Topic 3 - Posture Flashcards
A debated subject among health professionals that holds strong cultural, political and societal meanings, but these beliefs are often unsupported by evidence.
Posture
“____” posture is generally overemphasized and is referred to as being “straight” and “aligned.” “___” posture is associated with slouching.
“Good”
“Bad”
Physiologically, all postures or movements load _______ differently, so context becomes an important consideration.
Tissues
The total force through particular musculoskeletal tissue.
Tissue Loading
The configuration of the body’s head, trunk and limbs in space. It includes position and relative relationships of the bony skeleton and supporting soft tissues.
Posture
Posture is in part the relative ___________ of the parts of the body to each other, however what needs to be considered is the particular _______ in which it is used.
Arrangement
Context
Posture is a shifting pattern of righting and ___________ reflexes, habits and adaptive responses to things such as _______, ADL’s, psychological states and personal anatomical limitations.
Stabilizing
Gravity
Functional and _____________ considerations are integral to the concept of posture as are the consequences of various postures to performance and _______.
Biomechanical
Comfort
identifying and describing the relationships between various factors which influence posture is integral to the analysis needed to identify ___________, treat them with the appropriate massage techniques and provide the _________ necessary to help with postural complaints.
Impairments
Self-Care
T/F - Many MSK complaints are attributed to the narrative of muscle imbalances, which research can back up with evidence.
False - Many MSK complaints are attributed to the narrative of muscle imbalances, BUT research CANNOT back THIS up with evidence.
There is evidence that posture can shape ____ and that there are emotional dimensions of posture including links to __________.
Mood
Depression
T/F - Individuals suffering from depression often show greater anterior head inclination, thoracic kyphosis and a slumped posture.
True
Some ____ ____ posture suggestions include:
- Frequent movement
- Avoid prolonged sitting
- Minimal use of muscular effort/problematic loading for sustained periods
- Efficient use of muscles to avoid fatigue
- Efficient movement at a joint
Pain Free
________ ( ________ ) curves are normally present in the lumbar and cervical regions.
Lordotic (Anterior)
________ ( _________ ) curves are normally present in the thoracic and sacral regions.
Kyphotic (Posterior)
Normal curvature and flexibility of the spine allow for distribution of ______ and efficient use of the associated muscles and joints.
Forces
The weight bearing and shock absorbing portion of the spine.
Anterior Pillars (aka. Vertebral Bodies) & Intervertebral Discs
Made up of the articular processes and facets. They provide the gliding mechanism for movement.
Posterior Pillars (aka. Vertebral Arches)
The posterior pillars also include bony ______ (e.g. TVPs & SPs) to which the muscles attach and function to allow for ________ and control. They also provide spinal stability.
Levers
Movement
When it comes to ________ postural alignment, the list of landmarks that should align from a _______ view are:
- Anterior ankle
- Head of fibula
- Greater trochanter
- Bodies of lumbar spine
- Middle of acromion
- Cervical spine
- External auditory meatus
Standing
Lateral
T/F - For athletes, imbalances between agonist and antagonist muscles is something we want to correct.
False - For athletes, imbalances between agonist and antagonist muscles is something we DON’T ALWAYS want to correct.
The pelvic tilt from ASIS to PSIS should be ____ or PSIS is slightly ______. The average is 0-15 degrees.
Even
Higher
ASIS and the pubic bone should be aligned __________.
Vertically
A line through pubic symphysis and PSIS in the transverse plane.
Pelvic Angle
How many degrees is the pelvic angle?
30 degrees
The following are part of ________ posture:
- Medial border on rib cage
- 3-4 patient’s finger widths from midline
- Stretch weakness of scapular retractors
- Inferior angle sits on thorax
- Spine of scapula at T3
- Spine of scapula at 15 degrees of inclination
Scapular
_______ stresses the structures that help to maintain upright posture.
Gravity
The point in the center of an object, where the objects mass behaves as if it were concentrated. It will change in different postures.
Center of Gravity
In anatomical position, the center of gravity of the upright adult human is anterior to the ___.
S2
The basic level of tension required to brace our joints and maintain cellular activity. It is unlike resting tone because constant muscle activation is needed.
Postural Tone
What are the 3 subsystems that need to be considered for postural stability?
