Assessing and Treating Posture Workshop

@Physiocouk #manchesterphysio facebook.com/physiocouk

Welcome
Assessing and Treating Posture Workshop.
Tessa and Louise.

3@Physiocouk #manchesterphysio facebook.com/physiocouk
Who are we?
Louise’s Twitter: @LouPhysiocouk
Tessa’s Twitter: @TessaPhysiocouk

Let’s connect
Website: www.physio.co.uk
Twitter: @physiocouk
Facebook: www.facebook.com/physiocouk

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Aims of today
To learn about posture
To learn different types of posture
To learn how to assess posture
To learn a variety of treatment
methods for postural correction

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Itinerary
10.00 - 10.30 Arrival /Induction
10.30 – 11:00 Theory: Posture
11:00-12:00 Theory: treating posture
12.00 – 12.30 Lunch
12.30 - 15:00 Practical: Treating posture

Theory: Posture

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What is posture?
“The form of the body when sitting, walking or standing”
“The rotational and translational position of adjoining body segments
and their orientation relative to gravity”
“The position of all body segments observed at a specific moment”

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Evolution of
human posture

Anatomy
○ Lordotic cervical spine
○ Kyphotic thoracic spine
○ Lordotic Lumbar spine
stresses within these curvatures can
increase the risk of postural related
injuries!

Modern activities of daily
living

What is good posture?
• Standing with the head balanced effortlessly
above the spine.
• Straight and vertical except for the slight
natural curves in the spine.
• Position that allow for pain free movements.
• Recognised as being associated with good
appearance, good health, strength and
stamina.

What is bad posture?
• Commonly described position in which
the head and shoulders are placed
forward of the spine.
• Referred to as a slouched, or hunchback posture.
• Bad posture cause muscle shortening, which can make joint
movements more difficult to achieve.

Scoliosis
Sway back
Flat back
Upper crossed syndrome
Lumbar lordosis
Thoracic kyphosis
Lower cross syndrome Ideal / normal
Different types of
posture

Posture
Examples

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Sway Back

Flat Back

Upper
Crossed
Syndrome

Lower
Crossed
Syndrome

Kyphosis -
Lordosis

Scoliosis

The ideal
posture

Posture Assessment
Observation
Strength
Ax movement
Palpate

Outcome Measures
- Back pain functional scale
- Visual analogue scale/ Numerical rating scale
- Goniometry
- Observation of posture- scapula protraction
- Length of time before symptoms begin during
aggravating activities

Treatments to improve
posture
Exercise
Stretching
Massage
Postural education
Taping
Workstation Assessment

Exercise
programmes
Lynch (2009) recruited 28 elite level collegiate swimmers with a forward head
rounded shoulder posture. The experimental group were given postural
exercises involving strengthening of the lower and middle fibres of trapezius
and serratus anterior and stretching of pectoralis minor and cervical
extensors. Assessments were made on postural position, shoulder pain and
function, and maximal strength of muscles around the shoulder blade.
The results revealed that the experimental group had decreased forward
head and shoulder position and reduced pain, suggesting that posture did
improve after an exercise programme.

Exercise
programmes -
Theory (Neck and
Shoulders)

Exercise programme
Deep Neck Flexors
Chin tuck and hold
Supine or sitting
10 x 10 sets daily
Lower traps/rhombs
Theraband or weights
(3-4 sets) x (8-12 reps)
Face pulls, Low rows, ER in side lying.

Exercise programme
Gluteus medius
Clam shell (Ax and Tx)
Wall dips (Ax and Tx)
Theraband/weights
(3-4 sets) x (15-20 reps)
Gluteus Max
SL glute bridge (Ax and Tx)
(3-4 sets) x (8-12 reps)
Lunges/Squats.
Deep Core/ TvA
Level 1 exercises
Variety of different positions
Frequency can vary

Pilates
Emery et al (2009) looked at nineteen subjects (9 controls, 10
experimental) that were assessed twice, 12 weeks apart,
during which the experimental group was submitted to a
Pilates training program (two 1-h sessions per week). The
Pilates training program was effective in improving
abdominal strength and upper spine posture as well as in
stabilising core posture as shoulder flexion movements were
performed.

Pilates
Kuo, Tully and Galea (2009) found that Immediately after a
Pilates based exercise program (twice weekly for 10 weeks) for
older adults (over 60) stood with slightly decreased thoracic
flexion and sat with slight increased lumbar extension, however,
No differences were found during a follow up period.

Pilates - Theory
The Deep Core
Transversus Abdominis
Pelvic Floor
Diaphragm
Multifidus
What is Pilates?
Core strengthening
Neutral spine education
Breathing control
Can i learn Pilates?
YES!

Stretching

Stretching
Carita et al, (2017) found a 16 week programme including
pectoralis, levator scapulae and sternocleomastoid stretching
and serratus anterior and middle and lower trapezius
strengthening could promote postural improvements focused on
cervical and shoulder angles.

