Posture

Mahmooda Naqvi
Sr. Lecturer
BPT,PPDPT
Posture
Posture is a position or attitude of
the body, the relative arrangement of
body parts for a specific activity

It is alignment of the body parts
whether upright, sitting, or
recumbent.
Posture
It is the attitude which is assumed
by body parts to maintain stability
and balance with minimum effort
and least strain during supportive
and non supportive positions.

Posture
Can be
Dynamic
Static
Static posture
Alignment of the
body and its
segments
maintained in
certain positions.
Eg: standing,
sitting, lying, and
kneeling.

For any stationary posture to be
maintained, two rules of equilibrium
must be satisfied:

A vertical line,
directly through
centre of gravity
of the body must
fall within the
bodys base of
support.
The net torque (or
moment) about
each articulation
of the body must
be zero.


Types of static postures
Dynamic posture
Postures in which the
body or its segments
are moving.
This posture is adopted while the
body is in action, or in the anticipatory
phase just prior to an action occurring.
Eg: walking, running,
jumping, throwing, and lifting.

Raising arm and single stance
CORRECT POSTURE
Is the position in which minimum
stress is applied to each joint. This
stress should remain minimal
during rest and while in activity.
DEVELOPMENT OF GOOD POSTURE
A stable psychological
background
Good hygienic conditions
Opportunity for plenty of
natural free movement
Is Correct Posture Applicable To Both Static Or
Dynamic Posture



Applicable to both
static and dynamic postures
like standing, sitting, lying,
walking, lifting.

Good posture in standing
GOOD DYNAMIC POSTURE
FAULTY POSTURE
Any static position that
increases the stress to the
joints may be called faulty
posture.
Impairments in the joints,
muscles, or connective tissue
(ligaments, capsule) may
lead to faulty posture.
FAULTY POSTURE
Faulty postures may lead to impairments in the
joints, muscles and connective tissues as well as
symptoms of discomfort and pain.
Many musculoskeletal complaints
can be attributed to stresses that
occur from repetitive or sustained
activities when in habitually
faulty postural alignment.

IS RELAXING POTURE IS A
GOOD POTURE
POSTURAL MUSCLES
Postural muscles act predominantly to
sustain posture in the gravity field.
These muscles contain mostly slow-
twitch muscle fibers and have a
greater capacity for sustained work.

POSTURAL MUSCLES
Shoulder girdle-
Arm
Trunk Pelvis- Thigh Lower leg- Foot
Pectoral Muscles
Levator Scapulae
Trapezius (upper)
Biceps Brachii
Scalenes
Subscapularis
Sternocleidomast
oid
Suboccipitals
Masseter
Temporalis
Wrist & Finger
Flexors
Lumbar Erector
Spinae
Cervical Erector
Spinae
Quadratus
Lumborum
Hamstrings
Iliopsoas
Rectus Femoris
Adductors
Piriformis
Tensor Fasciae
Latae
Gastrocnemius
Soleus
FACTORS AFFECTING
POSTURE
Faulty posture may be caused
due to:
a.Structural factors
b.Postural/Positional factors

STRUCTURAL FACTORS
Structural deformities which are the
result of congenital anomalies,
developmental problems, trauma, or
disease, may cause alteration of
posture.
Eg: A significant difference in leg
length or an anomaly of spine.
STRUCTURAL FACTORS



























Structural deformities involve
mainly changes in bone
Are not easily correctable without
surgery.
Relieved of symptoms by proper
postural care instructions.
POSTURAL (POSITIONAL)
FACTORS
The most common postural problem
is poor postural habit. Whatever the
reason may be, the patient does not
maintain correct posture.
The majority of postural non
structural faults are relatively easy to
correct after the problem has been
identified.
POSTURAL (POSITIONAL) FACTORS
The treatment involves
strengthening weak muscles,
stretching tight structures, and
teaching the patient to maintain a
correct upright posture in
standing, sitting and other
activities of daily living.
Postural factors
The functional incorrect posture
may be seen in the following:
Prolong standing or sitting
and then begins to slouch.
In children not wanting to appear taller than
ones peers. Eg: Tight hamstrings in
adolescents due to early growth of bone and
slow growth of muscle.


Muscle imbalance or muscle
contracture.
Eg: Tight iliopsoas increases
lumbar lordosis in the lumbar spine.


Pain- The person suffering from
pain may adapt certain posture
so as to relieve pain.
Respiratory conditions
Eg: Emphysema
Excess weight loss




Loss of proprioception


Muscle spasm
Eg: Cerebral palsy


Postural Sway
In standing position,
there is a continuous
movement due to
alternating action of
antagonistic muscle
groups working to
resist gravitational
stresses.
This work keeps the
total centre of gravity
of the body within the
bodys base of
support.
Postural Sway
The above
continuous
movement results
in a slight anterior
posterior swaying
of the body of body
Approx 4cm
excursion called
the postural sway
or sway envelop.

