This document discusses posture and postural alignment. It defines posture and describes the development of spinal curvature from birth. Good posture is defined as a position with stability, balance and minimal effort. Poor posture results from deviations from good alignment. Factors like muscles, nerves, reflexes and the central nervous system contribute to postural control. Techniques for assessing and correcting posture include exercises, stretching, strengthening, taping and myofascial release. Maintaining mobility, muscle balance and retraining awareness can help improve poor posture.

1. Nootan Physiotherapy College,
Visnagar.
Prepared By:
Dr. Nidhi Vedawala

3. Introduction
 The postural alignment starts its development from early
period of life with development of the spine and its
curvature.
 At first ,at birth the spine has C – shaped curve with one
convexity and one concavity.
 Then , as the child is trying to raise his head ‘from prone
lying position cervical curve start to develop and in the
early phase of education of walking , another curves are
considered as “secondary curve” to the first one which is
called “primary curve”.

4. curvature of spine:
frontal view

5. curvature of spine:
sagittal view

6. POSTURE
“Posture is the attitude assumed by the body either
with support during muscular inactivity, or by
means of coordinated action of many muscles
working to maintain stability or form an essential
basis which is being adapted constantly to the
movement.”
 Ligaments, fasciae, bones, joints – inert structures that
support the body
 Muscles and their tendinous attachments are the
dynamic structures that maintain the body in a posture
or move it from one posture to another.

7. Types of Posture
Inactive Posture
 Muscular activity reduce
to a minimum
 e.g.. Resting, sleeping.
Active Posture
 Maintained by integrated
action of many muscles
 It has two types.
static and dynamic
posture.

8. Inactive posture
 Make minimal demands upon the muscles responsible for
the maintainence of essential body functions

9. Active Posture
Static Posture
 Pattern of posture is constant.
 Body and its segments are
aligned and maintained in
certain positions
 E.g. Standing, kneeling,
sitting
Dynamic Posture
 Pattern of posture is
constantly modified
 Body and its segments are
moving
 They form an efficient base
for movement
 eg. Walking, running,
jumping, throwing, lifting

10. Active Posture
Static Posture Dynamic Posture

11. • Muscles
• Nervous Control
Postural Mechanism

12. Muscles
 Muscle requirement depends on static or dynamic
posture
 Mostly some specific group of muscles are working
to maintain erect position, they are working to
counteract the effects of gravity.
 They are known as Antigravity Muscles usually
extensor group of muscles

13. The postural muscles
Antigravity postural muscles
Slow twitch and fast twitch
muscle fiber

14. Antigravity Muscle Stuctural Characteristics
 Type 1 muscle fibers
 Multipennate & fan-shaped-signifies powerful action
 Red colour due to rich blood supply-myoglobin content high
 Contraction in response to stimulation is slow, but can be
sustained for a considerable time without fatigue.
 Rate of fatigue- Slow

15. Nervous Control
 Postural reflexes are the major component to maintained
any kind of posture.
 Postures are maintained or adapted as a result of
neuromuscular co-ordination, the appropriate muscles
being innervated by means of very complex reflex
mechanism.

16. Postural Reflexes
 Reflex is defined by efferent response to afferent stimuli
 Afferent stimuli > higher centre > efferent response
 The efferent response is a motor one, the anti-gravity
muscles being the principal effector organs
 Afferent stimuli arise from variety of source all over the
body, the most important being situated in the muscles
them selves, the eyes & ears

18. Receptor Organs
Muscles:
 Neuromuscular & neurotendinous spindles within muscles
record changing action
 Increased tension causes stimulation & reflex contraction of
muscle i.e. Stretch Reflex
Eyes :
 Visual sensation record any change in position as per
surrodings
Joint Structures :
 In weight bearing position, approximation of bones stimulates
receptors in joint structures which elicit reflex reaction to
maintain erect posture
Skin sensation also plays a part, especially that of soles of feet,
when body is in standing positions

19. Ears:
 Stimulus of receptors of vestibular nerves results from the
movements of fluid contained in semicircular canal of internal
ear
 Each canal lie in different planes any movement of head disturb
fluid they contain, and thus knowledge and direction of
movement is recorded

