In a world that increasingly draws us into a forward bend—over our smartphones, computers, and desks—the quest for optimal posture has never been more pressing. Good posture is not just an aesthetic attribute; it's a cornerstone of musculoskeletal health, influencing everything from our breathing efficiency to spinal integrity. Yet, many of us struggle with postural imbalances that can lead to chronic discomfort and diminished quality of life.
This article, delves into the transformative power of manual therapy and exercise, offering insight and guidance on realigning the body's posture for enduring health and functionality.
Article Index
Introduction
Manual Therapy
Exercise
Frequency
Conclusion & References
Understanding Posture
Maintaining good posture is crucial for overall musculoskeletal health, but it's often not given enough attention. It's the foundation for efficient movement and overall body function. Good posture helps distribute gravity evenly throughout the body, allowing muscles and joints to work at their best. This balance involves both maintaining a stable position and moving correctly, influenced by how the body senses its position and coordinates its muscles and nerves. Evaluating posture in a clinical setting goes beyond just looking at someone; it involves a detailed understanding of body landmarks, how they align with standard body mechanics, and how this affects the load on the musculoskeletal system. New tools for measuring posture have improved our ability to pinpoint and treat issues with posture more accurately.
Bad posture can lead to a range of problems, from temporary muscle tiredness to long-term issues like spinal disc problems and joint dysfunction. Our modern lifestyle, with lots of sitting and technology use, is causing more posture-related problems, making it important to teach and actively manage good posture. There's also a two-way link between posture and mental health, highlighting the broader significance of posture. Understanding the biomechanics of posture reveals the need for a comprehensive approach that considers both muscle and bone health in maintaining and restoring a balanced posture.
Postural Assessment Checklist
Assessing posture is vital in musculoskeletal care for identifying imbalances and deviations that can lead to pain and dysfunction. It helps in early detection and treatment of potential issues, ensuring efficient movement and optimal bodily alignment. A thorough postural assessment, like the one detailed in the following checklist, is key to creating effective interventions for improved musculoskeletal health and overall well-being.
Head and Neck
Head Alignment: Normal is a centered head. Each inch of forward head posture increases the weight on the neck by 10 pounds.
Cervical Spine Curvature: Normal lordosis is 20-40 degrees. Excessive curvature can compress nerves and strain muscles.
Forward Head Posture: Ideally, the earlobe aligns with the shoulder. Each inch of forward shift significantly strains cervical spine structures.
Jaw Alignment and Tension: Normal alignment maintains occlusal balance; misalignment can affect cervical spine posture.
Shoulders and Thoracic Spine
Shoulder Level: Should be level in a normal posture. Imbalances can be a sign of scoliosis or muscular asymmetry.
Scapular Position: Normal is flat against the rib cage. Winging indicates serratus anterior weakness; protraction suggests tight chest muscles.
Thoracic Spine Curvature: Normal kyphosis is 20-40 degrees. Deviations can affect lung capacity and spinal loading.
Clavicular Angle and Symmetry: Ideally, clavicles are symmetrical. Asymmetry can indicate altered biomechanics in the shoulder girdle.
Lumbar Spine and Pelvis
Lumbar Curvature: Normal lordosis is 40-60 degrees. Abnormal curvatures can lead to increased spinal loading and pain.
Pelvic Tilt: Normal is a slight anterior tilt (about 10 degrees). Variations can lead to lumbar spine and lower limb issues.
Pelvic Rotation and Iliac Crest Levels: Asymmetry can result in functional leg length discrepancies, affecting gait.
Lower Extremities
Knee Alignment: Normal is a slight valgus angle (about 5-7 degrees). Varum or valgum significantly alters knee joint forces.
Patellar Position: Normal is in line with the second toe. Deviations can strain the patellofemoral joint.
Ankle and Foot Alignment: Normal is a slight foot arch. Flat feet (pes planus) or high arches (pes cavus) affect shock absorption and gait.
Arch Integrity: The medial longitudinal arch normally has a height of about 15mm. Compromised arches impact foot biomechanics.
Overall Posture and Balance
Plumb Line Assessment: In a Plumb Line Assessment, the ideal alignment is indicated by a vertical line that aligns the earlobe, shoulder, hip, knee, and ankle when viewed from the side. This alignment reflects a balanced distribution of forces across the joints, suggesting efficient biomechanical functioning.
Symmetry: Asymmetry can lead to compensatory changes and increased risk of injury.
Weight Distribution: Ideally, weight should be evenly distributed across both feet. This balance is crucial for maintaining proper posture and ensuring muscular symmetry. To evaluate this, observe the patient standing naturally and note if there's a tendency to lean more on one foot than the other.
