Exploring perfect posture

8/18/2019 Exploring perfect posture

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CHAPTER 4

Exploring

Perfect Posture

For pain management specialists, developing a

basic understanding

of

how distorted postural pat

terns lead to chronic head, neck and back pain is

essential. The logical first step is to first attempt to

define this complex thing called perfect posture .

Simply put, perfect posture is a condition where:

•

Body

mass is evenly distributed and balance

is evenly maintained

during

standing and

locomotion, or

•

Body

mass is evenly dispersed in relation to

gravity over a given base

of

support.

For posture to be truly functional , it is vital

that this base

of

support include all structures

from the feet- to the base of the skull.

Proper

alignment

of

the lower extremities, pelvis, and

aanial

base are particularly significant.

Each of us is affected by the mysterious and

potentially stressful force

of

gravity.

Our

bodies

Jre eloquently designed to react to any shift in

~ n t r

of

gravity through sophisticated somatic

mechanisms.

When

the normal function

of

any

part

of

the somatic system becomes overstressed,

J vicious cycle ofpain and dysfunction begins

Fig. 1).

Our job as pain management therapists is

to maintain the normal mobility of all components

)f the somatic system and to correct postural im

alances to minimize gravitational stra in.

If

, for a moment, we assume that

posture

is the

result of the dynamic interaction of two groups

)f

forces acting on the

human

body the envi

nmental force of gravity on one hand. .. and the

_ rength of the individual on the other, then pos

·ure could be considered as the ideal expression

f balance between these two groups

of

forces.

Therefore, any deterioration

of

posture indicates

:hat the individual is losing ground in his contest

\ ith this unrelenting force called gravity.

Proprioceptive Influence

o

Body Homeostasis

Postural homeostatic lessons are learned by

the central nervous system early in life. Visual

and proprioceptive input continually supplies the

individual with much needed information as h/she

grows and develops. The presence of optimal

posture suggests that there is a perfect distribution

of body mass around the center of gravity. Posture

is both static (structural) and dynamic (func

tional). It is static in its alignment of body mass

with respect to gravity.

t

is dynamic because this

alignment constantly adjusts to the individual's

changing postural demands.

101

Injury

'

Repetitive

Strain

Inflammation

'

f.

Muscle ~ ~ Muscle

Spasm w k

~ ~ ~ / ness

Joint

Stiffness

Fig. 1

Vicious Cycle of Pain and Dysfunction

When

the

normal function

of any part of the

somatic system becomes over-stressed, a vicious

cycle

of

pain and

dysfunction

ensues leading

to

decompensation .


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3/8

103 Exploring Perfect stu re

+

Leg

-

Short

Left

Leg

Type

1 Pelvis

Cranial

Side

Shift R)

Type

I Pelvis

Fig.

3.

Compensation

is

the Counter-Balancing

of any Defect of

Structure

or Function.

Notice in th Type I Pelvis how th cranium has successfully compensated for the short

l ft

leg and sacral base unleveling. Decompensation due to a combination

of

leg length and cranial

imbalances forms the Type IA Pelvis.

Gravity and Tensegrity

Through a dynamic antigravity tensegrity

. - tern, tensional and compressional forces are

enly dispersed throughout the entire organism.

he pelvic tensegrity system is an example

of

an

)quently designed myofascial web designed to

m s m i t forces from above

and

below to

spring

e body into motion. he body s bony framework

-upported and moved by an intricate myofascial

~ m e n t o u s system that houses these powerful

nsegrity forces. When

working

properly, this

tigravity network

maintains

spinal curvature,

·compresses and hydrates intravertebral discs

during locomotion,

and

nourishes facet joint

cartilages by sucking in lubricating synovial

fluids Fig. 5).

Some humans seem to be genetically blessed

with optimal posture, where muscles are not

actively working as restraining tissues, liga

mentous tension is perfectly balanced against

compressive and tensegrity forces and normal

everyday activities such as standing and walking

require minimal energy expenditure.

Ideally, during the act

of

standing, postural

muscles are in a state of normal tonus and not


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104

Exp

lo

rin

g Perfect Posture

feedback from sensory receptors located

raniocervical Junction

in

joint

capsules, fasciae, and interverte

bral discs. Structural asymmetries increase

sensory information to the CNS which is

then interpreted and reflected in predictable

asymmetrical postural patterns such

ervlcothoracic

Junction

as Janda's upper crossed syndrome Fig .

