endomysium z Tonic/phasic components within a line

z Fibre bundle z Other lines that assist/oppose to achieve balance

z Perimysium z Stimulate NS & blood flow – mobilisers

z Myofascial release – foam roller or therapist
z Muscle
z Facilitate - mobilisers
z Epimysium
z Effective movement – exercises

Postural Assessments Static Postural Assessment

z Assessment of posture in “relaxed” position

z Static z Begin with a general observation to get an idea of
z Useful in identifying overt abnormalities global alignment
z Head / Cervical Spine
z Critical for effective exercise prescription
z Shoulder / thoracic spine / scapulae / arms
z Dynamic z Lumbar spine / pelvis
z ‘3 big rocks’ z Knees
z Targeted movement screens z Ankles & feet
z Intervention flow chart z Observe client’s posture sequentially: inferior to
superior or vice versa
z Observe from anterior, posterior & lateral viewpoints
z Move focus to specific screening points
Muscle Imbalances Postural Screening – Back View

z Weight shift
z PT Academy view: z Ankle alignment
z Take a global look z Relative knee alignment
z Tonic & phasic still z Varus/valgus
has relevance z PSIS levels
z View as part of z Oblique folds
myofascial line z Gluteal folds
disturbance z Spinal alignment
z Prolonged sitting z Scapulae
z Flat against upper back
z Shoulder height
z Head carriage

Video Link

Static Postural Assessment – Anterior

View Scoliosis

z Feet & ankle z Structural & functional

z Relative knee position z Compensatory lateral
displacement of spinal
z Pelvis - Iliac crest height
column
z ASIS z Often notice imbalances
z Shoulder height – level? in tone/mass of spinal
z Hand position erectors
z Head carriage z Beyond scope of PT -
Refer!
z Laterally flexed /
rotated?
z Weight shift?
z Nose & umbilicus

Video Link Video Link

Lateral View Anterior Pelvic Tilt

z Slightly anterior to ankle bone

z Leg vertical and at right angle to sole of foot z Short/tight erector spinae?
z Through or slightly anterior to centre of knee
z Knees neither flexed or hyperextended
z Short/tight quadratus lumborum?
z Through or slightly posterior to hip bone
z Pelvis - neutral position, not tilted
z Short/tight iliopsoas?
z Hips - neither flexed or extended
z Through the shoulder
z Thoracic Spine - slightly convex posteriorly z Short/tight rectus femoris?
z Lumbar Spine - slightly convex anteriorly z Long/weak hamstrings and gluteus
z Through lobe of the ear maximus?
z Head not tilted forward or back
z The interactions are complicated
Video Link
z Kinetic chain!!
 Upper & Lower Crossed Back
Posterior Pelvic Tilt Posture

z Head: Forward, cervical spine hyper-

extended
z Short upper traps & SCM
z Short/tight rectus abdominus? z Long neck flexors
z Thoracic Spine: kyphosis
z Long mid traps & rhomboids
z Short/tight external obliques? z Short pecs & lats
z Pelvis: Anterior tilt
z Short erector spinae
z Short/tight gluteus maximus? z Long abdominals
z Short hip flexors
z Long hamstrings & gluteus maximus
z Short/tight hamstrings? z Knee Joints: Hyperextended
z Ankle Joints: slightly plantar flexed
z Long/weak hip flexors? z Short plantar flexors

Lower Crossed (Lumbar Lordosis) –

Pertinent Myofascial Lines Lordosis – Management Plan
DFL SBL SFL
Foam Roller ITB
Adductors
Calves
TLF
Mobilisers Sag hip mobiliser
Tri-plane adductor
Anterior knee driver
Video Link
Basic Exercises Cable rev woodchop
Squat w/ diagonal cable row
Alt arm bent knee shoulder
press w/ hip driver
Advanced Exercises 2-arm DB uppercut
High cable saggital jacks
Rev step DB scaption (extra
load)

Upper Crossed (Thoracic Kyphosis) –

Pertinent Myofascial Lines Kyphosis – Management Plan
SFAL DFAL SFL DBAL

Foam Roller Thoracic

Lats
Mobilisers Incline crawl
Segmented gait with lateral
reach
Tri-plane shoulder press w/ hip
driver
Basic Exercises Reverse step scaption
YTWL
T-push-up
Advanced Exercises 1-arm hip extension swings
1-leg backhander
Multi-directional punching

