The Perils of Perfect Posture

The Perils of Perfect Posture, Part I

By Erik Dalton, PhD

Throughout history, human posture has been scrutinized for symbolic values ranging from socioeconomic status to psychological babble. In schools, teachers often reprimanded students to sit up straight.

Young girls innocently walked with books balanced perfectly on the top of their heads during "charm school" classes. Aesthetically, even the dancer has come to represent the epitome of graceful posture and balance, with the ethereal vision of the lithe ballerina artlessly stretching to the sky. Meanwhile, the rest of us may never forget the words of well-intentioned parents, "Now, stand up straight or people will think you have something to hide." Society's undying commitment to its tradition for proper postural codes remains alive today, in circles that not only envelop the military private, but also the young debutante in white.

But as we begin to casually observe the people around us, the question must arise: Is perfect posture really a reasonable goal for the average American living in a flexion-addicted society?

Clinical evidence overwhelmingly supports the fact that prolonged sitting or sleeping in flexed positions neurologically shortens and tightens the body's hip flexors, particularly the iliopsoas muscles. As the antagonist gluteus maximus muscles gradually become reciprocally inhibited and weak, a primary muscle imbalance pattern ensues. Could more harm fall upon someone in this condition? Simply put, yes. As he rises from his chair, the shortened iliopsoas and rectus femoris muscles drag the hips and lumbar spine forward. Thus, the unsettling "before" snapshot: A swayback posture and protruding belly ... paving the way to a disappointing first impression.

However, prolonged slumped sitting can also promote an even greater pain-generating problem. While slouching or leaning forward, such as when we tirelessly perform computer or couch potato work, our swayback curve gradually begins to reverse itself by overstretching the posterior low back ligaments and joint capsules. Gravity loudly demands its pound of flesh, and this newly formed "reversed lordosis" gets an extra boost in its battle with the flexion-addicted swayback.

As we repeatedly stand, sit and slouch throughout a typical 8- to 10- hour workday, our low back curve is forced to repetitively translate anteriorly to posteriorly. The inevitable strain from local lumbar hypermobility soon begins to ravage the vulnerable sensory receptors in the body's joints, ligaments and intervertebral discs. Noxious afferent stimuli bombards the central nervous system causing the brain to react by triggering layers of muscle spasm to protect the unstable spine from further insult. Digging out the deep spasm and fascial contractures is usually a sad waste of time and energy unless the underlying joint dysfunction is first appropriately treated. Approaches to restore optimal posture and relieve chronic pain should include specific techniques designed to co-activate hyperactive sensory receptors such as mechanoreceptors, nociceptors and chemoreceptors in joints and ligaments, while activating muscle spindles to tonify inhibited weak tissues.

Ligaments, Muscles and Strain Patterns

While the overstretched ligaments valiantly strive to maintain spinal stability, the unrelenting force of gravity pounds the posterior facet joints and flattens the lumbar discs. The brain then begins its selective recruitment of specific muscles to provide ancillary support to the unstable spine. The problem worsens since contractile tissues designed to move bones are now required to work as spinal stabilizers. Sustained isometric muscular contraction neurologically weakens the lumbar myofascia due to the sudden influx of lactic acid and other toxic waste products. As the shortened tissue tugs unevenly on the spine, the joints' axis of rotation is altered. Predictable strain patterns and postural compensations reverberate throughout the thorax, neck and head. Forward head postures and slumped shoulders are two favorite dance partners of the pained swaybacks in this rapidly growing social circle of "flexaholics."

Postural muscles, such as the iliopsoas, quadratus lumborum, rectus femoris, and hamstrings, are structurally designed to resist fatigue in the presence of prolonged gravitational exposure. So why are distorted postures and chronic pain problems dominating our practices? The easy answer: overuse, underuse and just plain old abuse.

These three primary culprits create muscle imbalances that reduce the body's capacity to resist stress. As with everything in life, the body exists on a plane of give and take. Therefore, when postural muscles tighten, the antagonist groups are overstretched and weakened, allowing asymmetric patterns to develop. Soon the anti-gravity function of the body's myofascial system sends an alarm to deeper structures, such as spinal ligaments, joint capsules and intervertebral discs, to brace for the overbearing compressional loads. The homeostatic threshold has been violated.

The body must now prepare to battle the devastating, self-perpetuating pain/spasm/pain cycle manual therapists confront each workday.

If considering the medley of countless occupations that require the typical 12-pound head to be held in a bent forward position, with arms positioned in front of the body, why is it any shock that neck, shoulder and arm pain run rampant in today's society? Consider the typical profiles of individuals fitting this definition. This endless list runs the gamut from dentists, car mechanics, stockbrokers, hairdressers, etc. - even bodyworkers.

