Postures, Appearance, and Muscle Imbalance

Chapter 14

Introduction

• Important objective for fitness/wellness

• Physical attractiveness

• Strength and flexibility fitness goals should take into consideration postures

• We assume many postures each day and they are connected

Good Postures: Strength and Flexibility

• Mechanically efficient body positions and movement patterns

• Balance between strength and flexibility

• Major principle of postures training is to strengthen the extensors (antigravity muscles)

Assessment of Postures

• Examination of muscle balance or alignment of body parts

• Persons with paralysis and spasticity are at higher risk of severe alignment problems

• Imbalances can be minimized by strapping, bracing, casting, and surgery

• Proper positioning is essential

Spinal Column Curves

• Mature development of the spinal column by age 7 or 8 includes the following curves– Concave - cervical spine– Convex - thoracic spine– Concave - lumbar spine– Convex - sacral spine

Analysis of Muscle Imbalance

• Muscles on which surface are too tight? – Which stretching exercises are indicated?

• Muscles on which surface are too loose? – Which strengthening exercises are indicated?

• What role is gravity playing in the muscle imbalance?

Normal Postural Development

• Cervical spine - 4 to 5 months of age• Lumber spine - after the child learns to walk• Flat back - normal in children until age 3 or 4• Lordosis - normal in young children and lessens

by adolescence• Winged scapulae a prominence or protrusion of

the scapulae is normal until adolescence

Posture Training Guidelines

• Develop short-term objectives

• Use game-like activities that focus on particular muscle groups

• Use kinesthetic, vestibular, and visual sense modalities

• Emphasize full extension activities

• Use relaxation

Contraindicated Exercises

• Straight leg lift and hold

• Straight leg sit-ups

• Push-ups

• Swan

• Deep knee bends and duck walk

• Straight leg toe touch and bear walk

Behavior Management and Postures

• Suitable for some posture problems

• Utilizes auditory and vibrotactile feedback when user slouches or moves out of alignment

• Utilizes auditory reinforcement when user maintains the appropriate posture

Forward Head and Neck

• Diagnosed when the earlobe is no longer in alignment with the tip of the shoulder– Mild - head droops forward– Severe - round back, hyperextended cervical

spine, increased dorsal convexity of thoracic spine

– Dowager’s hump - develops to the point of having a prominent seventh cervical vertebra and excess adipose tissue

Exercises That Help

• Strengthening of extensors if mild

• Stretching cervical extensors if severe– Chin-to-shoulder touch stretch– Lateral flex stretch with ear touch– Halo push– Object-on-head walk

Contraindicated Exercises

• Circling the head

• Neck hyperextension

• Activities related to atlantoaxial instability when working with individuals with Down syndrome

Excessive Head Tilt

• Top of head tilting toward the right - right tilt (RT)

• Top of head tilting toward the left - left tilt (LT)• May be symptomatic of vision or hearing

impairments• Can cause adaptive shortening and tightening of

the neck muscles on the side of the tilt– Lateral flexion exercises opposite of tilt

– Slow, static stretch and hold is effective

Kyphosis

• Increasing backward convexity in the thoracic region

• Associated with disease of the intervertebral disks or of the epiphyseal area of the vertebrae

• Scheuermann’s disease affects adolescents• Osteoporosis - affects older people,

especially women

Lordosis

• Exaggeration of the normal posterior concave curve in the lumber region

• Throws the pelvis out of correct alignment

• Various causes

• Established characteristics

• Correction includes increasing proprioceptive awareness and increasing abdominal strength

Abdominal Weakness

• Various classifications

• Abdominal protrusion is typical in young children and those who lead sedentary lifestyles

• Often accompanies obesity and paralysis

• Daily abdominal exercises and full extension activities are recommended

Abdomen and Lower Back Exercises

• Adhere to exercise principles for abdomen and lower back

• Various exercises in the creeping position

• Various exercises in the supine or bent-knee sit-up position

Values of Abdominal Exercises

• Relieve congestion in the abdominal or pelvis cavities

• Relieve menstrual pain

• Strengthen muscles needed for coughing in asthma and respiratory diseases

• Strengthen muscles to improve appearance and function

Flat Back

• Decrease or absence of the normal anteroposterior curves

• Opposite condition from lordosis

• Associated with the debutante slouch

• Characteristic of body build of young toddlers

• Various exercises are beneficial

Scoliosis

• Lateral curvature of the spine

• Keynote positions– Adam’s position - relaxed forward bending held

for several seconds from a standing posture– Hanging with both arms from a horizontal bar– Symmetrical arm raise from a standing position

• Exercises prescribed by a physician

Scoliosis

• Lateral curves are named in terms of the direction of their convexity

• Left curve is most common

• Adhere to exercise principles for scoliosis

• More prevalent in girls

• Causes are idiopathic

• Treatments include bracing and surgery

Uneven Shoulder Height

• Higher shoulder recorded as LH (left high) or RH (right high)

• Assessment using a horizontal line on the wall

• Check lateral spinal curve

• Typically dominant side of body has slightly depressed shoulder and slightly higher hip

Uneven Hip Height

• Higher hip recorded as LH or RH

• Use anterior superior iliac spines as anatomical landmarks

• Can be caused by scoliosis, uneven leg length, or the habit of standing on one leg for long periods of time

