POSTURAL RE-EDUCATION

Accessory muscle breathing can also lead to hypertonicity of the quadratus lumborum and other rib cage depressors as they try to counteract the upward displacement created by the sternocleido- mastoid and scalenes.

The restoration of optimal breathing mechanics can be aided with simple instruction of diaphragmatic breathing using visualisation and kinaesthetic awareness and is an important step in any postural re-education programme.

Diaphragmatic breathing - with the client lying supine with legs straight or knees bent, instruct them to place one hand just below the belly button, (Figure 1). They should begin by breathing naturally through the nose, noting where the movement predom- inantly resides - in the chest or the abdomen. Now ask them to imagine a balloon in their abdomen that they are filling up as they inhale, allowing the hand to rise. As they slowly exhale they should feel the belly flatten. It may help to ask them to visualise the diaphragm being pulled down as they inhale and rising as they exhale. Performing this exercise lying supine over a stability ball can further enhance the lateral displacement of the rib cage that should be experienced during diaphragmatic breathing. Placing the anterior abdominal muscles in a position of gentle traction will bring a significant degree of

proper rib cage excursion during breathing.

Pandiculation Sensory motor amnesia (SMA) is a condition in which sensory motor neurons have lost the ability to control some or all of the muscles of the body (4). SMA occurs as a functional deficit where the ability to contract a muscle is under automatic control. These automatic patterns chronically contract muscles and the voluntary ability to relax the muscles is lost. In the framework of posture, muscles held in partial contraction can create postural distortions. There are three processes by which SMA can occur: ■ The trauma reflex - a protective muscular response to severe injury or trauma

■ The startle reflex - anterior muscular contractions creating a dominance of the sympathetic nervous system

■ The Landau response - an arousal response that contracts the posterior muscles in preparation for movement (4). SMA can be overcome by sensory motor re-education - allowing the nervous system to achieve voluntary relaxation of the muscle. One way to achieve this is via a phenomenon known as pandiculation.

Pandiculation is a sensory motor action used to arouse the motor cortex in preparation for sensing and movement, such as yawning and stretching in the morning (5). By making a strong voluntary muscle contraction, an equally strong sensory stimulation is fed back to the nervous system. The effects of the pandicular response induce sensory-motor learning, resulting in a rapid reduction of habitual muscular hypertonicity. The arch and curl exercise uses pandiculation to restore a feeling of relaxation and length to the spine and consequently, improved control and awareness of posture. Used at the beginning of a series of postural correction exercises, it can help to prepare the kinetic chain for movement.

kinaesthetic awareness to

Arch and curl - the client is instructed to lie on their back, knees bent, feet flat on the floor, and hands above the head (Figure 2a). They should begin by inhaling, gently and gradually arching the small of the back off the floor. At the same time, instruct them to press the elbows, the back of the head, and the tailbone down into the floor, so that the entire spine is arched (Figure 2b). The client should imagine that their heels are being dragged towards their buttocks, so contracting the posterior thigh muscles. This part of the exercise should be performed to a maximum, yet pain- free level of muscle tension. Once a maximum level of tension is achieved in the arch, the client is instructed to exhale slowly. As they do so, they should be instructed to relax all efforts from the above movement very slowly, allowing the back to flatten and the head to curl upwards slightly (Figure 2c). The balls of the feet can be pushed into the floor to help the back flatten. This part of the movement will begin to produce tension in the anterior muscles of the trunk and neck. Once a maximum level of tension is reached, there should be complete exhalation. While curled, they should be instructed to inhale fully, then continue to inhale as they very slowly and gently roll back down, and repeat the arch. This arching and curling should be repeated five times, slowly and deliberately, until the feeling becomes familiar.

Coupled movement Coupled movement focuses on breaking down a movement pattern into its component parts to increase internal awareness and control. Much of the somatic educational work of Alexander and Feldenkrais looked at movement in this way and is based on inter- rupting habitual or unconscious postural patterns by focusing on sensations during movement, rather than the end goal of move- ment (6,7). By directing conscious attention to the proprioceptive background of a movement, the quality of the movement can

Figure 1. Diaphragmatic breathing

Figure 2a. Arch and curl

Figure 2b. Spine is arched 18

Figure 2c. Back is flat and head is curled upward www.sportex.net