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POSTURE 1

STANDING, LINE OF GRAVITY AT JOINTS, POSTURAL SWAY and

CORRECTION OF PERTURBATIONS

STANDING
We generally think of standing as a passive, static situation, but there are at
least two reasons why it's not:
(1) changes in stance
(2) postural sway

Changes in stance (Smith 1953,1956)

Symmetrical stance. One may stand symmetrically, as in standing at ease, in
which case the body weight is borne equally by the two legs, and the knees
are about 6 degrees short of full extension.
Asymmetrical stance. But most of the time, people tend to stand
asymmetrically, with most of their weight on one leg (about 80 - 90% of
body weight) while the other leg acts as a prop to control forward sway of
the body. In this case, the knee of the supporting limb is extended further
into the locking range, within about 2 degrees of full extension (Carlsöö
1972) p.54, Smith, 1953. At the same time, the pelvis is allowed to tilt
laterally, downwards on the side which bears less weight. A small amount
of pelvic tilt is controlled by the abductors of the thigh, gluteus medius and
minimus: but as the pelvis is allowed to tilt further, the iliotibial tract
takes more and more of the load, so that activity measured
electromyographically in the abductors becomes less and less until they
fall silent (Evans 1979) Inman, 1947. Thus in the 'pelvic slouch' the knee of
the supporting limb is fully extended and the thigh fully adducted. In both
cases the force which opposes gravity is provided not by muscles, but by
ligaments. According to Evans, the asymmetrical stance or 'pelvic slouch' is
used by people who are waiting or bored---said to be a problem with ballet
dancers. As soon as one is about to do something else, one changes over to a
symmetrical stance.
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MAINTENANCE OF STANDING POSTURE AT DIFFERENT JOINTS.

Man is unique, at least among mammals, in his upright posture. This posture
means that the centre of gravity of any segment of the body lies more or
less over the joint which supports it, in a condition of unstable equilibrium.

Line of gravity through all the joints

In fact early workers (Braune & Fischer, 1889) working on German soldiers
suggested that the normal upright posture was that in which the axes of
rotation of the joints lie in the same frontal plane as the centre of gravity.

SLIDE 1 (Haycraft) illustrates this idea

Muscle activity unnecessary If this were the case, standing would require no
muscular activity (contrary to views of Duchenne & Rademaker, 1927) and
would be maintained by joint reaction forces and tension in the ligaments
alone. (This forms a possible definition of 'ideal' posture).

Line of gravity in front of the ankle This is very close to the truth except that
the line of gravity, i.e. a vertical line through the C.G. (just in front of S2),
passes 2-5 cm in front of the transverse axis of the ankle, roughly bisecting
the base of support-i.e. between the heel and the metatarsal heads.
(Joseph & Nightingale,1952).

SLIDE 2 (Haycraft)

shows the unnatural posture obtained if all the transverse joint axes are
aligned in the same frontal plane as the C.G.
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FOOT - ANKLE
The line of gravity passes 2-5 cm in front of the axis of the talocrural joint. Even
with substantial backward sway, the line of gravity still passes in front of
the ankle (Carlsöö 1972) p61.

sketch

The body therefore tends to fall forward about the ankle, and this tendency to
dorsiflex the foot must be opposed by the plantar flexors. EMG recordings
show that the soleus is more or less continuously active during stance.
(Soleus is composed predominantly (90%) of slow motor units which are
resistant to fatigue). Gastrocnemius is also intermittently active,
presumably during extremes of forward sway (Joseph & Nightingale,
1952).

Fore and aft load distribution In the equilibrium position, the body load is
divided between the forefoot and the heel, with very little load on the
middle part of the foot. The heel carries between one and three times the
load on the forefoot. Of this forefoot load, the toes carry between 5 & 10%,
but this fraction increases up to 25% during forward sway and restoration
of balance (Hutton et al, in Klenerman 1976).