Functional Movements: Observing movement patterns can reveal compensatory mechanisms or muscle weaknesses.
Major Posture Muscles & Joints
Before diving into manual therapy techniques and exercise interventions, it's essential to review some of the major postural muscles and joints. Understanding the roles and interrelationships of these key anatomical structures is fundamental in addressing postural imbalances. This foundational knowledge not only assists in effectively managing existing musculoskeletal conditions but also plays a crucial role in preventing injuries and enhancing overall physical health. Let's explore the primary muscles and joints that significantly contribute to maintaining our body's posture, as this understanding is vital for the subsequent application of manual therapy and exercise-based treatments.
Major Posture Muscles
Erector Spinae: These muscles, running along the spine, are essential for maintaining an upright posture and resisting the forces of gravity. They provide critical stabilization during spinal extension and are key in the prevention of lumbar flexion.
Rectus Abdominis and Obliques: These abdominal muscles play a significant role in trunk stability and balance, providing anterior and lateral support to the spine. They are integral in controlling the tilt of the pelvis and the curvature of the lumbar spine.
Gluteus Maximus: As a primary muscle in hip extension, the gluteus maximus is vital for stabilizing the pelvis during standing and walking. It counteracts the forward tilt of the pelvis and is instrumental in maintaining the alignment of the lower extremities.
Hamstrings: Positioned at the back of the thigh, the hamstrings are involved in hip extension and knee flexion, playing a crucial role in postural alignment by balancing the forces exerted by the quadriceps and maintaining the neutral position of the pelvis.
Quadriceps: These front thigh muscles are essential for knee extension. They provide stability to the knee joint and play a key role in shock absorption during gait, directly influencing the alignment and biomechanics of the lower limbs.
Trapezius: This upper back muscle is involved in stabilizing the shoulders and neck. It helps maintain scapular alignment and upper back posture, crucial for the balance and function of the cervical and thoracic spine.
Rhomboids: Working in tandem with the trapezius, the rhomboids retract and stabilize the scapulae, playing a critical role in maintaining upper back posture and preventing shoulder protraction and rounding of the upper spine.
Latissimus Dorsi: These large back muscles assist in stabilizing the shoulder and back. They are involved in movements that draw the arms towards the body’s midline and play a role in maintaining the structural integrity of the lower thoracic and lumbar spine.
Pectoralis Major and Minor: The chest muscles, particularly influential in the posture of the shoulders and upper back, can contribute to a forward-rounded posture if overly tight, affecting the overall alignment of the upper body.
Serratus Anterior: This muscle plays a vital role in scapular movement and positioning. It stabilizes the scapula against the thoracic wall, enabling effective arm elevation and rotation, and is crucial for maintaining shoulder alignment.
Iliopsoas: As a deep hip flexor, the iliopsoas is important in maintaining the curvature of the lower spine. It influences pelvic tilt and lumbar spine stability, playing a pivotal role in the balance and alignment of the lower body.
Major Posture Joints
Cervical Spine Joints: These joints enable head movement and support, facilitating a wide range of motions such as flexion, extension, rotation, and lateral bending. They play a critical role in maintaining the alignment of the head with the spine and directly influence the tension and alignment of the cervical musculature.
Shoulder Joints: Comprising the scapula, clavicle, and humerus, these joints are crucial for upper limb mobility. They allow for a vast range of movements including abduction, adduction, flexion, extension, and rotation, making them essential for the functional positioning of the arms and hands.
Thoracic Spine Joints: These joints provide stability and some mobility in the mid-back, supporting the rib cage and serving as an anchor for the spinal muscles. Their limited mobility is crucial for protecting vital organs while still allowing necessary movement for breathing and upper body motions.
Lumbar Spine Joints: Critical for lower back movement and support, these joints bear a significant portion of the body's weight and are involved in flexion, extension, and lateral bending motions. Their stability and health are key to preventing lower back pain and maintaining overall spinal alignment.
Hip Joints: As ball-and-socket joints, they provide movement and stability for the lower limbs. They support body weight in both static (standing) and dynamic (walking, running) conditions and are crucial for activities requiring lower body strength and flexibility.
Knee Joints: These hinge joints are crucial for lower limb movement, enabling flexion and extension necessary for walking, running, and jumping. They are also vital for absorbing shock during these movements, thus playing a key role in lower limb biomechanics.
Ankle Joints: Essential for foot mobility, these joints adapt to various surfaces during movement. They allow for dorsiflexion, plantarflexion, inversion, and eversion, playing a key role in balance, gait stability, and the effective transfer of forces from the lower limbs to the ground.
The interplay between these muscles and joints is integral to maintaining and correcting posture, ensuring functional movement and reducing the risk of musculoskeletal disorders.
