CHAPTER 1 POSTURE
Correct postural balance and strength are important for efficient movement in everyday life and for optimal performance in sporting situations and it all begins when we are babies. In the womb we develop in the foetal position and after birth we start strengthening the muscles that comprise the posterior chain. These are the muscles running from the head down the spine to the hips and down the back of the legs to the feet. Babies have great mobility and quickly start to develop the stability and strength they need to get to their feet and start walking. Motor patterns and movement are practised and perfected until they can stand, then walk and eventually run around with confidence and good posture. Toddlers have great squatting and dead-lifting technique too.
As children start attending school they find themselves sitting down for longer periods at a time, and this is when bad postural habits and muscle imbalances can start to develop. Kids need to move. Movement develops motor skills, maintains mobility and is vital to ensure healthy development of the whole body. As we get older the pressures of modern life make it harder to find opportunities to maintain optimal mobility and good posture. We spend more and more of our waking hours sitting down: on the way to work, on the train or in the car; at work for hours on end; on the way home again; and at home in the evening watching television. None of this is good for the posterior chain that developed so well in infancy. Then, to make things worse, because we sit around so much we develop a paunch, so we start doing sit-ups in a vain attempt to get six-pack abs. This only adds to the overdevelopment of the anterior chain and contributes to poor posture, among other problems.
Athletes and non-athletes develop posture and movement dysfunctions through daily habits and poorly designed training programmes. Poor posture can lead to neck, shoulder, back, hip or knee and ankle pain, and possibly injury. Adopting the correct posture during athletic movements will reduce the risk of injury by making sure that all joints and structures are in the right position to absorb and generate forces. Good posture can be encouraged and reinforced with an appropriate mobility and strength programme that addresses muscle imbalances and movement dysfunctions.
Healthy Posture
Posture can be influenced by many factors, from repetitive sporting actions and frequently held positions at work or rest, to acute or chronic injuries, emotional stress and even sleep positions. It is a very complex subject and one that cannot be extensively explored here. Proper analysis and treatment of postural and movement dysfunction, especially in the presence of pain, requires the skills of an appropriately qualified therapist. However, some of the more common and basic dysfunctions can be assessed with movement screens such as the Functional Movement Screen (FMS) devised by Gray Cook and helped with corrective exercise strategies. Below are some basic explanations of common postural dysfunctions, which will give an idea of how the body is linked throughout with many ways of integrating muscles for producing movement and providing support.
Healthy posture does not need to be perfect and the ideal posture should be used as a guide to assess where there may be areas that need attention. When the body is viewed from the side there should be alignment from the ear to the shoulder through the hip joint just behind the centre of the knee and down to the ankle. From the front the head should be held straight, the shoulders and hips should be level and, with the feet hip width apart, there should be good alignment from hip to knee and ankle. With a good posture the spine has three natural curves: a lordosis at the neck and lumbar spine and a kyphosis at the thoracic spine.
Looking at static posture can provide some information of possible dysfunction, but it is also vital to assess dynamic posture. This is where the Functional Movement Screen is used to assess how the joints and segments move and interact with each other in order to perform effective and efficient movement. At the bottom of the squat for instance the pelvis must be able to tilt anteriorly, to maintain a strong and stable spine position. If the pelvis tilts posteriorly the lumbar spine will round out and be subjected to damaging compressive and shear forces.
Common Postural Dysfunctions
Rounded Shoulders
Some of the most common postural dysfunctions start with the position of the head. When the head is held forward of the shoulders it results in extension at the neck and a rounding of the shoulders and thoracic spine. The sternocleidomastoid is a muscle attaching at the skull behind the ears, running down to the clavicle (collar bone) and sternum, which exerts a simultaneous upward and downward force when the head is held in the right position. The downward force tilts the head backwards and the upward force tilts the head forwards. When in the correct postural position the sternocleidomastoidās upward force pulls on fascial connections running all the way down the front of the torso to the pubis, which lifts the chest and helps with the correct pelvic position. When the head is carried forward of the shoulders the sternocleidomastoid cannot exert its upward pull so the chest drops and the abdominals slacken, allowing the pelvis to tilt forward.
Slouched shoulders can cause neurogenic tension in the lumbar spine, which can then make an anterior pelvic tilt worse. In addition, the muscles across the chest, particularly the pectoralis minor, tend to be over-active and the muscles of the upper back tend to be under-active. All this contributes to what Janda termed the āupper crossed syndromeā and is very commonly seen in todayās largely sedentary population.
Anterior Pelvic Tilt
Another common problem is at the pelvis, independent or in conjunction with a forward head carriage. Anterior pelvic tilt is when the front of the pelvis tilts forwards, resulting in an exaggerated lumbar lordosis. There can be a number of contributing factors in any postural dysfunction and it may be necessary to change daily habits or sports techniques as well a s addressing mobility, stability and muscle imbalances. Anterior pelvic tilt can result in a tight lower back and hip flexors or a tight lower back and hip flexors can contribute to an anterior tilt. Rather than trying to discover what came first, the best approach might be to address the most common contributing factors. Sitting down for long periods can lead to reduced activation in the glutes and over-activation in the hip flexors. Repetitive short-range hip flexion, as in running and cycling, can also lead to tight hip flexors, which can then caus...