FOOT - TARSAL JOINTS AND INTRINSIC MUSCLES

Foot- lateral balance. If a person is pushed to one side, say to the right,
equilibrium is restored by increasing the total load on the right foot, and by
supination of the right foot to increase the load on its lateral edge.
Foot- intrinsic muscles. As we've mentioned before, the longitudinal arch of the
foot is braced by plantar ligaments and the plantar aponeurosis. The
intrinsic muscles of the foot are virtually inactive in standing (Basmajian
and De Luca 1985).
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sketch of major joints to put in torques:

KNEE
The line of gravity which is important for the
remaining joints in terms of stability, is
that through the C.G. of the part of the
body above the joint.
For the knee, this passes in front of the knee
joint, roughly through the patella. Since
the line of gravity passes in front of the
knee, the torque is such as to extend the
knee joint, so that activity in the
quadriceps muscle is unnecessary, and
EMG shows it to be inactive. In fact
during stance the patella can easily be
displaced from side to side, showing that
the muscle is relaxed (Carlsoo, p63). One
might expect to find one or more of the
knee's flexors active to prevent
hyperextension, but EMG shows that
none of them is active, and the knee is
apparently stabilized against
overextension by the passive tension in
the flexor muscles and their tendons,
tension in the articular ligaments, and
compression of articular cartilage as the
knee becomes close packed (Barnett,
1953; Smith, 1956).
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HIP
In erect standing, the centre of gravity of that part of the body above the hips is
at the anterior edge of the lower surface of T11 vertebra (Carlsoo p66; T10
(Inman et al. 1981) p83a). The line of gravity of the upper body passes just
behind the transverse axis of the hips, so that the trunk tends to tip
backwards; a tendency which is eventually opposed by the iliofemoral
ligament in front of the hip joint (Green and Silver 1981) p129. However,
the hip in standing is about 10-15 degrees from full extension, and some
muscles show tonic EMG activity, although at a relatively low level. These
muscles are the psoas, (Nachemson, 1966) or iliopsoas preventing
backward tilt, and tensor fasciae latae and gluteus medius probably acting
to prevent adduction of the weight bearing leg (see above).

However, they appear to be active bilaterally (Soames and Atha 1981) which
ties in with Carlsoo's explanation: iliopsoas and tensor fasciae latae act in
conjunction as flexors of the hip, while gluteus medius, or rather its
posterior part, still retains an extensor function (as in the apes) even
though it is primarily an abductor of the thigh).

If the trunk sways forward slightly, biceps femoris (a hip extensor) may also be
activated. However, the gluteus maximus is not active during standing,
and appears to be active mainly when powerful extension of the hip is
required, as in straightening up from touching the toes, or in climbing
upstairs.

VERTEBRAL COLUMN
Postural sway of the vertebral column on the pelvis is controlled by the erector
spinae which extend it, and the rectus abdominis which flexes it. Of course
the external and internal obliques acting together will also flex the spine.
Thus in most people (80%) there is slight tonic EMG activity in the erector
spinae, which becomes greater during forward sway. The proportion of slow
motor units in erector spinae is quite high (c. 70%, Bylund et al; 56%, MA
Johnson et al, 1973), and becomes even higher on the convex side in
scoliosis (P. Bylund et al, Clin Orthop. 214, 222-228; 1987)
In a few people (20%) rectus abdominis is tonically active instead (Floyd and
Silver 1955; Klausen 1965). The proportion of slow fibres varies quite
widely between individuals from about 40 -70% (T. Häggmark & A.
Thorstensson, 1979), and might be correlated with postural activity.
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On leaning forward to touch one's toes, the erector spinae becomes increasingly
active to control flexion. However, at extreme flexion, activity ceases
altogether, because passive tension in the muscles and ligaments is high
enough to resist the load. However, any further load in this position may
result in damage.

Abdominal pressure The abdominal muscles not only produce flexion; they may
also act to raise the pressure in the abdominal cavity. This pressure helps
support the load of the upper body in flexion, working in a similar way to
the intervertebral discs. For this reason slack abdominal muscles may
predispose to back problems (RSRP, p18).

UPPER LIMB
In the upper limb during relaxed standing, the muscles are relaxed except for
the supraspinatus and part of the deltoid. The horizontal pull of
supraspinatus is required to hold the head of the humerus in the glenoid
cavity (Basmajian 4 p186).

