13 Points To Check Your Posture

Posture

Posture is the attitude which is assumed by body parts to maintain stability and balance with minimum effort and least strain during supportive and non supportive positions.

Types of Posture:

1- Inactive Posture: resting positions.

2-Active Posture: which could be static or dynamic.

Standing Posture (Erect Posture)

Although the COG level in normal standing posture is relatively high and presence of an arrow base of support (both feet width and length) only a minimal activity  of muscular contraction is required in maintenance of static standing posture.

Factors affecting mechanics of posture:

1- Body Physique. Body build i.e. percentage of fat free component (muscles and bones to adipose tissue.

2- Nervous Control of posture.

3- Pathway of line of gravity.

4- Pelvic Inclination.

Normal pathway of line of gravity in static standing posture:

In normal optimal standing posture the LOG falls close to not through most joint axes. Which is counterbalanced by passive tension produced by ligaments and other soft tissues, joints reaction forces in addition to  active tension produced by minimal muscular activity.

From frontal view

The LOG passes through the body’s center of gravity which theoretically bisects the body into two equal halves, with the body weight is equally distributed between the two feet.

From lateral view

1- Vertex.

2-Passes through the lobe of the ears.

3-Odontoid process.

4- Anterior to the axis of flex./ext. of the neck: 

Creating a flexion moment which is (counterbalanced by tension in ligamentum nuchae and activity of neck extensor muscles, to keep head in neutral position.

5-Posterior to the cervical spine: Thus creating extension moment. So no need for further activity of neck muscles.

6- At the junction of the cervico-dorsal vertebrae:   No moment.

7- Anterior to the body of the dorsal vertebrae: Thus creating flexion moment.

8- At the junction of the dorso lumbar vertebrae: No moment.

9- Posterior to the body of the lumbar vertebrae: Thus creating extension moment. Counterbalanced by anterior longitudinal ligament of the spine.

10-Through 5th lumbar vertebrae, and posterior to the junction of the lumbosacral joint: Thus creating extension moment. Counterbalanced by anterior longitudinal ligament of the spine.

11-Anterior to sacroiliac joint: Thus creating flexion moment (which tends to cause the superior portion of the sacrum to rotate interiorly and inferiorly and the inferior portion of the sacrum to rotate in the posterior direction). Counter balanced by sacrospinous and sacrotuberous ligaments.In addition to the sacroiliac ligament which counterbalance the anterior rotation of the upper sacrum.

12-Just behind (through greater trochanter) or via the axis of the hip joint (no moment): Thus may create extension moment which tends to rotate pelvis posteriorly on the femoral head. So counterbalanced by illiopsoas muscle activity and iliofemoral, pubofemoral and ischeofemoral ligaments.

13-Anterior to the axis of knee joint: Thus may create extension moment(stabilizing). Counterbalanced by passive tension in posterior joint capsule and associated ligaments to prevent hyperextension of knee joint. 

14- 5 cm (2 inches) in the front of the ankle joint at the level of the tarsal bones: Creates a dorsiflexion moment counterbalanced by calf muscles to prevent forward motion of tibia.).

Changes in Normal LOG Pathway

If a subject is carrying a mass or a pregnant woman so LOG moves further anteriorly and there will be a tendency to fall forward. Counterbalanced by activities of back extensors. If a subject climbs a hill the LOG falls backward, so the person will move forward to counterbalance this action. So he shifts the LOG forward and keeps it within the base of support. 

If a subjects descends a hill, the COG falls in front of him so he will move the trunk backward with increase in the lumbar lordotic curve to counteract the effect of gravity.In case of wearing high heeled shoes in normal standing position, the LOG moves forward more than usual and thus increase load on calf muscles.

Postural Evaluation

Hyperlordotic Posture:

Joints involved:Lumbar spine, pelvis, hip 

Possible cause:Tightened or shortened hip flexor muscles Weakened or elongated hip extensors or abdominals Poor postural sense

Adverse effects:↑ lumbar lordosis Anterior pelvic tilt Hips assuming a flexed position

Pathological conditions:↑ shear forces on lumbar vertebral bodies secondary to psoas tightness↑ compressive forces on facet joints Adaptive shortening of posterior lumbar spine ligaments and anterior hip ligaments Elongation of anterior lumbar spine ligaments and posterior hip ligaments Narrowing of lumber intervertebral foramen

Kypholordotic Posture:

