Posture stability and Balance

1. Posture stability and Balance

2. Posture • Principles • Definition of “good” posture • Examples of poor posture

3. Posture • Inherent to concept of posture are alignment and muscle balance • Good mechanics require that joint ROM be adequate, but not excessive • The more flexibility, the less stability • The more stability, the less flexibility • Why do only some people get pain? • Posture may be faulty, but individual has mobility so position can change readily • Posture may appear good, but mobility lacking so position cannot change readily

4. Mechanical Imbalance • An alteration of structure and function which is reflected in combinations of muscle tightness and weakness, ligamentous laxity and/or poor alignment of body segments

5. Posture - Principles • Faulty alignment results in undue stress on bones, ligaments and muscle • Adaptive shortening can develop in muscles that remain in a shortened condition • Stretch weakness can occur in muscles that remain in elongated conditions

6. Mechanical Imbalances • Kyphosis-lordosis posture Flat back posture

7. Kyphosis-Lordosis Posture • increased lumbar lordosis, promotes a forward pelvic tilt and a slightly flexed position of the hip • Leads to increased stress on L4L5 disc and facets and the sacroiliac (SI) joints • cause early recruitment of the lumbar extensors • increased knee flexion at heel strike increasing the potential for patellar tendon and patellar femoral joint injuries

8. Posture types • Normal sway Kyphotic flat

9. Kyphosis-Lordosis Posture • Head – forward • Cervical spine – hyperextended • Scapulae – abducted • Thoracic spine – increased kyphosis • Lumbar spine – increased lordosis • Pelvis – anterior tilt • Hip – flexed • Knee – slightly hyperextended • Ankle – slight plantarflexion

10. Kyphosis-Lordosis Posture • Elongated and weak • Neck flexors, upper ES, external obliques • Elongated, may be weak • hamstrings • Short and Strong • Neck extensors, hip flexors • Strong, may be short • Lumbar ES

11. Posture

13. Flat-back Posture • Head – forward • Cervical spine – slightly extended • Thoracic spine – upper increased flexion; lower straight • Lumbar spine – flattened (flexed) • Pelvis – posterior tilt • Hip – extended • Knee – extended • Ankle – slight plantar flexion

14. Flat-back Posture • Elongated and weak • One-joint hip flexors Short and Strong • Hamstrings, upper fibers of internal oblique • Strong, not short • Lumbar ES

15. General population • Swayback: Approximately 30% of men and 20% of women. • Kyphosis-Lordosis: Approximately 20% of women and 15% of men. • Flatback: Approximately 10% of men and women. • Only 5% of persons may have the optimal posture depicted to the left, with a further 15% coming reasonably close

16. Summary • Postures that deviate from ideal can produce adaptive shortening, strengthening, elongating and weakening that can affect structures quite distal to the poor posture culprit • Use a postural assessment to guide your specific assessment and treatment plans, especially for chronic, non-traumatic problems

18. Regaining postural stability and balance • “CoG” is located just above your pelvis. In order to remain “balanced”, your CoG must remain within the limit of stability “LOS”. • “balance” is the ability to maintain the body’s segments in alignment within a “limit of stability” (LOS). • Balance is the single most important element dictating movement strategies with in the closed kinetic chain.

20. Regaining postural stability and balance • Is both • Static • Dynamic • Dynamic for example, walking, climbing stairs, etc

21. MOVEMENT STRATEGIES What are the 3 movement strategies that are used by the body to maintain the CoG within a stable base of support? • 1. ankle • 2. hip • 3. stepping

22. MOVEMENT STRATEGIES • When would each strategy be used? • Ankle: when small, slow movements, close to CoG • Hip: larger, quicker movements required. Also if CoG gets closer to LOS. • Stepping: if CoG gets out of Limit Of Stability.

23. INJURY AND BALANCE • Studies of the knee and ankle show that there is a decrease in proprioceptive feedback from damaged ligaments to the CNS (sensory/afferents). • Therefore, is decreased reflex excitation of motor neurons (efferents) to the muscles responsible for preventing sway/controlling balance.

24. BALANCE TRAINING • MUST improve the balance and postural equilibrium of the athlete in order for them to return safely and effectively to the playing field.

25. BALANCE TRAINING • General rules when developing a balance training program: • Exercises must be safe, yet challenging • Stress multiple planes of motion • Incorporate a multi-sensory approach • Begin with static, bilateral, stable. Progress to dynamic, unilateral, unstable. • Progress to sport-specific

26. BALANCE TRAINING • CLASSIFICATIONS OF BALANCE TRAINING/EXERCISES • 1. static: • 2. semi-dynamic: • 3. dynamic: • 4. functional:

27. BALANCE TRAINING • static: • CoG is maintained over fixed base of support on a stable surface. • i.e. Rhomberg tests

28. 2. semi-dynamic: 2 types • (a) maintain CoG over fixed base of support while on moving surface or unstable surface (BAPS/Wobble board) • (b) transfer CoG over a fixed base of support to areas within the LOS while standing on a stable surface (pick up pens)

29. BALANCE TRAINING • 3. dynamic: • CoG maintained within the LOS, while over a moving base of support on a stable surface. • Requires a stepping strategy • i.e. hopping, walking on a balance beam

30. Balance Training • 4. functional: • same as dynamic, except also have sport specific tasks included. • i.e. catching/throwing a ball while running.