HEAD
The C.G. of the head lies over the atlanto-occipital joint, so that most neck
muscles are silent- at least those which have been examined using EMG.
These include the sternomastoid, longus colli, longissimus cervicis, and
semispinalis
The only tonically active muscle is temporalis, which fights a constant battle
against gravity to keep your mouth from falling open. However, it does not
have a particularly high proportion of slow motor units (c. 47%, MA
Johnson et al, 1979).

SUMMARY
Surprisingly few muscles are continuously active during standing, although a
few more are recruited to oppose postural sway. As a result, the metabolic
energy difference between standing and lying down is very small (Joseph &
Williams 1957,p293). This difference is said to be about 25% IRT p118
and Ch.3) cf Sato & Tanaka, 1973, cited by Soames & Atha, 1981.
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POSTURAL SWAY
During relaxed standing, the body sways continually - mostly backwards and
forwards, with relatively little lateral sway. Postural sway is increased
when the eyes are closed. The sway can be measured by recording
movements of the head - these have an amplitude of about 4 cm. However,
records of the centre of pressure of the foot are more useful, and can be
made with a force plate.
The centre of foot pressure (CFP) indicates the intersection of the line of gravity
with the ground, provided that the body is stationary; but during sway
movements, the amplitude of the CFP movement is greater than the
amplitude of C.G. movement (Mizrahi 2000; Thomas and Whitney 1959).

graph
2D excursion of CFP

Two joints Postural sway takes place not only at the ankles, but also at the
hips; the angular rotations at the ankle and hip are about the same in
amplitude, and are the same in direction.

Three components of sway Postural sway has three components. Firstly, a

low frequency component (0.1-0.4 Hz, or one cycle in 2.5-10 sec.). This
component has a relatively high amplitude, of the order of 1 cm, and the
oscillation is probably due to the time delays in the neural circuitry which
detects and corrects postural sway.
Secondly, superimposed on this is a high frequency component, (6 Hz) but with a
relatively low amplitude of about 10 micrometres, or about 1/1000 that of
the low frequency sway. This is most probably due to physiological tremor,
which has the same frequency.
There appears to be a third component at about 1 Hz (Mizrahi 2000)

graph of position of CFP wrt time

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FIXED PATTERNS OF POSTURAL ADJUSTMENT

There are two cases in which postural adjustments take place in a fixed pattern,
with several groups of muscles responding in a stereotyped way. The first
example is the correction of excessive postural sway; the second is
anticipatory postural adjustments.

Correction of perturbations It has been shown that there are two 'strategies'
for correcting postural sway (Horak and Nashner 1986).
Extended support. If you are standing on an extended support, i.e. large enough
for your whole foot, then you tend to correct sway by activating either
anterior or posterior muscles, starting at the ankle and radiating
successively up to thigh and trunk muscles. Thus if you sway forwards the
plantar flexors are activated, followed c. 20 ms later by hamstrings and
another 20 ms later by paraspinal muscles (Fig 2A). If you sway backwards
the anterior muscles are activated in sequence, i.e. tibialis anterior,
quadriceps and abdominal muscles, again from distal to proximal. Both
these sequences produce a compensatory torque about the ankle joint.
Short support. However, if you stand on a bar, or a support short in comparison
with your foot, changes in ankle angle will not stabilise you, so you use a
different strategy and activate trunk and thigh muscles antagonistic to
those in the ankle strategy: i.e. if you sway forwards you activate the
abdominal muscles and then the quadriceps, but this time starting with
proximal (abdominal) and going on to distal (quads.) This sequence
produces a horizontal force or shear against the support.
In both cases it seems unlikely that these patterns are elicited by stretch
reflexes alone - rather they are centrally coordinated patterns of
movement. NB - without somatosensory information the hip strategy is used;
without vestibular inputs the ankle strategy is used Soc. Neurosci Abstr. 1985
11 704.
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Anticipatory postural adjustments (Massion 1992).

When a movement is made which will move the centre of gravity of the body, a
postural adjustment must be made. In many cases it turns out that this
postural adjustment is made prior to the movement - i.e. an anticipatory
postural adjustment. For example, if while standing you make a reaching
movement with the arm, there is EMG activity in postural muscles such as
external oblique and paraspinal muscles before activity in deltoid.
However, if you are sitting, the base of support is larger and the CG is not
moved outside it, and activity in deltoid precedes activity in the postural
muscles (Moore et al. 1992).
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REFLEXES OF STANDING
In addition to the major postural reflexes which we've covered so far, there are
some which are best described as reflexes of standing: these depend on
receptors in muscle, skin and perhaps joints.

