Postures, Appearance, and Muscle Imbalance

1
Postures, Appearance, and Muscle Imbalance

• Chapter 14

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Introduction

• Important objective for fitness/wellness
• Physical attractiveness
• Strength and flexibility fitness goals should
  take into consideration postures
• We assume many postures each day and they are
  connected

3
Good Postures Strength and Flexibility

• Mechanically efficient body positions and
  movement patterns
• Balance between strength and flexibility
• Major principle of postures training is to
  strengthen the extensors (antigravity muscles)

4
Assessment of Postures

• Examination of muscle balance or alignment of
  body parts
• Persons with paralysis and spasticity are at
  higher risk of severe alignment problems
• Imbalances can be minimized by strapping,
  bracing, casting, and surgery
• Proper positioning is essential

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Spinal Column Curves

• Mature development of the spinal column by age 7
  or 8 includes the following curves
• Concave - cervical spine
• Convex - thoracic spine
• Concave - lumbar spine
• Convex - sacral spine

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Analysis of Muscle Imbalance

• Muscles on which surface are too tight?
• Which stretching exercises are indicated?
• Muscles on which surface are too loose?
• Which strengthening exercises are indicated?
• What role is gravity playing in the muscle
  imbalance?

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Normal Postural Development

• Cervical spine - 4 to 5 months of age
• Lumber spine - after the child learns to walk
• Flat back - normal in children until age 3 or 4
• Lordosis - normal in young children and lessens
  by adolescence
• Winged scapulae a prominence or protrusion of the
  scapulae is normal until adolescence

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Posture Training Guidelines

• Develop short-term objectives
• Use game-like activities that focus on particular
  muscle groups
• Use kinesthetic, vestibular, and visual sense
  modalities
• Emphasize full extension activities
• Use relaxation

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Contraindicated Exercises

• Straight leg lift and hold
• Straight leg sit-ups
• Push-ups
• Swan
• Deep knee bends and duck walk
• Straight leg toe touch and bear walk

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Behavior Management and Postures

• Suitable for some posture problems
• Utilizes auditory and vibrotactile feedback when
  user slouches or moves out of alignment
• Utilizes auditory reinforcement when user
  maintains the appropriate posture

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Forward Head and Neck

• Diagnosed when the earlobe is no longer in
  alignment with the tip of the shoulder
• Mild - head droops forward
• Severe - round back, hyperextended cervical
  spine, increased dorsal convexity of thoracic
  spine
• Dowagers hump - develops to the point of having
  a prominent seventh cervical vertebra and excess
  adipose tissue

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Exercises That Help

• Strengthening of extensors if mild
• Stretching cervical extensors if severe
• Chin-to-shoulder touch stretch
• Lateral flex stretch with ear touch
• Halo push
• Object-on-head walk

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Contraindicated Exercises

• Circling the head
• Neck hyperextension
• Activities related to atlantoaxial instability
  when working with individuals with Down syndrome

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Excessive Head Tilt

• Top of head tilting toward the right - right tilt
  (RT)
• Top of head tilting toward the left - left tilt
  (LT)
• May be symptomatic of vision or hearing
  impairments
• Can cause adaptive shortening and tightening of
  the neck muscles on the side of the tilt
• Lateral flexion exercises opposite of tilt
• Slow, static stretch and hold is effective

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Kyphosis

• Increasing backward convexity in the thoracic
  region
• Associated with disease of the intervertebral
  disks or of the epiphyseal area of the vertebrae
• Scheuermanns disease affects adolescents
• Osteoporosis - affects older people, especially
  women

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Lordosis

• Exaggeration of the normal posterior concave
  curve in the lumber region
• Throws the pelvis out of correct alignment
• Various causes
• Established characteristics
• Correction includes increasing proprioceptive
  awareness and increasing abdominal strength

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Abdominal Weakness

• Various classifications
• Abdominal protrusion is typical in young children
  and those who lead sedentary lifestyles
• Often accompanies obesity and paralysis
• Daily abdominal exercises and full extension
  activities are recommended

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Abdomen and Lower Back Exercises

• Adhere to exercise principles for abdomen and
  lower back
• Various exercises in the creeping position
• Various exercises in the supine or bent-knee
  sit-up position

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Values of Abdominal Exercises

• Relieve congestion in the abdominal or pelvis
  cavities
• Relieve menstrual pain
• Strengthen muscles needed for coughing in asthma
  and respiratory diseases
• Strengthen muscles to improve appearance and
  function

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Flat Back

• Decrease or absence of the normal anteroposterior
  curves
• Opposite condition from lordosis
• Associated with the debutante slouch
• Characteristic of body build of young toddlers
• Various exercises are beneficial

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Scoliosis

• Lateral curvature of the spine
• Keynote positions
• Adams position - relaxed forward bending held
  for several seconds from a standing posture
• Hanging with both arms from a horizontal bar
• Symmetrical arm raise from a standing position
• Exercises prescribed by a physician

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Scoliosis

• Lateral curves are named in terms of the
  direction of their convexity
• Left curve is most common
• Adhere to exercise principles for scoliosis
• More prevalent in girls
• Causes are idiopathic
• Treatments include bracing and surgery

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Uneven Shoulder Height

• Higher shoulder recorded as LH (left high) or RH
  (right high)
• Assessment using a horizontal line on the wall
• Check lateral spinal curve
• Typically dominant side of body has slightly
  depressed shoulder and slightly higher hip

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Uneven Hip Height

• Higher hip recorded as LH or RH
• Use anterior superior iliac spines as anatomical
  landmarks
• Can be caused by scoliosis, uneven leg length, or
  the habit of standing on one leg for long periods
  of time