Postural Sway
The extent of the sway
envelop for a normal
individual standing with 4
inches feet apart can be
as large as
12 in the sagittal
plane
16
o
in the frontal
plane

Vision is the most
important factor in
reducing postural sway.
Fixating the vision on a
given point lessens
excursion.
Postural sway varies
across the lifespan, being
greatest in the young and
elderly.
Postural control
Postural control which can either be
static or dynamic, refers to the persons
ability to maintain stability of the body
and body segments in response to
forces that threaten to disturb the
bodys equilibrium.
Brought about by the activity of the
Central Nervous System.
Maintenance and control of posture
depends on the integrity of the CNS, visual
system, vestibular and musculoskeletal
system.
Postural control also depends on
information received from receptors
located in and around the joints (in joint
capsules, tendons, and ligaments), as well
as the soles of the feet, muscles ,eyes, skin
and ears.


Perturbations
Perturbation is any sudden change in
conditions that displaces the body posture
away from equilibrium. They can be:
Sensory:
Caused by altering visual,
sensory input.
Eg: Such as covering a
persons eye unexpectedly.
Mechanical: Caused by movements of either
body segment or entire body.
Mechanical perturbations are displacements that
involve direct change in the relationship of the
bodys CoM to the BoS.
Pushing someone


Breathing can displace CoM.
Perturbation in standing that result
from respiratory movements of
the ribcage are counterbalanced
by movements of the trunk and
lower limb.
Response
The Central Nervous System interprets and
organizes inputs from the various structures and
systems and selects responses on the basis of
past experience and the goal of the response.
Reactive (compensatory) response: Occurs as
reactions to external forces that displace the
bodys COM.
Proactive (anticipatory) response: Occurs in the
anticipation of internally generated destabilizing
force such as raising arms to catch a ball or
bending forward to tie shoes.

CENTRE OF MASS
It is the point on an object at which
the relative position of the distributed
mass sums to zero
The point about which objects rotate.
Cont

Although a human body has complicated features, the
location of the center of mass (COM) could be a good
indicator of the body proportions.
The center of mass of the human body depends on the
gender and the position of the limbs.

Cont
In a standing posture, it is typically about 10
cm lower than the navel, near the top of the
hip bones.
Motion of the whole bodys center of
mass when stepping over
obstacles of different heights
Tripping over obstacles and imbalance during gait were reported as two of
the most common causes of falls in the elderly. Imbalance of the whole
body during obstacle crossing may cause inappropriate movement of the
lower extremities and result in foot-obstacle contact. Thus, this study was
performed to investigate the effect of obstacle height on the motion of the
whole bodys center of mass (COM) and its interaction with the center of
pressure (COP) of the stance foot while negotiating obstacles. Six healthy
young adults were instructed to perform unobstructed level walking and to
step over obstacles of heights corresponding to 2.5, 5, 10, and 15% of the
subjects height, all at a comfortable self-selected speed while walking
barefoot. A 13-link biomechanical model of the human body was used to
compute the kinematics of the whole bodys COM. Stepping over the higher
obstacles resulted in significantly greater ranges of motion of the COM in
the anterior-posterior and vertical directions, a greater velocity of the COM
in the vertical direction, and a greater anterior-posterior distance between
the COM and COP. Incontrast, the motion of the COM in the medial-lateral
direction was less likely to be affected when negotiating obstacles of
different height(Li-Shan Chou a,1, Kenton R. Kaufman a,*, Robert H. Brey
b, Louis F. Draganich)
Estimation of the centre of mass for the
study of postural control in Idiopathic
Scoliosis patients: a comparison of two
techniques
The objective of the present study is to quantify the position of the Centre of Mass (COM)
during quiet standing using a force plate and compare this technique to the quantification of
the COM with an anthropometric model. The postural control of 18 healthy adolescents and
22 IS patients was evaluated using an Optotrak 3D kinematic system, and two AMTI force
plates during quiet standing. The position of anatomical landmarks tracked by the Optotrak
system served to estimate the position of the COM of both groups using an anthropometric
model (COManth). The force plate served to estimate the position of the COM through
double integration of the horizontal ground reaction forces (COMgl). The mean position and
root mean square (RMS) amplitude of COMgl, in reference to the base of support (BOS) and
the first sacral prominence (S1) were quantified in the AnteriorPosterior (A/P) and Medial
Lateral (M/L) directions. There was a significant difference between the control subjects and
IS patients for the displacement of the COMgl in reference to the BOS in both the A/P and
M/L directions. There was no difference between groups for the mean position of the COMgl,
however, 63% of the IS and 43% of the controls had a lateral position of the COMgl in
reference to S1 of greater than 5 mm. There was a significant difference between groups in
the A/P and M/L directions for the amplitude of error between the COMgl and COManth
technique
Muscle synergies/strategies
Horak and associates described synergies
as centrally organized patterns of muscle
activity that occur in response to
perturbations of standing postures. The
three types of muscle synergies include:
1.Fixed-support synergies
2.Change-in-support synergies
3.Head-stabilizing synergies ----
Proactive
Reactive
Strategies are automatic and occur 85
to 90 msec after the perception of
instability is realized

1. Fixed-support synergies
Stability is regained through
movements of body parts, but feet
remains fixed on the BOS.
Ankle-strategy:
Involves shifting of the CoM forward
and back by rotating the body as a
relatively fixed pendulum about the
ankle joints.
Most commonly used strategy when
disturbances are small, well within the
BOS or LOG.

