By Dr. Vic Weatherall
Posture is essentially the position of the body in space, the relationship of the body parts—head, trunk, and limbs—to each other. Changes in posture occur when any part of the body is moved.
Posture also communicates nonverbal body language, reflecting self-esteem and mental attitude.
Optimal or ideal posture is the state of muscular and skeletal balance that protects the supporting structures of the body against injury or progressive deformity, whether at work or rest. It involves the positioning of the joints to provide minimum stress on the body.
Conversely, faulty posture increases stress on the joints.
Increased stress can be compensated for by strong muscles, but if they are weak or the joints lack mobility or are too mobile, joint wear and modification can occur. Damage and changes to the surrounding tissues can also occur.
Posture involves the chain-link concept of body mechanics in which problems anywhere along the body chain can lead to problems above or below that point. Examples:
The effects of posture can be far reaching, involving respiratory, digestive, and circulatory systems as well as the musculoskeletal system. But how is poor or faulty posture developed?
The causes of faulty posture can be divided into two categories: positional and structural.
Structural causes are basically permanent anatomical deformities that may not amenable to correction by conservative treatments. However, some leg length inequalities and some ankle and foot issues can be corrected conservatively.
Positional causes of poor posture include
Posture control involves static and phasic reflex activities:
Both types of reflex are integrated at various levels in the central nervous system (CNS) from the spinal cord to the cerebral cortex and are largely effected through extrapyramidal motor pathways.
Postural reflex patterns from reflexes, such as the stretch and flexion (withdrawal) reflex pathways, result in a coordination of many joint movements and combinations of muscle actions:
The integrative pattern of posture is predominantly automatic and unconscious, resulting from the incessant shifting of weight (postural sway).
Postural corrections are continuously mediated by spinal reflexes. Posture is further mediated by the visual, labyrinthine, neck-righting reflexes, and by the interplay of joint reflexes.
While the control of posture is primarily controlled by various reflex mechanisms, there is also extensive input from the higher centers of the nervous system. Therefore, posture to some extent can be relearned (corrected) just as it was learned in the first place.
Postural faults must be accurately analyzed before they can be effectively corrected.
Examination should include the following:
The importance of muscle testing to postural analysis cannot be over-emphasized. Much of the specific therapy in posture correction relies directly on muscle tightness and weakness found during examination.
Five main modalities are employed in the conventional treatment of faulty body mechanics and hence postural faults: heat; massage; stretching; strengthening exercises; and supportive measures to treat ligaments, bones, and nerves.
Shortened agonist muscles must be stretched before the antagonist muscles can be optimally exercised to increase their strength, or vice versa. Depending on the condition, manipulation may also be required to release an accompanying fixation. Therefore, manipulation should be added to the list of posture correction therapies.
“Back schools” educate patients (students) in back health care and body mechanics in daily living, the workplace, and during perisurgical care. These schools use props and obstacles for activity evaluation purposes and to teach proper posture and body mechanics.
Custom foot orthotics are often used to correct structural postural faults that underlie many back lower limb problems. They help to correct issues such as overpronation and oversupination. They can also act as vehicles for heel lifts to correct leg length inequalities.
In extreme cases, such as developmental or chronic anatomical abnormalities, or stabilization following trauma or deteriorating conditions during development, orthotic devices are employed to correct and support posture. An orthosis is an external appliance worn to restrict or assist motion or to transfer the load from one area to another.
There are many types of orthoses and they will not be dealt with in detail here; however, scoliosis orthoses are of special interest to chiropractors. Children and adolescents with thoracic, thoracolumbar, or lumbar scoliosis or kyphoses may be fitted with an orthosis, such as the Milwaukee brace, to apply forces to realign the vertebral column and thoracic cage. Orthoses such as the Milwaukee brace provide stabilizing effects while being worn and most importantly they prevent the curve from increasing beyond its original contour.
It is interesting to note that some authors believe that the effectiveness of a brace, such as the Milwaukee brace, could depend on its ability to signal spinal curvature through increased discomfort at the pressure points, thereby creating a motivational effect for patients to correct their posture.
Applied biofeedback is a group of therapeutic procedures that use electronic or electromechanical instruments to accurately measure, process, and feed back to patients information, with reinforcing properties, about their normal and abnormal neuromuscular and anatomic activity. This information usually takes the form of analog or binary auditory or visual feedback signals, or both.
Biofeedback helps patients develop greater awareness and voluntary control over their physiological process that are otherwise outside awareness or under less voluntary control. The patient first achieves awareness and control using the measuring device to manipulate the external signal and then uses internal psychological cues to do the same.
Examples of postural defects treated using biofeedback include adolescent idiopathic scoliosis, torticolis, and rounding of the back or slouching (functional thoracic kyphosis) due to poor posture.