Stanbridge - T4 - TE2 - W2 - Spine & Posture (Part2)

Therapeutic Exercise II: PTA 1010

• Course covers spine part 2 (Posture)
• Objectives include describing normal and abnormal postures, recognizing common pain syndromes, the interactive role of spinal structures, and differentiating global and segmental muscle activity.
• Further objectives include instructing patients in programs to improve postural alignment, implement exercise programs for individuals with spine conditions, and teach healthy habits, ergonomics, and relaxation techniques for injury prevention.
• The course outline includes Posture and related pain syndromes, Generalized Guidelines for Management if Spinal Impairments, and Spinal Stability.

Posture and Pain Syndromes

• Slides 123-132 present a recent article discussing posture, perceptions, and spinal dysfunction, which is considered a current hot topic in the PT community.

• Some believe posture is the main source of symptoms, while others believe poor postures are a normal part of life.

• The background and objectives of a study regarding the perceptions and beliefs of physiotherapists on optimal standing and sitting postures were investigated.

• The study used an online survey with three sections: perceived importance of posture education, choice of optimal sitting and standing postures, and demographic information.

• Key results show 93.9% of physiotherapists considered postural education importantly

• Three sitting and two standing postures were most commonly selected as "optimal".

• Six major themes in the justifications of optimal postures were identified: natural spinal curvatures, muscle recruitment & energy expenditure, optimal pelvis position, neutral spine, stereotypes for ideal posture, and line of gravity (for standing).

• Clinical implications highlight the importance for clinicians to understand patients' strong postural beliefs, especially how these beliefs may influence how they are treated.

• These beliefs can lead to potentially harmful treatment advice that creates unnecessary problems.

Pain Syndromes Related to Impaired Posture

• Three categories describe pain created by posture: postural fault, postural pain syndrome, and postural dysfunction.

• Postural fault: deviations from normal alignment without structural impairments (e.g., slouching).

• Postural Pain Syndrome: pain resulting from sustained faulty postures for extended periods. Pain is relieved with activity. No structural impairments yet.

• Postural Dysfunction: pain due to prolonged poor posture or following trauma/surgery. This includes adaptive shortening of soft tissues and muscle weakness. Examples include stroke patients and those with knee replacements.

• Common faulty postures include issues in the pelvic/lumbar region (lordosis, slouching, flat back), cervical/thoracic region (forward head, kyphosis, flat upper back), and frontal plane deviations (scoliosis, lower-extremity asymmetries).

• Different postural presentations and the associated problems are discussed with detailed descriptions and figures.

Spinal Stability

• Three subsystems provide spinal stability: inert structures/bones and ligaments (passive system), muscles (active system), and neural control system.

• Spinal stability issues may result from a combination of inert tissue damage, insufficient muscle strength/endurance, or poor neuromuscular control.

• The active subsystem, composed of all muscles working together, is crucial for spinal stiffness and stability during all movements. Global muscles are involved in compression, while deep segmental muscles are directly attached to the segments for dynamic support.

• The need for proper neuromuscular control is essential for maintaining balance, and proper timing and strength of muscles is important.

• The Valsalva maneuver, a forceful exhalation against a closed glottis, can affect intra-abdominal pressure which affects spinal stability, however, improper execution can be dangerous and is not recommended.

• Spinal posture, its various deviations, and their impact on the supporting musculature and potential injury points are examined.

• Understanding and handling segmental instability, neutral spine/neutral zone concept, and assessment methods including muscular activation tests and positional endurance tests are critical topics.

Management of Impaired Posture

• Postural training techniques create kinesthetic awareness focusing on correcting spinal positioning.
• Important considerations include flexibility exercises, strength & endurance training, proper body mechanics, stress management/relaxation, and establishing healthier exercise habits.
• Different phases of treatment, such as acute and chronic phases, have tailored protocols (including exercises) for managing spinal impairments.

Additional Considerations

• Various types of spinal impairments (e.g., spondylolisthesis) and their treatment options are addressed.
• The importance of cardiopulmonary endurance and exercises that are suitable for managing specific postural conditions are discussed.
• Exercises for various spinal regions (e.g., cervical, lumbar), including posture and stability exercises, and their progressions are illustrated, as well as strategies for assessing spinal stability.