The Role of Manual Therapy in Posture Correction
Manual therapy, correcting postural imbalances especially when combined with specific exercise routines. MSR effectively addresses myofascial adhesions, joint restrictions, and muscle muscle imbalances, greatly aiding in postural correction . MSR also promotes the body's own remodeling processes, improving tissue flexibility and joint movement for lasting posture improvement. Next, I'll present MSR videos targeting key structures involved in posture. These are select examples from a wider array of MSR techniques we apply to enhance musculoskeletal health.
Neck Adjustments or Neck Mobilization - The Choice Is Yours!
Most patients do not realize that they have choices in how restrictions in the joints of their necks are addressed. In this video Dr. Abelson shows you examples of Cervical Joint Mobilization.
Effective Shoulder Joint Mobilization
In this video, Dr. Abelson (the developer of MSR) demonstrates highly effective procedures for mobilizing the shoulder joint using the MSR technique.
Gluteus Maximus & Medius
In this video, Dr. Abelson demonstrates Motion Specific Release (MSR) procedures for releasing the Gluteus Maximus and Medius muscles. These muscles are not merely anatomical structures; they serve as functional pillars that influence a wide range of movements and activities, from athletic performance to injury prevention and posture.
Hamstring Muscle Release
In this video, Dr. Abelson demonstrates Motion Specific Release (MSR) procedures for releasing the hamstrings muscles. These muscles are not merely anatomical structures; they serve as functional pillars that influence a wide range of movements and activities, athletic performance to injury prevention and posture.
Exercise as a Tool for Postural Improvement
Exercise is a cornerstone in the quest to correct and enhance posture, acting as a vital complement to manual therapy. The role of targeted exercise is multifaceted, strengthening the musculature that supports proper alignment, increasing flexibility in tight areas that constrain movement, and enhancing the proprioceptive abilities that are crucial for maintaining an erect posture.
Strengthening Exercises:
Core Stability: Engaging in exercises that build a strong core, as these muscles are fundamental in stabilizing the spine and maintaining pelvic alignment.
Upper Body: Focusing on the upper back and shoulder muscles to counteract the forward slump and elevate the thoracic spine into its natural curvature.
Lower Body: Strengthening the glutes and lower extremities to support the alignment of hips, knees, and ankles, which directly affects the stability of the posture.
Flexibility and Range of Motion:
Dynamic Stretching: Implementing dynamic stretches to improve the range of motion, especially in the hip flexors and hamstrings, which can affect pelvic tilt and lumbar spine positioning.
Myofascial Release: Using foam rollers or balls to self-administer myofascial release, mitigating tightness and promoting muscle elasticity.
Proprioceptive Training:
Balance Exercises: Incorporating balance exercises that challenge the body's sense of position and stimulate the proprioceptive feedback mechanisms, which are essential for correcting automatic postural adjustments.
Functional Movements: Engaging in functional movement exercises that replicate daily or sports-specific activities to ensure that the body maintains proper posture during dynamic activities.
Exercise Demonstrations
The exercise videos provided here are illustrative of the types of exercises we may recommend to our patients. It's important to note that these are just examples from a broader range of exercises we utilize to assist our patients in improving their posture.
Correct Your Posture Now
There's no time like the present to improve your posture! Don't wait any longer. Poor posture can have negative impacts on both your physical and emotional wellbeing. Not only is it linked to lower self-confidence, decreased energy, and reduced alertness, but it can also impair lung function, circulation, and digestion, and cause significant musculoskeletal pain. Therefore, it's essential to correct your posture as soon as possible.
Myofascial Release For Upper Traps!
The function of the trapezius muscle is to stabilize and move the scapula. The upper trapezius elevates and upwardly rotates the scapula and extends the neck. It is a very common area to store tension, especially when working on a computer. Try the following self-myofascial release exercise you will enjoy the results.
5 of the Best Hamstring Exercises
The hamstring muscles are highly functional muscles that play several critical roles in musculoskeletal health. In addition to serving as powerful hip extensors, second only to the gluteus maximus muscle, the hamstrings also function as knee flexors, medial and lateral rotators, and important stabilizers of the knee joint.
Treatment Frequency for Postural Correction
The journey toward achieving and maintaining optimal posture involves a multifaceted approach that combines manual therapy and targeted exercises. Postural change is incremental and requires a systematic and evidence-informed treatment plan to guide the body through necessary adaptations.
Initial Phase of Postural Re-alignment:
Manual Therapy: One session of Motion Specific Release (MSR) manual therapy per week is recommended. This frequency supports the gradual realignment of the musculoskeletal system while allowing for tissue recovery between sessions. The first six weeks are crucial for initiating postural changes and establishing a foundation for further improvement.
