POSTURE TREATMENT

takes place by regularly practising good alignment. This can be performed as a home exercise, but due to the regular supervision and motivation required it is often more successful to refer a patient to a Pilates or yoga class.

SUBOPTIMAL POSTURE IN THE SHOULDER REGION Kyphotic posture

Figure 7: Supported side-bend action over a bench

Figure 8: Side-shift action against a wall

syndrome. The position of the spine is one

of extension and side flexion (more accurately side shift), leading to tissue shortening on one side and lengthening on the other. Soft tissue therapy aims to release the tight tissue and should be followed by stretching to regain tissue length. Consider using massage in a sitting position with the patient supported and side flexed away from the tight side, or side lying over a roll with the tighter side uppermost. As the swayback is often an

asymmetrical posture, exercise therapy is asymmetrical as well. Supported side-bend actions (Figure 7) over a bench and side-shift actions (Figure 8) against a wall are useful. Re-education

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Within the thoracic region postural changes are seen to the scapulae and thoracic curve, with the two being intimately connected. Optimally, the scapulae lie three finger widths from the spine, with their straight medial border vertical. The inferior angle of the scapula typically lies level with T7, the root of the scapular spine with T4 and the superior angle with T1. Our modern daily living sees us working at desks, using tools and driving, all activities that require us to flex and adduct the arms. As a result the scapulae often move apart and away from the midline (scapular abduction). At the same time they often downwardly rotate, pointing the glenoid cavity further downwards. This posture has important implications for coordinated movement of the scapula and humerus and is a risk factor for shoulder impingement conditions. The forward motion of the scapula draws the whole weight of the arm forwards and away from the posture line, increasing the arm’s leverage effect. The result is that the thoracic spine follows the motion and flexes, increasing the curvature of the thoracic kyphosis, giving the classic kyphotic posture. The abducted and downwardly rotated position of the scapulae in the kyphotic posture places stress on the rhomboid muscles and levator scapulae. These muscles often develop trigger points that respond well to soft tissue therapy, as do the thoracic erector spinae. Soft tissue therapy should be paralleled by exercise to retract and stabilise the scapulae and press the thoracic spine into extension. The sternal lift exercise (Figure 9) is a typical action where the patient draws their scapulae down and together, while lifting the sternum and straightening

FOR POOR

CAN USE TAPOTEMENT AS MUSCLE FACILITATION AND COMBINE

THIS WITH EXERCISE

the thoracic spine. Where the thoracic spine is very stiff, passive stretching over a roll or gym ball may also help to extend the thoracic spine and open up the ribcage (Figure 10). Later in life, the kyphotic posture

may result from osteoporosis, with the anterior portion of the vertebral body narrowing to give a wedge shape. The rarefied nature of the thoracic vertebrae contraindicates powerful massage techniques, but less forceful actions are still very useful to relieve pain. Most of the postural pain in late-

Figure 9: Sternal lift exercise

RECRUITMENT WE

Figure 10: Thoracic spine passive stretch over a roll

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