6

.

Fi

g

4

Transitional Zones

These critical cross-over

junctions

are areas where

anatomical

structural

changes create the

greatest

potential

for

neuromyoskeletal dysfunction.

actively contracting. In reality, however, most

people have less-than-perfect postural balance

the result

of

life's micro- and macro-traumas. As

a result, active muscular contraction is required to

redistribute body mass and effectively hold it in

place- muscles are now working against grav

ity, performing the job

of

ligaments by stabilizing

joints.

An

enormous amount of information can be

gleaned by visually assessing for these postural

irregularities. Observation

of

posture provides the

clinician with the first clues to the client's overall

physical , emotional and psychological condition.

Because locomotion requires the controlled

loss and regaining

of

balance, movement of any

body part with respect to the rest of the body

shifts its centerline

of

gravity, causing an in

evitable change in overall balance. Muscle and

ligamentous tension is maintained by negative

The Advanced Myoskeletal

Techniques

First Line o Defense . . the

Dirty Dozen, introduces practical thera

peutic interventions for correcting Janda's

posturally-initiated pain patterns. The

Third Line of Defense .. Receptor Tech

niques, explores posture from a sensory

reflex approach and seeks to restore proper

neurological functioning to the cervical joint

soft tissues- particularly those in the upper

cervical complex 0/A, A/A and C2-C3

Fig.

7

.

Breaking the Homeostatic

Threshold

I t is important to note that shoulder girdle

postural muscles such as the pectorals , leva-

tor scapula and upper trapezius are structurally

designed to resist fatigue and function normally

n

the presence of prolonged gravitational exposure.

So why do we see so many clients presenting with

distorted postures and chronic pain syndromes?

The answer is easy: overuse, underuse, and plain

ole' abuse. These three culprits perpetuate muscle

imbalances that reduce the body's capacity to re

sist stress, disrupting life's normal give and take.

When

a person's homeostatic threshold has

been violated,

postural

muscles (tonics) tighten

and shorten while their phasic antagonists are

overstretched and weakened. Asymmetric pat

terns

de

velop, and soon the antigravity function

of

the body's myofascial system sends

an

alarm to

deeper intrinsic structures (spinal ligaments, joint

capsules, and intervertebral discs) to brace against

overbearing compressional loads.


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Fig. 5

Facet

joints articular

cartilage

and

capsules.

:>uring locomotion, the myofascial systems

anti-

gravity

springing mechanism decompresses and hy-

drates

intravertebral

discs and nourishes facet

joint

cartilages by sucking in lubricating fluids .

.\eland's Video Atlas

of

Human Anatomy,

_1ppincott Williams nd Wilkins

2002

=leprinted with permission.

The Battle Between

Intrinsics and Extrinsics

Deep intrinsic postural muscles contain more

low-twitch fibers

and

like to

burn

oxygen for

··uel

(oxidative metabolism). These tonic muscles

ave a higher capillary density than extrinsics

md are better designed to withstand sustained

ompressional loading during normal activities

uch as standing and walking. Since tonic (pos-

: ural) muscles have more high-density slow-twitch

~ h e r s they react to functional disturbances by

hortening and tightening. Joint dysfunction can

1eurologically invade the muscle spindles' gamma

y tern and neurologically weaken intrinsic para

ertebral muscles.

When the body's joint cartilages, capsules and

gaments are exposed to prolonged asymmetrical

)mpressive forces, surrounding intrinsic muscles

i re

the first to feel the effects of increased

..lbnormal stimuli. As the deep muscles become

pasmodic, their fascial bags react by forming

mtractures. This leads to a loss of oxygen fuel

ausing muscle fatigue and eventual collapse of

he body's innate antigravity system.

Exploring Perfect Posture 105

The compressive load must then shift to the

extrinsic phasic muscles. Typically, the phasic

shoulder girdle muscles that react first are the

rhomboids, lower trapezius, posterior

rotator

cuff, serratus anterior, and triceps brachii. Since

these tissues contain a greater number of fast

twitch fibers, they are dynamic ..emitting bursts

of energy. But their reliance on glucose (glyco

lytic metabolism) for fuel causes them to fatigue

easily. As the supply of glucose diminishes, the

extrinsics give-out and reluctantly shift the load

back to the already overworked and exhausted

intrinsics. Many of the aberrant postural patterns

that

enter

our offices

belong to

bodies that

are

screaming out for help; either because they are in

an intrinsic or extrinsic stage

of

collapse.

