POSTURE

POSTURE
 CONTENTS

• Definition
• Types
• Postural control
• Good posture
• Overview of standing posture
• Deviations from normal posture
• Postural re-education
 DEFINITION

 Posture is the attitude assumed by the body, either with support during
muscular inactivity, or by means of co-ordinated action of many muscles
working together , to maintain stability.

 Postures are attained to form an essential basis, which is being adapted

constantly to the movement, which is superimposed on it.
 TYPES OF POSTURE

POSTURE

INACTIVE ACTIVE

STATIC DYNAMIC
 INACTIVE POSTURE ACTIVE - STATIC POSTURES

STANDING SITTING KNEELING

ACTIVE – DYNAMIC POSTURES

WALKING RUNNING JUMPING

 POSTURAL CONTROL
 Postural control is defined as the ability to maintain stability of body
and body segments , in response to forces , that threatens to disturb
the body’s equilibrium.

POSTURAL CONTROL

MUSCULAR NEURAL
CONTROL CONTROL

COMBINED
NEUROMUSCULAR
CONTROL
 1. MUSCULAR CONTROL

• The amount of muscle work required for control of

both static and dynamic postures varies considerably.

• The major group of muscles which are most frequently

employed are “ANTI-GRAVITY MUSCLES”.

• These muscles present certain structural

characteristics, such as -
1. they are multi-pennate and fan-shaped, which
signifies powerful action.
2. constituent fibres are ‘red’, indicating their
capability of sustained contractions without fatigue.
 2. NEURAL CONTROL

• The ability to maintain stability of any posture is the skill

of CNS.

• The CNS learns this ability, using information from :

1. passive biomechanical elements
2. sensory systems
3. muscles

• The CNS interpretes and organizes inputs from various sources, and selects
responses on basis of past experiences , and the goal of response.

• The responses can be either: REACTIVE or PROACTIVE

• The major goals of postural control in standing position are :
1. to maintain body’s CoM over the BoS.
2. to control body’s orientation in space.
3. to stabilize head with regards to the vertical, so that eye gaze is
appropriately oriented.

• The CNS must be able to respond to all the inputs with appropriate output ,
to maintain equilibrium of the body.

• The control is disturbed in two conditions :

1. Absent or Altered INPUTS
2. Absent or Altered OUTPUTS
 ALTERED INPUTS

RECEPTORS

EFFECTOR
ORGAN
ALTERED OUTPUTS
 3. COMBINED NEUROMUSCULAR CONTROL

 POSTURAL REFLEX :
 MUSCLE SYNERGIES :
They are defined as centrally - organized patterns of ms. activity, that occur
in response to perturbations of standing postures.

• Three types of synergies are identified :

1. Fixed – support synergy
a). Ankle synergy
b). Hip synergy

2. Change – in – support synergies

a). Stepping
b). Grasping

3. Head – stabilizing synergies

a). Head stabilization in space
b). Head stabilization on trunk
 GOOD POSTURE
• The posture is said to be “good” when it fulfils the purpose for which it is
used, with maximum efficiency and minimal effort.
A state of body, which can be maintained with the minimum of
muscular effort and which is aesthetically pleasing to the eye.

 DEVELOPMENT OF GOOD POSTURE :

• A good or efficient posture develops naturally, provided the essential
mechanisms for its maintenance & adjustment are intact and healthy.

• The chief factors responsible for a good posture are :

1. stable psychological background
2. good hygienic conditions
3. opportunity for plenty of natural free movements
 POOR POSTURE

• Posture is said to be “poor” when it is inefficient, i.e. when it fails to

serve the purpose, for which it has been designed, or if an unnecessary
muscular effort is used to maintain it.

• Such faulty alignments leads to necessity of additional muscle work, to

maintain balance.

• They look aesthetically unpleasant, or this may in itself have an

unwelcome psychological reaction.
 PRE-DISPOSING FACTORS :
• Mental attitude of person

• Poor hygienic condition

• General debility after a constitutional illness.

• Prolonged fatigue

• Local factors : pain, muscular weakness, occupational stress, or localized

tension, which leads to muscular imbalance and alters the posture.
 STANDING

 ANKLE :
• In optimal position, LOG passes slightly ant. to
lateral malleolus, i.e. ant. to ankle joint.

• G produces external “dorsi-flexion moment”.

• It needs to be opposed by an internal plantar-flexion

moment, to prevent forward motion of tibia.

• Activation of plantarflexor muscles. Soleus plays

major role, in applying a post. pull on tibia.
 KNEE :
• In optimal position, knee is in full extension

• LOG passes ant. to midline of knee , and post. to

patella.

• G produces external “extension moment”.

• It needs to be opposed by an internal flexion

moment.

• Production of passive tension in post. capsule

and associated ligaments, in order to prevent knee
hyper-extension.

• Also, a small amount of activity is noted in hamstrings.

 HIP AND PELVIS :
• In optimal position, hip is in neutral position and pelvis
is level with no ant. or post. tilt.

