Postural Retraining & Muscle Balance


POSTURE

When people not only exercise with but live their life with good posture they have the ability to ‘function’ efficiently and so with reduced risk or injury.

What is ideal posture?

Posture describes the position the body is in at any one time. Ideal posture places the skeleton in good alignment in order to distribute forces travelling through it.

Much like a car, regular use and repetitive trips may lead to imbalances and changes in the ideal distribution of forces that are experienced during movement.

What can cause poor posture?

  • Muscle imbalance

  • Poor core stability

  • Low self esteem/depression

  • Lack of physical awareness

  • Occupation

  • Pregnancy

  • Injury

  • Disability

  • Congenital joint or spinal abnormalities

Which muscles in the human body generally tend to get tight and shorten (become tight)?

  • Rectus Femoris (major muscle in quads/thigh)

  • Hamstrings

  • Hip flexors (iliopsoas)

  • Pec major/minor (chest)

  • Upper trapezius (back/shoulders)

  • Scaleni

  • Levator Scapulae (muscles around the shoulder blade)

  • Sternocleidomastoid (neck)

  • Gastrocnemius (calf)

  • Lower back (QL)

Which muscles in the human body generally become weak (lengthen)?

  • Lower back muscles

  • Deep abdominal muscles

  • Lower/mid trapezius and rhomboids

  • The gluteals (bum!)

  • Muscles of the rotator cuff (a group of small stabilising muscles in the back)

Types of muscles imbalances

  • Agonist – Antagonist (e.g. bicep/tricep or chest/back)

  • Left – Right (often lower back or shoulders)

  • Commonly TIGHT muscles

Commonly WEAK muscles

IDENTIFYING POSTURAL ABNORMAILITIES

FEET

Over-Pronation

Over-Supination

A degree of pronation and supination is essential for the correct biomechanical function of the lower limb and absorption of shock/high impact associated with walking, running and jumping.

When the degree of pronation or supination becomes excessive and the stresses that are applied to the feet during activity are inadequately distributed, greater levels of stress to the lower limbs are experienced. The result of the added stresses may include instability, tightened muscles and overuse injuries such as bursitis, tendonitis and stress fractures.

Pronation

Pronation of the foot is the act of turning the foot so that the rear foot everts and the arch flattens.

This can lead to increased ground reaction forces on the medial aspect of the foot, which can lead to numerous conditions including stress fractures of the metatarsals.

Supination

Supination of the foot is the act of turning the foot so that the rear foot inverts and the medial aspect (arch) is elevated.

This can lead to poor shock absorption leading to stress fractures and is connected to lateral instability of the foot causing valgus (displaces foot away from the midline) and an increased incidence of ankle and foot sprains.

LEGS

Bow legs (genu varum)

Bow legs is the abnormal out-curving of the legs resulting in a gap between the knees on standing.

Bow legs cause compression medially on the knee.

Knocked knees (genu valgum)

Knocked knees is the abnormal in-curving of the legs resulting in a gap between the feet when the knees are in contact.

Knocked knees cause compression laterally on the knee.

Hyperextended

The knees extend more than is normally seen. Some people are more mobile than others; care needs to be taken to protect their joints as they are more prone to damage. These are more commonly seen in those with a history of dance or gymnastics, or those with an anteriorly tilted pelvis.

Somebody suffering from hyperextended knees could have weak hamstrings and tight quadriceps.

PELVIC TILTS

Anterior tilt

An excessive anterior pelvic tilt is often a result of poor control (weak or long) of the rectus abdominus (abdominals), gluteus maximums (bum) and hamstrings. The lack of acceptable muscular control of these major muscles in combination with tight hip flexors, rectus femoris (quads), tight lumbar extensors (Quadratus Lumborum – QL, Erector Spinae or lower back) leads to the increased anterior tilt of the pelvis.

Posterior tilt

An excessive posterior pelvic tilt may be due to lack of control (weak or long) in the lumbar extensors (lower back) and hip flexors. And a lack of flexibility (tight or short) in the hamstrings, gluteus maximus and rectus abdominus muscle groups.

Lateral pelvic tilt

Excessive lateral pelvis tilt may be due to such factors as leg length discrepancies and poor control (weak) of the lateral stabilisers such as the obliques, gluteus medius, hip abductors and adductors of the weight bearing limb. Tight muscles on one side of the body may also result in lateral tilting of the pelvis such as quadratus lumborum (QL) and obliques.

