The Monday Memo
November 4th, 2019 PITT DPT STUDENTS
The Importance of Posture in Physical Therapy Wellness and Prevention
Many of our patients visit us with problems unrelated to a specific mechanism of injury, and our job is to find out and treat their specific impairments. The current vision statement for the APTA is “transforming society by optimizing movement to improve the human experience”. This is a very powerful statement. I interpret this as not only helping patients recover from a specific injury, but providing them with the skills and tools that they need in order to function in the safest and most effective way. Prevention and wellness are important to introduce to patients to assist in preventing further injury. In our evaluation, we must address the patient’s current movement pattern. This can include an observation of posture, seated posture, gait, and/or another activity. This can provide us with significant information of what initial hypotheses we should form, and the testing that should be done to either accept or reject the initial hypotheses.
When a person assumes a certain posture, the muscles and fascia will begin to mold to the length that they are resting in. This can create imbalance and lead to impairment if a normal posture is not assumed. A person’s posture and movement patterns can either be the result of a previous ailment, or a choice of how to hold one’s body based on comfort, muscle tone, or societal norms.
Typical faulty postures include upper-crossed syndrome, lower-crossed syndrome, thoracic kyphosis, lumbar hyper-lordosis, etc. However, there is one very common posture in today’s society that I would like to discuss. The sway-back posture. It is scientifically defined as the hips swayed forward and the rib cage swayed back. This may also be referred to as the “sitting-man’s posture”. Physical therapists must understand this posture because our population is becoming more and more sedentary. The sway-back posture is basically a way to stand with less work. It essentially compresses the spine and over-extends the knee and hip to prop the body in a standing position. We must encourage others to move more often throughout their day to combat this posture. Sway-back posture may often times be confused with an increased lumbar lordosis. This is not the same. Observe the greater trochanter. The person with sway-back posture will present with a greater trochanter that is in front of the lateral malleolus from a sagittal plane view but may have a neutral or posteriorly tilted pelvis. A person with a lumbar hyper-lordosis will present with a greater trochanter that is still directly over the lateral malleolus but is anteriorly tilted in the pelvis. Also, individuals with sway-back posture may present with weak gluteals, short rectus abdominus, and short hamstrings while the individual with lumbar hyper-lordosis is more likely to present with long hamstrings and abdominals. Of course, further examination and muscle length and strength testing must be done to confirm this and to guide your treatment plan. Choose exercises based on your findings. For example, you may find that a patient with sway back posture has a short rectus abdominus, so you should not prescribe a lot of sit-ups. Poor posture assumed during an exercise may fail to work the muscles that you are trying to target. If a patient does not seem to be responding to the exercise program, correcting postural alignment could change the outcome.
What I hope to see in the future is that physical therapists make a strong effort to understand posture and have enough knowledge to teach a patient how to correct their posture. Often times the question will come up in the clinic, “is this how I should stand?” Patients may want to know this to avoid further injury or look more aesthetically pleasing. You should have the most appropriate answers to help them maintain optimal muscle balance and function. More importantly, as students, it is imperative that we begin thinking about and practicing good posture in our own bodies. Our profession requires much wear and tear on our bodies, and we must take control to minimize the strain. We should observe and work with each other during our time here, so that we are prepared to enter the profession as movement experts.
Check out this link for images and instructions on how to stand properly!
-Cassie Ruby, SPT, NCPT
Fujitani, Ryo, et al. “Effect of Standing Postural Deviations on Trunk and Hip Muscle Activity.” Journal of Physical Therapy Science, vol. 29, no. 7, 2017, pp. 1212–1215., doi:10.1589/jpts.29.1212.
Kendall, F.P., et al. 2005. Muscles: Testing and Function, With Posture and Pain. (5th ed.). Baltimore: Lippincott Williams & Wilkins.
Sahrmann, S.A. 2002. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: Mosby.
Romani-Ruby, Christine. “Designing a Program for Swayback Posture.” IDEA Fitness Journal, Test 4, Nov. 2010, p. 88