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Standing
Sitting
Standing with good intention
Typical seated posture
Sitting with good intention
Postural Support Syndromes
Upper Crossed Syndrome
Scapular Destabilization Syndrome
Lower Crossed Syndrome
Posture affects the Body and
the Brain
The spine and musculature are affected
Organs are affected
Mood is affected
Chronic pain syndrome (UCS) can result in
the absence of other positive clinical
findings
Faulty Posture
Muscles in slightly shortened positions tend
to be stronger
Muscles in slightly elongated positions
tend to be weaker than their opposers
If we can balance muscle groups there is
a sense that posture can self-correct
Patterns
Postural or tonic muscles shorten while phasic muscles weaken
Type 1 Postural fibers contract slowly
Burn O2 more efficiently than phasic muscles
Allows them to work slow and steady over time
Shorten in response to stress and overuse
Patterns Phasic or Type 2 fibers weaken and lengthen
under prolonged stress
Type 2a fast-twitch fibers Contract faster than type 1
Resist fatigue due to more mitochondria and myoglobin Walking and sprinting
Type 2b fast-twitch glycolytic depend more on blood sugar for energy (strength training, weight lifting)
Patterns
Tonic or Postural Muscles tighten and
shorten
Pectoralis Major and Minor
Upper trapezius
Levator Scapulae
Sternocleidomastoid
Patterns
Phasic muscles weaken
Lower and Middle Trapezius
Serratus Anterior
Rhomboid Major and Minor
Pain
Symptoms are the product of too much
strain and the physiological changes that
happen to soft tissues over time
Altered Posture
Occ, C1 and C2 hyper extend
Head translates anteriorly
Lower cervicals and upper thoracic are
now stressed
Altered Posture Scapula rotates and abducts
Due to the upper traps and levator scapula shortening and contracting
This inhibits the lower traps and serratus anterior
Scapula looses stability
Excess demand now put on humerus and the levator scapulae, upper trapezius and supraspinatus are called to maintain functional efficiency
Upper Crossed Posture Tight
Trapezius
Levator scapula
Pectoralis major and minor
Latissimus dorsi
Weak Rhomboids
Serratus anterior
Deep neck flexors
Motor control loss is a central issue here
Upper Crossed Posture
Eyes are looking forward
Excess Arch in the neck (tight sub
occipital)
Levator scapula sign (prominent)
Shoulders are rolled inward
Thumbs point toward hips rather than
forward
Upper Crossed Posture
As head migrates forward there is less
ability to rotate
For each inch forward it doubles in weight
and applies more force to the cervical
thoracic junction
This causes increased potential for
degenerative changes
Upper Crossed Posture
Headaches can appear due to upper
cervical involvement and can refer to the
frontal and temporal or vertex
There are correlations with
temporomandibular joint pain
TOS becomes more likely due to structural
tightening
Upper Crossed Posture
Shoulder impingement can become
more likely as space under the acromial
arch is decreased due to the forward tilt
of the scapula
Upper back and mid back pain increase
due to chronic tension and overwheming
tissue capacity
Scapular Instability
Downward rotation
Inferior border closer to the spine
May be depressed
Weak Serratus anterior
Musicians are at high risk
Scapular Instability
We want to stabilize the scapula not
move it
Wrap
Decrease Upward rotation, posterior tilt,
depression
Lower crossed Posture
Tonic or Postural muscles
Iliopsoas, Rectus Femoris, Tensor fascia Latae and Erector Spinae
All tighten and shorten
Phasic muscles
Abdominal, Gluteal and Quadratus Lumborum
Weaken
Lower Crossed Posture
Pelvis is tilted forward
Flexing hip and exaggerating lumbar
lordosis
L5-S1
Soft-tissue and joint distress
Pain and irritation
Lower Crossed Posture
In the sagittal plane
Quadratus Lumborum
Shortens
Glute Maximus and Medius
Weaken
Lower Crossed Posture
Unstable lower cross leads to
SI joint becomes unstable
Piriformis syndrome
Other Factors
Congenital
Misuse
Immobilization
Inappropriate breathing
Chronic negative emotional
Reflexive influences such as Trigger points
and facilitated segments
Other Factors
Laxity of ligaments
Fascial tightness
Muscle tonus
Pelvic angle
Joint position and mobility
Neurologic outflow and inflow
Tissue distorters