1) Passive (e.g. inert structures/bones & ligaments)
2) Active (e.g. muscles)
3) Neural Control (e.g. PNS/CNS)
T/F - Self-care should incorporate all 3 subsystems of postural stability.
True
___________ and muscular _________ are often a combination of inert tissue damage, insufficient muscular strength or endurance and poor neuromuscular control.
Instability
Imbalance
The inability to maintain equilibrium under dynamic and static conditions, such as preparation of movements, perturbations (e.g. uneven surfaces) and quiet stance (e.g. standing still).
Postural Instability
For weight bearing joints to remain stable, there must be a force to __________ the force that is created by greavity.
Counteract
____________ to gravity is provided by:
- Muscular activity and inert tissue
- Bones, muscles and joints from body levers
- Resistance further from axis leads to increased use of muscles
- Neural control coordinates response of muscle
Counterforce
When the gravitational force is posterior, the hip _______ are involved and passive support by the iliofemoral ligament. When gravitational force is anterior, the hip _________ assume more responsibility to maintain posture.
Flexors
Extensors
Center of gravity falls ________ to the atlanto-occipital joints. The cervical ________ muscles counteract this force into flexion.
Anterior
Extensor
T/F - When postural deviations are extreme, there is more dependence on active structures to maintain stability.
False - When postural deviations are extreme, there is more dependence on INERT structures to maintain stability.
T/F - Muscular endurance is promoted more than strength to maintain posture.
True
T/F - Many MSK complaints can be attributed to the stresses from prolonged postures and movement patterns.
True
Impairments of the joints, muscles or connective tissues can lead to postural ______. Prolonged postures can result in the feeling of discomfort and ____.
Stress
Pain
Pain resulting from the stretching or compression of pain sensitive structures/tissues, which contain nociceptors and when they are stressed, pain is felt.
Mechanical Pain
Muscles, ligaments, joint capsules and periosteum are __________ and can cause pain when mechanically stressed.
Innervated
T/F - Mechanical pain is pathological in nature.
False - Mechanical pain is NOT pathological in nature.
_______ _____________ provides an evidence-based explanation for many cases of “unexplained” chronic musculoskeletal pain.
Central Sensitization
A strategy that changes maladaptive illness perceptions to reconceptualise ideas of pain by patient education about central sensitization and its role in chronic pain.
Pain Physiology Education
If pain occurs for __ to __ months, it is considered chronic in nature and is often considered to be “centralized.”
3-6 months
Posture that deviates from normal and there are no adaptive changes.
Postural Fault (aka. Faulty Posture)
Adaptive shortening and/or muscle weakness are involved with postural ___________.
Dysfunction
Pain from mechanical stresses of poor/prolonged posture, which is likely due to postural stress.
Postural Pain Syndrome
Any habitual, self-imposed positioning that causes physical stress, especially coping poorly with postural challenges (e.g. ADLs that are difficult to do comfortably).
Poor Posture
A challenge to your posture that is imposed on you, as opposed to something you’re doing to yourself out of laziness (e.g. sleeping on a plane).
Postural Stress
T/F - Postural stresses overtime are not associated with degenerative changes.
False - Postural stresses overtime CAN BE associated with degenerative changes.
Connective tissue layers may adhere to each other and with palpation there is an inability to differentiate tissues.
Fascial Adhesions
Increased demands will result in more muscular tension.
Increased Resting Tension
Myofascial _______ ______ result from an overload of the muscles.
Trigger Points
Reduced weakness and _________, along with fatigue result in the inability to _______ a posture.
Endurance
Sustain
_____ is more likely to occur when muscles are fatigued, weak or lack normal flexibility.
Spasm
____________ can occur through increased abdominal pressure and there is usually urinary leaking. It is also linked to heartburn and constipation.
Incontinence
Assessment findings and characteristics of _____________ include:
- Decreased ROM
- Reduced quality of movement
- Muscle attachments are closer together
- Inability of someone to assume a corrected posture
- Increased resistance to active & passive elongation
- Possible associated weakness
Hypomobility
The adaptive shortening of a muscle or other soft tissue (e.g. joint capsule, fascia, skin) that prevents normal extensibility of the involved structures and is mostly associated with trauma.
Contracture
Most severe form of muscle weakness that is often overlooked clinically. The overused muscle shortens over time, changing the muscle’s length-tension curve and becoming more readily activated and weaker after time.