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Winged Scapulae

• Prominence of the inferior angles of the scapulae
• Serratus anterior is usually weak
• Typical in preschool and elementary children
• May be associated with round shoulders,
  congenital anomalies, and postural conditions in
  which the ribs protrude

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Round Shoulders

• Forward deviation of the shoulder girdle that
  brings the acromion processes in front of the
  gravitational line
• Caused by the strength of the shoulder girdle
  abductors being greater than that of the
  adductors
• Incidence high among persons who work desk jobs

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Round Shoulders

• Athletes often have overdevelopment of muscles
  that cause round shoulders
• Various compensations in alignment as a result
• Stretching and strengthening exercises stress
  shoulder girdle abductors and adductors

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Deviations of the Chest

• Associated with asthma, other chronic upper
  respiratory disorders and rickets
• Limitations in chest flexibility and improper
  breathing practices
• Degree of severity varies
• Often associated with congenital anomalies

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Hollow Chest

• Most common
• Depression of the anterior thorax accompanied by
  round shoulders and/or kyphosis
• Linked to the failure of the neck and pectoral
  muscles to exert their usual lifting effect on
  the ribs and sternum

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Barrel Chest

• Occurs in persons with severe, chronic asthma who
  become permanently hyperventilated because of
  their inability to exhale properly
• Lateral widening of the thorax from side to side
  so that it no longer resembles a barrel occurs
  normally as a result of play

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Funnel Chest

• Abnormal increase in the lateral diameter of the
  chest with a marked depression of the sternum and
  anterior thorax
• Usually a congenital anomaly
• Appears in many persons with severe mental
  retardation
• Also caused by rickets or severe nasal
  obstruction
• Associated with Turner and Noonan syndromes

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Pigeon Chest

• Abnormal prominence of the sternum
• Rare, caused by rickets during the early growth
  period
• May also be congenital
• Associated with les autres conditions like
  osteogenesis imperfecta

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Alignment of Lower Extremities

• Quick screening device -- Four Coins
• Individual differences in leg alignment and in
  locomotor patterns are largely dependent upon the
  hip joint
• Can be traced to a strength imbalance in the
  muscles that rotate the femur at the hip joint

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Hip Joint Problems

• How the head fits into the acetabulum determines
  function and stability
• Affects leg alignment and gait
• Abnormal positioning of the femoral head
• Coxa vara - decreased angulation
• Coxa valga - increased angulation
• Corrected by casting, bracing, and surgery

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Knee Joint Problems

• Congenital or acquired through injury
• Malalignment increases risk of osteoarthritis
• Long-term obesity can injure knee joint
• Weight-bearing exercises are often
  contraindicated for obese persons

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Bowlegs (Genu Varum)

• Inward bowing of one or both legs
• Typical in children under age 2
• Blounts disease or tibia vara
• Outward bowing of the tibia caused by retarded
  growth of the epiphyseal plates
• May complicate other disorders
• No exercises are recommended

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Knock-Knees (Genu Valga)

• Bending outward of the lower leg so that the
  knees touch, but ankles do not
• Occurs in obese person and predisposes the knee
  joint to injury
• Developmentally normal in children under 7
• Stretching and strengthening exercises may be
  prescribed

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Hyperextended Knees

• Knees are pulled backward beyond their normal
  position
• Contributes to lordosis
• Caused by knee extensor weakness, tight calf
  muscles, Achilles tendon contractures, and bony
  abnormalities
• Severe cases - prescription of a knee-ankle brace
• Contraindicated activities

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Tibial Torsion

• Tibia is twisted and the weight-bearing line is
  shifted to the medial aspect of the foot
• Often accompanies knock-knees, flat feet, and
  pronated feet
• Congential tibial torsion is corrected in infancy
  with casts, braces, splints, and/or surgery

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Deviations of the Feet

• Poor alignment in any part of the body affects
  the weight-bearing function of the feet
• Obesity increases the stress on the joint
• Abnormal formation of the bones, weak, or
  paralyzed leg and foot muscles affect alignment

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Toeing Inward

• Caused by strength imbalance in the hip joint
  muscles
• Associated with scissors gait in cerebral palsy
• Exercises include stretching inward rotators and
  strengthening outward rotators

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Toeing Outward

• Occurs when the posterior group of muscles on the
  sacrum is stronger than the prime movers for
  inward rotation
• Common for toddlers, elderly, blind, and others
  unsure of footing to widen stance
• Exercises include stretching outward rotators and
  strengthening inward rotators

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Supination and Pronation

• Typical walking patterns include slight
  supination
• Pronation is taking the weight of the body on the
  inner border of the foot
• Flat foot is a related disorder
• Corrective shoes and exercises prescribed by
  physicians

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Flat Foot (Pes Planus)

• Congenital flat foot may not be considered a
  postural deviation
• Severity of combined flat foot and pronation
  disorders diagnosed using
• Feiss line method
• Helbing sign method
• Stretching and strengthening exercises may be
  prescribed

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Pain Centers

1. Sole of the foot under the metatarsophalangeal
   joints
2. Sole of the foot close to the heel where the
   plantar ligaments attach to the calcaneus
3. Under the surface of the navicular
4. Middorsum, where shoelaces tie
5. Outer surface of the sole of the foot, where most
   of the weight is borne

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Syndactylism

• Extra toes, the absence of toes, or the webbing
  of toes
• Affects mechanical efficiency, especially the
  absence of the big toe
• Learn compensation
• Webbing is usually corrected surgically
• Extra toes may be removed

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Hallus Valgus (Bunion)

• Marked deviation of the big toe toward the four
  lesser toes
• Bursa changes as a result of pressure
• Enlarged bursa is called a bunion
• Inflamed bursa - bursitis
• Deposit of calcium - exostosis