SOFT TISSUE THERAPY

ASSESSING POSTURE - AN ESSENTIAL TOOL

By Susan Findlay BSc, RGN, DipSMRP, MSMA

As sport massage practitioners, sometimes, the solutions to our clients’ problems are simple, we do our job and the file is closed. However, often the key to long-term success is the ability to follow the chain of muscular imbalances and dys- function to a source. In cases of trauma the reasons for pain and dysfunction are normally fairly obvious but for clients with more long-term problems the symptoms can be cam- ouflaged behind the presenting condition and the reasons for it are not so forthcoming.

There are many ways in which we can test and assess our clients but out of these postural assessment is easy to incorporate into the treatment session. It does not have to be a detailed and precise assessment with a plumb line, pro- tractors and/or boards but a more general approach that can be invaluable in revealing vital clues. This article looks at postural assessment as an essential tool for sports massage practitioners.

A good posture will maximise the function of muscles and joints, aiding in the well-being and performance of an athlete. As sports massage practitioners, one of our goals is to develop and main- tain the optimal balance between muscles and their relationship with the skeletal system.

Postural dysfunction can be a result of faulty biomechanics, pre- vious injury and psychosocial reasons. Whether it is just one of these reasons, or a combination of several, it will play an impor- tant role in influencing a practitioner’s approach to treatment.

More often than not, the circumstances in which we first meet our clients will be related to an acute problem accompanied by pain, needing our immediate attention. The tendency is to focus on the area of pain so as to give some immediate symptomatic relief, which in itself is reasonable. However, in order to make an accu- rate assessment and correct the existing condition we need to understand the underlying influences that may have contributed to this problem.

POSTURE AND ALIGNMENT To appreciate posture and its relationship to alignment, it is nec- essary to comprehend a few basic principles about muscles and how they react to faulty loading. Postural muscles are classified as stablilisers, their job is to fix a joint and prevent movement while mobilisers (phasic), create movement (1,2) (see table one).

Postural muscles are stronger and deliver more work than phasic 18 www.sportex.net

muscles. They are composed of more slow twitch muscle fibres, which have a greater capacity for prolonged work. Because of this, postural muscles have a tendency to shorten and tighten to faulty loading, while phasic muscles tend to react by weakening and becoming inhibited. This leads to muscles suffering over and underuse symptoms, leading to a predisposition to poor joint alignment and function.

As a massage practitioner it is worth taking this into considera- tion when presented with this type of muscle condition, ask, “where is this coming from?” and try to follow the chain of events to its source. Simply treating the area of discomfort will limit the success of the sports massage.

Postural assessments include: ■ Examination of the alignment when the subject is standing ■ Tests for flexibility and muscle length ■ Tests for muscle strength ■ Palpation techniques. But for our purposes we are only looking at the assessment procedure while standing and then expanding this to include sitting and lying down.

CASE STUDY The following is a case study that proves the point that as sports massage practitioners we sometimes need to be persis- tent and work our way back to the original cause.

The client is a single professional mother, 32 years of age and her sport is swimming.

Presenting complaint: Right shoulder pain and tension that has developed gradually over a period of two years.

Symptoms: Progressed slowly over a couple of years, the pain comes and goes. She used to be able to resolve the symptoms with a bit of Iyengar yoga and Alexander Technique. Recently over the past few months there has been no relief from the dis- comfort and it has started to keep her awake at night (Pain scale 6-7). No numbness or decreased sensation to her fingers. Range of motion in neck limited on both sides. Right hip also aches, the pain is more diffuse and is more or less in the back- ground (Pain scale 4). The postural assessment showed right shoulder slightly dropped. Evidence of bilateral tension in upper trapezius. Pelvic rims even. Increased skinfolds on her right side between her T12 and the iliac crest. Alignment of feet and knees is normal.