Transcript Active, Healthy Lifestyles for All: Thinking About Philosophy

Postures, Appearance, and Muscle
Imbalance
Chapter 14
Introduction
• Important objective for fitness/wellness
• Physical attractiveness
• Strength and flexibility fitness goals should
take into consideration postures
• We assume many postures each day and
they are connected
Good Postures: Strength and
Flexibility
• Mechanically efficient body positions and
movement patterns
• Balance between strength and flexibility
• Major principle of postures training is to
strengthen the extensors (antigravity
muscles)
Assessment of Postures
• Examination of muscle balance or
alignment of body parts
• Persons with paralysis and spasticity are at
higher risk of severe alignment problems
• Imbalances can be minimized by strapping,
bracing, casting, and surgery
• Proper positioning is essential
Spinal Column Curves
• Mature development of the spinal column
by age 7 or 8 includes the following curves
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Concave - cervical spine
Convex - thoracic spine
Concave - lumbar spine
Convex - sacral spine
Analysis of Muscle Imbalance
• Muscles on which surface are too tight?
– Which stretching exercises are indicated?
• Muscles on which surface are too loose?
– Which strengthening exercises are indicated?
• What role is gravity playing in the muscle
imbalance?
Normal Postural Development
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Cervical spine - 4 to 5 months of age
Lumber spine - after the child learns to walk
Flat back - normal in children until age 3 or 4
Lordosis - normal in young children and lessens
by adolescence
• Winged scapulae a prominence or protrusion of
the scapulae is normal until adolescence
Posture Training Guidelines
• Develop short-term objectives
• Use game-like activities that focus on
particular muscle groups
• Use kinesthetic, vestibular, and visual sense
modalities
• Emphasize full extension activities
• Use relaxation
Contraindicated Exercises
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Straight leg lift and hold
Straight leg sit-ups
Push-ups
Swan
Deep knee bends and duck walk
Straight leg toe touch and bear walk
Behavior Management and
Postures
• Suitable for some posture problems
• Utilizes auditory and vibrotactile feedback
when user slouches or moves out of
alignment
• Utilizes auditory reinforcement when user
maintains the appropriate posture
Forward Head and Neck
• Diagnosed when the earlobe is no longer in
alignment with the tip of the shoulder
– Mild - head droops forward
– Severe - round back, hyperextended cervical
spine, increased dorsal convexity of thoracic
spine
– Dowager’s hump - develops to the point of
having a prominent seventh cervical vertebra
and excess adipose tissue
Exercises That Help
• Strengthening of extensors if mild
• Stretching cervical extensors if severe
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Chin-to-shoulder touch stretch
Lateral flex stretch with ear touch
Halo push
Object-on-head walk
Contraindicated Exercises
• Circling the head
• Neck hyperextension
• Activities related to atlantoaxial instability
when working with individuals with Down
syndrome
Excessive Head Tilt
• Top of head tilting toward the right - right tilt (RT)
• Top of head tilting toward the left - left tilt (LT)
• May be symptomatic of vision or hearing
impairments
• Can cause adaptive shortening and tightening of
the neck muscles on the side of the tilt
– Lateral flexion exercises opposite of tilt
– Slow, static stretch and hold is effective
Kyphosis
• Increasing backward convexity in the
thoracic region
• Associated with disease of the intervertebral
disks or of the epiphyseal area of the
vertebrae
• Scheuermann’s disease affects adolescents
• Osteoporosis - affects older people,
especially women
Lordosis
• Exaggeration of the normal posterior concave
curve in the lumber region
• Throws the pelvis out of correct alignment
• Various causes
• Established characteristics
• Correction includes increasing proprioceptive
awareness and increasing abdominal strength
Abdominal Weakness
• Various classifications
• Abdominal protrusion is typical in young
children and those who lead sedentary
lifestyles
• Often accompanies obesity and paralysis
• Daily abdominal exercises and full
extension activities are recommended
Abdomen and Lower Back Exercises
• Adhere to exercise principles for abdomen
and lower back
• Various exercises in the creeping position
• Various exercises in the supine or bent-knee
sit-up position
Values of Abdominal Exercises
• Relieve congestion in the abdominal or
pelvis cavities
• Relieve menstrual pain
• Strengthen muscles needed for coughing in
asthma and respiratory diseases
• Strengthen muscles to improve appearance
and function
Flat Back
• Decrease or absence of the normal
anteroposterior curves
• Opposite condition from lordosis
• Associated with the debutante slouch
• Characteristic of body build of young
toddlers
• Various exercises are beneficial
Scoliosis
• Lateral curvature of the spine
• Keynote positions
– Adam’s position - relaxed forward bending held
for several seconds from a standing posture
– Hanging with both arms from a horizontal bar
– Symmetrical arm raise from a standing position
• Exercises prescribed by a physician
Scoliosis
• Lateral curves are named in terms of the
direction of their convexity
• Left curve is most common
• Adhere to exercise principles for scoliosis
• More prevalent in girls
• Causes are idiopathic
• Treatments include bracing and surgery
Uneven Shoulder Height
• Higher shoulder recorded as LH (left high)
or RH (right high)
• Assessment using a horizontal line on the
wall
• Check lateral spinal curve
• Typically dominant side of body has slightly
depressed shoulder and slightly higher hip
Uneven Hip Height
• Higher hip recorded as LH or RH
• Use anterior superior iliac spines as
anatomical landmarks
• Can be caused by scoliosis, uneven leg