Similar to hyperlordotic posture:↑ total lumbar lordosis

Differences: Compensatory ↑ in thoracic kyphosis: Attempt to maintain spine in position of equilibrium Cervical spine:  ↑ in lordosis (Forward head posture)

Joints involved: Pelvis, hip joint, lumbar spine, thoracic spine, cervical spine

Possible causes: Poor postural sense

Muscle imbalance: Tightened/shortened hip flexors Weakened or elongated hip extensors or trunk flexors

Adverse effects: Anterior pelvic tilt Hip joint flexion↑ lumbar lordosis↑ thoracic kyphosis

Pathological conditions: Adaptive shortening of anterior chest muscles Elongation of thoracic paraspinal muscles↑ compressive forces on anterior thoracic vertebrae and posterior lumbar vertebrae↑ tensile forces on ligamentous structures in posterior thoracic spine and anterior lumbar spine↑ facet joint compression Forward head posture Forward shoulder posture

Swayback Posture:

Key:  ↑ reliance on ligaments for postural stability Joints at end ROM (excessive stress on ligaments)

Joints involved:Knees, hips, lumbar spine, lower thoracic spine, cervical spine

Possible causes: Ectomorph body: hypomobility of joints Poor postural sense Tightened/shortened hip extensors Weakened or elongated hip flexors or lower abdominals↓ general muscular strength

Adverse Effects:Genu recurvatum Hip joint extension Posterior pelvic tilt Lumbar spine in neutral or minimal flexed position↑ in lower thoracic, thoracolumbar curvature

Pathological Conditions:Elongated or ↑ tensile forces on anterior hip ligaments and posterior aspect of lower thoracic spine Adapted/shortened or ↑ compressive forces on posterior hip ligaments and anterior lower thoracic spine↑ tensile force on posterior knee and compressive force on anterior knee↑ shearing forces on L5/S1 Forward head and shoulder posture

Flat Back Posture:

Key:  Lost normal “S” shape spine curvature in the sagital plane

Joints:Hip joint, lumbar spine, thoracic spine,cervical spine

Possible causes: Shortened/tightened hip extensors, abdominal musculature Weakened, elongated hip flexors Poor posture

Adverse effects: Extended hip joint / posterior pelvic tilt Extended thoracic spine Flexed middle and lower cervical spine,extended upper cervical spine

Pathological conditions: Compressive forces in posterior hip joint,anterior lumber and mid-low cervical spines, posterior thoracic and upper cervical spines Elongation of soft tissue Forward head posture (compensation for posterior spine displacement)

Scoliosis:

Lateral curvature of spinal column 

Functional:  spine attempts to compensate to maintain the head in a neutral position and keep eyes level Muscular imbalance, pelvic obliquity, limb-length discrepancy

Structural:  defect or congenital bony abnormality of vertebrae

Forward Shoulder Posture:

Key:  characterized by protraction and elevation of scapulae and a forward, rounded position of shoulders May include scapula winging and IR Forward head posture

Joints: Scapulothoracic articulation Glenohumeral joint Thoracic spine Cervical spine 

Possible causes:Tightened, shortened pectoral muscles Weakened or elongated scapular retractors (mid and low trapezius, rhomboids)Poor postural awareness and/or muscle fatigue

Adverse effects:Humeral head stress (displaced anteriorly)Forward head posture

Pathological conditions: Thoracic outlet syndrome:Adaptive shortening of pectoralis minor, anterior/middle scalenes → compression of subclavian artery, vein, and medial cord of brachial plexus Abnormal scapulohumeral rhythm and scapular stability Acromioclavicular degeneration Bicipital tendonitis Impingement syndrome Abnormal GH biomechanics

Scapula Winging:

Weakness of serratus anterior, middle and lower trapezius Long thoracic nerve; and < pectorilis minor/major short/tight

Biomechanics of normal arm movement thrown off

Forward Head Posture:

Key:  anterior displacement of head relative to thorax

Joints:Cervical spine, GH, thoracic spine

Possible causes:Poor eyesight (need glasses)Muscle fatigue/weakness Poor postural sense

Adverse effects:Flexion of lower cervical spine Flattening of mid cervical spine GH motion affected 

Pathological conditions: Shortened suboccipital muscles, scalenes, upper trapezius, levator scapula Hypomobile upper cervical region Abnormal GH biomechanics TMJ dysfunction Thoracic outlet syndrome (scalene involvement)Forward shoulder posture Myofascial pain(posterior cervical muscles)

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