The Standing Posture

KINESIOLOGY II
Objectives
1. Identify and describe the skeletomuscular and
neuromuscular antigravity mechanisms involved in the
volitional standing position
2. Summarize the similarities and differences that occur in
the relation of the line of gravity to various body
landmarks with good and poor anteroposterior
segmental alignment
3. Discuss the factor that affect the stability and energy cost
for the erect posture
Objectives
4. Explain the effects that the variables of age, body build,
strength, and flexibility have on the alignment of body
segments in the standing posture
5. Name the values, if any, of good posture
6. Perform kinesiological analyses on the posture of
individuals of different ages and body builds
Posture
 Posture is the position of your body parts in relation to each
other at any given time.

 Static posture : as in a stationary position such as standing,

sitting or lying.

 Dynamic posture : as the body moves from

one position to another.
 POSTURE

 Posture is the attitude which, is assumed by Body parts to

maintain stability and balance with minimum effort and least
strain during supportive and non supportive positions.

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 POSTURE
 Posture :The relative arrangement of the body
 Good posture : the state of muscular and skeletal balance which
protects the supporting structures of the body against or
progressive deformity irrespective of the attitude in which these
structures are working or rest
 Poor posture : a faulty relationship of the various parts of the
body which produce increased strain on the suppoting structures
and in which there is less efficient balance of the body over its
BOS
(The posture committee of American of Orthopedic Surgeons,1947)

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 EFFECT OF GOOD POSTURE
Maintaining good posture has its values in different
body functions and systems includes:

1. Helps the muscles in the body to be unloaded and relaxed.

2. Improves respiratory and circulatory efficiency.
3. Prevents unnecessary strain and fatigue.
4. Decreases the incidence of diseases resulting from bad
posture.
5. Improves the subject’s state; mentally or
psychologically.

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 Thoracic and sacral curves are
concave anteriorly and convex
posteriorly.

 lumbar and cervical curves are

convex anteriorly and concave
posteriorly

 must be maintained during rest and

activity,

 Act as shock absorbers and reduce

the amount
of injury
 CURVATURES OF THE SPINE
 1- FROM FRONTAL VIEW:

 If the spine is viewed from

the front or the back view it
seems to be straight and
symmetrical.

Posterior (Back) Spinal Column

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 CURVATURES OF THE SPINE
2- FROM SAGITTAL VIEW:
If the spine is viewed from
the lateral side, 4 normal
curves will appear which are:

a- Two primary curves: dorsal

and sacral which are
convex posteriorly.

b- Two secondary curves:

cervical and lumbar which
are convex anteriorly.
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POSTURAL CURVES
 position of the pelvis has great influence on the vertebral
column, especially the lumbar region.

 pelvis should be in a neutral position

 Neutral position : the posture of the spine in which overall

internal stresses in the spinal column and the muscular effort
to hold the posture are minimal ( Panjabi , 1992)
NEUTRAL POSITION
 Defined:

(1) when the anterior superior iliac spine (ASIS) and posterior
superior iliac spine (PSIS) are same level with each other in a
transverse plane
(2) when the ASIS is in the same vertical plane as the symphysis
pubis
 Muscle contractions
responsible for keeping the
body in the upright
position in both static and
dynamic posture.

 The muscles called as

antigravity muscles
 Other muscles,
1. trunk and neck flexors
2. lateral benders, hip abductors and adductors,
3. the ankle pronators and supinators.

 If all of these muscles were to relax, the body would

collapse.
 Postural sway :anterior-
posterior motion of the
upright body

 caused by motion occurring

primarily at the ankles.
 plantar flexors and dorsi
flexors are important in
controlling postural sway
 This sway is the result of
constant displacement and
correction of the COG within
the BOS
 POSTURAL SWAY
 Movement of body in still position

 The phenomenon of constant displacement and

correction of the position of the center of gravity within
BOS ( Smith et.al,1996)

 Components

AP Sway : 5-7mm at quite stance in young adult

ML Sway : 3-4mm at quite stance in young adult

 Mechanism : the higher COM of the human body and

the small BOS in standing posture place the body in
unstable equilibrium, resulting in constant displacement
of the body pivoting about the ankle joint

