Causes of Postural Misalignment?
Have you ever observed a person using the same mannerisms or standing in the same pose as one of that person’s parents or grandparents? Have you noticed how family portraits often reveal not only similar facial features but also similarities in body size, shape and posture? Just as you inherit your skin, eye and hair colour, you inherit your body type. You inherit shapes and sizes of bones and muscles and your capacity for range of motion. It is likely that you inherit a propensity for a certain posture as well. However there are many other causes for postural malalignment—injury, for example. Here are examples of some things that may cause malalignment:
The forward-head posture may result from repeated craning of the head when viewing a computer screen or concentrating on a hobby such as needlework, model making or illustrating. Carrying a heavy backpack intensifies this posture
An increased kyphotic spine may be the result of maintaining a prolonged kyphotic posture, for example as the result of many hours spent on a computer. Or it may be the result of a vertebral fracture resulting in wedging of the thoracic vertebrae, as sometimes occurs with osteoporosis.
An anteriorly tilted pelvis may be the result of prolonged, repeated overuse of the ilio-psoas muscle, pulling the lumbar vertebrae anteriorly. Or it may be the consequence of hypermobility of joints in the lumbar spine. It is frequently observed in the late stages of pregnancy and in people with distended abdomens.
Rotation of the head may be due to maintaining a static head posture to one side, as when watching television. Or it may be due to repeated unilateral rotation, as when looking over the shoulder to reverse a vehicle. Or it may be due to avoidance of neck movement to one side for fear of pain. Or it may be associated with spasm of the cervical rotator muscles.
Protracted scapulae may result from overtraining the muscles responsible for protraction, as might be the case in boxing. Or the condition might result from habitual slumped posture as when sitting at a desk. Unilateral protraction could result from holding the bow in archery or might be observed in people whose job or hobby involves repeated flexion of the shoulder, a movement that requires scapular protraction.
The Genu Varum (Bowlegs) knee posture may be the consequence of bowing of the tibia (shinbone) due to mineral deficiency during growth. Or it may be due to osteoarthritis in the knee joint, causing distortion of joint surfaces. Or it could result from overstretching of the lateral collateral ligament due to injury. Or it may develop in response to excessive pronation at the foot and ankle.
Pes planus (Flatfoot) is a condition in which the longitudinal arch in the foot, which runs lengthwise along the sole of the foot, has not developed normally and is lowered or flattened out may be hereditary due to increased weight gain or laxity of ligaments of the foot.Improper work ergonomics and casual habits are other prominent causes for postural malalignment.
Five Steps to Posture Correction
The following five steps are offered as a means of correcting posture. Individual techniques / exercises are shown together with the body part to be treated.
Step 1: The first step is to identify contributing factors to this posture and eliminate or reduce those factors. Whether the posture has arisen for an obvious reason such as an injury or surgery or whether it developed gradually due to bad postural habits.
Step 2 is to increase the range of motion in hypomobile segments. Correcting the alignment of a joint involves both increasing range of motion in hypomobile joints and decreasing range of motion in hypermobile joints. Mobility of joints may be improved by lengthening shortened soft tissues specific to that joint. Stretching exercises are helpful in this regard.
Step 3 is to decrease movement in hypermobile segments. (Hypermobile joints are joints that move beyond the normal range with little effort) Decreasing movement in a hypermobile joint helps stabilize that joint. You might achieve this by shortening the tissues that are lengthened through the use of strengthening exercises. Taping and bracing may also be used to limit joint mobility.
Step 4: Once you decrease movement in hypermobile segments, maintaining normal joint position is step 4. One of the key techniques in maintaining a realigned joint is avoiding perpetuating factors, where possible. For example, if the joint in question is the knee, you should avoid sitting on the foot and ankle if it is a habit, because sitting on the foot in this way places uneven stress through the knee joint even though there is no weight bearing through the knee itself in this position.
Step 5 is to re-learn movement patterns. Joints that have been mal-aligned have a tendency to stay that way unless the neural mechanisms responsible for joint position and movement are re-educated to acknowledge the improved joint position.
COMMON FAULTY POSTURES
CHARACTERISTICS AND IMPAIRMENTS
The head, neck, thorax, lumbar spine, and pelvis are all interrelated; and malalignment in one region affect the other areas.
