Posture is the alignment of our weight-bearing joints under the constant pressure of gravity. It is a snap-shot in time, in that it changes whenever we shift or change position. The importance of static postures are most telling, because they provide information about muscle and nerve function. They correlate with general health, confidence and emotional well being.
You may see reference to posture as different from alignment, but they are inter-related. Posture most often refers to spinal alignment, and the influence of gravity is paramount. Otherwise alignment is usually joint specific alignment, referenced by the joints above and below the joint of interest. Joint alignment, especially of lower limbs, very much influences spinal alignment. Although posture can influence every injury and pain presentation, it has a heightened relevance for posture pain presentations and repetitive strain injuries. For these clients, they can’t get truly better without dealing with their posture issues.
In the clinic, postural dysfunction presents in two main ways: it directly causes pain or it complicates a diagnosis. When poor posture causes pain, it can be difficult to determine the source, because the site of pain hurts under some conditions, but may not be inflamed or sore to direct touch. An example of this is a client with knee pain, who does not test positive to the usual knee stress tests and whose knee only hurts while hiking. Further assessment might reveal a tight hip, same side or other side or positive findings in other, non painful joints, etc. The possible presentations are endless.
Repetitive Strain Injuries
These are generally considered to be the result of overuse, repeating the same movement repeatedly, very often related to work, sports or other recreational activity. These injuries are often given a named diagnosis, such as plantarfasciitis or trocanteric bursitis, etc. Symptoms may develop over time or seem to present very quickly. The site of pain is inflamed; possibly swollen, hot, red, tender to touch. The inflammatory signs vary with the type of tissue that is injured and the severity of the inflammation. It is easy to isolate treatment to the area of injury and declare success when pain is relieved and the client returns to everyday activities. In the interest of long term health, the prevention of recurrence and of preventing other posture pain presentations, we recommend thorough posture assessments and follow-through correction programs.
Common Posture Faults
When your posture is assessed by a physiotherapist, the following are the major signs of poor posture which may be observed:
- Feet that turn in or out from straight ahead position
- Flat feet or feet with very high arches
- Knock knees, bow knees or knees that bend backward into a position called recurvatum
- Knees that turn in or out from straight ahead position
- Very narrow stance or a wide based stance
- A hip that rotates forward or backward, in comparison with it’s mate
- A hip that appears higher than it’s mate
- A flat low back or one that has an excessive curve
- Excessive mid and/or upper back slump
- A trunk that rotates or tips to one side
- A shoulder that is higher than it’s mate
- A forward head position
- Neck tilt or rotation to one side
Posture is sneaky and our bodies most accommodating. It is common to observe one or more of these signs of poor posture during a physio assessment, without associated pain. They are always a sign of muscle imbalance. Left uncorrected, over time they are likely to associate with muscle and joint pain conditions. Postural correction exercises are difficult to provide for a mass audience, because they need to address all the poor posture signs observed during a client assessment. They differ from regular exercise in that they must be mindful, of low effort and slowly performed. Gait retraining is another important way in which your physiotherapist will help you correct your posture.
How is our Care Different?
Most physiotherapists consider posture when assessing clients. Our care differs because we have advanced posture training which influences how we assess clients, as well as the selection of remedial exercise. In a typical presentation, the physiotherapist will highlight the most obvious posture issues during assessment and initiate a home exercise program. Laser may be offered if there is evidence of inflammation at the site of injury or underlying arthritis. Full posture correction is a decision made by our clients, as success requires considerable commitment, both in terms of focus and time.