Stretching: Theory
Types of stretching:
- Static
- Active assisted
- Passive
- Contract-relax

Stretching: Theory
Neck and shoulders:
- Upper fibres of trapezius
- Pectorals
- Neck extensors
Lower back:
- Hip flexors
- Hamstrings
- Erector Spinae

Massage

Massage
Ibrahim and Akindele’s (2018) case study found:
- Postural education
- Therapeutic massage
- Stretching
- Motor control exercises
Improved
- Excessive lumbar lordotic
- Thoracic kyphotic curves
- Reduced VAS scores

Massage
Massage techniques
Effleurage
Petrissage
Trigger point therapy

Massage - Theory

Massage
Benefits:
● Increase circulation
● Decrease pain
● Reduction of tissue adhesions
● Aids with collagen realignment
● Increased range of movement
● Reduced stiffness
● Improved muscular spasms
● Release of natural endorphins

Postural Education

Postural Education
● Anatomy
● Queuing posture
improvements
● Moving patients into correct
postures
● Demonstrations of good and
bad postures
● Correct movements for
activities of daily living

Taping
Castro-Sanchez et al (2012) found in there study (albeit
minimal participants) that K- tape reduced disability and pain
in participants with non-specific LBP
Paoloni et al (2011) looked at 39 subjects and 3 groups: KT,
exercise, and KT and exercise. All 3 groups had a significant
reduction in pain and KT was found to help normalize lumbar
muscle function
Murray (2010) found that KT can enhance scapula retraction.
This was found to significantly reduce pain

Taping is an adjunct to our services that can offer support,
immobilisation or proprioceptive feedback depending upon
what is required for the individual
2 main types:
K-tape = elasticated tape with acrylic glue
Zinc Oxide = non stretch cotton with a zinc oxide adhesive
What is taping?

Zinc Oxide K Tape
• Mechanical method
• For functional immobilisation
• Restricts and protects range of
movement
• Aims to protect muscles and
tendons
• A sensory technique
• Offers full range of movement
• Normalises muscle function
Zinc Oxide vs K-tape

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The Benefits
Pain relieving
Increases circulation
Decreases swelling
Increases or restricts movement
Decreases muscle tension
Improves posture
Provides support
Aids proprioception
Enhances performance
Early return to sport / activity
It looks good!

Infection
Open wounds
DVT in area
Renal problems
Heart failure
Skin irritation
Compromised sensation
Allergies to plasters
Cancer
Incorrect application may cause
or aggravate injury
Contraindications

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PLACEBO OR NOT?!

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How does K-Tape
work?
The Decompression Effect
WRINKLES!

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How it works
The Fluid Effect = blood flow swelling
The Mechanical Effect = stability
The Neurological Effect =
Paingate theory
Reduced pressure on nerve endings
Increased ‘active’ stabilisation

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Pre application
Ensure the skin is dry and clean
No hair
Wait 1-2 hours after swimming/ exercise/showering
Ensure K-tape has rounded edges and ‘anchors’ ready

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Application
For Pain Relief – stretch the muscle before applying tape. Apply tape
with no additional stretch.
For Structural Support – keep the muscle in a shortened position and
stretch the centre of the tape from 30-80%. The final 2-3″ at either end
of each strip must be applied with absolutely no stretch. Applying stretch
to the ends of the tape can quickly lead to skin irritation and abrasions.
To Reduce Swelling – lightly stretch both the muscle and the tape as
the tape is applied. As noted above, the final 2-3″ of each strip must be
applied with no additional stretch.

Should be able to move
Fine to shower
No rubbing
If any rash/irritation remove tape
After Care
Taping is not the solution – exercises must still be completed!
Remove after 3 days (Max!)

Observe them working
Neutral spine
- cervical
- Lumbar
90/90 rule
Reachable distances

Key Outcomes
Offloaded painful structures
Improved alignment
Reduced muscle stresses
Education

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Practical

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Postural assessment
- Observations
- AROM
- Strength
- Palpate

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Case study 1- neck and
shoulders
PC/ 28yr old waiter reports
neck pain. Nil neurological
symptoms/ red flags.
Aggs- Carrying heavy trays.
Eases-Paracetamol.
HPC/ Gradual onset over the
past 3 months after
increasing working hours.

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Possible treatments:
● Taping
○ Cervical retraction
○ Shoulder retraction
● Strengthening
○ Deep neck flexors
○ Lower traps/rhoms
● Stretching/ Massage
○ Pectorals
○ Sternocleidomastoid
○ Upper trapezius/ levator scap

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Case study 2- : Lower back
PC/ 54 year old office worker
reporting low back pain. nil
neurological symptoms or red flags.
Aggs- standing for long periods
Eases- lying down
HPC/ intermittent pain over past
year.

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● Strengthening
○ Abdominals- scissors L1
○ Gluteus medius- clams
○ Gluteus max - SL shoulder bridge
● Stretching/ Massage
○ Hip flexors
○ Erector spinea
● Taping
○ lower back

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Case study 3 - Mid/Low back
PC/ 18 year old student reporting
mid and low back pain. Nil red flags.
Also complains of some headaches .
Aggs- Prolonged studying and
running 30 minutes.
Eases- Standing and heat.
HPC/ Symptoms worse over the
academic year. Nil issues prior..

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● Advice on posture
○ Neutral spine
○ Refresh exercises
● Work Station Assessment
● Strengthening
○ Glute med - clams
○ Glute max - SL briging
○ Abdominals - Pilates
● Stretching/Massage
○ Glutes
○ ThxLxES massage
● Taping
○ ThxLxES

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QUESTIONS??

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Thanks for coming!
Don’t forget to follow us on Twitter: @physiocouk

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