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Posture

 

Posture And Gait:  Kinesiology Application To Motion

 

Men and women have different centers of gravity and thus differ in their natural posture stances.


 

During evolution, perhaps the most important changes to occur in the spine was the ability to stand erect or biped. In order to become erect, there has to occur approximately 30° anterior inferior tilt of the sacrum in the upright posture creating a natural lumbar lordosis. Because of this phenomenon, the mass of the gluteus maximus developed to a size unique to man that also necessitated a concurrent size increase of the quadriceps muscle.


 

In standing, establishing a stable base at the foot and the ankle are important. Although many muscles can produce tension to maintain a relative equilibrium, most research studies agree that the soleus muscles is primarily responsible more so than the gastrocnemius, tibialis anterior, peroneus, or the tibialis posterior muscle. Physiologically as a slow twitch muscle, the soleus can remain active for long durations of time.


 

In the pelvis area, the sacroiliac joints are responsible for balancing of weight transmitted between the spinal column and the lower extremities. The sacrum that is wedged between the two ilia normally experiences little movement. Upright posture however has a tendency to rotate the sacrum forward and downward.


 

In sitting postures, the spine angle to the pelvis was evaluated and found that without any back supports the spine has the least amount of stress when the lumbar spine to the pelvic angle is 135°. As a result, there were new designs in chairs that had no back that tilted the seat downward and supported the lower leg to accommodate this 135-degree angle. However, in the case where the low back had some type of lumbar support the smallest strain on the back with natural posture occurred with an incline of a 120 degrees of spine to hip.


 

PELVIC TILTING


 

Anteroposterior tiling of the pelvis exerts significant influence on the primary curves of the spinal column. Excessive downward pelvic tilting is found in individuals who developed contracture of the iliopsoas muscle, necessitating for increased curvature of the thoracic spine as a compensatory mechanism.


 

Muscular deficiencies can also produce deficits that have postural implications. The most serious in the lower limb injuries involve the posterior calf muscles, the quadriceps, and the hip extensors. If the plantar flexors are lost, maintaining balance also becomes a problem. Quadriceps insufficiency creates a little difficulty during standing because the center of rotation of the knee is posterior to the line of gravity.

Motion of the pelvis is critical for normal locomotion. The pelvis has been shown to rotate approximately 11.5° advancing anteriorly on the side of the limb swinging forward. During the stance phase, the hip abductors must be active in order to prevent the opposite side of the pelvis from dropping. The upper trunk rotates in the opposite direction of the pelvis in order to maintain a balanced mechanism. As the lower limb is advanced, the contralateral arm moves forward. The shoulder flexion and extension during this motion is 32 degrees.


 

GAIT

Muscular activity with gait involves the gluteus maximus, rectus femoris, vastus muscles, and hamstrings to control the extension moments required at the hip and knee. The abductor group is not required to control movements but are found to be active during the gait cycle. For abduction and adduction, the most significant movement involves hip abduction. This movement is consistent with contraction of the gluteus medius and minimus and the institution of the abductor mechanism that accomplishes elevation of the contralateral side of the pelvis.


 

Using engineering methodology in determination of joint torque to calculate joint arthrosis it was found that the greatest component of joint force acts vertically. Similar patterns exists all lower extremity joints.


 

TRUNK

Control of the trunk can be considered from either the viewpoint of flexors versus extensors or by the way of regions of the spine. The categorizing of flexors versus extensors provides the ability to categorize the musculature functionally while categorizing them by regions of the spine allows for important regional differences. In describing the posterior musculature of the lumbar spine, the deepest layer is the erector spinae group. The intermediate layer is the serratus posterior inferior, and the most superficial layer is the latissimus dorsi. All these muscles are important in the extension of the lumbar spine as well as the ability to increase lumbar lordosis.


 

The posterior muscles of the neck are much more complex. The deepest layer contains the suboccipital muscles. The next layer includes the semispinalis, capitis, and cervicis. The splenius and levator scapulae are just beneath the superficial plane. The trapezius and sternocleidomastoid muscles are the most superficial plane muscles.


 

A muscle of interest is the psoas muscle. This muscle extends from the upper lumbar spine anteriorly, transversing through the pelvis and attaches in the lesser trochanter of the femur. This muscle has a complex function due to its multiple segment attachments. Furthermore, this muscle is draped over the anterior rim of the pelvis, which provides a mechanism for altering the position of the pelvis. Because upward and downward tilting of the anterior rim of the pelvis is directly related to the degree of respective flexion and hyperextension in the spine, the effect of this psoas muscle on the lumbar spine can be dramatic. The patient who has tightness of the psoas muscle will pull the anterior rim anteriorly creating an anterior pelvic tilt. Such tilt causes the sacrum to be inclined further forward, which in turn positions the fifth lumbar vertebrae more anteriorly. The result of this is increased lumbar lordosis.


 

To counteract the anterior tilt, it is important to strengthen and utilize the abdominal muscles, notably the rectus abdominis and the external obliques. In standing, the internal obliques were more active than the external obliques with little activity in the rectus. The function of the abdominal muscles during exercise provides an effective means of strengthening the anterior abdominal wall. The highest levels of rectus abdominis activity occurred during the sit-up performed in the hook lying position.




 

Taras V. Kochno, M.D.

Board Certified in Physical Medicine & Rehabilitation

Copyright July 2, 2012

 

 

 

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