Tight and spasmed muscles
Inflammation
Scars
Proprioceptive loss
Ligament laxity
Loss of coordination
Muscle inhibition
Poor locomotor recruitment
Ideal tissue shape and
tone are restored by
removing distorters from
the body
Considerations beyond
asymmetries or contracture
The Autonomic Nervous System (ANS)
Soft tissue has sympathetic innervations not parasympathetic
These regulate neuromuscular and cardiovascular
Sympathetic produces more waste and consumes more O2
Stress tightens soft tissue and causes General Adaptive Response (Selye 1984)
Postural dysfunction results
Habituation Adaptive demands on the musculoskeletal system
are exceeded
The capacity to absorb the load is overwhelmed
Elastic limits are exceeded resulting in structural ad functional modifications
Repeated postural and traumatic insults over a lifetime
Somatic effect of emotional and psychological origin
Confusing pattern of tense, short, fatigued then fibrous tissue.
Sensory awareness and
movement modalities
It is a memory loss of how certain muscle
groups feel and how to control them”
Thomas Hanna
Sensory motor-amnesia
Red light reflex
Green light reflex
Trauma reflex
Sensory awareness and
movement modalities
“On acting on the significant parts of the
body such as the eyes, the neck, the
breath, or the pelvis, it is easy to effect
striking changes of mood on the spot”
Moshe Feldenkrais
Sensory awareness and
movement modalities
“There is no such thing as the right
position, but there is such a thing as the
right direction”
“You come to learn to inhibit and direct
your activity” F.M. Alexander
The Cure
Vitalism
The historical concept of vitalism proposes the idea that our spirit animates and operates the body…
If our mood is depressed we may slump…If we slump we may have a depressed mood
Postural Spirit Put your Spirit up front rather than the ego
If ego is up front in posture it can drive it down
In our mind we have a body image of ourselves that is internal in orientation but we can get a sense of it when we look in the mirror. We are seeing our body image but it is better to look as if seeing someone behind the mirror. That is look for your image.” We need to rebuild where the wound is in the body image. Hubert Goodard
Gravity
There can be a change in hormone
production due to the way that you hold
your body against gravity
“Balance reveals the flow of gravitational
energy through the body” Rolf
Gravity
It is when the gravity-combating active
subsystem of the huan organism becomes
deficient or defective in some way that
stress begins to be put on the joints and
passive subsystems of the body. Most
commonly, this takes the form of an upper
or a lower crossed syndrome. Leon
Chaitow
Natural posture
Learning to push away from our support
pillars while sitting or standing
Helps us feel more open and connected
with our world
Often we can let Nature determine our
posture rather than dictate our posture to
nature
Pillars of structural support
Feet
Feel the contact points with the ground and push away
Use a wall to measure HFP (head forward posture)
Sitz bones
Feel the contact on the ischium and push away
If you arch your lower back a little it is harder to slump
If uncorrected FHP will
continue to decline
It is very common to observe 2 inches of anterior head placement in my patients.
Our heads weigh about 12 pounds. Would you be surprised that your neck, upper back or shoulders hurt if your neck had to hold up a 20-30 pound pumpkin all day ?
Uncorrected, forward head posture will get worse and continue to decline.
One study showed that the further a
persons head is away from the wall the
earlier they would die from any cause
death
In a nut shell this is a good reason to be
looking for FHP in our patients
For every inch your head moves forwards, it gains 10 pounds in weight, as far as the muscles in your upper back and neck are concerned, because they have to work that much harder to keep the head (chin) from dropping onto your chest. This also forces the suboccipital muscles (they raise the chin) to remain in constant contraction, putting pressure on the 3 Suboccipital nerves. This nerve compression may cause headaches at the base of the skull. Pressure on the suboccipital nerves can also mimic sinus (frontal) headaches. Kapandji (physiology of the Joints, Vol III).
