Posture
Good posture is important because it helps your body function at top speed, movement, efficiency and endurance. It also contributes to an overall feeling of well-being.
Good posture is also good prevention. If you have poor posture, your bones are not properly
aligned, and your muscles, joints, and ligaments take more strain than nature intended. Faulty
posture may cause you fatigue, muscular strain, and, in later stages injury. Many individuals with
chronic pain can trace their problems to years of faulty postural habits. In addition, especially in the elderly, poor posture can affect the position and function of your vital organs, particularly those in the abdominal and thoracic region. Good posture also contributes to good appearance; the person with good posture projects poise, confidence, and dignity.
Goals of Physical Therapy:
A long-term goal in Physical Therapy is to teach the patient how to manage and/or alleviate their current problem and how to prevent future episodes of injury from reoccurring.
Specific goals may be to increase strength, stability, flexibility, decrease pain, muscle tightness and ridiculer signs. Other functional goals are made based on the patient's specific sign and symptoms and complaints, whether there is an inability to sleep, sit/stand for an extended period of time, do ADLs, exercise or work without decrease function pain or discomfort.
Motivation:
If we as a clinic, can be mindful of our own posture, co-workers and patients, we possibly give tactful reminders to each other when appropriate, it may make us more mindful of posture in our day to day lives.
Anatomical Posture:
We can think of posture in relationship to joints, vertebral disc, cartilage, and other soft tissues. And how these things relate to our patients diagnosis.
When standing properly your center of gravity should be directly under your Pelvis. When we are leaning to much in any direction it moves our center of gravity in the same direction putting undue stress on us. Segmentally this is also true if one segment of our bodies is not in the proper alignment it will also put undue stress on that segment and others.
Plume Bob.
Correct posture is best described by using a plume line as a reference point.
From the lateral view, certain bony landmarks can be compared with reference lines to access proper alignment.
Slightly anterior to the lateral malleolus
Slightly anterior to the midline of the knee joint
Approximately through the greater trochanter
Midline of the trunk (through the bodies of the lumbar vertebrae).
Through the shoulder joint (middle of shoulder)
Through the bodies of the cervical vertebrae
Through the lobe of the ear
Abnormalities or asymmetry you may see:
Forward Head,
Rounded Shoulders
Protracted Shoulders
Rib hump, Scapular winging
Kyphosis
Straight Back
Lordosis
Leg(s) bent, straight or hyper-extended to much
Problems with:
Increase lordosis or concavity can
Shorten, lengthen, weaken, over over strengthen soft tissue.
Decrease active and passive range of motion needed for normal wear and lubrication of joints,
and ease of motion
Pinching Lumbar, Thoracic or Cervical disc bulge or herniation (most being posteriolateral), making it swell or impinge on nerve root.
Puts to much pressure on the facet joints
Problems with:
Increased rounded / convexity of spine posteriorly
Shorten, lengthen, weaken strengthen soft tissue to much.
Decrease active and passive range of motion needed for normal wear and lubrication of joints.
Also Kyphosis of the upper thoracic area.
exacerbate bulge, causing it to bulge more
Increasing or causing radicular signs
Problems with:
Rounded shoulders with protraction
Shorten, lengthen, weaken strengthen soft tissue to much.
Decrease active and passive range of motion needed for normal wear and lubrication of joints.
Significant decrease in glenohumeral motion
Soft tissue impingement with pain and tenderness
Adding to kyphosis, increases cervical concavity and those associated problems.
Problems with rib articulations
Facet joints
Bulging or herniated disc
Disc and/or joint degeneration
Plum Bob From the anterior view, all structures front and back should be symmetrical about the plum line.
ASIS
Pelvic Rim
Shoulders
Knees
From the Anterior or posterior view:
Asymmetrical knees, pelvis hip, spine, shoulder or head, anteriorly or posteriorly
Shorten, lengthen, weaken strengthen soft tissue to much.
Decrease active and passive range of motion needed for normal wear and lubrication of joints.
One shoulder to high, one arm to close to the body
Ideal situation:
A neutral spine without to much posterior, anterior pelvic tilt, excessive lordosis or flat back, Kyphosis, thoracic convexity or cervical concavity. With the ideal posture the joints and soft tissue will be in there more normal position with less stress. Promoting the normal curves of the spine will help all segments of the body. A ore neutral pelvis will help improve the Lumbar, thoracic and cervical regions. so when we focus on the other, seemingly non-related segments of a patients body it is also helpful.
*A more neutral cervical spine with a slight concavity or retracted posture.
*shoulders in the proper alignment with the persons head/ear and thorax.
*Normal thoracic convexity
*Neutral Pelvis, with neither to much anterior, posterior or lateral tilt.
*Normal Lumbar lordosis / concavity
*Normal symmetry of the knees Superior or posterior plane
*Normal ankle pronation, supination and arch (Pes Planus/flat foot).
Abnormalities or asymmetry you may see:
*Locked knees versus knees relaxed versus increased lordosis, forward shoulder and head
*Shoulders in a forward rounded and retracted posture versus bilateral scapula in an
adducted and protracted posture
*Forward Head verses a normal retracted head position
*Excessive anterior pelvic tilt (Flat Back) versus normal pelvic tilt
*Excessive posterior pelvic tilt (Lordosis) versus normal neutral pelvic tilt
*Feet pointed straight, to much inversion, eversion, pronation or supination versus
normal foot with slight eversion.
*Pelvis high on one side versus symmetrical pelvis
Side Notes:
*Vertebral Artery Syndrome.
When a patient has a impingement of there vertebral artery their blood flow can be included if their neck is extended and rotated. If this happens, and they pass out, you need to put there neck in the proper anatomical position to restore blood flow.
*Taking into consideration that normal posture may be different for different people. And that changing posture of a person without etiology may not, always be advisable.