Winged Scapulae

• Prominence of the inferior angles of the scapulae

• Serratus anterior is usually weak

• Typical in preschool and elementary children

• May be associated with round shoulders, congenital anomalies, and postural conditions in which the ribs protrude

Round Shoulders

• Forward deviation of the shoulder girdle that brings the acromion processes in front of the gravitational line

• Caused by the strength of the shoulder girdle abductors being greater than that of the adductors

• Incidence high among persons who work desk jobs

Round Shoulders

• Athletes often have overdevelopment of muscles that cause round shoulders

• Various compensations in alignment as a result

• Stretching and strengthening exercises stress shoulder girdle abductors and adductors

Deviations of the Chest

• Associated with asthma, other chronic upper respiratory disorders and rickets

• Limitations in chest flexibility and improper breathing practices

• Degree of severity varies

• Often associated with congenital anomalies

Hollow Chest

• Most common

• Depression of the anterior thorax accompanied by round shoulders and/or kyphosis

• Linked to the failure of the neck and pectoral muscles to exert their usual lifting effect on the ribs and sternum

Barrel Chest

• Occurs in persons with severe, chronic asthma who become permanently hyperventilated because of their inability to exhale properly

• Lateral widening of the thorax from side to side so that it no longer resembles a barrel occurs normally as a result of play

Funnel Chest

• Abnormal increase in the lateral diameter of the chest with a marked depression of the sternum and anterior thorax

• Usually a congenital anomaly• Appears in many persons with severe mental

retardation• Also caused by rickets or severe nasal obstruction• Associated with Turner and Noonan syndromes

Pigeon Chest

• Abnormal prominence of the sternum

• Rare, caused by rickets during the early growth period

• May also be congenital

• Associated with les autres conditions like osteogenesis imperfecta

Alignment of Lower Extremities

• Quick screening device -- Four Coins

• Individual differences in leg alignment and in locomotor patterns are largely dependent upon the hip joint

• Can be traced to a strength imbalance in the muscles that rotate the femur at the hip joint

Hip Joint Problems

• How the head fits into the acetabulum determines function and stability

• Affects leg alignment and gait

• Abnormal positioning of the femoral head– Coxa vara - decreased angulation– Coxa valga - increased angulation

• Corrected by casting, bracing, and surgery

Knee Joint Problems

• Congenital or acquired through injury

• Malalignment increases risk of osteoarthritis

• Long-term obesity can injure knee joint– Weight-bearing exercises are often

contraindicated for obese persons

Bowlegs (Genu Varum)

• Inward bowing of one or both legs

• Typical in children under age 2

• Blount’s disease or tibia vara– Outward bowing of the tibia caused by retarded

growth of the epiphyseal plates

• May complicate other disorders

• No exercises are recommended

Knock-Knees (Genu Valga)

• Bending outward of the lower leg so that the knees touch, but ankles do not

• Occurs in obese person and predisposes the knee joint to injury

• Developmentally normal in children under 7

• Stretching and strengthening exercises may be prescribed

Hyperextended Knees

• Knees are pulled backward beyond their normal position

• Contributes to lordosis• Caused by knee extensor weakness, tight calf

muscles, Achilles tendon contractures, and bony abnormalities

• Severe cases - prescription of a knee-ankle brace• Contraindicated activities

Tibial Torsion

• Tibia is twisted and the weight-bearing line is shifted to the medial aspect of the foot

• Often accompanies knock-knees, flat feet, and pronated feet

• Congential tibial torsion is corrected in infancy with casts, braces, splints, and/or surgery

Deviations of the Feet

• Poor alignment in any part of the body affects the weight-bearing function of the feet

• Obesity increases the stress on the joint

• Abnormal formation of the bones, weak, or paralyzed leg and foot muscles affect alignment

Toeing Inward

• Caused by strength imbalance in the hip joint muscles

• Associated with scissors gait in cerebral palsy

• Exercises include stretching inward rotators and strengthening outward rotators

Toeing Outward

• Occurs when the posterior group of muscles on the sacrum is stronger than the prime movers for inward rotation

• Common for toddlers, elderly, blind, and others unsure of footing to widen stance

• Exercises include stretching outward rotators and strengthening inward rotators

Supination and Pronation

• Typical walking patterns include slight supination

• Pronation is taking the weight of the body on the inner border of the foot

• Flat foot is a related disorder

• Corrective shoes and exercises prescribed by physicians

Flat Foot (Pes Planus)

• Congenital flat foot may not be considered a postural deviation

• Severity of combined flat foot and pronation disorders diagnosed using– Feiss line method– Helbing sign method

• Stretching and strengthening exercises may be prescribed

Pain Centers

1. Sole of the foot under the metatarsophalangeal joints

2. Sole of the foot close to the heel where the plantar ligaments attach to the calcaneus

3. Under the surface of the navicular4. Middorsum, where shoelaces tie5. Outer surface of the sole of the foot,

where most of the weight is borne

Syndactylism

• Extra toes, the absence of toes, or the webbing of toes

• Affects mechanical efficiency, especially the absence of the big toe

• Learn compensation

• Webbing is usually corrected surgically

• Extra toes may be removed

Hallus Valgus (Bunion)

• Marked deviation of the big toe toward the four lesser toes

• Bursa changes as a result of pressure

• Enlarged bursa is called a bunion

• Inflamed bursa - bursitis

• Deposit of calcium - exostosis