Therapeutic Kinesiology:Musculoskeletal Systems, Palpation, and Body Mechanics

Therapeutic Kinesiology Instructor Manual: Ch07 p.1 TK INSTRUCTOR MANUAL: CHAPTER 7 Posture Chapter manuals include: Objectives Lecture Notes Suggested Classroom and Student Development Activities For other chapter-by-chapter resources, see: Key Term Quizzes Muscle Origin and Insertion Worksheets Muscle OIAs List by Chapter MyTest Test Bank For additional resources see “Teaching Tips and Tools”: 7 research-based learning principles for kinesiology courses in massage 5-step self-directed learning cycle for body mechanics courses Tools that build metacognitive skills: e.g., concept (mind) maps, grading rubrics, and self-assessments inventories OBJECTIVES Define posture and describe the components of optimal upright posture. Name two postural reflexes and describe how they work. List and briefly describe architectural features of the spine, pelvis, shoulders, and head. Describe how each of the three movement systems contributes to postural support. Describe how postural muscles work as joint stabilizers. Describe a stability dysfunction, a substitution pattern, and how they affect a pain cycle. Define and contrast primary and secondary postural stabilizers. Discuss why mobilizer muscles function poorly as postural stabilizers. List and define three directions that spinal curvatures deviate from optimal alignment. Name and describe five patterns of faulty posture. List and describe two common alignment problems in the knees. Describe how a postural assessment is made. List five steps for changing faulty posture. Describe how posture affects body mechanics. LECTURE NOTES COMPONENTS OF POSTURE Posture is the relative body alignment in any position To posture is to take a stance Postures reflect an individual's psychological state Optimal upright posture COGs align along LOG over BOS Weight-bearing joints are in extension Dynamic postural reflexes Postural sway Normal, swaying motion when standing Mediated by tonic stretch reflexes Important for venous return from legs Righting reflexes that bring head over body Optical righting reflexes: Mediated by vision Head-righting reflexes: Mediated by inner ear equilibrium apparatus Ideokinesis: Process of changing posture and movement with imagery Use images and lines of movement from posture laboratory Images must be anatomically sound Begin each exercise from relaxed state Inhibit voluntary effort before initiating motion Skeletal architecture Spine as curved column Curves absorb shock Curves are resilient under vertical loading/axial compression Spinal alignment depends on: Maximal length in curves Vertical stacking of body masses (head, thorax, pelvis) Pelvis as braced arch Two vertical columns buttress against two diagonal blocks Triangular keystone in center of arch Pelvic alignment and efficient force transmission depend on: Alignment of lower limbs under pelvis Alignment of spine over pelvis Shoulders as hanging yoke Clavicles provide horizontal struts for yoke Arms hang like buckets off sides Shoulder alignment and movement efficiency depend on: Neutral spine, optimal alignment Balanced tensional pulls in shoulder muscles Head as top load Head rests as top load on spine Spine forms dimensional cross with shoulder yoke Head/neck alignment and movement depends on Head being centered over thorax Spine optimally aligning in neutral Shoulder girdle balancing in horizontal Role of movement systems in posture A three-legged system that includes: Passive restraints of ligaments and joint capsules Active forces of muscular contractions Motor control from nervous system When one system fails, other two compensate Problems with eccentric loading in spine Occurs when muscles contract eccentrically to support off-centered body mass Caused by flexed postures in spine Creates bending stresses; the most damaging Examples: kyphosis and forward head posture Muscles become taut and fibrous, stretch-weakened MUSCLE PATTERNS IN UPRIGHT POSTURE Standing posture is remarkably economical Minimal muscular effort supports vertical axis Maximal economy occurs when COGs stack vertically Economy lost when and body mass strays from vertical Postural stabilizers Muscles that support optimal posture/joint neutral Muscles that stabilize weight-bearing joints Characteristics of muscles that work as postural stabilizers Have more slow fibers Are fatigue resistant Produce light, sustained isometrics Tend to be smaller, uniaxial, core muscles Stability dysfunctions and joint instability Stability dysfunction: Tissue trauma from joint instability Joint instability: Inability to control joint motion in normal range Often caused by inhibited postural stabilizers Results in faulty NM coordination evident in faulty movement Results in excessive joint play Leads to pain from stability dysfunction Substitution patterns Muscular compensations to joint instability Mobilizers chronically contract to provide postural support Also called compensatory or adaptation patterns Dynamics of substitution patterns in pain cycle Postural stabilizers fail to fire, become inhibited Adaptive shortening in mobilizers results in muscular fatigue and trigger points Delayed recruitment timing causes faulty NM coordination Causes joint instability, poor posture, faulty movement Escalates into stability dysfunction and injury Steps in pain cycle from stability dysfunction Mobilizers locked in substitution pattern develop fatigue Mobilizers become ischemic and fibrous Mobilizer dysfunction causes more pain Increased pain causes stabilizer inhibition Stabilizer inhibition results in mobilizer spasm Spasm escalates and perpetuates pain cycle Postural stabilizers and core control Core control: Ability to contract core muscles at will Core muscles work as primary postural stabilizers Postural muscles in the