A classic example of this is a parent who always holds their children on one side of the body. Such tilts also have knock-on effects for other parts of the body.

SPINAL ABNORMALITIES

Lordosis

Lordosis is the term given to excessive inward curvature of the spine at the lumbar region. A certain degree of curvature is normal at the lumbar and cervical regions of the vertebral column. However, exaggerated lordosis often goes in hand with an anterior pelvic tilt and is caused by and contributes to worsening posture.

What exercises should be avoided?

Caution should be taken when weight bearing on the neck or above the head takes place such as with barbell squats or shoulder press. The loss of correct alignment of the lumbar area decreases the ability of the body to absorb compressive forces. When squatting using bodyweight or dumbbells, a shorter range of movement may be required for the exercise to be performed comfortably and correctly. Stretch therefore becomes important to increase the range of motion before adding load.

Kyphosis

Kyphosis is the term given to excessive outward curvature of the thoracic spine, causing hunching of the spine.

What exercises should be avoided?

Any exercise where abduction or flexion takes place at the glenohumeral (shoulder) joint places the soft tissue structures of the shoulder at higher risk. The risk would depend on the extent of the postural concern and the degree of movement at the joint.

Caution should also be taken when weight-bearing on the neck takes place such as with barbell squats. When an individual has rounded shoulders the lumbar curve may also be affected.

Loss of correct alignment of the lumbar area with compression forces increased potential for low back injury.

Flat back

Flat back is the term used to describe a lumbar area that has an absence of a lumbar curve. Flat back posture often goes hand in hand with a posterior pelvic tilt.

What exercises should be avoided?

Caution should be taken when waiting on the neck or above the head takes place such as with barbell squats or shoulder press. The loss of correct alignment of the lumbar area decreases the ability of the body to absorb compressive forces.

Monitor the frequency of impact movements such as running and jumping where a higher amount of stress may be distributed through the lumbar area.

SCOLIOSIS

Scoliosis is the lateral and rotational deviation of the vertebral column caused by congenital or acquired abnormalities of the vertebrae, muscles and nerves or through compensation.

Functional scoliosis often goes hand in hand with lateral pelvic tilt.

What exercises should be avoided?

Weight-bearing on the neck or adding loads above the head should be avoided such as barbell squats or shoulder press. When an individual has scoliosis the ability to handle compressive forces is reduced, increasing the potential for injury to the facet joints and intervertebral discs.

Scapula

Rounded shoulders

Rounded shoulders are the protraction of the scapula and the internal rotation of the humerus, and often go hand in hand with kyphosis. As a result of tight / short pec major +/- pec minor and under active / weak mid trapezius and rhomboids.

Avoid exercises that raise the shoulder above 90 degrees of abduction or flexion as there is a higher chance of impingement of the biceps tendon or the supraspinatus tendon.

Winged scapula

Winged scapula is a result of weakness in the serratus anterior. The scapula does not remain against the ribs, particularly noticeable under load. To correct, use push-ups against a wall to encourage good engagement of the scapula stabilizers.

Elevated scapula

One scapula is higher than the other, or both are elevated. As a result of under-active lower trapezius and over-active upper trapezius.

NECK

Anterior head carriage

The head is carried in a forward position, placing increased stress and compression on the facet joints and discs in the spine. Can be a result of tight sternocleidomastoid (neck), or of over-tight upper traps and cervical muscles.

Often goes hand in hand with kyphosis and rounded shoulders and if the shoulder girdle stability is rectified the head carriage usually self-rights.

Lateral head tilt

Often as a result of a tight sternocleidomastois (SCM), upper traps or levator scapulae but can also be compensatory from imbalances further down the spine (scoliosis for example).

SCAPULAR RETRAINING

This term is used to describe the re-balancing of the muscles around the scapula (shoulder blade). Typically this means the stretching of the pectorals, upper traps, scaleni, SCM, rhomboids, lats, and occasionally muscles of the rotator cuff.

  • It also involves strengthening of several key muscles surrounding the scapula and shoulder. These may include the lower and mid traps, rhomboids, posterior deltoids, serratus anterior and muscles of the rotator cuff.

  • The term ‘retraining’ is used because many people will find it very difficult to activate these muscles correctly. For this reason the help and guidance of a postural trained personal trainer may need to help the person to ‘retrain’ these muscle groups.

  • This would include specific stretches, one or more exercises for postural retraining, one or more exercises for core stability and one or more exercises for scapular retraining.