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SIGNIFICANCE OF POSTURE
 Posture means position
 The multisegmented human body does not have a single
posture
 Most posture research has been related to the volitional
standing position
 A custom is to accept standing posture at a person’s basic
posture from which all other postures stem
SUPPORT OF THE STANDING POSTURE
Muscular Activity in Erect Standing

• Humans have a very economical antigravity mechanism

• Muscle energy to maintain erect posture is not great
• Ligaments play a major role in supporting and maintain the
integrity of the joints
• Muscles that are active are those that aid in keeping the
weight-bearing column in relative alignment and oppose
gravity
Muscular Activity in Erect Standing
Foot: Only muscular activity is in the push-off phaseor rising on
the toes
Leg: Posterior calf muscles are more active the anterior
Thigh & Hip:Very little activity
 Swaying produces bursts of abd/adductors
 Iliopsoas constantly active, preventing hyperextension of the hip
joint
Muscular Activity in Erect Standing
Spine:Very slight activity is sacrospinalis or abdominals
Upper Extremity: low-grade activity in a number of muscles
– Serratus anterior & trapezius support the shoulder girdle
– Supraspinatus resist downward dislocation of the humerus
– No activity in elbow or wrist joints, when passively hanging
The Neuromuscular Mechanism for
Maintaining Erect Posture
 Proprioceptors are responsible for most of the reflex
movements to maintain posture
 Posture modification of posture depends on;
1. Voluntary decision towards change
2. Experience with desired posture
3. Instruction resulting in different strategies
4. Environmental influences
Postural Stability
• Hellebrandt (1940) “Standing is, in reality, movement upon a
stationary base”
• CG does not remain motionless
• Subjects were constantly swaying
• Today, force platforms can record postural sway in
magnitude, direction, and pattern
• Postural stability is currently measured as sway motion
between CG and center of pressure
STANDING STABILITY
Ankle Stability
 LOG passes anterior to the
ankle joint and through the
calcaneocuboid joint
 active stability
- calf muscle (soleus)
- to prevent the tibia
forward rotation and ankle
dorsiflexion

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 Knee Stability
 LOG passes slightly anterior to
the knee joint and just behind the
patella
 Active stability
- calf muscles(gastrocnemius)
- hamstrings
 passive stability
- anterior cruciate ligament -
posterior capsule

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 Hip Stability

 LOG may pass slightly anterior to,

slightly posterior to, or directly
through the hip joint depending on
postural sway and the pattern of stance
 active stability
- hip flexors
 passive stability
- iliofemoral ligament
 malalignment
- sway back posture
hyperextension of the hip
with posterior tilt of the pelvis
and decreased lumbar
lordosis
- hyperlordotic back (hollow
back)
- flat back
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 Alignment of
Body Segments
 “Good posture”
 Weight-bearing segments
balanced vertically
 Rotary effect of gravitational
force in minimized
Fig 15.1
 Alignment of
Body Segments
 “Fatigue posture”
 Muscles have let go
 Ligaments prevent collapse
 Zigzag alignment of weight bearing
segments increase rotary effect of
gravitational force Fig 15.2
 SEGMENTAL ALIGNMENT
Sagittal Plane alignment body landmark

Head and Neck • Inferior to the external auditory meatus

Shoulder • ACJ

Hip • Greater throcanter

Knee • Lateral epicondyle of femur

Ankle • Lateral malleolus

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Sagittal Plane body landmark
 TRUNK AND PELVIC ALIGNMENT
In normal standing :-

• Thoracic & Sacral

Kyposis • Curve are convex posteriorly

• Cervical & Lumbar

Lordosis • Curve concave posteriorly

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  Cobb Angle - method to assess spine curve

Cobb Angle

Cobb angle
20*-70* at lumbar
20*-50* at thoracic

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 FRONTAL PLANE ALIGNMENT

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 Anterior pelvic tilting is add
on 5* from normal range

