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POSTURE TREATMENT POSTURE: PART 2 BY DR CHRIS NORRIS, MCSP, PHD
SUBOPTIMAL POSTURE IN THE LUMBOPELVIC REGION When assessing posture from the side using a plumbline, four posture types are commonly seen. Flatback, swayback and lordotic postures reflect the alignment of the pelvis relative to the lumbar spine. Kyphotic posture shows the alignment of the thoracic spine (Figure 1).
Flatback posture In an optimal posture the greater trochanter of the hip lies on the posture line. The pelvis remains level, with a line through the anterior superior iliac spine (ASIS) and posterior superior iliac spine (PSIS) being roughly horizontal (5° anterior tilt). In a flatback posture, the pelvis remains level or is slightly posteriorly tilted, but the most important feature is the reduction or loss of the lumbar lordosis. Effectively each lumber vertebra becomes slightly flexed relative to its neighbour, although on closer examination the loss of lordosis may be more noticeable in the upper or lower lumbar spine. The distinction into upper or lower regions occurs due to the postural stress that has been imposed on the spine. When lumbar flexion is led by posterior pelvic tilt (sitting or drawing the knees to the chest), the lumbar spine flexes from below upwards, so L5 moves before L4 and L3. Where lumbar flexion is led by forward bending (stooping and lifting actions), lumbar flexion occurs from above downwards (L1 moving before L2 and L3). The former stress (sitting) tends to flatten the lower lumbar curve, and the latter (stooping) the upper. The flatback posture typically
shows thickening within the spinal musculature that responds well to massage. Once the muscles begin to relax (reduce tone), they should be gently lengthened by encouraging supported lumbar flexion, either lying and drawing the knees to the chest
This is the second of two articles by Dr Chris Norris that looks at the importance of posture in clinical practice. In Part 1 (sportEX dynamics Apr 2011) he looked at optimal posture and postural assessment. In this second part the author examines methods to correct suboptimal posture using soft tissue therapy and exercise.
Lordotic Kyphotic Swayback Flatback Figure 1: Posture types
(lower lumbar spine) (Figure 2) or standing and flexing the spine while taking the bodyweight through the arms (Figure 3). As the flatback posture is typically caused by prolonged flexion actions, back care advice is essential and spinal extension movements (McKenzie programme) are often used by a physiotherapist to restore the lumbar lordosis.
Figure 2: Supported lumbar flexion in lying Lordotic posture
With a lordotic posture the lumbar lordosis is increased and the pelvis anteriorly tilted so that the ASIS is substantially lower than the PSIS. This may occur in upper or lower portions, with obesity and lax abdominal muscles tending to give a lower lordotic posture and an upper lordotic posture often being associated with a swayback posture (see below).
Figure 3: Supported lumbar flexion in standing
The classic imbalance of the lordotic posture is lengthening of
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