Mobility Exercises: Daily mobility exercises are essential for enhancing joint range of motion and reducing stiffness. Regular movement facilitates the re-education of postural habits and supports the manual therapy process.
Strengthening Exercises: Strengthening exercises should be performed three times per week. This schedule allows for adequate muscle recovery while promoting the development of strength in postural muscles, which is vital for sustaining proper alignment.
Progression and Adaptation:
After six weeks, an assessment should evaluate the progression of postural improvements. Given positive developments, manual therapy can then be adjusted to once every two weeks for two months. This reduction acknowledges the body's ability to maintain and build upon the initial changes with less frequent intervention.
During this phase, continued adherence to the prescribed daily mobility and thrice-weekly strengthening exercises remains imperative to solidify the postural changes.
Long-term Management and Maintenance:
Once the desired postural alignment is achieved, it is essential to prevent regression. Therefore, transitioning to a maintenance phase is necessary to ensure the longevity of postural corrections.
Maintenance Manual Therapy: After the intensive initial and progression phases, manual therapy sessions may be spaced further apart, with sessions recommended monthly or as clinically indicated based on the individual's lifestyle, activities, and any arising postural challenges.
Ongoing Exercise Regimen: The daily mobility exercises should remain a fixture in the individual’s routine. The strengthening exercises, while possibly adjusted for intensity or complexity, should continue to be performed three times per week to maintain muscle tone and support the established postural alignment.
It is critical to understand that each individual's response to treatment can vary. Regular assessments provide the feedback necessary to tailor the frequency of manual therapy and exercise prescriptions. Adherence to the recommended regimen is vital for achieving and maintaining postural improvements.
Conclusion
In the digital age, where sedentary lifestyles and poor ergonomics are prevalent, understanding and maintaining proper posture is more crucial than ever. Good posture is a bedrock of musculoskeletal health, impacting everything from respiratory function to spinal health. Yet, postural imbalances are common and can lead to persistent discomfort and a lower quality of life. This article has explored the transformative power of manual therapy and exercise in realigning the body's posture for sustained health and functionality, emphasizing that posture is not just an aesthetic concern but a critical aspect of overall well-being.
Manual therapy is a cornerstone in treating postural imbalances, targeting myofascial adhesions, joint stiffness, and muscle dysfunction. Coupled with exercise, it aids in long-term postural improvements. The role of exercise is multifaceted, enhancing muscular strength, flexibility, and proprioception—all vital for maintaining an upright posture. The videos presented here demonstrate just a fraction of the exercises and MSR techniques we deploy to address postural issues.
DR. BRIAN ABELSON DC. - The Author
Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.
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References
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Clark, Micheal, Lucett, Scott. "NASM Essentials of Corrective Exercise Training." Lippincott Williams & Wilkins, 1st edition, 2010.
Cook, Gray. "Movement: Functional Movement Systems: Screening, Assessment, Corrective Strategies." On Target Publications, 1st edition, 2010.
Hammer, Warren I. "Functional Soft-Tissue Examination and Treatment by Manual Methods." Jones & Bartlett Learning, 3rd edition, 2007.
Hertling, Darlene, and Kessler, Randolph M. "Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods." Lippincott Williams & Wilkins, 4th edition, 2006.
Jull, Gwendolen, et al. "Whiplash, Headache, and Neck Pain: Research-Based Directions for Physical Therapies." Churchill Livingstone, 1st edition, 2008.
Kendall, Florence Peterson., et al. "Muscles: Testing and Function, with Posture and Pain." Lippincott Williams & Wilkins, 5th edition, 2005.
Liebenson, Craig. "Rehabilitation of the Spine: A Practitioner's Manual." Lippincott Williams & Wilkins, 2nd edition, 2006.
McGill, Stuart. "Low Back Disorders: Evidence-Based Prevention and Rehabilitation." Human Kinetics, 3rd edition, 2015.
Myers, Thomas W. "Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists." Churchill Livingstone, 3rd edition, 2013.
Neumann, Donald A. "Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation." Mosby Inc., 2nd edition, 2009.
Page, Phil, Frank, Clare C., Lardner, Robert. "Assessment and Treatment of Muscle Imbalance: The Janda Approach." Human Kinetics, 1st edition, 2010.
Sahrmann, Shirley. "Diagnosis and Treatment of Movement Impairment Syndromes." Mosby Inc., 1st edition, 2001.
Stecco, Carla, Stecco, Antonio. "Fascial Manipulation for Musculoskeletal Pain." Piccin Nuova Libraria, 1st edition, 2004.
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