Posture stability and Balance

Posture Principles Definition of “good” posture Examples of poor posture

Posture Inherent to concept of posture are alignment and muscle balance Good mechanics require that joint ROM be adequate, but not excessive The more flexibility, the less stability The more stability, the less flexibility Why do only some people get pain? Posture may be faulty, but individual has mobility so position can change readily Posture may appear good, but mobility lacking so position cannot change readily

Mechanical Imbalance An alteration of structure and function which is reflected in combinations of muscle tightness and weakness, ligamentous laxity and/or poor alignment of body segments

Posture - Principles Faulty alignment results in undue stress on bones, ligaments and muscle Adaptive shortening can develop in muscles that remain in a shortened condition Stretch weakness can occur in muscles that remain in elongated conditions

Mechanical Imbalances Kyphosis-lordosis posture Flat back posture

Kyphosis-Lordosis Posture increased lumbar lordosis, promotes a forward pelvic tilt and a slightly flexed position of the hip Leads to increased stress on L4L5 disc and facets and the sacroiliac (SI) joints cause early recruitment of the lumbar extensors increased knee flexion at heel strike increasing the potential for patellar tendon and patellar femoral joint injuries

Posture types Normal sway Kyphotic flat

Kyphosis-Lordosis Posture Head – forward Cervical spine – hyperextended Scapulae – abducted Thoracic spine – increased kyphosis Lumbar spine – increased lordosis Pelvis – anterior tilt Hip – flexed Knee – slightly hyperextended Ankle – slight plantarflexion

Kyphosis-Lordosis Posture Elongated and weak Neck flexors, upper ES, external obliques Elongated, may be weak hamstrings Short and Strong Neck extensors, hip flexors Strong, may be short Lumbar ES

Posture

Flat-back Posture Head – forward Cervical spine – slightly extended Thoracic spine – upper increased flexion; lower straight Lumbar spine – flattened (flexed) Pelvis – posterior tilt Hip – extended Knee – extended Ankle – slight plantar flexion

Flat-back Posture Elongated and weak Strong, not short One-joint hip flexors Short and Strong Hamstrings, upper fibers of internal oblique Strong, not short Lumbar ES

General population Swayback: Approximately 30% of men and 20% of women. Kyphosis-Lordosis: Approximately 20% of women and 15% of men. Flatback: Approximately 10% of men and women. Only 5% of persons may have the optimal posture depicted to the left, with a further 15% coming reasonably close

Summary Postures that deviate from ideal can produce adaptive shortening, strengthening, elongating and weakening that can affect structures quite distal to the poor posture culprit Use a postural assessment to guide your specific assessment and treatment plans, especially for chronic, non-traumatic problems

Regaining postural stability and balance “CoG” is located just above your pelvis. In order to remain “balanced”, your CoG must remain within the limit of stability “LOS”. “balance” is the ability to maintain the body’s segments in alignment within a “limit of stability” (LOS). Balance is the single most important element dictating movement strategies with in the closed kinetic chain.

Regaining postural stability and balance Is both Static Dynamic Dynamic for example, walking, climbing stairs, etc

MOVEMENT STRATEGIES What are the 3 movement strategies that are used by the body to maintain the CoG within a stable base of support? 1. ankle 2. hip 3. stepping

MOVEMENT STRATEGIES When would each strategy be used? Ankle: when small, slow movements, close to CoG Hip: larger, quicker movements required. Also if CoG gets closer to LOS. Stepping: if CoG gets out of Limit Of Stability.

INJURY AND BALANCE Studies of the knee and ankle show that there is a decrease in proprioceptive feedback from damaged ligaments to the CNS (sensory/afferents). Therefore, is decreased reflex excitation of motor neurons (efferents) to the muscles responsible for preventing sway/controlling balance.

BALANCE TRAINING MUST improve the balance and postural equilibrium of the athlete in order for them to return safely and effectively to the playing field.

BALANCE TRAINING General rules when developing a balance training program: Exercises must be safe, yet challenging Stress multiple planes of motion Incorporate a multi-sensory approach Begin with static, bilateral, stable. Progress to dynamic, unilateral, unstable. Progress to sport-specific Multiple planes of motion – flexion vs extension, adduction vs abduction Multisensory approach – eyes open vs eyes closed Begin with static, bilateral, stable. Progress to dynamic, unilateral, unstable. Various surfaces – wobble boards, pillow, trampoline, etc Sport specific exercises are always done last

BALANCE TRAINING CLASSIFICATIONS OF BALANCE TRAINING/EXERCISES 1. static: 2. semi-dynamic: 3. dynamic: 4. functional:

BALANCE TRAINING static: CoG is maintained over fixed base of support on a stable surface. i.e. Rhomberg tests

2. semi-dynamic: 2 types (a) maintain CoG over fixed base of support while on moving surface or unstable surface (BAPS/Wobble board) (b) transfer CoG over a fixed base of support to areas within the LOS while standing on a stable surface (pick up pens)

BALANCE TRAINING 3. dynamic: CoG maintained within the LOS, while over a moving base of support on a stable surface. Requires a stepping strategy i.e. hopping, walking on a balance beam More into plymetics – hopping, climbing, jumping, up stairs, down stairs, etc Ex dynmaic test for basketball player – shuffle side to side on their own Functinal/sport specific – have the basketball player mimic the motions of the trainer

Balance Training 4. functional: same as dynamic, except also have sport specific tasks included. i.e. catching/throwing a ball while running.