Common Postural Deviations and Proposed Fixes
*UPDATE* (August 29, 2016): Did you know that studies have come out disputing the idea that 'bad' posture causes pain? In fact, there is little correlation between the two. Check out this write-up for more information!
Posture.
Did it work? Gotcha. The vast majority of people straighten up almost immediately after reading the word. Maybe by bringing their shoulders back slightly, or perhaps adjusting their footing a bit. Whatever it may be, the correction rarely lasts very long as we quickly revert back to bad habits.
As physical therapists, posture is a key area to address with each patient and should be included in any comprehensive treatment plan. It has the ability to affect factors such as muscle force production and diaphragmatic excursion, as well as play a role in acute and chronic injury prevention. It even has the potential to cause headaches and affect our mood.
That said, here are some common postural deviations and a few example exercises to help improve upon them. Remember that it is very common for a patient to have multiple deviations, not just one. I encourage readers to exercise their own clinical judgment and find individualized interventions for each of their patients. Look at the patient's body as a whole - you may find that an issue lower in the chain, such as a length-length discrepancy, can have consequences for areas of the upper body. Also realize that deviations secondary to a structural anomaly or neurological pathology are not always simple fixes.
Forward Head
Tight/shortened: Upper trapezius, levator scapulae, deep neck extensors
Weak/lengthened: Deep neck flexors
Stretches:
Strengthening:
Rounded Shoulders/Increased Thoracic Kyphosis
Tight/shortened: Pectoralis major & minor
Weak/lengthened: Middle and lower traps, rhomboids, rotator cuff musculature
Stretches:
- Doorway stretch
- Pec minor release (manually or with lacrosse ball)
Strengthening:
Uneven Shoulders [may be due to hand dominancy]
Tight/shortened: Upper trapezius on elevated side
Weak/lengthened: Middle and lower trap, serratus anterior on elevated side
Stretches:
Strengthening:
Anterior Pelvic Tilt/Increased Lumbar Lordosis
Tight/shortened: Iliopsoas, rectus femoris, erector spinae
Weak/lengthened: Abdominals, gluteus maximus
Stretches:
Strengthening:
Posterior Pelvic Tilt/Decreased Lumbar Lordosis
Tight/shortened: Abdominals, gluteals, hamstrings
Weak/lengthened: Iliopsoas, rectus femoris, erector spinae
Stretches:
Strengthening:
- SLR (with or without band)
- Alternating arms and legs
Closing Thoughts
Posture can be a tricky thing to address. An hour session at a PT clinic is not going to be enough if a person is just going to revert back to poor habits during the remaining 23 hours of the day. What can be done? Here are some suggestions on making it all stick:
- Drive it home - high repetition is important to establish a new postural norm.
- Education on standing and sitting posture - do they work a desk job? Can they take more standing breaks? Is ergonomics an issue?
- Evaluation of footwear and suggestions of alternatives - does the patient wear heels all the time? Do they exercise in worn-out tennis shoes?
- Deep breaths - teaching full diaphragmatic breathing can help reduce excessive accessory muscle use that can contribute to poor posture.
- Sleep posture - what side do they sleep on? How many pillows do they use? Bed firmness?
- Written reminders - even a post-it note on a person's car dashboard can be enough to help them straighten up.
- Therapeutic taping - external cuing can be very useful; tape placement between one's shoulder blades, for example, can help keep the scapulae retracted.
- Use of a foot insert if a leg-length discrepancy is present.
Find out as much information about the person's daily schedule as reasonably possible. With this information, you can help influence a patient's posture for the better and in a far more efficient manner.
What methods have you found helpful when addressing posture?