PHYSICAL THERAPY By Kesh Patel, MSc, RNutr, CPT and Suzanne Patel PhD

Many sports therapists and trainers are concerned with posture and its relationship to the neuromuscular system. Poor posture can be a root cause of injury or can occur post- injury as the body over compensates for the injury. While a multitude of active and passive techniques are available to improve posture, it’s also important to consider unconscious habits that can cause excessive muscular tension. Focusing on correcting these habits, before and during movement, can help restore postural control. This approach involves re- education and can be used effectively to improve posture when integrated with other techniques to restore muscle length and strength (1,2). Postural re-education focuses on stimulation of the appropriate neural pathways associated with the maintenance of postural homeostasis and movement intention. This article explores several techniques that can be used to re-educate the sensory motor system to improve postural awareness and alignment, and gives some examples of how these techniques can be applied.

POSTURAL RE-EDUCATION EXERCISES The exercises described below are by no means exhaustive; how- ever, they will give the reader an idea of the scope available in postural re-education.

Breathing Breathing is one of the most important issues to consider when correcting posture (3), as poor posture can often result from inefficient breathing mechanics. Diaphragmatic breathing is considered the most efficient form of respiration and the diaphragm should be recruited during both rest and exertion.

Inefficient breathing, when the action of the diaphragm is inhib- ited or hindered, often results in accessory muscle recruitment, which in turn affects posture. These muscles predominantly include the sternocleidomastoid (long neck muscle) and the scalenes (paired neck muscles), which can become hypertonic and contribute to elevation of the clavicle and first rib. The resultant postural changes include forward head carriage, forward and medially-rotated shoulders, a depressed sternum, and changes to the alignment of entire kinetic chain. This can lead to common postural-based conditions such as thoracic outlet syndrome.

RE-EDUCATING THE POSTURE

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