Fundamentals of Posture

1. Fundamentals of Posture

2. Types of Posture • Good Posture • Kyphotic-lordotic Posture • Flat-back Posture • Sway-back Posture

3. Correct Posture • Maximal biomechanical efficiency • Minimal stress on ligaments and strain on muscles “…that state of muscular and skeletal balance which protects the supporting structures of the body against injury or progressive deformity irrespective of the attitude (erect, lying, squatting, stooping) in which these structures are working or resting. Under such conditions the muscles will function most efficiently and the optimum positions are afforded for the thoracic and abdominal organs.” (AAOS)

4. Posterior (Back) Spinal Column Normal Spine Curvature

5. Correct Posture (Lateral) Line is… • Through external auditory meatus (Ear) • Midway through shoulder • Through lumbar bodies • Slightly anterior to midline of knee • Slightly anterior to lateral malleolus

6. Poor Posture (AAOS) • Increased strain on body and less efficient • Cause of various physiological and anatomical impairments “…faulty relationship of the various parts of the body which produces increased strain on the supporting structures and in which there is less efficient balance of the body over its base of support.” (AAOS)

7. Kyphotic-Lordotic Posture Head- Forward Cervical Spine- Hyperextended Thoracic Vertebrate- increased flexion Lumbar Vertebrate- lordosis; hyperextended Pelvis- Anterior tilt (forward and down) Knees- hyperextended Ankle joints- plantar flexed, legs are behind midline IDEAL

8. Flat-Back Posture Head- Forward Cervical Spine- extended Thoracic Vertebrate- reduced curvature (extension) Lumbar Vertebrate – straight (flexion) Pelvis- posterior tilt (backward) and down) Hips- extended Knees- extended Ankle joints- slightly plantar flexed IDEAL

9. Sway-Back Posture Head: Forward Cervical Spine -Hyper extended Thoracic Vertebrate- slight flexion Lumbar Vertebrate –slight extension Pelvis-posterior tilt and anterior to midline Hips- flexed Knees- Hyper extended IDEAL

10. Evaluation Lateral Evaluation • Plumb Alignment: aligned anterior to lateral malleolus Things to Examine • Position of knees • Check for hyperextension or flexion • Pelvic position and spine curvature • Head, chest and abdominal position

11. Lateral: Knee Position Hyperextension of knees Flexion of Knees Good Alignment

12. Anterior Evaluation • Position of feet • Check for pronation or supination • Check arch of the foot • Position of legs • Check for bowlegs • Position of knees • Check for knock-knees • Appearance of ribs • Position of head

13. Anterior: Good Alignment Knee caps face straight ahead Legs are straight up and down Arches have normal half-dome shape Toes are straight

14. Anterior: Foot Supination & Pronation Slight knee knocking Contracted anterior tibalis Feet are supinated Weight is on outside of feet Feet are pronated

15. Evaluation Posterior Evaluation • Plumb Alignment- align midway between heels Things to Examine • Note alignment of Achilles Tendon • Hip adduction/abduction • Check for level posterior iliac spine • Check for lateral pelvic tilt • Check for spine and shoulder problems

16. Posture of Children • Child development and flexibility allows for momentary deviations that would be considered faulty in adults. • Foot generally flat until 6-7 years of age • Hyperextension of knees common • Knock-knee common until 6-7 years of age

17. Scoliosis • Lateral curve in the spine • Types of Scoliosis • Congenital • Neuromuscular • Paralytic • Idiopathic • 85% of cases • Unknown Cause • Adolescent Idiopathic Scoliosis (AIS)

18. Scoliosis: Perform Posture Analysis • Check if shoulders are level • Check distance between arms and side of body • Check if hips are level • Check if head is centered over the pelvis.

19. Scoliosis • Shoulders not level, prominent or uneven scapulas • Uneven gap between arm and body • Elevated or uneven hip • Head not centered over pelvis • Bending test reveals uneven portions of back

20. Example

21. Perform Forward Bending Test • Determine if curve is structural or functional • Structural- prominence seen in forward bending • Functional-no prominence seen in forward bending

22. Scoliosis Examination Summary • Physical assessment • Cardiopulmonary • Adam’s Forward Bending Test • Leg length • Plumb line • Range of motion • Palpation • Neurological assessment

23. Posture and Weight training Good posture is the foundation of all exercise! Focus on learning the right technique at the beginning. Work continuously at perfecting your technique.

24. Posture and Weight training Perform the movements with control, not jerky. Always keep your joints slightly bent – don’t lock out. Keep focused on the working muscles and stabilize the others. Listen to your body – it will tell you if something is not right.

25. References • Kendall, F.P. & McCreary, E.K., et. al. (2005). Muscles: Testing and Function with Posture and Pain (5th ed.). Baltimore: Williams & Wilkins. • American Academy of Orthopaedic Surgeons. Available online: http://www.aaos.org/ • http://www.scoliosis-australia.org/scoliosis/about_scoliosis.html (forward bending image) • http://www.aafp.org/afp/20020501/1817.html (scoliosis) • http://orthoinfo.aaos.org/brochure/thr_report.cfm?Thread_ID=14 (slide 23) • www.nlm.nih.gov