By Patricia Staszak, PT

In this last article of the body wellness series, we will review how postural deficiencies can make us more vulnerable to overuse injuries and what we can do to prevent this from happening. To quickly review what we have discussed so far: We know that to avoid excess stress on our joints, we would like our posture to be in line with gravity and our joints to be in a neutral position as much as possible. Doing this will help us better keep our deep stabilizing muscles working at that low hum to give us postural support and keep our joints healthy.

But where does it go wrong, and what is actually happening in the musculoskeletal system of a person with bad posture? As we age and develop movement and postural habits, we tend to develop areas of our body that are stiff, or hypomobile, and others that move too much, or are hypermobile. These patterns develop because when we move, our body follows the rules of physics: it takes the path of least resistance. This means that we are more likely to move through our hypermobile areas, even if the new pattern does not use correct biomechanics. We are essentially changing the way the joint functions, and it is bad for our body.

After a while, this can actually change the joint axis. This leads to changes in the way our muscles work, increased wear and tear on the joint, and eventually arthritis. The resulting muscle imbalance and changes in our joint structure and function can actually change our posture over time.

We can change or slow down this process by working to stabilize our unstable joints and mobilize our restricted areas, and then teaching the body to move the way it was designed to move.

There are four ways a joint or joint segment gains stability:

•    Form closure: Stability gained from the shape of our joints, the supporting ligaments, and other supporting structures around the joint.
•    Force closure: Stability provided by the muscular system.
•    Motor control: Stability provided by our neural system; this includes timing and control in the use of our muscles and coordination.
•    Emotional state: More focus and concentration increases our ability to isolate muscles and movements.

Often our patients present themselves with a problem in their form closure—ligament strains and sprains, cartilage tears, or arthritis. Despite the impairment, we can increase the stability of the joint by improving our force closure and motor control. So, we work on strengthening, timing, coordination, balance—all those fun physical therapy treatments. And the more focused we are during our exercise, and the more awareness we have about our posture and body movement, the faster we will be able to affect change in our body.

During this process we are concurrently stretching the muscles and joints in the tight areas, so our body is better able to move into those areas. For example, low-back pain is a common problem that we treat in our clinic. In a normal spine, our low back (lumbar spine) is designed for only a minimal amount of rotation; the rotation should occur through the thoracic spine and rib cage above and the hips below. Oftentimes the patient evaluation will reveal tightness in the thoracic spine, rib cage, and hips. We all rotate our spines in everyday function, but if we are tight above and below the lumbar spine, the energy has to be absorbed somewhere, so we rotate excessively through the lumbar spine and cause wear and tear. In treatment, we will work to stabilize the lumbar spine, but to be able to move with correct form, we also have to increase movement in the hips and the thoracic spine.

As we restore balance to our joints, our goal is to hold these recently acquired soft-tissue changes. Then in our day-to-day life, if we then align our body with gravity the best we can and use our level-one stabilizers to gently hold us in the correct position, we can reinforce this pattern. So gradually, we can restore our normal posture, create better balance in our muscular system, and decrease stress though our joints.



Works Cited

Lee, Diane: The Pelvic Girdle.  Third Ed.  Edinburgh: Churchill Livingstone, 2004.  Print.

Sahrman, Shirley. Diagnosis and Treatment of Movement Impairment Syndromes. Ed. Kellie White. St. Louis: Mosby, 2002. Print.

“STOTT Pilates RMR-1 Spinal, Pelvic & Scapular Stabilization: Matwork and Reformer.” STOTT Pilates Rehab Instructor Trainer Workshop. STOTT Pilates Corporate Headquarters, Toronto. April 2009. Workshop.

Vleeming, Andry, Vert Mooney, Chris Snijders, Thomas Dorman, and Rob Stoeckart. Movement, Stability and Low Back Pain: the Essential Role of the Pelvis. Second ed. New York, NY [u.a.: Churchill Livingstone, 1999. Print.