1. Posture stability and Balance

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

3. Posture
Posture is the relative alignment of the various body segments with one another
Good posture – body alignment is balanced so that stress applied to the body segments is minimal
Poor posture – body alignment out of balance – causing exaggerated stress to various body segments
Overtime continued stress cause anatomical adaptations
These changes alter the individuals ability to perform

4. Correct Standing Alignment
Three planes - sagittal, frontal , transverse
Plumb line – point of reference
Anterior ( frontal)
Bisects body – left and right
Standing facing forwards, feet relaxed , arms handing by side
Plumb line bisects nose , mouth , sternum, umbilicus and pubic bones
Following should be level , earlobes, shoulders , finger tips, nipples, iliac crest, patella and medial malleoli
Patella should point forward , feet straight ahead or slight outward rotation
Body weight equally distributed

5. Correct Standing Alignment
Posterior
Similar to anterior view to anterior
Plumb line should bisect the head, follow the spinous process
So posteriorly the iliac crests , gluteal fold , posterior knee creases should appear level
Scapulae should lie about 2” from spinous process,
Calacneous should be straight
Shoulders relaxed , symmetrical trunk musculature
Body weight equally distributed

6. Correct Standing Alignment
Lateral
Plumb line anterior to lateral malleolus
Plumb line passes through the external auditory meatus, the earlobe , bodies of cervical vertebrae , centre of the shoulder , greater trochanter, midway between the back and the chest, posterior to the hip and slightly ant to the knee.
Knees are straight but not locked , body weight equally distributed between heel and forefoot
Chin slightly tucked
Mild curve inward in low back and neck regions

7. Pathological Alignment
Bad posture usually develops as we age
Toddlers have good posture , start to develop bad habit by the time we enter primary school
Good posture allows the individual to use body effectively and efficiently
Bad posture causes shortening and lengthening of structures , which may cause impairment , pain and injury
Posture recorded in terms of relativity
Mild
Moderate
severe

8. Pelvis and Lumbar Area
Excessive lumbar lordosis ( anterior pelvic tilt)
Excessive – sway back
Tight hip flexors , low back extensors
Weak abdominals and gluteals
Overtime causes narrowing of disc space , facial tightness , approximation of vertebral facets , increase stress on ant longitudinal ligament
Flat lumbar spine ( posterior pelvic tilt)
Abnormal hip extensor and Rectus abdominis tightness
Weak hip flexors and lumbar extensors
This posture reduces bodies ability to absorb impact forces and increase stress on post longitudinal ligament

9. Thoracic Area This area can be excessively rounded or excessively flat
Mild kyphosis is normal , but excessive rounding in response to a lumbar curve or cervical lordosis is pathological
Chest muscles tight , weak thoracic ES , rhomboids, traps
Often associated with rounded shoulders
Scapulae is more than normal 2” from spine
Flat back- reduction of thoracic curve – not as common
Depressed scapulae and flat neck
Tight ES , rhomboids and weak anterior thoracic muscles

10. Thoracic Area Scoliosis- lateral curve of spine
Either S shaped or C shaped
Usually includes rotation of the vertebrae
Can be congenital
Often caused by leg length differences , long term unilateral activities

11. Head and Cervical area Cervical lordosis-
weakness in lower cervical and upper thoracic erector spinae and anterior neck muscles is over powered by tightness in upper cervical muscles including Lev Scap , Sternocleidomastoid, scales and upper traps
Increases cervical disc pressure , irritates cervical facets , nerve pressure and increased stress on ligaments

12. Lower extremities Hip Knee Patella
Coxa valga- abnormally larger angle between femoral neck and femoral shaft
More likely hood of hip arthritis
Coxa vara – smaller than normal angle between femoral neck and femoral shaft
More likely hood of femoral fractures
Knee
Genu valgum- knock kneed
Genu varum – bow legged
Patella
Squinting – face towards each other
Frogs eye angle away from each other
Genu recurvatum – hyperextension

14. Lower extremities Foot
Medial longitudinal arch , draw a line from the distal aspect of med mal to the weight bearing surface of the 1st MT ,
in both non and weight bearing the navicular should be on the line
Pes cavus – high arch – hypomobile – more rigid reduced ability to absorb stress , more prone to stress fractures
Pes planus- low arch – hypermobile – difficult to create a solid platform – PF , Achilles issues
Hallux valgus –positioning laterally of the great toe

15. 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

16. Mechanical Imbalance
Results from abnormal relationships between forces that act on area
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
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

18. 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

19. 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

21. Treatment
Important to correct postural deviations and not only address current injury
Could be a source or a contributing factor
Must identify the tight structure and the over stretched structure
We must lengthen and strengthen
Example – swimmers rounder shoulder
Provide reminders – visual clues
Physical reminders – tape
Habit & relationship between tight and weak muscles