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 ALIGNMENT OF BODY SEGMENTS
Good posture Fatigue posture Rigid posture

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PHT413/HAYATI
Alignment of Body Segments
 Even the most ideal posture have some rotary force present
1. Supporting column of trunk being more posterior
2. Support base (feet) being projected forward
3. Spinal column being curved anteroposteriorly
4. Chest forming an anterior load
 Females breasts are an additional anterior load
Relationship of Alignment of Body Segments and
Integrity of Joint Structure
 Prolonged postural strain is injuries
 Ligaments can permanently stretch
 Cartilages can be damaged due to abnormal friction
 Arthritic changes in weight-bearing joints
FACTORS RELATED TO THE STANDING
POSTURE
1. Energy Cost
• “Fatigue posture”
• Requires a minimum of
metabolic increase
Knees - hyperextended
Hips – forward Fig 15.3
Increased thoracic curve
Head – forward
Trunk - posterior lean
2. Evolutionary and Hereditary Influences
 As man began to walk upright
 There was a shift form a vertically suspended position to a
vertically support one
 Although no specific principle, changes had to occur to the
musculoskeletal structure
3. Strength and Flexibility
 Seem to be universally accepted relating to the
preponderance of strength and flexibility exercises
 Strength of abdominals
 Scapula retractors
 Pectoralis muscle
 Hamstring muscles
Age
 Several Physical and neurological factors
 Infant initially lack muscular strength and neurological
development
 The aging adult tends to alter posture
 Older people lean forward
 Bone mineral loss
 Muscular weakness
 Fear of instability
Psychological Aspects
 Atypical postures may be symptoms of personality problems
or emotions
 Emotional reaction to an abnormal posture
 Mental fatigue
 Depression, Joy, or Fear
 Evidence exist on the correlation between mood state and
performance (Huddleston et al., 2000)
PRINCIPLES APPLIED
TO POSTURE
1. The weight-bearing segments of the body are so aligned in
good standing posture that angles of inclination in the trunk
and in the pelvic girdle are within “normal” limits
2. In order to be stable, the intersection of the line of gravity
with the base of support will be close to the geometric
center of the base.
3. Good standing posture is a position of extension of the
weight-bearing joints.
PRINCIPLES APPLIED Of POSTURE
4. Form the point of view of energy expenditure, good posture
would seem to be a position that requires a minimum
expenditure of energy for the maintenance of good
alignment
5.Good posture permits mechanically efficient function of the
joints
6. Good posture, both static and dynamic, requires a minimum
of muscle force
PRINCIPLES APPLIED
TO POSTURE
7. Good posture, both static and dynamic, requires sufficient
flexibility in the structure of the weight-bearing joints to
permit good alignment without interference or strain
8. Good posture requires good condition
– neuromuscular control & reflexes
9. Adjustments in posture can be made more readily by individuals
who have a good kinesthetic awareness of postures they assume
and of the degree of tension in their muscles
POSTURAL ADAPTATIONS TO EXTERNAL
CONDITIONS AND SPECIAL PROBLEMS
Standing on an inclined plane: bending at knees, hips, or spine
adjust CG above the base of support
• Same for wearing high heels, pregnancy, and carrying a
heavy bundle in front of the body

Standing on a moving surface: be prepared to make adjustments

to acceleration, deceleration, and side-to-side sway
– Comfortably wide stance in the direction of motion
POSTURAL ADAPTATIONS TO EXTERNAL
CONDITIONS AND SPECIAL PROBLEMS
Standing on one foot:
 Usually managed automatically by the muscle, joint, and
labyrinthine proprioceptors, and reflex response
 Shift body weight to supporting limb
 Fatigue Posture

It is asymmetrical or sagging posture

This position is relaxed and can be

maintained for a long time as most of body's
joints are in semi-flexion. The load on the
muscles will decrease and the energy
expenditure is 10% less than easy posture.

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PHT413/HAYATI
 Rigid Posture

It is called posture of attention. It

doesn't mean normal posture

This position can not be assumed

for a long time as most of body's joints
are. In extension; so, the load will
increase on joints and muscles and
energy expenditure is 20% more than
easy posture.