lower body Tibialis posterior: Lifts medial arch Soleus: Stabilizes body during forward postural sway Vastus medialis oblique: Stabilizes patella Perineum: Supports pelvic viscera Transversus abdominis: Stabilizes lumbar and sacroiliac joints Psoas major: Stabilizes anterior lumbar spine Seats head of femur in socket Lumbar multifidus: Stabilizes posterior lumbar spine Postural muscles in upper body Lower and middle trapezius: Maintains scapula neutral Serratus anterior: Maintains scapula neutral Longus colli: Stabilizes anterior cervical spine Cervical multifidus: Stabilizes posterior cervical spine FAULTY POSTURES AND SPINAL CURVATURES Two general patterns of faulty posture Lifted up, hypertonic, and rigid: Military posture Sunken, hypotonic collapsed Kyphoticlordotic posture All curves collapse and increase Low postural tone Sway-back posture Upper body sways behind lower body Pelvis tucks Head thrusts forward to counterbalance Flat-back posture Posterior pelvic tilt and flattened lumbar curve Examples: dowager’s hump and forward head posture Examples: anterior thoracic curve and flattened cervical curve Round-back posture Excessive thoracic flexion, exaggerated kyphosis Two types of round-back posture Functional: From poor posture Congenital (e.g., Scheuermann's disease) Scoliosis Lateral curvature of spine Involves a combination of flexion and rotation Two types of scoliosis Acquired: From asymmetrical muscle use Congenital: From genetic coding Creates deformities of vertebrae and ribs Can compress heart and lungs Severe compression requires surgical intervention Torticollis From damage to sternocleidomastoid Head tilts to one side in "wry-neck" Causes scoliosis in cervical spine Alignment problems in lower limb Hyperpronation Medial arch flattens Often occurs with genu valgum (knock-knees) Hypersupination Medial arch lifted Often occurs with genu varum (bow-legs) POSTURAL ASSESSMENTS Structural postural assessments Observe from front and back To check bilateral markings To assess symmetry/asymmetry To check for scoliosis To check leg dominance Observe posture from side To check how body masses align along a plumb To check for lordotickyphotic tendencies To assess core support or failure of postural muscles Observe body in supine position Assess horizontal grounding/client's ability to relax Assess resting muscle length Assess resting joint alignment Compare spinal alignment in standing and seated postures Assess muscular tensions in both positions Torque in standing but not seated spine From imbalance in lower limbs Vice versa also applies Assessing skeletal alignment Assess direction joints deviate from neutral Assess degree that joints deviate from neutral Assessing muscle function Assess which muscles are adaptively shortened Assess which muscles are stretch-weakened Assess which postural muscles are inhibited Determining source of faulty posture Structural From bony deformities (e.g., hemi-pelvis) From genetic anomalies (e.g., Scheumann’s disease) Functional From muscular imbalances From poor postural habits Client-centered postural assessments Focus on what client perceives Cultivate self-awareness as a tool for change Relate posture to body problems Determine what improves/worsens posture THERAPEUTIC APPLICATIONS FOR POSTURAL EDUCATION Steps in postural education Developing kinesthetic awareness of body alignment Shifting skeletal alignment into joint neutral Training postural muscles to support joint neutral Relaxing and stretching overworked muscles Integrating postural awareness into daily activities Applying postural education to body mechanics Effective body mechanics rely on optimal posture Train postural stabilizers to support joint neutral Work on postural awareness during daily activities Use mirrors for feedback about posture Integrating postural education into bodywork sessions Gives clients tools for change Teach clients postural muscle isometrics Integrate with hands-on stretching and repositioning Enhances bodywork by improving NM patterns Challenges with postural corrections Negative feedback can evoke overcorrection of posture Postural overcorrections often make posture worse Overcorrecting increases holding patterns Dealing with challenges to postural corrections Find out how clients perceive their posture Study your own posture and perceptions Study how realignment of one area affects another Make subtle corrections Practice moving between old and new pattern SUGGESTED CLASSROOM AND STUDENT DEVELOPMENT ACTIVITIES PROVIDE AN OVERVIEW OF THE CLASS Before class, write a short, schematic overview of the class on the board, then go over it at the beginning of class. For example: Today's class covers: Components of posture Muscle patterns in upright posture Faulty postures Postural assessments Therapeutic applications for postural education Activities: Review, lecture, posture lab, recap, and homework GOING OVER GUIDELINES EXERCISES The use of imagery in postural education (p. 158) Checklist for assessing posture (p. 172) Client communication around postural problems (p. 174) Helping clients develop postural awareness (p. 176) DIGITAL PICTURE POSTURE ASSESSMENT Have students take digital pictures of themselves in a side view, in a bathing suit or tight clothes that show the outline of the body, then bring the picture to class. Have students bring pictures to class, then get in groups of three with their pictures. Each group will study the pictures by drawing three oval circles over each body mass (see Figure 7.34), then drawing a plumb line over the center of each photo (see Figure 1). Pencils with erasers and rulers would enhance this exercise so that students can correct mistakes. Have students discuss postural patterns in photos by identifying where the body masses have tipped off a neutral position and describing the overall effect on