Video Link
 Flat Back – Pertinent Myofascial
Flat Back Posture Lines
DFL SBL
z Head: Forward, cervical spine slightly
extended
z Short upper traps & SCM
z Long neck flexors
z Thoracic Spine: Upper part increased flexion,
lower part straight
z Long mid traps & rhomboids
z Short pecs & lats
Video Link
z Straight (flexed) Lumbar Spine & Posterior
tilt of pelvis, with hip extended
z Long erector spinae
z Short abdominals
z Long hip flexors (iliopsoas)
z Short hamstrings (& gluteus maximus)
z Knee Joints: Extended (or flexed)
z Ankle Joints: Slightly plantar flexed
z Short plantar flexors

Flat Back – Management Plan Sway Back Posture

z Head: Forward, cervical spine slightly extended
Foam Roller Hamstrings z Short upper traps & SCM
Lower leg z Long & weak neck flexors
z Thoracic Spine: Increased flexion (long kyphosis
Mobilisers Prone dynamic knee drive with posterior displacement of upper trunk)
Rev woodchop w/ forward/reverse z Long mid traps & rhomboids
step z Short pecs, lats
Functional chest mobiliser
z Short upper abdominals
Basic Exercises 2-arm cable row with knee driver z Lumbar Spine: Flattening of lower lumbar spine
Cable lawnmower z Strong (but not short) erector spinae
Reverse step dumbell scaption
z Long lower abdominals & obliques
z Pelvis: Posterior tilt with hip extended & forward
Advanced Exercises 2-D uppercut z Long & weak iliopsoas
Cable trunk rotation w/ knee z Short & tight hamstrings (& gluteus maximus)
driver z Knee Joints: Hyperextended
Barbell kayak z Ankle Joints: Neutral Position (pelvis deviation) or
plantar flexed
z Short plantar flexors??

Sway Back – Pertinent Myofascial

Lines Pronation
SBL SFAL DBAL DFL SBL Spiral Lateral DFL

Video Link
Pronation Distortion– Management
Plan Winging Scapula
DFAL SFAL DBAL Lateral
Foam Roller Medial calf
Glutes
Adductors
ITB

Mobilisers Hip swings

Pigeon-toed walking
Forward/rev step w/foot adaptors

Basic Exercises Dynamic squat w/ toe-in Video Link

Cable toe-in step
Alt arm bent-knee shoulder press
w/ knee driver
Advanced Exercises Bent-over leg swings
Cable x-over posterior toe-in step
2-arm cable ward w/ frontal bound

Winging Scapula – Management

Plan Summary

Foam Roller Thoracic serratus pulse

Thoracic z Know your limits
z Refer where appropriate
Mobilisers Multi-planar wall scap mobiliser z Do good, do no harm
Squat diagonal reach w/ foot
adaptors
z Remember the Kinetic Chain
Wall fixed arm step around z Compensations

Basic Exercises Reverse step scaption z Augment with movement screen

T-push up z Observation, observation, observation
YTWL
Advanced Exercises Barbell kayak
Low cable pull w/ DB press
Multi-directional punching

THE BIG “3”

z THE ANKLE (TALOCRURAL) COMPLEX

z ILIO-FEMORAL (HIP) JOINT

DYNAMIC POSTURAL z THORACIC SPINE

ASSESSMENTS
Michol Dalcourt
THE ANKLE (TALOCRURAL) JOINT
z Made up of:
z Tibiotalar Joint
z Fibulotalar Joint
z Tibiofibular Joint
THE Ilio-Femoral (Hip) JOINT
z Normal Motions available:
z 110 - 120° Flexion
z 10 - 15° Extension
z 30 - 50° Abduction
z 30° Adduction
z 30 - 40° Internal
Rotation
z 40 - 60° External
Rotation
THE THORACIC SPINE
z Normal Motions available:
z 30 - 40° Flexion
z 20 - 30° Extension
z 20 - 25° Lateral Flexion
(from neutral)
z 35° Rotation (from
neutral)
THE ANKLE (TALOCRURAL) JOINT
z Normal Motions available:
z 20° Inversion
z 10° Eversion
z 20° Dorsiflexion
z 50° Plantarflexion
z 19° Rotation
THE Ilio-Femoral (Hip) JOINT
z Normal Motions available:
z 110 - 120° Flexion
z 10 - 15° Extension
z 30 - 50° Abduction
z 30° Adduction
z 30 - 40° Internal
Rotation
z 40 - 60° External
Rotation
Movement Assessments –
Video Links
• Assessment 1 – Ankle complex
• Assessment 2 – Hip complex
• Assessment 3 – Thoracic spine complex
Movement Screen Examples More Movement Screen Examples

• Initial Movement Screen

• Mobilisers linked to the previous • Latissimus Dorsi Foam Roller linked to

Movement Screen Movement Screen

• Thorax Foam Roller linked to Movement

• Movement Screen Re-testing
Screen

• Mobilisers linked to Movement Screen and

Re-test