POSTURAL RE-EDUCATION

■ monoarticular, deep and close to the joint

■ slow twitch ■ resistant to fatigue ■ continuous in their activity ■ independent of the direction of move- ment

■ protective in function prior to loading (17,18).

Examples of postural or stabiliser muscles include transversus abdominus, multi- fidus, and vastus medialis oblique (VMO).

Alexander acknowledged that postural muscles are activated not through exer- cise, but by ‘how’ the body is balanced against gravity. Specifically he described the balance of the occiput on the atlas, the ability to lengthen the spine and the symmetry of the pelvis as the influencing factors of activating these postural mus- cles. He called this the Primary Control. By altering/improving your posture, so that joints become aligned, postural muscles are activated in an ordered, efficient and balanced way with no additional effort.

Muscle imbalance is the net result of us having moved in an unbalanced, ineffi- cient way and no amount of strengthening will permanently resolve this imbalance. This is why people feel better while doing their exercises, but symptoms often return when they stop. It is like putting scaf- folding around a falling building. However, unless you address the way the building is balanced, the scaffolding is only a temporary solution.

Since then it has been noted that neuro- logically you can have problems affecting

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Strengthening your transverse abdominus will not improve your posture but improving your posture will activate your transverse abdominus.

THE POSTURAL SOLUTION

■ educational and empowering ■ permanent and preventative ■ achieves balance so muscles work together efficiently ■ aims to reduce damaging biomechanical forces exerted on joints and soft tissues

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balance that are descend- ing patterns ie from the head to the feet, or ascending from the feet to the head (or a com- bination of the two). For the purpose of this article we are describ- ing an ascending problem.

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Draw attention to what any move- ment feels like, in order to enable change.

PATELLOFEMORAL PAIN SYNDROME (PFPS) Aetiology is not clear according to current literature, but suggests excessive loading of the patellofemoral joint (PFJ) (19). This can have a plethora of intrinsic and extrinsic factors, but we view this as a symptom of habitual misuse of functional movement patterns (20).

Patients commonly present with anterior knee pain (AKP) but this is a symptom and not a diagnosis and can be caused by different pathology (21).

Symptoms are commonly pain: ■ in sitting with the knees flexed, ■ during and after walking, running, physical activity

■ ascending and descending stairs (22).

PHYSICAL ASSESSMENT Observation of: ■ various static postures that produce or may produce the patient’s symptom ie. sitting and standing

■ various movement patterns ie. sitting to standing, gait, stairs and running.

For the purpose of this article we will address standing posture and the re-edu- cation of various movement patterns for a client to return safely to sport.

Kendall (23) describes four aberrant standing postures, namely, lordotic, sway back, flat back and kyphotic.

We will refer to the lordotic standing pos- ture, which characterises the following: ■ anteriorly rotated pelvis inferring weak abdominals and gluteals (maximus and medius) and adaptively shortened iliopsoas, adductor longus, tensor fas- cia lata, iliofemoral and pubofemoral ligaments (24)

■ extension of low lumbar vertebrae restricting hip extension and external rotation

■ increased Q angle at the tibio-femoral joint (TFJ) giving the appearance of “squinting patellae” with often hyper- extended knees inferring poor inner range quadriceps control (25) (Fig.6).

■ subtalar joint (STJ) pronation (Fig.7) ■ externally rotated or “duck” feet (Fig.6) ■ centre of gravity shifted anteriorly, leading to tight hamstrings and calves (‘standing on balls of feet’), as balance is maintained by their static contraction

■ client may have a weight shift preference.

Clinical observation shows that these habits are often transferred into other activities, and so you will see patients who stand with ‘duck feet’ will often sit with their feet at the same angle.

Gait - inadequate lateral heel strike with the knees in increased flexion will result in poor shock absorption. Subtalar joint

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