Inhibited

Neck

Flexors

Tight

Pectorals

Tight

Upper

Trapezius

Levator

Scapulae

Inhibited

Rhomboids

&

Serratus

Anterior

Fig. 6

Upper Crossed Syndrome

Structural asymmetries increase sensory infor-

mation

to

the

NS

which is

then interpreted

and

reflected in predictable asymmetrical postural

patterns

as illustrated in Janda's

upper

crossed

syndrome


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106

Exploring Perfect Posture

Athletics and posture

As mentioned earlier, the issues of faulty pos

ture are often magnified n athletic clients. Imbal

ances such as short-leg syndromes resulting from

a tilted pelvis can dramatically reduce speed,

strength, coordination and endurance

(Fig. 8).

Moreover, an athlete s joints are often subjected to

abnormal mechanical stresses. Alterations n joint

function caused by capsular restriction or loss of

joint play either inhibit or facilitate muscles that

cross the misaligned joint.

When treating muscle imbalances n athletes,

the primary goal s restoration of length, strength,

and control of muscle function. Many of today s

exercise programs address length and strength,

but few deal with the issues

of

motor control.

Fig. 8

Short

Leg

Syndrome.

Imbalances such as

short-leg

syndromes

resulting

from

a

tilted

pelvis can

dramati

cally reduce speed,

strength

coordina-

tion

and endurance

in

amateur

and

pro

fessional athletes.

Fig. 7

Upper Cervical

Complex ..

0-A

A-A

and

C2-3.

Receptor Techniques seek

to restore function to

the

vitally

important

myoskeletal tissues

of the

upper cervical complex.

Acland s Video Atlas

of

Human Anatomy,

Lippincott Williams

nd

Wilkins 2002

Reprinted with permission.

Any successful exercise program must focus on

restoring proper central nervous system control.

The sequencing of muscular firing order

s of

particular concern to today s sports therapist. The

following has proven to be an excellent program

for restoring muscle balance, reducing nocicep

tion and improving proprioception in competing

athletes and the general population as well :

• Correct ing firing order patterns n hip

hyperextension, hip abduction and shoulder

abduction;

• Lengthening short, hypertonic muscles and

their enveloping fascia;

• Strengthening weak, inhibited muscles

through specific hands-on spindle

techniques and retraining exercises;

• Proprioceptive motor balance routines

(mini trampolines, yoga, etc.);

• Home

or

gym strengthening routines; and

• Aerobic exercises.


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Electromyographic studies have demonstrated

again and again how alterations in the sequence

of

muscle activation (firing order patterns)

adversely affect speed

and

coordination in

competing athletes.

Note: Clinically, it

has

been

found that in

some

athletes, inhibi

tion of

dynamic

extrinsic muscles

-

commonly due

to

joint

dysfunction

may be so great, that attempting

to strengthen the inhibited muscles

through resistance training

may only

_ erve

to

further

intensify the inhibi

tion.

This

is a vital piece

of

informa

tion for the

sports

therapist.

The

bottom line is to first create myofas

_

ial balance and restore

joint

play

fore

recommending

strengthening

;:xerc1ses.

In the Myoskeletal Approach,

the treatment sequence appears

follows:

• Lengthening tight agonist

muscles using

deep

tissue, myofascial mobili

zation, and receptor work

until full restoration

of

the muscle s normal rest ing

length is achieved;

• Improve strength and

endurance

through

reciprocal innervation of

the previously inhibited with

assisted stretching techniques;

• Create tone in weak, neurologically

inhibited tissues with fast-paced

spindle-stimulating maneuvers, and

•

Correct aberrant

firing order patterns.

Once muscle balance, posture, and pain-free

\ement are established ..

he

client can resume

Ttance

retraining and aerobic exercises.

Exploring Perfect Posture 107

Firing Order

Hip Hyperextension

As discussed in

Myoskeletal Alignment

Techniques Volume

I

muscle dysfunction is not

only

due to

facilitation and inhibition

but

also

to

the sequential

manner

in which muscles fire.