20. Postural mechanism

21. Central Nervous System Organs
 Cerebral cortex
 Cerebellum
 Red nucleus
 Vestibular nucleus

22. Pattern Of Posture
1. Good posture
Good posture is the attitude which, is assumed
by body parts to maintain stability and balance
with minimum effort and least strain during
supportive and non supportive position
2. Poor posture
Poor posture is a position resulting from any
deviation from ideally aligned erect posture
(good posture)

23.  Patterns of posture, both static and dynamic, are gradually
build up by integration of the many reflexes which together
make up the postural reflex.
 Some of these component reflexes are inborn and some are
conditioned, being developed as the result of constant
repetition of posture maintained by voluntary control.
Pattern Of Posture

25. Good Posture
 Posture is said to be good when it fulfills the purpose for
which it is used with maximum efficiency and minimum
effort.

26.  As the physical characteristics of no two people are
identical, the precise pattern of good posture must vary with
the individual. It is possible, however , to generalize to
some extent.
 For example, in the erect posture the alignment of specific
parts of the body usually leads to perfect balance of one
segment upon another, a state which is aesthetically
pleasing to the eye.
 As dynamic posture involve constant readjustment to
maintain the efficiency of posture background throughout
the progress of the movement , they are much more difficult
to assess.

27.  In many activities however the same alignment of various
segments of the body which is satisfactory in the erect
posture forms the basis from which these adjustment are
made.
 For example , in walking or sitting and writing.

28. Development of good posture
 Efficient posture develops quite naturally, provided the essential
mechanisms for its maintenance and adjustment are intact and
healthy.
 The chief factors which predispose to the health and development
of the muscles and the posture reflex are:-
1. A stable psychological background
 Joy, happiness - posture in which position of extension.
 Sad, unhappy - in which position of flexion.
2. Good hygienic condition.
3. Opportunity for plenty of natural free movement.

29. 1. A stable psychological background:-
 Emotion and mental attitude have a profound effect upon the
nervous system as a whole , and this is reflected in the posture of
the individual.

30. 2. Good hygienic condition:
 particularly with regard to nutrition
and sleep, are essential for a healthy
nervous system and for the growth
and development of bones and
muscles.

31. 3. The opportunity for plenty of natural free:
 movements also encourage the harmonious development of the
skeletal muscles. Activities which are much enjoyed by the
normal healthy child at play, for example, running, jumping and
climbing ,are those in which movements of active extension
predominate.

32. Poor posture
 Posture is poor when it is inefficient , that is, when it fails to
serve the purpose for which it was designed, or if an unnecessary
amount of muscular effort is used to maintain it.
 Poor alignment of the body segment in the erect positions may
lead to the necessity for additional muscle work to maintain
balance.
 On the other hand, efficient compensation may take place, in
which case no additional muscular effort is required , but the
attendant ligamentous stain or cramping of thoracic movement
are disadvantages which cannot be ignored.

33.  The purpose of dynamic posture is to serve as an efficient
and adaptable background to movement.
 Posture patterns which do not fulfil this function impede and
reduce the efficiency of the movement and therefore must be
considered poor.

34. Causes of poor posture
 The causes of poor posture are often very
obscure, and even if they are known are difficult
to remove.
 Poor posture may occur due to:-
1. Defects in:
 Joints : such as stiffness or immobilization.
 Bones :such as shortening or deformity.
 Muscle: such as weakness, paralysis or contracture.
 Vision or Hearing.

35. 2. Bad habits :
 Either from early childhood or from occupation position .
Example for that is the individual that perform jobs which
require continuous flexed position of trunk.

36. 3. pain , fatigue or bad psychological state.

37. Effects of poor posture :
 Poor posture causes deviations from the normally aligned
posture.
 As a result the body function are altered and this may lead to
dysfunction and diseases.
 Poor posture may cause one or more of following
dysfunction:
1. Easy fatigability and high energy expenditure.
2. Decrease both respiratory and circulatory efficiency.
3. Pain , bad cosmetic appearance and psychological
disturbances.

38. Re-education
 The measure which can be taken by PT to correct the faulty
posture and to train another and more efficient postural pattern
depend largely on the cause.
 The success of any physical treatment depends on her ability
to gain the co-operation of the patient.

