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Posture stability and Balance
Posture
PrinciplesDefinition of “good” postureExamples of poor posture
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
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
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
Mechanical Imbalances
Kyphosis-lordosis posture
Flat back posture
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
Posture types
Normal sway Kyphotic flat
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
Kyphosis-Lordosis Posture
Elongated and weakNeck flexors, upper ES, external obliques
Elongated, may be weakhamstrings
Short and StrongNeck extensors, hip flexors
Strong, may be shortLumbar ES
Posture
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
Flat-back Posture
Elongated and weakOne-joint hip flexors Short and StrongHamstrings, upper fibers of internal
obliqueStrong, not short
Lumbar ES
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
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
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 body’s 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.
Regaining postural stability and balance
Is both StaticDynamic
Dynamic for example, walking, climbing stairs, etc
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. ankle2. hip3. stepping
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.
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.
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.
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
BALANCE TRAINING
CLASSIFICATIONS OF BALANCE TRAINING/EXERCISES
1. static:2. semi-dynamic:3. dynamic:4. functional:
BALANCE TRAINING
static:CoG is maintained over fixed base of
support on a stable surface. i.e. Rhomberg tests
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)
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
Balance Training
4. functional: same as dynamic, except also have sport
specific tasks included. i.e. catching/throwing a ball while running.