People with Asthma have
decreased lung capacity
“Head in forward posture can add up to thirty pounds of abnormal leverage on the cervical spine. This can pull the entire spine out of alignment. Forward head posture (FHP) may result in the loss of 30% of vital lung capacity. These breath-related effects are primarily due to the loss of the cervical lordosis, which blocks the action of the hyoid muscles, especially the inferior hyoid responsible for helping lift the first rib during inhalation.” Rene Cailliet M.D.,
Persistent forward head posture also known as a hyperkyphotic posture puts compressive loads upon the upper thoracic vertebra, and is also associated with the development of Upper Thoracic Hump, which can evolve into Dowager Hump when the vertebra develop compression fractures (anterior wedging). A recent study found this hyperkyphotic posture was associated with a 1.44 rated of increased mortality.
Parkinsons patients
benefit neurologically
from physical medicine,
posture control and
rehab therapy
Implications for the spinal joints
Phase 1 – Initial sprain.
Phase 2 – Beginnings of fibrosis.
Phase 3 - Complete fibrosis. Complete
fibroses and the beginnings of fibrosis are
not reversible, leading to permanent
spinal biomechanical impairment.
Implications for the spinal joints
Hypomobility: Abnormal restriction of joint motion
Hypermobility: Abnormal increase in joint motion
Compensation reaction: Long term hypomobility causes the joint above the hypomobile area and occasionally the joint below to become hypermobile.
Positional dyskinesia, dynamic misalignment: Joint misalignment throughout the entire range of motion of the involved joint
Golf Posture One of the fundamentals of golf is posture.
Many golfers have muscle imbalances which prevent them from physically getting into the posture and positions that their PGA or LPGA instructor is recommending.
The two most common postural distortions are:
Upper Cross Syndrome or C-Posture
Lower Cross Syndrome or S-Posture
The Upper Cross Syndrome is often developed by people who are used to sitting over a computer or desk. It is a forward shoulder posture where the pecs become over contracted and the muscles in your shoulder blades get weak. The C-Posture has an excessive rounded curvature in the back which limits ability to rotate in the back swing.
The Lower Cross Syndrome is often the result of extensive sitting whereby the hip flexers are shortened. Since the brain thinks the hip flexers are contracted, the abdominals get relaxed. Often it causes a Reverse Spine angle swing fault and leads to back injury. The S-Posture has excessive curvature which looks like a sway back or S shape.
UCS Evaluation Stand next to a wall
Sit in a chair
Watch them as you are doing their first interview
Take a photo
Phone or computer apps
• Computer Physical Performance testing
Hands on
Evaluate tightened and shortened muscles
ROM
Palpation
Evaluate weakened and lengthened muscles
Strength testing
Computerized Physical Performance Testing
ROM Testing
Extension strength
Flexion strength
Strength ratio Cervical extension strength should be stronger
than flexion strength
Stretch flexors prior to working with strengthening extensors
When treating patients with UCS, Sherrington's Law proposes that the shortened muscles must be restored before embarking on training of the weakened muscles. The basis for this is reciprocal inhibition… when one muscle is shortened or tightened its opposite muscle relaxes.
Treatment Goals Restoring energy-efficient and strain-free
movement
Ideal body movement and fitness are the end points of care.
The quality of movement produces the actions that make our dreams real and give life value.