length, or the habit of standing on one leg
for long periods of time
Winged Scapulae
• Prominence of the inferior angles of the
scapulae
• Serratus anterior is usually weak
• Typical in preschool and elementary children
• May be associated with round shoulders,
congenital anomalies, and postural conditions
in which the ribs protrude
Round Shoulders
• Forward deviation of the shoulder girdle
that brings the acromion processes in front
of the gravitational line
• Caused by the strength of the shoulder
girdle abductors being greater than that of
the adductors
• Incidence high among persons who work
desk jobs
Round Shoulders
• Athletes often have overdevelopment of
muscles that cause round shoulders
• Various compensations in alignment as a
result
• Stretching and strengthening exercises
stress shoulder girdle abductors and
adductors
Deviations of the Chest
• Associated with asthma, other chronic
upper respiratory disorders and rickets
• Limitations in chest flexibility and improper
breathing practices
• Degree of severity varies
• Often associated with congenital anomalies
Hollow Chest
• Most common
• Depression of the anterior thorax accompanied by
round shoulders and/or kyphosis
• Linked to the failure of the neck and pectoral
muscles to exert their usual lifting effect on the
ribs and sternum
Barrel Chest
• Occurs in persons with severe, chronic
asthma who become permanently
hyperventilated because of their inability to
exhale properly
• Lateral widening of the thorax from side to
side so that it no longer resembles a barrel
occurs normally as a result of play
Funnel Chest
• Abnormal increase in the lateral diameter of the
chest with a marked depression of the sternum and
anterior thorax
• Usually a congenital anomaly
• Appears in many persons with severe mental
retardation
• Also caused by rickets or severe nasal obstruction
• Associated with Turner and Noonan syndromes
Pigeon Chest
• Abnormal prominence of the sternum
• Rare, caused by rickets during the early
growth period
• May also be congenital
• Associated with les autres conditions like
osteogenesis imperfecta
Alignment of Lower Extremities
• Quick screening device -- Four Coins
• Individual differences in leg alignment and
in locomotor patterns are largely dependent
upon the hip joint
• Can be traced to a strength imbalance in the
muscles that rotate the femur at the hip joint
Hip Joint Problems
• How the head fits into the acetabulum
determines function and stability
• Affects leg alignment and gait
• Abnormal positioning of the femoral head
– Coxa vara - decreased angulation
– Coxa valga - increased angulation
• Corrected by casting, bracing, and surgery
Knee Joint Problems
• Congenital or acquired through injury
• Malalignment increases risk of
osteoarthritis
• Long-term obesity can injure knee joint
– Weight-bearing exercises are often
contraindicated for obese persons
Bowlegs (Genu Varum)
• Inward bowing of one or both legs
• Typical in children under age 2
• Blount’s disease or tibia vara
– Outward bowing of the tibia caused by retarded
growth of the epiphyseal plates
• May complicate other disorders
• No exercises are recommended
Knock-Knees (Genu Valga)
• Bending outward of the lower leg so that
the knees touch, but ankles do not
• Occurs in obese person and predisposes the
knee joint to injury
• Developmentally normal in children under 7
• Stretching and strengthening exercises may
be prescribed
Hyperextended Knees
• Knees are pulled backward beyond their normal
position
• Contributes to lordosis
• Caused by knee extensor weakness, tight calf
muscles, Achilles tendon contractures, and bony
abnormalities
• Severe cases - prescription of a knee-ankle brace
• Contraindicated activities
Tibial Torsion
• Tibia is twisted and the weight-bearing line
is shifted to the medial aspect of the foot
• Often accompanies knock-knees, flat feet,
and pronated feet
• Congential tibial torsion is corrected in
infancy with casts, braces, splints, and/or
surgery
Deviations of the Feet
• Poor alignment in any part of the body
affects the weight-bearing function of the
feet
• Obesity increases the stress on the joint
• Abnormal formation of the bones, weak, or
paralyzed leg and foot muscles affect
alignment
Toeing Inward
• Caused by strength imbalance in the hip
joint muscles
• Associated with scissors gait in cerebral
palsy
• Exercises include stretching inward rotators
and strengthening outward rotators
Toeing Outward
• Occurs when the posterior group of muscles
on the sacrum is stronger than the prime
movers for inward rotation
• Common for toddlers, elderly, blind, and
others unsure of footing to widen stance
• Exercises include stretching outward
rotators and strengthening inward rotators
Supination and Pronation
• Typical walking patterns include slight
supination
• Pronation is taking the weight of the body
on the inner border of the foot
• Flat foot is a related disorder
• Corrective shoes and exercises prescribed
by physicians
Flat Foot (Pes Planus)
• Congenital flat foot may not be considered a
postural deviation
• Severity of combined flat foot and pronation
disorders diagnosed using
– Feiss line method
– Helbing sign method
• Stretching and strengthening exercises may
be prescribed
Pain Centers
1. Sole of the foot under the
metatarsophalangeal joints
2. Sole of the foot close to the heel where the
plantar ligaments attach to the calcaneus
3. Under the surface of the navicular
4. Middorsum, where shoelaces tie
5. Outer surface of the sole of the foot,
where most of the weight is borne
Syndactylism
• Extra toes, the absence of toes, or the
webbing of toes
• Affects mechanical efficiency, especially
the absence of the big toe
• Learn compensation
• Webbing is usually corrected surgically
• Extra toes may be removed
Hallus Valgus (Bunion)
• Marked deviation of the big toe toward the
four lesser toes
• Bursa changes as a result of pressure
• Enlarged bursa is called a bunion
• Inflamed bursa - bursitis
• Deposit of calcium - exostosis