The Neck and Upper back Region (Cervical and Thoracic Region) :
Round Back (Increased Kyphosis) with Forward Head Posture
The round back with forward head posture is characterized by an increased thoracic curve, protracted scapulae (round shoulders), and forward (protracted) head. A forward head involves increased flexion of the lower cervical and the upper thoracic regions, increased extension of the upper cervical vertebra, and extension of the occiput on C1. There also may be temporomandibular joint dysfunction with retrusion of the mandible.
Forward Head Posture
In this posture the normal lordotic curve of the neck is lost and the cervical spine appears straight on x-ray. This posture is sometimes called "Scholar's Neck" or "Reading Neck." There is no definitive description for the forward head posture but, as the name suggests, it is one in which the head is observed to be forward (anterior) to the imaginary vertical line bisecting the body in the sagittal plane.
Forward head posture can lead to chronic pain, numbness in the arms and hands, improper breathing and even pinched nerves. This is because every inch your neck goes forward there is an extra 10 lbs. (4.5 kg) of weight on your neck. Many people do not realize that they have poor neck posture, so you will want to test your posture to see if prolonged computer use, television viewing or incorrect sleeping positions have affected how you hold your head. After you determine that your posture should be corrected, you will need to strengthen your neck muscles with exercises
Diagnosing Incorrect Posture
Stand with your back flush against a wall. Align your heels at shoulder width apart, your buttocks against the wall and your shoulder blades touching the wall.
Notice as you get into this stance whether the back of your head touches the wall or not. If it does not touch the wall, you have forward head posture, and it is likely that you suffer from weak neck muscles.
Five Steps to Postural Correction for Forward Head Posture:
Step 1: Identify any factors that may contribute to the maintenance of a forward head posture and avoid these where possible. Pay particular attention to head and neck posture when using a computer, watching television or driving. Carrying a heavy backpack increases this posture so better to avoid this.
Step 2: Stretch upper posterior neck tissues by resting with the head on a folded towel or a book. This is also a useful position in which to practice head retraction discussed in the next point.
Draw your head backwards without your chin lifting up. Keep your chin tucked in and down you may need to look into a mirror a first to do this. Draw it back as far as you can comfortably. You want to repeat this 10 times and hold for 3 seconds. Draw it back as far as you can, hold for 3 seconds and release.
Do 10 repetitions and turn your head about an inch each side 3 times.
Step 3: Strengthen global neck flexors. One way to do this is to practice isometric neck flexion
Step 4: Maintain optimal posture during work. Some of common work postures are shown under:
Correct the neck posture when sitting or standing. One way to visualize the strain a forward head posture places on the muscles on the back of the neck is to imagine that when is in the forward position, posterior neck muscles need to work like the reins of a horse to pull back the head over the torso. The further forward you hold your head, the more force is required to retain the position.
Step 5: Is to relearn the optimum neck position and practice the above mentioned exercises in routine. As you know that the neck is only one portion of the spine so to achieve an optimum neck posture it is essential to that other postures including the complete spinal posture, posture of the upper extremity and lower extremity are optimal. Specific details have been mentioned in the each of segments.
An abnormal, convex curvature of the spine, with a resultant bulge at the upper back. An overgrowth of fatty tissue in the cardiothoracic junction is often present, perhaps a response to this posture and the associated soft tissue imbalance. Kyphosis is a posture associated with aging and is frequently observed in elderly patients. There is a marked increase in the kyphotic angle after the fifth decade.
Step 1: Identify any factors that may contribute to the maintenance of a kyphotic posture and avoid these where possible. Not all of the contributing factors may be avoidable. For example, where there are degenerative changes to vertebrae. Pay particular attention to posture when watching TV, and avoid slouching. Avoid hunching over a steering wheel or desk. When using a laptop position this to avoid a slouched posture and wherever possible use a detachable keyboard. Follow the advice for the correct set up of electronic display screen equipment mentioned in a separate section.
Step 2: Actively stretch shortened muscles, in this case the pectorals. Contraction of the rhomboids is a simple method of stretching pectorals and has the advantage that it can be performed surreptitiously almost anywhere.
Where chest stretches prove to be uncomfortable, a client could rest supine with a bolster or pillow placed longitudinally along the length of the thorax allowing the arms to relax. As the scapulae relax into a neutral or retracted position, tissues of the anterior chest wall stretch. Clients with pronounced kyphosis may struggle to adopt this resting position and might even find it uncomfortable because it encourages both extension of the spine (from the normal or exaggerated kyphotic curve) and retraction of the scapulae. In such cases, simply resting supine in the floor will encourage correction of the spine, unless this is anatomically fixed.