• LOG passes slightly post. to hip joint through greater

trochanter.

• G produces external “extension moment” at hip, and

tends to rotate pelvis post.

• Compensation by passive tension in iliofemoral,

pubofemoral, & ischiofemoral ligaments.
 LUMBOSACRAL JOINT :
• The average lumbo-sacral angle (b/n bottom of L5
vert. & top of sacrum) is about 30 degrees.

• In optimal position, LOG passes through body of L5

vert. and close to axis of rotation of LS joint.

• G produces slight “extension moment” at L5 to S1,

which tends to slide L5 and entire lumbar spine down
& forward on S1.

• This is opposed by – ALL and iliolumbar ligament.

 SACRO-ILIAC JOINT :
• When sacrum is in optimal position, the LOG passes
slightly ant. to sacroiliac joints.

• The external gravitational moment tends to cause :

1. ant. sup. portion of sacrum to rotate ant. &
inferiorly.
2. post. Inf. portion to rotate post. & superiorly.

• Internal moment is generated by passive tension in

sacrospinous and sacrotuberous ligaments, and
causes upward tilting of lower end of sacrum.
 VERTEBRAL COLUMN:
• In neutral position, LOG passes
1. post. to axes of cervical and lumbar vertebrae
2. ant. to thoracic vertebrae
3. through body of L5 vertebra

• The gravitational moments tends to increase the

natural curves in lumbar, thoracic & cervical spine.
 HEAD :
• The LOG in relation to head passes ant. to frontal axis
of rotation .

• Production of external “flexion moment”.

• This flexion moment tends to tilt the head forward .

• Compensation is done by internal moments generated

by ligamentum nuchae, tectorial membrane, &
post. aspect of zygapophyseal joint capsules.
 DEVIATIONS OF POSTURE

1. Deviations in sagittal plane

2. Deviations in frontal plane

 1. DEVIATIONS IN SAGITTAL PLANE

 FOOT AND TOES :

• Claw toes :
hyper-extension of MTP joints, with
flexion on PIP & DIP.

• Hammer toes :
hyper-extension of MTP, flexion of PIP,
& hyper-extension of DIP.
 KNEE JOINT :

1. Flexed knee posture 2. Hyper-extended knee

( Genu recurvatum )
 PELVIS :

• Excessive ant. pelvic tilt

 VERTEBRAL COLUMN :

1. KYPHOSIS 2. LORDOSIS
2. DEVIATIONS IN FRONTAL PLANE

 FOOT AND TOES :

• PES CAVUS
(High Arch)

• PES PLANUS
(Flat Foot)
 KNEE JOINT :

1. GENU VARUM 2. GENU VALGUM

 VERTEBRAL COLUMN :

• SCOLIOSIS
 POSTURAL RE-EDUCATION

• The measures used to combat poor posture depends on the cause.

• Patient’s awareness towards his incorrect posture is most important.

• Alteration in habitual mental attitude, and improvement of hygienic

conditions plays an important role.

• Various techniques of postural re-education includes :

1. Relaxation
2. Mobility
3. Muscle strengthening

• Patients are encouraged to perform exercises in front of mirror, for

appropriate feedback.
RELAXATION :

• Initially, general body relaxation , reduces muscular tension, and gives a

feeling of alignment.

• Specifically, relaxation of muscle around shoulder girdle and neck

extensors is most important.

• Voluntary relaxation is taught first in lying position , and then erect

positions. Some examples are :

 Crook lying, lying or prone lying - general relaxation

 Crook lying, relax shoulders to supporting surfaces with expiration.
 Forehead support in prone, head raising and lowering.
 Sitting , shoulder shrugging and retraction followed by relaxation.
STRETCHING EXERCISES
MOBILITY :
• Maintenance of normal mobility is essential to enable a wide variety of
postures to be assumed.

• “Abnormal mobility is a liability rather than a asset”.

• Normal mobility is maintained by general free exercises , which are

rhythmical in character, and includes full-range movements of all joints.

• Emphasis is laid on full extension , as this is the movement which is most

liable to limitation.

• Exercise involving hanging positions, gives good alignment to body, and

are very much enjoyed by children.
HANGING EXERCISES
MUSCLE POWER :
• General muscular weakness is the root cause of poor posture.

• The use of anti-gravity muscles is important , as they are frequently used

to act in a postural capacity.

• E.g. work of upper back extensors & scapula retractors , is required during
re-education of a stooping posture.
BACK EXTENSION EXERCISES
FLEXION EXERCISES
IMMOBILIZATION IN CASTS AND BRACES :

• In case where postural deformities have been developed, casts and braces
can be used , to maintain the corrected posture.

• In spinal deformities, Milwaukee and Boston Braces are frequently used.

• For neck stabilization, various types of cervical collars are used.

• Mild deformities can be managed by taping techniques , along with

exercises.
PES PLANUS
PES CAVUS