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 MUSCULAR ACTIVITY IN ERECT STANDING
FOOT • Push off phase or rising on the toes

LEG • Posterior calf muscles are more active then anterior

THIGH & • Very little activity

• Swaying produces bursts of ad/adductors
HIP • Iliopsoas constantly active to prevent hip hyperextend

SPINE • Slight activity in sacrospinalis or abdominals

• Low grade activities

• Serratus anterior & trapizius support shoulder girdle
UE • Supraspinatus resist downword dislocation of the humerus
• No activity in elb/wrist joints when passively hanging
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 Standing Postural Muscles

 The thick black lines represent the

principal muscles involved in
standing.
 The vertical dotted line indicates the
center of gravity.
 Note this line falls behind the axis of
rotation of the hip and in front of
the knee. This renders the ligaments
of the joints tense, which are
represented by dotted lines passing
in front of the hip (ilio-femoral) and
behind the knee (posterior
ligament).
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 TYPES OF POSTURE

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 PRINCIPLES APPLIED TO POSTURE
 Correcting alignment is a process of neuromuscular
reeducation that requires enormous commitment,
patience, and the guidance of a scrutinizing eye.
 It is inconceivable to think that one posture will fit all.
However, the concept of an ideal posture serves as a
guideline and a reference by which we can detect
deviations and gauge changes.
 Posture affects every movement, exercise, and decision
in an exercise program, emphasizing different muscle
groups, with the selection of exercises and the cueing
appropriate for their particular posture

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 PRINCIPLES APPLIED TO POSTURE
 Good posture would seem to be a position that requires a
minimum expenditure of energy for the maintenance of good
alignment
 Good posture, permits mechanically efficient function of the
joints, requires a minimum of muscle force, requires
sufficient flexibility in the weight-bearing joints structure to
permit good alignment without strain

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 PRINCIPLES APPLIED TO POSTURE
 Good posture requires good neuromuscular control and
reflexes(good condition)
 Posture adjustments can be made by individuals who have a
good kinesthetic awareness of postures they assume and
degree of tension in their muscles
 The characteristics of normal posture change with age

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 APPLY THE PRINCIPLES OF GOOD
POSTURE

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 APPLY THE PRINCIPLES OF GOOD
POSTURE

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 POSTURE
SCREENING
 An optimal standing posture
Line of gravity falls:
 slightly anterior to lateral malleolus
 Midline of the knee
 Slightly posterior to hip
Fig 15.3a
 Anterior to sacroiliac joints
POSTURE SCREENING
1. Subject should wear minimal clothing
2. Subject assumes comfortable stance
3. Landmarks to line of gravity from the side
4. Alignment of foot, ankle, & knee from front
5. Alignment of spine & pelvis from rear

A screening matrix expedites observation of any deviations

POSTURE IN STANDING
1. Head: Through the earlobe

2. Shoulder :Through the tip of the acromion process

3. Thoracic spine : Anterior to the vertebral bodies

4. Lumbar spine: Through the vertebral bodies

5. Pelvis: same Level

6. Hip: Through the greater trochanter (slightly posterior to

the hip joint axis)

7. Knee: Slightly posterior to the patella (slightly anterior to

the knee joint axis) with the knees in extension

8. Ankle : Slightly anterior to the lateral malleolus with the

ankle joint in a neutral position between dorsiflexion and
plantar flexion
1. Head: Extended and level,
not flexed or hyperextended
2. Shoulders : Level and not
elevated or depressed
3. Sternum : Centered in the
midline
4. Hips: Level with both ASISs
in the same plane
5. Legs: Slightly apart
6. Knees: Level and not bowed
or knock-knee
7. Ankles: Normal arch in feet
8. Feet: Slight outward toeing
1. Head : Extended, not flexed
or hyper extended
2. Shoulders : Level and not
elevated or depressed
3. Spinous processes:
Centered in the midline
4. Hips: Level with both PSISs
in the same plane
5. Legs : Slightly apart
6. Knees: Level and not bowed
or knock-kneed
7. Ankles: Calcaneus should be
straight
 POSTURAL SCREENING

