Posture stability and Balance

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Posture stability and Balance
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Posture

• Principles
• Definition of good posture
• Examples of poor posture

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Posture

• Inherent to concept of posture are alignment and
  muscle balance
• Good mechanics require that joint ROM be
  adequate, but not excessive
• The more flexibility, the less stability
• The more stability, the less flexibility
• Why do only some people get pain?
• Posture may be faulty, but individual has
  mobility so position can change readily
• Posture may appear good, but mobility lacking so
  position cannot change readily

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Mechanical Imbalance

• An alteration of structure and function which is
  reflected in combinations of muscle tightness and
  weakness, ligamentous laxity and/or poor
  alignment of body segments

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Posture - Principles

• Faulty alignment results in undue stress on
  bones, ligaments and muscle
• Adaptive shortening can develop in muscles that
  remain in a shortened condition
• Stretch weakness can occur in muscles that remain
  in elongated conditions

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Mechanical Imbalances

• Kyphosis-lordosis posture
• Flat back posture

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Kyphosis-Lordosis Posture

• increased lumbar lordosis, promotes a forward
  pelvic tilt and a slightly flexed position of the
  hip
• Leads to increased stress on L4L5 disc and facets
  and the sacroiliac (SI) joints
• cause early recruitment of the lumbar extensors
• increased knee flexion at heel strike increasing
  the potential for patellar tendon and patellar
  femoral joint injuries

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Posture types

• Normal sway Kyphotic flat

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Kyphosis-Lordosis Posture

• Head forward
• Cervical spine hyperextended
• Scapulae abducted
• Thoracic spine increased kyphosis
• Lumbar spine increased lordosis
• Pelvis anterior tilt
• Hip flexed
• Knee slightly hyperextended
• Ankle slight plantarflexion

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Kyphosis-Lordosis Posture

• Elongated and weak
• Neck flexors, upper ES, external obliques
• Elongated, may be weak
• hamstrings
• Short and Strong
• Neck extensors, hip flexors
• Strong, may be short
• Lumbar ES

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Posture
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Flat-back Posture

• Head forward
• Cervical spine slightly extended
• Thoracic spine upper increased flexion lower
  straight
• Lumbar spine flattened (flexed)
• Pelvis posterior tilt
• Hip extended
• Knee extended
• Ankle slight plantar flexion

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Flat-back Posture

• Elongated and weak
• One-joint hip flexors Short and Strong
• Hamstrings, upper fibers of internal oblique
• Strong, not short
• Lumbar ES

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General population

• Swayback Approximately 30 of men and 20 of
  women.
• Kyphosis-Lordosis Approximately 20 of women and
  15 of men.
• Flatback Approximately 10 of men and women.
• Only 5 of persons may have the optimal posture
  depicted to the left, with a further 15 coming
  reasonably close

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Summary

• Postures that deviate from ideal can produce
  adaptive shortening, strengthening, elongating
  and weakening that can affect structures quite
  distal to the poor posture culprit
• Use a postural assessment to guide your specific
  assessment and treatment plans, especially for
  chronic, non-traumatic problems

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Regaining postural stability and balance

• CoG is located just above your pelvis. In
  order to remain balanced, your CoG must remain
  within the limit of stability LOS.
• balance is the ability to maintain the bodys
  segments in alignment within a limit of
  stability (LOS).
• Balance is the single most important element
  dictating movement strategies with in the closed
  kinetic chain.

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Regaining postural stability and balance

• Is both
• Static
• Dynamic
• Dynamic for example, walking, climbing stairs, etc

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MOVEMENT STRATEGIES

• What are the 3 movement strategies that are used
  by the body to maintain the CoG within a stable
  base of support?
• 1. ankle
• 2. hip
• 3. stepping

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MOVEMENT STRATEGIES

• When would each strategy be used?
• Ankle when small, slow movements, close to CoG
• Hip larger, quicker movements required. Also if
  CoG gets closer to LOS.
• Stepping if CoG gets out of Limit Of Stability.

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INJURY AND BALANCE

• Studies of the knee and ankle show that there is
  a decrease in proprioceptive feedback from
  damaged ligaments to the CNS (sensory/afferents).
• Therefore, is decreased reflex excitation of
  motor neurons (efferents) to the muscles
  responsible for preventing sway/controlling
  balance.

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BALANCE TRAINING

• MUST improve the balance and postural equilibrium
  of the athlete in order for them to return safely
  and effectively to the playing field.

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BALANCE TRAINING

• General rules when developing a balance training
  program
• Exercises must be safe, yet challenging
• Stress multiple planes of motion
• Incorporate a multi-sensory approach
• Begin with static, bilateral, stable. Progress
  to dynamic, unilateral, unstable.
• Progress to sport-specific

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BALANCE TRAINING

• CLASSIFICATIONS OF BALANCE TRAINING/EXERCISES
• 1. static
• 2. semi-dynamic
• 3. dynamic
• 4. functional

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BALANCE TRAINING

• static
• CoG is maintained over fixed base of support on a
  stable surface.
• i.e. Rhomberg tests

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• 2. semi-dynamic 2 types
• (a) maintain CoG over fixed base of support while
  on moving surface or unstable surface
  (BAPS/Wobble board)
• (b) transfer CoG over a fixed base of support to
  areas within the LOS while standing on a stable
  surface (pick up pens)

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BALANCE TRAINING

• 3. dynamic
• CoG maintained within the LOS, while over a
  moving base of support on a stable surface.
• Requires a stepping strategy
• i.e. hopping, walking on a balance beam

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Balance Training

• 4. functional
• same as dynamic, except also have sport specific
  tasks included.
• i.e. catching/throwing a ball while running.