posture. Students should describe where and how a body mass has strayed in what direction. Then have the students describe the compensatory pattern, where a part of the body has shifted in the opposite direction to counterbalance. Have a student from each group present to the entire group. Moderate the discussion to make sure students stay on task and that you cover all the patterns you want to describe. SELF-CARE EXERCISES Postural sway for fluid body mechanics (p. 155) Lower back protection with the transversus abdominis (p. 165) Training the postural stabilizers (p. 175) Centering your body over your feet (p. 177) POSTURE LAB ASSESSMENT NAME: ___________________________________ PARTNER: ___________________________________ Get together with a study partner and answer the following questions. Get feedback from your partner and study your digital pictures together. Turn in the digital pictures with this assessment. I. What are the best features of your posture? ___________________________________________________________________________________________ ___________________________________________________________________________________________ II. Describe your general level of body awareness. ___________________________________________________________________________________________ ___________________________________________________________________________________________ III. In a quiet standing posture, do you feel a slight postural sway? ______ Describe what it feels like. _____________________________________________________________ III. Do you have injuries or health problems that affect your posture? _______ If so, it is not required that you disclose these issues, but if you would like to share them, please do. ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ When viewing yourself from the side: Where do you feel weight on your feet? ________________________________________________ Are your feet directly under, behind, or in front of your pelvis and hips? _____________________ Are your knees extended, flexed, or hyperxtended? ____________________________ Are your hips extended, flexed, or hyperextended? ____________________________ Is your pelvis level or does it tilt? ____________ If it tilts, in what direction?____________________ Is your thorax level or does it tilt? ____________ If it tilts, in what direction? ___________________ Is your head centered over your thorax or forward of your thorax? _________________________ Does your cervical spine have a normal, flattened, or exaggerated curve? _____________________ Does your lumbar spine have a normal, flattened, or exaggerated curve? ______________________ POSTURE LAB ASSESSMENT, cont. p.2 Does your thoracic spine have a normal, flattened, or exaggerated curve? _____________________ Is your sternum lifted or sunken? __________________________________ Do your hands rest slightly in front of, beside, or behind your trunk? ________________________ Are your upper palate and occiput level? _______________ If not, do you tend to tilt your head down or up? _______ Is your jaw relaxed? _________ Is there a slight space between your molars or do you clench your teeth? _________ Does your rib cage and spine move as you breathe? __________ If so, how? ___________________ When viewing yourself from the front and back: Are your feet symmetrically positioned? ______ In what direction is each foot facing—forward, toed in, or toed out? ____________________________________________________________________ Are your feet pronated? _________________ Supinated? ___________________________ Are your knees symmetrical? ______ In what direction are your kneecaps pointing—straight ahead, toward each other, or sideways? ________________________________________________________ Are your hips symmetrical? _____ Are they turned out or turned in? __________________________ Is one hip higher than the other? _________ If so, which one? ________________________ Are your shoulders level? _________ If not, which one is higher? ______________________ Do your arms hang vertically from your shoulders or do you hike your shoulders? _____________ Is your chest wide in both the front and back? ______________ Are your shoulders rounded and protracted? ______________________ Do your scapulae lie flat against your rib cage? ____________ Are your scapulae symmetrical? _______ If not, describe how they differ. ____________________ In which direction do the palms of your hands face? __________________________ Are your clavicles horizontal and symmetrical? ________ If not, how are they positioned? ________________________________________________________________________________ POSTURE LAB ASSESSMENT, cont. p.3 General Questions and Corrections 1. How would you describe your overall postural pattern (e.g., well balanced, military and rigid, kyphoticlordotic and low-tone, sway-back, flat-back, round-back, or scoliotic )? ____________________________________________________________________________________________ 2. Using the nine lines of movement on page 158, which imaginary line(s) would help move your body toward a more balanced posture? ___________________________________________________________________________________________ 3. What are the three most important corrections you need to make to improve your posture? ___________________________________________________________________________________ ___________________________________________________________________________________ 4. What muscle groups do you need to strengthen and what muscle groups do you need to stretch to improve your posture? ____________________________________________________________________________________ ____________________________________________________________________________________ © 2013 by Education, Inc. Foster, Instructor Resources for Therapeutic Kinesiology