Step 3 Strengthen the middle and lower fibres of the trapezius and the rhomboid muscles to help retract scapulae, using exercises such as the dart (see box) and prone rhomboid retraction. Aim to increase the duration the client can hold the position in each exercise pose. For prone rhomboid retraction, ask your client to rest face down and to abduct the arms to about 90 degrees. Next, ask him to gently lift the arms off the floor and supinate the forearm so that the thumbs are pointing upwards
Darts: Lie face down on your stomach and place your arms laterally.During this exercise, your palms may face upwards or downwards.
Use a foam roller to facilitate spinal extension Use extreme care because these rollers are made of firm Styrofoam; used in this manner, they place considerable pressure on individual vertebrae. This would be contraindicated for anyone with osteoporosis or a history of thoracic spinal pathology (such as joint subluxation or disc herniation). Clients with inflammatory conditions should use caution
Step 4: Practice sitting up straight when performing seated tasks. It is not surprising that many people slouch, increasing the curve of the thoracic spine, because upright sitting requires more effort as evidenced by an increase in activation of thoracic spinal extensors compared to other seated postures.
Step 5: As mentioned earlier that spine and other parts of body work together so for correction of thoracic posture it is essential that any issues pertaining to related areas are addressed so any cervical lordosis and internal rotation of the humerus must be checked.
Reeducation of the proper body posture may be done with help of yoga. Practicing Mountain pose may be helpful in this regard.
Posture correction at lumbar spine in 5 steps
There are generally two types of impairments in posture of the lumbar spine increased lordosis (hyperlordosis)and decreased lordosis (hypolordosis), popularly termed flatback.
Increased lordosis is generally combined with kyphosis at the thoracic spine as described above.
An increased lumbar lordosis (hyperlordosis) can be best observed viewing yourself from the side. In the hyperlordotic posture the normal lumbar curve is exaggerated, hollowing the low back, and the pelvis is anteriorly tilted
Improve your lumbar spine posture in 5 steps
Step 1: Identify any activities that may be contribute to the maintenance of an increased lumbar lordosis and avoid these where possible. Not all of the contributing factors may be avoidable (pregnancy, for example). By contrast, patients can choose to avoid overly relaxed standing postures where the pelvis tilts anteriorly and the abdomen protrudes, thus increasing the lumbar curve, and can avoid sleeping on their stomach, another position that encourages lumbar lordosis
It is not only inactivity that can contribute to this posture. Sports which rely on strength in the hip flexor muscles could aggravate this posture, as psoas major pulls the lumbar vertebrae anteriorly (as many believe), increasing the lordosis.
Step 2: Actively stretch the lumbar spine. These positions will contribute to a lengthening of lumbar extensor muscles and relaxation of thoracolumbar fascia.
Frequently adopt resting positions in which the lumbar lordosis is decreased (flattened). Such positions can be achieved lying, sitting or standing. For example, resting supine with the knees and hips flexed, flexing the trunk whilst seated and double knee to chest
The advantage of this position is that is focuses the stretch to the lumbar spine whilst the upper back and neck remain relaxed.
Step 3: Practice posterior pelvic tilting in both standing and supine positions. This exercise changes the position of the pelvis and requires activation of lengthened, weakened muscles that are associated with an increased lumbar lordosis. To achieve the position, you have to contract the abdominal and gluteal muscles simultaneously. It is a useful exercise for correction of the lumbar lordosis posture because, once you master it, or you can learn to correct the lordosis whilst sitting or standing.
Posterior pelvic tilt: Lie down on the floor with the hips and knees flexed and to place a hand beneath the back so that the palm is against the floor. Next, use your back and try to flatten the hand into the floor. To do this, you will need to perform a posterior pelvic tilt. You can try this in a seated position also, by placing a hand behind your back, between the back and the back rest of your chair, and press your hand against the back rest of the chair
Step 4 : Actively stretch psoas. Once you have mastered a posterior pelvic tilt, you can start to stretch psoas muscle in supine or kneeling
Step 5: Increased lumbar lordosis is generally associated with kyphosis in thoracic spine so this must also be addressed the techniques for kyphosis correction have been mentioned in the section above.
Along with this you may be told to wear a lumbar corset while performing certain activities particularly sports as this limits extension and is therefore beneficial as a temporary mechanism to prevent low back pain caused by hyperextension, the obvious disadvantage of using such a device purely to correct posture is that muscles associated with the lumbar spine will weaken