ANKLE STRATEGY
Used when perturbation is
Slow
Low amplitude
Contact surface firm, wide and longer than foot
Muscles recruited distal-to-proximal
Head movements in-phase with hips

Hip-strategy
Involves shifts in the COM by
flexing or extending the hips.
The hip strategy is recruited
with larger and faster
disturbances of the CoM.

HIP STRATEGY
Used when perturbation is fast or large amplitude
Surface is unstable or shorter than feet
Muscles recruited proximal-to-distal
Head movement out-of-phase with hips


Perturbation of erect stance equilibrium caused
by backward horizontal platform movement.
A. Posterior movement of the platform causes
anterior movement of the body and, as a
consequence, displacement of the bodys
CoM anterior to the base of support.
B. B. Use of the ankle strategy (activation of
the extensors at the ankle, hip, back, and
possibly neck) is necessary to bring the
bodys CoM over the base of support and
reestablish stability.
Perturbation of erect stance equilibrium
caused by forward horizontal platform movement.
A. Anterior (forward) movement of the platform
causes posterior (backward) movement of the
body and, as a consequence, displacement of
the bodys CoM posterior to the base of support.
B. B. Use of the ankle strategy (activation of the
flexors at the ankle, hip, trunk, and possibly
neck) is necessary to bring the bodys CoM back
over the base of support and reestablish
stability.
2. Change-in-support strategies
Are defined as movements of the
lower or upper limbs to make a new
contact with the support surface.
Include stepping and grasping in
response to shifts either in the BOS or
the entire body
The stepping strategies are
recruited in response to fast,
larger perturbations.

3. Head-stabilizing strategy
Occurs in an anticipation of the internally generated
forces caused by changes in position from sitting to
standing.
Are used to maintain the head during dynamic tasks such
as walking.
a. Head stabilization in space (HSS):. These anticipatory
adjustments of head position are independent of trunk
movement.
b. Head stabilization on trunk (HST): Is one in which the head and
trunk moves as a single unit.
Kinetics and kinematics of posture
There are both internal and external forces acting upon the body.
Different structures of the body serve to provide active internal forces in order to
counteract the external forces that affect the equilibrium and stability of the
body.
Some of the external forces acting upon the body which are of biomechanical
importance include inertia, gravity, and ground reaction forces (GRFs).
The internal forces are produced by muscle activity and passive tension in
ligaments, tendons, joint capsules and other soft tissue structures.
The sum of all of the external forces and internal forces and torques acting on the
body and its segments must be equal to zero for the body to be in equilibrium.
Inertial and gravitational forces
In the erect standing posture, little or no acceleration of the
body occurs.
Gravity places stress on the structures responsible for
maintaining the body upright therefore affecting stability and
efficient movement.
For a weight bearing joint to be stable or in equilibrium, the
LoG must fall exactly through the axis of rotation, or there
must be force to counteract the moment caused by gravity.
Ground reaction forces
when the body contacts a ground ,the ground pushes back on to the
body. This force is known as Ground Reaction Force (GRF).
The vector representing GRF is known as the Ground Reaction Force
Vector (GRFV).
The GRF is a composite (or resultant) force that represents the
magnitude and direction of loading applied to one or both feet.
It has three components:
A vertical component force (along the y-axis).
Two force components directed horizontally: Medial lateral direction (along x-
axis) and Anterior Posterior direction(along z-axis)
The point of application of GRFV is at bodys Centre of pressure (COP)
Coincident action lines
In an ideal erect position, body segments are aligned in such a
way so as to minimize the torques and stresses on the body
therefore reducing the energy expenditure.
The coincident action lines formed by GRFV & LoG are used to
study effects of these forces on the body segments.
The location of LoG & CoP shifts continually because of
postural sway. This results in continuous changing moments
created around the joints.
External and internal moments
External gravitational moments are created when the LoG passes
at a distance from the joint axis. This moment causes rotation of
the superimposed body segments around that joint axis.
This rotation has to be opposed by a counterbalancing internal
moment provided by muscle contraction.
If LoG is located anterior to a particular joint axis, the gravitational
moments cause anterior motion of the proximal segment of the
body supported by that joint (Flexion moments).
If LoG is posterior to the joint axis, the moment will cause a
posterior motion of the proximal segment (Extension moment).
Refrences
Joint structure and function by Cynthia C. Norkin (5
th

edition)
Therapeutic exercises by Kisner and Colby (5
th
edition)
Orthopedic assessment by Magee
Brunnstroms Clinical Kinesiology (5
th
and 6
th
edition)
Physical rehabilitation by Susan O sullivan
Thank you