Tightness Weakness
With _________ weakness, there is an increase in non-contractile tissue and a decrease in elasticity, which leads to ___________. Overuse leads to ischemia and degeneration of muscle fibres, which further weakens the muscle.
Tightness
Hypertrophy
Assessment findings and characteristics of _____________ include:
- Increased ROM
- Muscle may test weak or have reduced endurance
- Muscle attachments are further apart
- Possible associated weakness
- Often congenital and poses no issues
Hypermobility
When muscles, ligaments and joint capsules are in a state of continual stretch. They can lengthen and ligament laxity results in hypermobility of a joint.
Adaptive Lengthening
Habitually lengthened muscles may become over-lengthened and exhibit stretch ________. When muscles and fascia adaptively lengthen, they must function in a lengthened position, which is considered a mechanical ____________.
Weakness
Disadvantage
Some risk factors for ________ pain include:
- Prolonged poor postures
- Age
- Changes in tissue tolerance
- Systemic pathologies
- Previous trauma
- Arthritis
- Generally deconditioned
- Depression
- Spondylolisthesis
- Fractures (e.g. broken/crushed vertebrae)
- Osteoporosis
- Disc degeneration
- Scheuermann’s disease
- Spinae Bifita
- Ankylosing spondylitis
- Muscular dystrophy
Postural
When treating postural pain:
- Address where the pain is ___________ from first (e.g. CNS, referred, mechanical)
- Movement stretching and strengthening to treat adaptive __________
- Connective tissue techniques to treat myofascial tissue
- Neuromuscular techniques for CNS
- Do not increase instability by increasing mobility in hypermobile joints
Originating
Shortening
T/F - Massage does not improve weakness.
True
_____________ modalities for treating postural pain include:
- Heat
- Stretching
- Exercise with full ROM
Complementary
Some goals of treatment when treating postural pain include:
- Improve body _________
- Identify sustained faulty posture
- Address lack of strength/endurance
- Identify ____________ factors
- Improve work area ergonomics
Awareness
Contributing
Increase in the lordotic curve of the lumbar spine and is often seen with increased pelvic tilt.
Lordotic Posture (aka. Hyperlordosis)
With an anterior pelvic tilt the hip is in _______.
Flexion
With ________ posture, muscles that may limit mobility due to weakness or a lack of extensibility could include:
- Rectus femoris
- Hip flexors (e.g. iliopsoas, TFL, anterior fibres of gluteus medius)
- Hip adductors
Lordotic
With ________ posture, antagonist muscles that are prone to be weakened and lack qualities to stabilize include:
- Hamstrings
- Hip extensors (e.g. gluteus maximus, posterior fibres of gluteus medius)
Lordotic
Possible associated impairments with ________ posture include:
- Decreased tissue extensibility
- Increased resting muscle tension
- Joint mobility issues
- Weakness
- Fascial restrictions
- Pain
Lordotic
Sources of symptoms with ________ posture include:
- Muscular ache/pain (e.g. mechanical, fatigue/overuse)
- Trigger points
- Narrowing of posterior disc spaces and IVF’s that can cause compression of neurovascular structures exiting the spine
- Approximation of articular facets leading to inflammation and synovial irritation
Lordotic
Common causes of ________ posture include:
- Comfortable position for patient
- Sustained faulty posture
- Lack of strength/endurance
- Pregnancy
- Obesity
- Weak/surgically adhered abdominal muscles
- Trauma
Lordotic
Common trigger points the can be experienced with ________ posture include:
- Gluteus maximus
- Gluteus medius
- Quadratus lumborum
- Iliopsoas
Lordotic
Some useful orthopaedic tests for ________ posture include:
- ROM testing for the hip and lumbar spine
- Modified Thomas test
- Ober’s
- Ely’s
- Schober’s
Lordotic
General management of lordotic posture includes:
- Treat _____ symptoms when present
- Treat tissue impairments that limit mobility
- Improve postural awareness and encourage _______
- Improve strength/endurance of muscles that maintain correct posture
Acute
Changes
Characterized by increased thoracic curve (rounded back) and protracted shoulders (round shoulders).
Kyphotic Posture (aka. Hyperkyphosis)
Involves increased flexion of lower cervical and upper thoracic regions, as well as increased extension of the occiput on C1.