Getting a specialist personal trainer to retrain these muscles with you benefits you in many ways:

  1. Assist in recovery without adverse effects

  2. Minimise the effects of de-conditioning

  3. Prevent future injury

  4. To over-see that you are training with correct posture and form

  5. To prevent over-training and the development of pathological conditions attributed to poor exercise program design

  6. Educate and inform

  7. Correct exercise selection, instruction and progression

  8. Reviews and progression/regression

CORE CONDITIONING

Core conditioning refers to a specialist branch of exercise that trains specifically the core muscle group. It is used by a range of professionals including physios, some chiropractors, spinal rehab centres, dancers, athletes and of course personal trainers. Core conditioning started to be used by the elite exercise professionals in the 1960s (pioneered then by Joseph Pilates) and about 10 years ago was brought to the mainstream by people like Paul Chek. Since then core training has become more and more widely used and popularised, with people jumping on the ‘pilates bandwagon’ and mixing the principles of core training with a number of other activities such as stretch classes and abdominal work outs.

Core muscles

  • Multifidus

  • Internal obliques

  • Transverses Abdominus (TVA)

  • Pelvic floor diaphragm

These muscles support the lumbar spine and pelvis and provide stability of the frame, connecting top and bottom halves of the body reinforcing the centre from which movements originate, giving power to the limbs reducing the risk of injury. It is difficult to do properly because mostly we are retraining neuro-muscular (NM) pathways that may be dormant or slow to fire (meaning global muscles are quick to take over their role).

Transversus Abdominus (TVA)

TVA’s fibres run parallel to the vertebral bodies. It acts to compress the abdominal contents, thus increasing the intra abdominal pressure (giving the spine more strength). TVA attaches to the thoracolumbar facia posteriorly and the linea alba anteriorly.

Internal Obliques

The fibres of the internal obliques are nearly parallel to the TVA and as their posterior attachments are indistinguishable, meaning functionally it is difficult to separate them.

Pelvic Floor and Diaphragm

Contraction of the pelvic floor and diaphragm also increases intra abdominal pressure (conceptually, the TVA and the internal obliques form the sides of a box, while the pelvic floor and the diaphragm form the top and bottom).

Multifidus

The important local mover, acts to prevent unwanted rotational movements in the spine by contracting as the spine flexes. It attaches to the transverse processes of the vertebra, and crosses 2 or 3 spinal segments at a time.

During a first episode of acute low back pain, studies have shown that this muscle becomes inhibited and does not spontaneously reactivate when the back pain resolves. Pathological changes (wasting and micro damage) in this muscle have been linked with poor outcome and recurrence symptoms.

Challenge

The challenge seems to be more a result of inadequate stabiliser function than a problem in the global muscles. For the stabiliser muscles, good functioning depends on more than strength, it depends on coordination from the nervous system. Timing is essential, to maintain a joint’s integrity they must be able ti fire before the main muscles of action. Stabilisation therefore should occur pre-movement.

Activation

Teaching activation is often best started with the client lying on their back on a mat, with the legs bent (hip and knees at 90 degrees) arms by the side.

Contraction of the TVA (along with some co-contraction of the multifidus) is stimulated through visualising drawing the belly button through the spine.

The pelvic floor is activated with a drawing up sensation, initiated from the lower pelvis (a kind of ‘stopping yourself from urinating’ sensation!).

The sensations should be subtle. A strong sensation of muscular contraction generally is associated with global muscle contraction (glutes, rotators, hamstrings, rectus abdominus) all of which may inhibit the action of the core muscles.

Breathing patterns are important. Research has shown that strongly exhaling through pursed lips increases the strength of the deep muscle contraction of TVA (therefore increasing the power/stability). Breathing out on movement ensures correct contraction of the target muscles. To aid movement patterns remember that inhaling encourages trunk extension and exhaling encourages trunk flexion.

SUMMARY

Postural Retraining

  • Pelvic tilts – Stretch (short/tight muscles) and strengthen (long/weak muscles)

Scapula Retraining

  • Stretch & strengthen

  • Retrain neuromuscular pathways

  • Program imbalance

Core conditioning

  • Mat and ball work – retrain neuromuscular pathways

  • Control through movement

Stretch

  • Rectus Femoris

  • Hip Flexors

  • Upper Traps

  • Pecs

Strengthen

  • Core

  • Mid/lower traps

  • Glute Max (bum)

  • Specific postural exercises

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