(1) The STRETCH REFLEX. When the load on a muscle is increased, the muscle
and its receptors are stretched. This activates the motoneurones of that
muscle, increasing the tension in the muscle. So an increase in load is
compensated for by a reflex increase in muscle tension, particularly in the
physiological extensors. (note that an increase in load will also be
compensated for by a non-reflex increase in muscle tension, simply due to
the stiffness of the muscle).

(2) The POSITIVE SUPPORTING REACTION. This is most easily seen in

animals and in children up to 6-9 months old (Dekaban). When the foot is
off the ground, there is little or no tension on the extensors. But when the
foot comes into contact with a suitable support, the toes are extended and
splayed. Receptors in the muscles (perhaps in the plantar interossei) cause
a reflex increase in the tension of extensor muscle so that the limbs can
support the load of the body. This response is the positive supporting
reaction (Rademaker, 1927; Schoen, 1926). It is appropriate provided that
the line of action of the resultant force passes through the hip and the
contact area of the foot. (Roberts 2 p.163).

(3) The SWAY REACTION or BUTTRESSING. When there is a horizontal force

tending to push the body to one side, the leg on that side is extended more,
and the foot is supinated, tending to oppose the horizontal force and keep
the body vertical.

(4) The LATERAL STEP (& FORWARD & BACKWARD STEP). If the side force
becomes great enough, buttressing alone is not enough, and a lateral step is
taken. The weight is transferred from the far leg to the nearside leg, so that
the far leg can be abducted and set down, ready to take most of the body
weight again. Similarly, backward and forward forces are compensated
firstly by shifting the body weight away from the point at which the force is
acting, and then if necessary, taking a step away from the force.

(5) The RIGHTING REFLEXES from the BODY. There are also some postural
reactions in which skin receptors are involved: the most important one is
righting. Even without the labyrinths or vision, animals lying on their side
will right themselves, using stimulation of the underlying skin as a cue.
This depends on the asymmetry of stimulation, so that in a
labyrinthectomized animal lying on its side, no righting reflex will occur if a
weighted plank is laid on the body. In this situation both sides of the body
receive similar cutaneous inputs. (Roberts 2, p.172).
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References

Basmajian, J.V. and De Luca, C.J., Muscles alive : their functions revealed by
electromyography, Williams & Wilkins, Baltimore, 1985, xii, 561 pp.
Carlsöö, S., How man moves: kinesiological studies and methods, Heinemann,
London,, 1972, vii, 198 pp.
Evans, P., The postural function of the iliotibial tract, Ann R Coll Surg Engl, 61
(1979) 271-80.
Floyd, W.F. and Silver, P.H.S., The function of the erectores spinae muscles in
certain movements and postures in man, J. Physiol. (Lond.), 129 (1955)
184-203.
Green, J.H. and Silver, P.H.S., An Introduction to Human Anatomy, Oxford U.P.,
Oxford, 1981.
Horak, F.B. and Nashner, L.M., Central programming of postural movements:
adaptation to altered support-surface configurations, J Neurophysiol, 55
(1986) 1369-81.
Inman, V.T., Ralston, H.J., Todd, F. and Lieberman, J.C., Human walking,
Williams & Wilkins, Baltimore, 1981, xi, 154 pp.
Klausen, K., The form and function of the loaded human spine, Acta physiol.
scand., 65 (1965) 176-190.
Massion, J., Movement, posture and equilibrium: interaction and coordination,
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Mizrahi, J., Biomechanics of unperturbed standing balance. In: Z. Dvir (Ed.),
Clinical biomechanics, Churchill Livingstone, New York, 2000, pp. viii,
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Moore, S., Brunt, D., Nesbitt, M.L. and Juarez, T., Investigation of evidence for
anticipatory postural adjustments in seated subjects who performed a
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Soames, R.W. and Atha, J., The role of the antigravity musculature during quiet
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