Posture is alignment of the parts whether upright,sitting or recumbent. it is the attitude assumed by co-ordinated action of many muscle working to maintain stability either when the body is stationary or when it is moving.it is a position in which you hold your body when standing or sitting.
TYPES OF POSTURE
- Inactive posture
- Active posture- a) static posture; b) dynamic posture.
- These are attitudes adopted for resting or sleeping.
- Minimal muscular activity.
- Usually assumed in need of relaxation.
2) Active posture
Integrated action of many muscles is required to maintain active postures. it can be either static or dynamic-
a) Static postures-
- A constant pattern of posture.
- In static posture, the body and its segments are aligned and maintained in certain positions.
- In the erect postures they preserve a state of equilibrium.
- Examples of static postures include standing, sitting, lying, and kneeling.
b) Dynamic postures-
- It is required to form an efficient basis for movement.
- Dynamic posture refers to postures in which the body or its segments are moving- walking,running, jumping, throwing, and lifting.
- So long as the line of gravity from the center of mass falls within the base of support, a structure is stable.
- Stability is improved by lowering the center of gravity (COG) or increasing the base of support (BOS)
For postural stability here we include muscle and neurological control: influence on stability
A) Muscles: Influence on stability
- The intensity and distribution of the muscle work which is required for both static and dynamic postures varies according to posture.
- The groups of muscles, which are used to maintain the erect position, known as the anti-gravity muscle.
- The muscles of the neck and trunk not only act as prime movers or as antagonists to movement caused by gravity during dynamic activity, they are important stabilizers of the spine.
- Without the dynamic stabilizing activity from the trunk muscles, the spine would collapse in the upright position.
- Both superficial (global) and deep (core) muscles function to maintain the upright posture.
Muscles controlling the spine
1)Lumbar region- superficial and deep muscle play critical role in providing stability and maintaining the upright posture
- Rectus abdominis
- External and internal obliques
- Quadratus lumborum (lateral portion)
- Erector spinae
b) Deep muscle
- Transversus abdominis
- Quadratus lumborum (deep portion)
- Deep rotators
2) Cervical region
a) superficial muscles-
- Levator scapulae
- Upper trapezius
- Erector spinae
b) deep muscles-
- Rectus capitis anterior and lateralis
- Longus colli
B) Neurological control: influence on stability
Postures are maintained or adapted as a result of neuromuscular co-ordination, the appropriate muscle being innervated by means of a very complex reflex mechanism.
The postural reflexes- A reflex is, by definition, an efferent response to an afferent stimulus.
The efferent response in this instance is a motor one, the anti-gravity muscle being the principal effector organs. afferent stimulus arises from a variety of source all over the body, they are-
- The muscles- neuromuscular and neurotendinous spindles within muscles record changing tension, that causes stimulation and appears to be a manifestation of the myotatic, or stretch reflex.
- The eyes- visual sensation records any alteration in the position of the body with regard to its surrounding
- The ears- stimulation of the receptors of the vestibular nerve results from the movement of fluid contained in the semicircular canals of the internal year.
- Joint structure- in the weight bearing position approximation of bones stimulates proprioceptive receptors.
- Skin sensation- also plays a part, especially that of the soles of the feet, when the body is in standing position.
Impulses from all these receptors are conveyed and co-ordinated in the central nervous system( ex-cerebral cortex, cerebellum, red nucleus, vestibular nucleus.), complex series of efferent response together constitute the postural reflex.
THE PATTERN OF POSTURE
Patterns of posture, both static and dynamic, are gradually built up by intergration of the many reflexes, which together make up the postural reflex.
A) Good posture
Posture is said to be good when it fulfils the purpose for which it is used with maximum efficiency and minimum effort.
An ideal standing posture would be one in which the body segments were aligned vertically and the LoG passed through all joint axes. Normally body structure makes such an ideal posture impossible to achieve, but it is possible to attain a posture that is close to the ideal, in an optimal posture.
Development of good posture
The chief factors which predispose to the health and development of the muscles and the postural reflex are-
- A stable psychological background
- Good hygienic condition
- Opportunity for plenty of natural free movement.
A stable psychological background→ emotion and mental attitude have a profound effect upon the nervous system, and this is reflected in the posture of the individual. joy happiness and confidence are stimulating and are reflected by an alert posture, in which positions of extension predominate. conversely unhappiness, conflict and a feeling of inferiority have just the opposite effect.
Good hygienic condition→ particularly with regard to nutrition and sleep, are essential for healthy nervous system and for the growth and development of bones and muscles.
