Posture and Body Mechanics

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Posture and Body Mechanics

• CHAPTER 11

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Posture

• Relative alignment of body segments
• Allows efficient and effective movement
• Small changes overtime reduce efficiency
• Static standing posture reference point
• Plumb line

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Assessing alignment

• Standing alignment
• Compare anterior, posterior, and lateral views
• Body bisected
• ASIS and PSIS connected with horizontal line

• Sitting alignment
• Hips and knees at 90/90
• Seat depth behind knees
• Chair back support lumbar and thoracic spines
• Lumbar roll enhancement
• Chair arms at 90
• Wrists in neutral if using keyboard
• Head not forward
• Shoulders not rounded

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Pathological alignment

• Developed from bad habits
• Best posture observed in small children
• Causes shortening and lengthening of paired
  structures
• Abnormal alignment measured relatively
• Misalignment causes compensation

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Lumbar lordosis

• Swayback
• Anterior pelvic tilt
• Tight hip flexors
• Weak LB extensors and abdominals
• Fascia tight
• Stress on anterior longitudinal ligament
• Narrowing of vertebral spaces
• Nerve compression

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Flat lumbar spine

• Posterior pelvic tilt
• Little lordosis
• Hip extensors and rectus abdominus tight
• Weak hip flexors and LB extensors
• Spine loses ability to absorb stress
• Stress on posterior longitudinal ligament

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Kyphosis

• Hunchback
• Chest muscles tight
• Erector spinae, rhomboids, and trapezius weak
• Scapulae will be more than 2 from spinous
  processes
• Can lead to TOC

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Flat thoracic spine

• Not common!
• Exaggerated attention posture
• Depressed scapulae
• Flat neck
• Tight erector spinae and scapular retractors
• Weak protractors and anterior thoracic muscles
• Can lead to TOC

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Scoliosis

• Lateral curvature of spine
• Leg length discrepancies
• Unlevel pelvic landmarks
• Longer lower medial arch
• Congenital deformities
• Long-term unilateral activities
• Tissue tight on side of concavity
• Also nerve impingement
• Tissue weak on convex side
• Also increased ligament stress
• Dont confuse with lateral shift

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Head forward posture

• Common compensation in the elderly
• Dowagers hump
• Can also lead to TMJ problems

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Faults in the extremities

• Coxa valga
• Coxa vara
• Anteversion
• Hip medial rotation
• Squinting patellae
• Decreased stability
• Retroversion
• Hip lateral rotation
• Frogs or grasshopper eye
• Increased stability

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Faults in the extremities

• Genu valgus/valgum
• Weak quads
• Excessive foot pronation
• Genu varus/varum
• High arches
• Genu recurvatum
• With lumbar lordosis and anterior pelvic tilt
• Tibial torsion
• Measured with patient in supine
• Bisect malleoli

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Faults in the extremities

• Medial longitudinal arch
• Height of navicular
• Peas planus
• Pes cavus
• Claw and hammer toes
• Shoulder rounding
• Dorsal hand plancement
• GH implingement
• Weak scapular rotators
• Tight anterior shoulder muscles

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Muscle imbalances

• Causes
• Bad posture and/or pain
• Loss of flexibility/shortening of muscles
• Sports
• That emphasize anterior muscles
• Unilateral activities
• Joint abnormalities
• Hypermobile vs. hypomobile
• Injuries

• Treatment
• Lengthen tight side
• Strengthen weak side
• Need conscious correction
• Related injuries
• ITB syndrome in runners
• Friction massage
• Strengthen glutes, quads
• Impingement in overhead
• Stretch anterior capsule
• Strengthen trapezius, infraspinatus, teres minor
• Improve scapular motion

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Body mechanics

• Positioning and use of the body during activity
• Spine straight pelvis in neutral
• Wiggly spine wont transfer forces
• Lower center of gravity
• Back straight when lowering the body
• Widen base of support
• Stand in direction of force application
  (front/back)
• Side-by-side stance for right/left force
• Abdominal strength necessary to transfer force
  between upper and lower extremities
• ADLs??
• Clinicians mechanics??

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Feldenkrais method

• Engage whole person to promote self-esteem and
  improve learning
• Uses developmental movements
• Begin simple and progress
• Allow relaxation during changes of position
• Uses imagery to focus attention
• Pain avoided

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Alexander technique

• Advocated unlearning incorrect habits
• Uses light touch, verbal cues, and self-awareness
• Emphasizes thought over action
• Stress free movement

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Pilates method

• Combination of yoga, Zen and ancient conditioning
• Art of control
• Integrated body awareness
• Coordinated movements
• All motions begin in the core