The Spine and Posture

What is Posture? Posture means position Posture is the body’s alignment and positioning with respect to COG. Attitude of the body, the relative alignment of body/limb segments Types Static posture: In which body segments aligned and maintained in certain positions (Standing, lying, sitting). No mechanical work. Dynamic posture: In which body segments are moving (Walking – running, lifting) 5/2/2011

Postural Development The adult spine is divided into four curves: Two primary or posterior curves because they are present in the infant and the convexity is posterior Thoracic spine Sacrum Two compensatory or anterior curves because they are Develop as the infant learns to lift the head and eventually stand, and the convexity is anterior Cervical spine Lumbar spine 5/2/2011

POSTURAL ANALYSIS Good posture Poor posture Muscles function most efficiently Optimum conditions for internal organs Good posture Increased strain on supporting structures Less efficient balance of the body over its base of support Poor posture POSTURAL ANALYSIS 5/2/2011

Causes of poor posture Positional factors Muscle imbalances/contractures Pain Respiratory conditions Typically can be managed through therapeutic ex & education Structural factors Congenital deformity Developmental problems Trauma Disease Not typically easily managed 5/2/2011

STANDARD POSTURE Line of Gravity Through ear lobes Through bodies CV Through shouder jt. Through trunk Through GT Anterior to midline knee Anterior to lat malleolus 5/2/2011

FAULTY POSTURE Any deviation from the normal/proper posture 5/2/2011

Factors affecting posture Neurologic issues Muscle weakness Hypermobile joints Hypomobile joints Bony abnormalities Leg length Spinal column 5/2/2011

FAULTY POSTURE Postural pain syndromes Postural dysfunctions Posture deviates from normal alignment but no structural limitation Mechanical stress but relieved by activity or change of position No abnormalities in musculoskeletal structures Postural dysfunctions Adaptive shortening of soft tissues and muscle weakness Imbalance in strength and flexibility 5/2/2011

FAULTY POSTURE: Standing Head and neck Shoulder and scapula Head, neck, shoulder and scapula Trunk Feet and knees 5/2/2011

Head and Neck Forward head Inc flexion of the lower cervical and upper thoracic regions Inc extension of the occipital on the upper cervical vertebrae Protrusion of mandible 5/2/2011

Head and Neck Flat neck Dec cervical lordosis Inc flexion of the occiput on the atlas Retraction of the mandible Exaggerated military posture 5/2/2011

Head and Neck Head Posterior Tilt Head Anterior Tilt Marked Anterior Forward Head with Attempted Correction 5/2/2011

Scapula Adducted Slightly Elevated Shoulders and Scapula Shoulders and scapula Good position Scapula Abducted Slightly Elevated Scapula Adducted Slightly Elevated 5/2/2011

Shoulders and scapula Shoulders and scapula Shoulders Elevated Good position Shoulders Elevated Scapula Adducted Shoulder Depressed Scapula Abducted 5/2/2011

Shoulders and Scapula Winging of the Scapula Shoulders and scapula Good position Winging of the Scapula Scapula depressed 5/2/2011

Head, Neck, Shoulders and Scapula Upper crossed syndrome The occiput and C1/C2 will hyperextend with the head being pushed forward The lower cervical to 4th Thoracic vertebrae will be posturally stressed Rotation and abduction of the scapulae occurs 5/2/2011

Head, Neck, Shoulders and Scapula Upper crossed syndrome Tight muscles: Pectoralis major and minor, upper trapezius, Levator scapulae, SCM Weak muscles: Lower and middle trapezius, Serratus Anterior, Rhomboids 5/2/2011

Kyphosis An exaggerated curvature in the sagittal plane Long rounded curve (round back) Sharp posterior angulation (hump back) Possible causes Wedge compression fracture Ankylosing spondylitis osteoporosis Destructive tumors of spine

Trunk Kyphosis-Lordosis Forward head Increased cervical lordosis Short and Tight: Neck extensors Hip flexors Low back Scapula Abducted Increased thoracic kyphosis Increased lumbar lordosis Lengthened and Weak: Neck flexors Hamstrings Erector spinae Possibly abdominals Anterior pelvic tilt Knees slightly hyperextended Ankles slightly plantarflexed 5/2/2011

Trunk Sway-back Forward head Increased cervical lordosis Short and Tight: Upper abdominals Intercostals Hamstrings Increased thoracic kyphosis Decreased lumbar lordosis Lengthened and Weak: Neck flexors Hip flexors Thoracic extensors Lower abdominals Posterior pelvic tilt Knees slightly hyperextended Ankles neutral 5/2/2011

Trunk Military type Normal-slightly posterior Normal Normal kyphosis Short and Tight: Lumbar extensors Hip flexors Increased lumbar lordosis Anterior pelvic tilt Lengthened and Weak: Abdominals Hamstrings Knees slightly hyperextended Ankles slightly plantarflexed 5/2/2011

Trunk Flat back Forward head Increased cervical lordosis Decreased kyphosis Short and Tight: Neck extensors Abdominals Hamstrings Decreased lumbar lordosis Posterior pelvic tilt Lengthened and Weak: Neck flexors Back extensors Hip flexors Knees slightly hyperextended Ankles slightly plantarflexed 5/2/2011

Trunk Scoliosis Lateral deviation of the spine Deformity Structural Fixed deformity Apical vertebrae Vertebral body on convex Spinous process on concave Non-structural Flexible deformity Positional, functional, postural 5/2/2011

Scoliosis A medio-lateral curve of the vertebral column Exceeding 100 Types Structural Neuromuscular Idiopathic Non-structural Treatment Exercises Bracing

How is scoliosis detected? Forward bending test Skyline view 5/2/2011

Description of the curve Cobb angle greater than 25-30 will require decompression and fixation surgery. 5/2/2011

Feet and Knees Ideal alignment Patella faces forward Feet are in good alignment Hips and feet neutral 5/2/2011

Feet and Knees Genu Varum Knee separation Hyperextension of the knee Axis of knee is oblique Hindfoot Supination Forefoot pronation Squinting Patella 5/2/2011

Feet and Knees Genu valgum Hip adducted; IR of the femur Patella tilted medial Hindfoot pronation Forefoot supination Hyperextension Knee is oblique Frog eyes 5/2/2011

Feet and Knees Patella alta Patella baja 5/2/2011