Long hours of passive sitting at the computer, or leaning over therapy tables, create stretch weakness in the rhomboids and lower trapezius. This repetitive physical practice contributes to forward dragging of the shoulder girdle due to the pectorals propensity for domination. Tight latissimus dorsi and subscapularis muscles unite with the clavicular head of pectoralis major to internally rotate the humerus. With the scapulae protracted and the arms internally rotated, the neck reluctantly moves forward on the shoulders often forming the unattractive "dowager's hump". Unfortunately, as the spinal facet joints slide open, the cervical curve loses its lordosis and transforms to a typical straight cervical curve. To prevent the person from only looking at the ground, the brain recruits the suboccipitals and other capital extensor muscles to cock the head back into hyperextension. As the occiput hyperextends and slides forward on the atlas vertebra, the posterior occipital atlantal membrane is squashed along with local neural and vascular structures.

Sadly, tonic reflexes and dural attachments originating at the O-A joint dictate postural muscle tone throughout the entire trunk. Stubborn head, neck, brachial, and scapular pain refuses to leave when in an agitated state. These painful and chronic conditions frustratingly persevere until the therapist chooses to systematically balance the shoulder girdle on the rib cage, the neck on the shoulders, and the head on the neck.

To better understand the consequences of forward head postures and slumped shoulders, try these two experiments:

Exercise #1

• Assume a comfortable sitting or standing posture.
• Tuck the chin toward the chest. Allow the shoulders to come back into an ideal postural position.
• Slowly turn the head as far to the right and left as comfortably possible. Take notice of the available range of cervical motion.
• Assume the forward head posture. Rotate the head as far left and right as possible.

Most people experience a 25 percent to 50 percent decrease in range of motion while in the forward head position. This exercise helps illustrate the physical limitations of people suffering forward head postures and demonstrates the negative impact these sensitive neck structures must endure during normal activities, such as driving, shopping, dancing, etc., Spondylosis, degenerative disc disease and osteoporosis are but a few names that describe what physically transpires when this structural alignment problem is not corrected in a timely manner. The farther the head slides forward on the sagittal plane, the more devastating the long-term effects. The posterior longitudinal ligament likes to tear away from the discs and vertebral bodies from C4 to C6 causing internal pressure to fill the cracks with calcium or bone spurs (osteophytes) - the resounding reason why bone spurs originating from forward head postures have become the most common cause of chronic neck pain.

Exercise #2

• Assume a comfortable sitting or standing posture.
• Tuck the chin toward the chest. Allow the shoulders to come back into an ideal postural position.
• Close the eyes. Raise the arms from your sides as high as comfortably possible.
• In the same postural position, raise the arms to the front as high as possible.
• Assume a slumped shouldered/forward head posture. As in the first exercise, again raise your arms to your side and to the front as high as possible.

Both exercises lead to a compromising conclusion: Always begin upper-quadrant postural alignment by balancing the shoulder girdle on the rib cage, neck on the shoulders, and the head on the neck,before tackling specific extremity pain problems, such as supraspinatus tendonitis or thoracic outlet syndrome.

Supraspinatus tendonitis pain is generally the result of forward head postures and slumped shoulders ... not the cause. When the humerus internally rotates from a slumped posture, the supraspinatus attachment at the greater tubercle of the humerus also rolls forward. Then when called upon to lift a heavy suitcase, the supraspinatus tendon cries for help as the shoulders are retracted. Pain shoots down the arm as the tendon flips back over the humeral head, and soon the fibers begin to tear.

Part II

Postural Harm to the Viscera

Prolonged sitting can contribute to a significant loss of cervical and lumbar curve, while increasing thoracic kyphosis.

Just like the newborn, the result is one big C-curve, with all the facet joints sliding open - beginning at the sacrum and curving all the way up to the occiput. With the shoulders drawn forward and the chest flattened, the abdomen protrudes below the belly button, resulting in altered breathing patterns. Tension increases on the pericardium and its neurovascular contents, because the diaphragm is now lowered. Individuals who suffer from this condition may seek help from their physician for complaints of heart palpitations or respiratory infections, while ignoring the real cause - a potential alteration of visceral position and function.

Exploring Perfect Posture

To fully understand why aberrant postural patterns create chronic head, neck, back and hip pain, perfect posture must be clearly defined. Simply put, perfect posture is a condition in which body mass is evenly distributed. Muscles are not actively working toward appeasement of pain. Ligamentous tension must be perfectly balanced against compressive and tensegrity forces, so the typical activities of standing and walking require minimal energy expenditure. Because locomotion requires the controlled loss and regaining of balance, movement of any body part with respect to the rest of the body shifts its centerline of gravity, causing an inevitable change in overall balance.

Wasting Precious Energy

Ideally, during standing, postural muscles should be in a state of normal tonus and not actively contracting. However, as the body is subjected to micro or macrotraumas during the normal routines of life, postural balance becomes less than perfect. When this happens, active muscle contraction is required to redistribute body mass and effectively hold it in place. At this point, the muscles are working against gravity requiring them to perform the ligament's job of stabilizing the joints.