Forward Head Posture
Observations with kyphotic posture include:
- Thoracic spine is in _______
- Lower cervical spine is in _______
- Upper cervical spine is in _________
- Scapulae are __________
Flexion
Flexion
Extension
Protracted
With protracted scapula, look for __ to __ patient’s finger widths from midline and weakness of scapular __________.
3-4
Retractors
With anterior tilt of scapula, look for ________ angle off of rib cage, possible shortness/weakness in pectoralis _____ and weakness/poor control of serratus ________.
Inferior
Minor
Anterior
With ________ posture, muscles that may limit mobility due to a lack of extensibility and weakness could include:
- Rhomboids
- Middle trapezius
- Erector spinae muscles
- G-H external rotators (e.g. teres minor, infraspinatus)
Kyphotic
With ________ posture, weakness in functional movements could be due to:
- Upper trapezius (lengthened in lower c-spine & flexed in upper)
- SCM, scalenes & levator scapulae (shortened due to HFC)
Kyphotic
Potential impairments with ________ posture include:
- Pain
- Decreased tissue extensibility (e.g. myofascial, joint, capsular)
- Increased resting muscle tension
- Weak muscles/lack of endurance
- Depression
Kyphotic
Potential sources of pain symptoms with ________ posture include:
- Muscular ache/pain (e.g. mechanical, fatigue/overuse)
- Trigger points
- Narrowing of posterior disc spaces and IVF’s that can cause compression of neurovascular structures exiting the spine
- Stress to anterior ligaments in upper c-spine and posterior ligaments/joint capsules in lower c-spine
- Narrowing of IVF’s in upper c-spine leading to compression of neurovascular structures
- Compression of nerves by muscles in the head/neck region
- Psychoneuroimmunological, mood and central sensitization origins
Kyphotic
Common causes of ________ posture include:
- Effects of gravity and poor ergonomics
- Prolonged postures
- Faulty prolonged sitting postures (e.g. working at a desk)
Kyphotic
Some useful orthopaedic tests for ________ posture include:
- Observing posture (e.g. spinal curves, tilt/protraction of scapulae)
- ROM testing for cervical spine, thoracic spine & shoulder girdle
- Pectoralis major/minor length test
- Testing strength of scapular muscles (e.g. rhomboids, middle/lower trapezius)
Kyphotic
Strategies to reduce _________ posture include:
- Task substitution (e.g. alternate between sitting and standing)
- Task interruption (e.g. short breaks to change position or stretch)
- Increasing incidental exercise (e.g. use stairs instead of elevator)
Sedentary
___________ related to posture that are significant to massage therapists include:
- Pain from mechanical stress from muscle tension, trigger points & sensitive structures
- Mobility impairments of muscles, joints & fascia
- Impaired muscle performance associated with poor muscular endurance
- Insufficient postural control by increasing strength of stabilizing muscles
Impairments
T/F - The client’s awareness of posture should be developed as soon as possible and they should be encouraged to adjust their posture throughout the day.
True
Common trigger points that can be experienced with ________ posture include:
- Pectoralis minor
- Pectoralis major
- Rhomboids
- Middle & lower trapezius
- Levator scapula
Kyphotic
Referred pain from a trigger point in _______ ______ is:
- Commonly identified as LBP
- Experienced along posterior iliac crest, sacrum & posterior/lateral aspects of the buttock
- Experienced in the upper thigh
Gluteus Medius
Symptoms of a gluteus medius trigger point would be pain when _______, lying on back/affected side and/or when ________ in a chair.
Walking
Slouched
What should you rule out before identifying a gluteus medius trigger point?
Sacroiliac Joint Dysfunction
Referred pain from a trigger point in __________ _____ may:
- Include the anterior chest and breast
- Extend down the ulnar aspect of the arm to the 4th & 5th fingers
- Be easily mistaken for that of ischemic heart disease if experienced on the left side
- Result in shoulders being rounded and head forward posture
Pectoralis Major
Referred pain from a trigger point in __________ _____ may:
- Cause entrapment of neurovascular structures from the taut fibres
- Be experienced over the anterior shoulder
- Be a big contributor to rounded shoulder posture
Pectoralis Minor
Referred pain from a trigger point in _______ _______ is:
- Often associated with a stiff neck & usually limits cervical rotation
- Concentrated at the angle of the neck and along the medial border of the scapula
Levator Scapula