In the lower quadrant,

the

optimal firing order

in prone hip extension should be:

• Hamstrings;

• Gluteus maximus;

• Contralateral lumbar erectors,

and

• Ipsilateral

lumbar

erectors.

The

most common alteration

of

this op

timum pattern occurs when a weak gluteus

maxi mus fires late causing substitution by the

hamstrings and

lumbar

erectors.

This

particu

lar dysfunctional firing order pattern is

com

monly identified in

runners

who

suffer

recur

ring

hamstring pulls. In this condition,

the weak

gluteus maximus is not helping the hamstrings

enough during the push

-off

phase during hip

hyperextension.

Fig. 9

Trunk Stabilizers

Through its

intim te

connection with the

thor co-

lumb r fascia, lumb r multifidus, and supraspinous

ligament, the tr nsversus abdominis stabilizes the

trunk and spinal column to allow fluid momentum

from upper

to lower body

and vice-versa.

LifeArt,

Lippincott Williams Wilkins

2005.

Reprinted

with

Permission.

Hip bduction

When

performed in a side-lying position, hip

abduction should produce

the

following firing

order

pattern:

• Gluteus medius;

• Tensor fascia lata;

• Jpsilateral quadratus lumborum, and

• Erector spinae.


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1 8 Exploring Perfect Posture

The

most

common

substitution

pattern

occurs when a weak gluteus medius fires late with

early firing by the tensor fascia lata (TFL) or qua

dratus lumborum (QL). Early firing of the TFL

results in internal rotation and flexion of the hip

during hip abduction. The most destructive and

most common aberrant hip-abduction pattern

occurs when the QL fires first. A unilaterally

short QL flattens lumbar lordosis

on

the ipsilater

al side creating pelvic obliquity and lumbosacral

pain.

Shoulder

bduction

The optimal firing order sequence for shoulder

abduction while seated follows:

• Supraspinatus;

• Deltoid;

• Infraspinatus;

• Mid and lower trapezius, and

• Contralateral quadratus lumborum.

The most common substitution pattern

exists when levator scapula and upper trapezius

fire first initiating shoulder abduction. A note

of

interest concerning firing order patterns: In all

throwing and kicking motions

of

the upper and

lower body, the transversus abdominis should

be the first muscle to fire. Through its intimate

connection with the thoracolumbar fascia, lumbar

multifidus, and supraspinous ligament, the trans

versus stabilizes the

trunk

and spinal column to

allow fluid momentum from upper to lower body

and vice-versa

Fig. 9).

Assessing and correcting aberrant firing order

patterns should be performed before an exercise

program is undertaken. Initiating a resistance

training

program

in the

presence

of

abnormal

muscle recruitment will perpetuate tightness,

shortening and hypertonicity in tonic muscles

while encouraging progressive inhibition

of

the

phasics.

Postural Energy Drains

Because muscle contraction requires energy,

postural imbalances drain energy in proportion

to the magnitude

of

the imbalance. This

s

lost

energy, energy unavailable for its original pur

poses. Energy drains have a dramatic effect on

the limbic system - the highest cortical level

regulating muscle tone. As whole-body tension

builds, therapists begin to see energy-draining

symptoms reflected in conditions such as fibromy

algia, chronic fatigue syndrome and digestive or

hormonal disorders. It has long been known that

psychological factors play a large

part

in creating

distorted postures through selective tightening

of

specific muscle groups. The word uptight

s

an

expression commonly used to denote that feeling

of tightness, stiffness and fatigue.

Bottom line Poor posture

s

always perpetuated

as tight muscles become tighter - weak muscles

become weaker - and CNS motor control be-

comes more disrupted

. This commonly

seen

postural sequence is the foundation for agonizing.

self-perpetuating pain/spasm/pain cycles.

Conclusion

No

approach to pain management is truly suc

cessful unless body posture is properly addressed.

Overall improvement

of

posture may be time

consuming and is therefore frequently neglected,

as both therapist and client become satisfied with

immediate alleviation

of

symptoms. However, a

hands on

structural

balancing

approach of

fer s

more

satisfying Jong-lasting results while

positively

contributing

to the illusive goal of

attaining perfect posture

.

Exploring perfect posture

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