Muscle contraction requires energy; therefore, postural imbalances result in an enormous energy drain, proportional to the magnitude of the postural imbalance. Of course, this becomes lost energy unavailable for its original purposes. Energy drains have a dramatic effect on the limbic system - the highest cortical level controlling muscle tone. As whole-body tension builds, clients begin to report strange symptoms resembling fibromyalgia, chronic fatigue syndrome and digestive or hormonal disorders.

Faulty posture becomes magnified in clients who participate in athletic competitions. For example, short leg syndromes from a tilted pelvis can create a dramatic loss in time, strength, coordination and endurance in both amateur and professional athletes. In addition to energy loss, the body's joints are often subjected to abnormal mechanical stresses. When the spinal musculature is involved in lateral curvatures due to compensations from a tilted or side-shifted pelvis, shortening of the ligaments and muscles on one side and lengthening on the other occurs. Alterations in joint function, caused by capsular restriction or loss of joint play, inhibit or facilitate the muscles that cross the misaligned joint.

If proprioceptive impulses from sensory receptors located in joint capsules, ligaments, tendons, muscles, fascia and intervertebral discs become agitated from pelvic misalignment, compensations resound up and down the spine. Even the slightest alteration in the normal balance of the various spinal segments leads to some degree of soft tissue change. Nature inherently attempts to automatically restore equilibrium, by contracting and shortening certain muscles and inhibiting and weakening others.

When a joint's axis of rotation changes, one side of the joint capsule and its supporting muscles and ligaments become overstretched and weak. Meanwhile, sensitive mechanoreceptors imbedded in the articular cartilages and discs on the compressed side send a barrage of mechanical distress signals to the spinal cord.

Facet joints are possibly the most innervated structures in the spine. Their cartilages despise prolonged compression and soon become swollen, inflamed, and eventually degraded. As chemical inflammatory agents accumulate, chemoreceptors are stimulated and join the mechanoreceptors in flooding the neuronal pool with warning bells of possible tissue damage. This stimulates the pain-producing nociceptors that cause the brain to tighten and shorten specific muscles to avoid further pain - the embodiment of our" crooked" clients in acute pain. The brain twists and torques the body in an attempt to alleviate the pain. Regrettably, the cerebellum has the ability to memorize these aberrant patterns and re-learn them as normal. This condition, when the deformed posture long outlasts the painful stimuli, is called neuroplasticity, reflex entrainment or spinal learning.

Feet-Shufflers

In the presence of joint blockage caused by capsular tightness and compression, normal articular reflexes may become so disrupted that when the tightened area of the joint capsule is overstretched, reflex inhibition of the overstretched muscle prevents further capsular elongation.

"Feet-shufflers," occasionally seen in malls and supermarkets, represent the perfect exaggerated embodiment of how a dysfunctional hip capsule can disrupt the firing order of muscles that cross a joint. During the walking cycle, the feet-shuffler's push-off leg can't extend backward, due to adhesions in the anterior part of the hip capsule. Therefore, he or she uses the hip flexors to throw the feet forward to walk. Therapists usually attribute this condition to tight hip flexors that won't allow the back leg to follow through in extension. However, during therapy treatment, attempts to increase hip extension by actively or passively stretching the hip flexors can cause an immediate firing of the joint and ligament mechanoreceptors creating a sort of stretch reflex. The adhesive capsule fools the joint receptors into believing the hip has already reached its end range of motion. A condition called arthrogenic muscular weakness inhibits the hip's prime mover, the gluteus maximus, and facilitates the already tight/short iliopsoas. This appears to be a local genetic protective device to prevent excessive hip extension and further jamming of the joints' compressed cartilage.

Regrettably, anterior hip capsule adhesions are a widespread and overlooked source of flexion addiction in our society. Some may conclude that this insidious hip condition is the reason for so many hip replacements being performed in this country each year. Athletes who complain of loss of speed in their competitive trials may also suffer from a lack of full hip extension in one or both hips. Hip flexor work alone just won't solve the problem. One helpful routine is to first dig-out, plunger and stretch the adhesive hip capsule, then tonify the weak gluteus maximus with fast-paced, spindle-stimulating maneuvers. To finalize this procedure, use techniques ranging from assisted stretching, myofascial release, trigger point therapy or muscle energy to lengthen the tight iliopsoas.

Conclusion

The mysterious yet potentially stressful force of gravity affects each of us here on planet Earth. Our body's somatic system is intrinsically involved in its reaction to a shift in the center of gravity. Muscle and ligamentous tension is maintained by negative feedback from sensory receptors located in joint capsules and intervertebral discs. When the normal function of any part of the somatic system becomes overstressed, the vicious cycle of pain and dysfunction begins. Our job as bodyworkers is to maintain normal mobility of all components of the somatic system, to help minimize gravitational strain and any consequences from postural imbalance.

Emerging from an industrial society to one rich in technology, we now live in a world in which our external environment greatly impacts the healthful functioning of our bodies. As therapists working with a flexion-addicted population, we must garner a greater understanding and respect for the goal of perfect posture and its relationship to chronic pain, so we can teach our clients how to lead healthier, happier and more productive lives. May we all be graceful dancers, stretching artlessly to the sky.