It has been said that : The better you can move the better your life will be
Remove the obstacles to cure
2 very important interferences to remove
Postural Distortion
Loss of movement control
Treatments General Wellness
Neuro approach versus simple structural changes Postural, functional and sensorimotor training
ROM exercises
Naturopathic spinal manipulation can be very corrective
Reverse joint fixations Reinvigorate the muscles that retract the head
Stretch the muscles that pull the head forward
General Wellness for the Body Cardio Training Strength training
Nutrition Lifestyle Cleanse Diet
Creates homeostasis and a new relationship with food
3 weeks
Weight Loss Hormones
Men convert testosterone into estrogen Get the right and enough dietary fat to provide hormone precursers
Eat cruciferous vegetables to remove estrogen at the level of the liver
Cardio
Interval running or spinning
Walk or cycle slowly for 2 minutes to warm up
20 seconds on at medium fast speed (8mph at 10% incline)and 10 seconds off. Repeat 5 x
This is a time efficient work out that takes less than 10 minutes and compares to about 2 hours of jogging
Build up intensity appropriately over time
Strengthening Creates
Improvement in Function
Causes a faster metabolism
Added power to movement
Enhanced flexibility
Aging well
Nutrition ‘Cleanse Diet’ for inflammation reduction Healthy and sane diet that is learned over time
Add in healthy goals once about every 2 weeks Eat more slowly and stop at 80% full Change focus to good Protein, Vegetables, Good Oils Avoid simple Carbs, processed and GMO Avoid high carb and additive Beverages
Grass fed organic meat
Seafood
Olive oil
Fish oil
Grape seed oil
Nuts and seeds
Filtered Water, Green tea, Coffee
Drink the weight of your brain (2L) in water every day to improve memory
Nutritional Treatment
The model of inflammation
Fish oils EPA and DHA versus Parent Omega
3’s
How are GMO foods affecting our bodies
and our environment
Lifestyle Standing correctly
Sitting correctly
Breathe into abdomen
Sleep Create a bedtime ritual
Turn off lights and TV 30 minutes prior to bed
Have a therapeutic bath, Peat and epsom salts Mg, Zn Phosphatidylserine serine to decrease night cortisol
& support brain health
Wait for about 30 minutes in the morning before exercise loading to preserve disc health
Physical Medicine Treatments Balance
Manual Therapy Stretching, Myofascial release, active release
Strengthening
Spinal Adjustments
Neuromuscular Re-education
Hydrotherapy Modalities
Cold Laser
Stim
Ultrasound
Balance
Stability (Swiss ball)
Pulse Flex
Wobble boards
Foam Roller
Squat test
Bird dogs
Superwoman pose
Pelvic bridge
Letting gravity help
Alternating arm flexions
Field goal on foam roller
Wobble board
Manual Therapy
Stretching
Muscle energy stretching
Myofascial release
Active release of musculature
Post isometric resistance
Stretching
PIR or MES
Sub occipital
SCMs
Upper traps
Levator Scapula
Pectoralis minor
Pectoralis major
Upper rectus abdominus
Strengthening
Deep cervical flexors
Supra and infra hyoid
Middle and lower traps
Rhomboids
Serratus anterior
Thoracic errectors
Scapular stability
Strengthening Exercises
Birddogs
Neck extension machine Use thoracic extension with cervical extension
• Inverted row with TRX straps
• Swiss ball crunch for abdominals Reach Roll and Lift
Bent over row with dumbells when your posture starts to fail you are done
Strengthening Exercises
Static wall lean
Neck rotations
Cable reverse flys
Barbell upright rows
Foam roller
Wall stretches upright diamond
Wall angels
Wall Angels
Lat Test
Note arching of mid back
Strengthening Exercises
Scapular stabilization exercises
Single arm pull backs with opposite scap
stabilized
Double arm alternating pullbacks
Wrap
Taffy pulls
Stabilized scapula opposite
arm row
Strengthening Exercises
Swimming
Naturopathic Spinal
Manipulation
Improvement in hypomobile joints
Imrovement in neurological compression
Neuromuscular Re-education
Establish correct patterns of muscle
movement
Kinesio-tape methods
The Nervous system is the
conductor
Retraining proper neural patterns in conjunction with organic healing of the tssues
In neuromusculskeletal medicine there are interference patterns that can be removed
Hydrotherapy
Hot bath
Contrast hydrotherapy
Balneotherapy
Peloid packs
Additive bath
Low Level Laser
Myofascial release
Muscle stretching
Scar sensory imput
Architecture faults
Facilitation of locomotor patterning with
therapeutic exercise
Brain balancing