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 POSTURAL SCREENING
To assess posture ideally, the subject stands upright,
and attention should be given to the following:

o No movement in the AOJ or AAJ which results in

protrusion of the jaw.
o Stands as straight as possible.
o Knees should be straight as much as possible.
o Head faces forward and arms beside the body.
o Almost all joints of the body must be in the neutral
position.
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 POSTURAL ASSESSMENT
Assessment should be From 3 Views:
1- Anterior view.
2- Posterior view.
3- Lateral view.

The Parts Which are Important to be

Observe:
1- Head alignment.
2- Curvature of the spine; cervical, thoracic and lumbar.
3- Shoulders and arms.
4- Pelvic inclination.
5- Hip, knee and ankle joints.
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 POSTURAL
ASSESSMENT

Anterior Evaluation
• Position of feet
– Check for pronation or supination
– Check arch of the foot

• Position of legs
– Check for bow legs

• Position of knees
– Check for knock-knees

• Appearance of ribs
• Position of head

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 POSTURAL
ASSESSMENT

Anterior: Good Alignment

Knee caps
face straight
ahead
Legs are
straight up and
down
Arches have
normal half-
Toes are straight
dome shape

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 POSTURAL
ASSESSMENT
Anterior: Foot Supination & Pronation

Slight
Contracted knee
anterior knocking
tibalis

Feet are
Weight is
pronated
on outside
of feet

Feet are
supinated

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 POSTURAL ASSESSMENT

Correct Posture
Lateral
Line is…
• Through external auditory
meatus (Ear)
• Midway through shoulder
• Through lumbar bodies
• Slightly anterior to midline
of knee
• Slightly anterior to lateral
malleolus

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 POSTURAL
ASSESSMENT

Lateral

Things to Examine
• Position of knees
– Check for hyperextension or flexion
• Pelvic position and spine curvature
• Head, chest and abdominal position

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 POSTURAL
Lateral
ASSESSMENT

Knee Position

Flexion of Hyperextensio
Good Alignment
Knees n of knees
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POSTURAL
ASSESSMENT

Posterior
Line is…
• In the center of head, neck,
back and pelvis

• Falls exactly in the mid point

between the two Knees and
ankles

Good 72
 POSTURAL
ASSESSMENT

Posterior
Things to Examine
• Note alignment of Achilles Tendon
• Hip adduction/abduction
• Check for level posterior iliac spine
• Check for lateral pelvic tilt
• Check for spine and shoulder problems

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SITTING POSTURE
 1. neck and trunk are upright,
2. trunk is supported, and maintain lumbar lordosis
3. The top of the monitor is at eye level.
4. The shoulders are relaxed.
5. The elbows are flexed and close to the body.
6. The hands, wrists, and forearms are straight and parallel to the
ground.
7. The chair should allow the hips and knees to be flexed.
8. The thighs are parallel to the ground and the lower legs are vertical,
allowing the feet to be flat on the floor or a footrest.

 maintains the lumbar lordosis will place the least amount of pressure on
the disks
Orientation of the pelvic
 upright pelvic alignment when standing, with a mean
anterior pelvic plane angle of 1.2° (range, -22°-+27°)
 In the sitting position the pelvis tended to extend posteriorly,
with a mean anterior pelvic plane angle of -36.2° (range, -
64°-+4°)

(DiGioia ,et al 2006)

Functional Pelvic Orientation Measured from Lateral Standing and Sitting Radiographs
Effect of Different Upright Sitting Postures on Spinal-
Pelvic Curvature and Trunk Muscle Activation in a
Pain-Free Population ( O’ Sullivan et al 2006)
The influence of different sitting postures on head/neck posture and
muscle activity ( Caneiro et al., 2010)
THORACIC KYPHOSIS AFFECTS SPINAL LOADS AND TRUNK MUSCLE
FORCE ( Briggs et al., 2007)