Opportunity for plenty of natural free movement→also encourage the harmonious development of the skeletal muscles.
How can I improve my posture when sitting?
Every people spend a lot of their time sitting – either at work, at school, or at home. It is important to sit properly, and to take frequent breaks:
- Switch sitting positions often
- Take brief walks around your office or home
- Gently stretch your muscles every so often to help relieve muscle tension
- Don’t cross your legs; keep your feet on the floor, with your ankles in front of your knees
- Make sure that your feet touch the floor, or if that’s not possible, use a footrest
- Relax your shoulders; they should not be rounded or pulled backwards
- Keep your elbows in close to your body. They should be bent between 90 and 120 degrees.
- Make sure that your back is fully supported. Use a back pillow or other back support if your chair does not have a backrest that can support your lower back’s curve.
- Make sure that your thighs and hips are supported. You should have a well-padded seat, and your thighs and hips should be parallel to the floor.
How can I improve my posture when standing?
- Stand up straight and tall
- Keep your shoulders back
- Pull your stomach in
- Put your weight mostly on the balls of your feet
- Keep your head level
- Let your arms hang down naturally at your sides
- Keep your feet about shoulder-width apart
B) Poor posture
- posture is poor when it is inefficient, that is,when it fails to serve the purpose for which it was designed,or if an unnecessary amount of muscular effort is used to maintain it.
- Impairments in the joints, muscles, or connective tissues may lead to faulty postures; or conversely, faulty postures may lead to impairments in the joints, muscles, and connective tissues as well as symptoms of discomfort and pain.
Factors which predispose to poor posture-
- Mental attitude of the patient
- poor hygienic condition
- local factors such as- localized pain, muscular weakness, occupational stresses, or localized tension .
Positional causes of poor posture include
- poor postural habit—for whatever reason, the individual does not maintain a correct posture
- psychological factors, especially self-esteem
- normal developmental and degenerative processes
- pain leading to muscle guarding and avoidance postures
- muscle imbalance, spasm, or contracture
- joint hypermobility or hypomobility
- respiratory conditions
- general weakness
- excess weight
- loss of proprioception—the ability to perceive the position of your body
- over reliance on passive support from a non-ergonomic chair
Common faulty postures
MANAGEMENT OF IMPAIRED POSTURE
Before developing a plan of care and selecting interventions for management, evaluate the findings from the examination of the patient, including the history, review of systems, and specific tests and measures, and document the findings.
- Postural alignment (sitting and standing),
- balance, and gait
- ROM, joint mobility, and flexibility
- Muscular strength and endurance for repetitions and holding
- Ergonomic assessment if indicated
- Body mechanics
- Cardiopulmonary endurance/aerobic capacity, breathing pattern.
Management guidelines-impaired posture→
Structural and functional Impairments
- Pain (including headaches) from mechanical stress to sensitive structures and from muscle tension
- Mobility impairment from muscle, joint, or fascial restrictions
- Impaired muscle performance associated with an imbalance in muscle length and strength between antagonistic muscle groups
- Impaired muscle performance associated with poor muscular endurance
- Insufficient postural control of stabilizing muscles
- Decreased cardiopulmonary endurance
- Altered kinesthetic sense of posture associated with poor neuromuscular control and prolonged faulty postural habits
- Lack of knowledge of healthy spinal control and mechanics
Plan of care and intervention
1. Develop awareness and control of spinal alignment in a variety of positions.
Intervention →Teach procedures to develop active control of spinal and extremity movement
2.Educate the patient about the relationship between faulty posture and symptoms
Intervention →Demonstrate relationship of symptoms with sustained or repetitive postures
3. Increase mobility in restricting muscles, joints, fascia.
Intervention →Manual stretching and joint mobilization; teach self-stretching
4. Develop neuromuscular control, strength, and endurance in postural and extremity muscles.
Intervention→Stabilization exercises; progress repetitions and challenge; progress to dynamic strengthening exercises
5. Learn safe body mechanic.
Intervention →Functional exercises to prepare for safe mechanics
6. Learn to correct stress provoking postures/activities.
Intervention →Adapt work, home, recreational environment
7. Learn stress management/relaxation.
Intervention →Relaxation exercises and postural stress relief
8. Improve aerobic capacity
Intervention →Implement and progress an aerobic exercise program
9. Develop healthy exercise habits for self-maintenance
Intervention →Integration of a fitness program, regular exercise and safe body mechanics into daily life