39. Techniques Of Re-education
 Good Atmosphere should be established for postural re-
education
 make patient feel that acquisition of good posture is worth
while , efforts will be noticed & appreciated
 Individual instructions-as no two patients have identical
difficulties
 But have much common to learn so group activity enables
atmosphere of enjoyment & patient is stimulated by working
with others

40.  Relaxation
 Muscle Strengthening Exercise
 Muscle Stretching Exercise
 Postural corrections
 Taping
 Myofascial Release

41. Procedure to Relieve Pain from Stress
and Muscle Tension
 Muscle relaxation techniques
 External postural supports such as lumbar pillow
 Education: demonstrate relationship of patient’s posture to
development of pain
 Modalities and massage

42. Procedure to increase mobility
 the maintenance of normal mobility is essential to
enable a wide variety of postures to be assumed.
 Normal mobility is maintained by general free exercises
which are rhythmical in character and include full-range
movement of all joints.
 Emphasis is laid on full extension-as it is most liable to
limitation
 Stretching of tight specific Muscle by manual mechanical
or by self stretching exs.

43. Exercises to lengthen the muscles
 Muscles that have become short and weak may restrict the
normal range of motion in a joint, preventing realignment.
 Active stretching that performed only by the client and
passive stretching may be of beneficial for correction of
posture .

46. Postural mal alignment Muscles need to strengthen Muscles need to stretch
Excessive cervical lordosis Anterior neck muscles
(Sternocleidomastoid,
Scalenes)
Upper fibres of trapezius,
Levator scapulae
Rounded Shoulder Middle and lower fibres of
trapezius
Shoulder horizontal
adductors (Pectoralis major,
Pectoralis minor)
Excessive thoracic Kyphosis Middle and lower fibres of
trapezius
Iliocostalis thoracis
Pectoralis major, Pectoralis
minor &
Rectus abdominis
Flat back Abdominals Iliocostalis thoracis
Excessive lumbar lordosis Abdominals, Hamstrings
Gluteus maximus
Trunk extensors and hip
flexors (Erector spinae
group in the lumbar region,
Psoas major)
Scoliosis Convex side of the curve Concave side of the curve

48. Upper trapezius stretching

49. Hamstring & calf muscle stretching Hip flexors stretching

51. To train and Strengthen Muscle And to Develop
Endurance For Postural Control
 Stabilization exs: progress by repetition and challenge
with extremity motions, progress to dynamic neck and
trunk strengthening exs.

52. Procedure to retrain kinaesthetic
awareness for postural correction
 Reinforcement techniques
 Reinforce learning and teach to maintain correct Posture
during functional daily activities.
 Those who have habitual poor posture often feel
uncomfortable and unnatural in any position other than the
one to which they have accustomed
 A mirror or posture recorder or photographs are useful to
compare with image of good posture
 Video-tapes also be used

53. Postural Correction
 Sitting on a stool , the patient relaxes into the fully flexed
slouched posture , with the head and chin pro truding .
 The patient then smoothly moves in to the erect sitting
posture , with the lumbar spine positioned in maximal
lordosis and the head retracted and chin pulled in.
 The sequence should be repeated several times in a flowing
manner.
 The patient is thus instructed to move into an extreme of
lordosis, but then release the last 10% of the movement.

55. Work related Postural correction

56. Muscular Strength and Posture
 The basic principles of working correctly and safely is to
plan balanced activity that helps to maintain both muscle
strength and flexibility.
 Imbalance between groups of antagonist muscles alters the
balance of forces exerted on the specific joints and affects
their position.
 An integral part of therapeutic exercise involves bringing
muscles to the appropriate length and strength for
maintaining optimal posture and function.

57.  The American College of Sports Medicine (2011) has some
evidence-based recommendations for resistance exercise when it is
used as part a fitness program for healthy adults; these guidelines can
be used as a starting point.

58.  If this procedure is practiced three times daily, ten to
fifteen times at each session , in a matter of a few weeks
the patient will have re educated their postural habit .

59.  This is useful in training dynamic postures in activities such
as tennis, diving and lifting-where faulty posture decrease
efficiency of movement
 Static postures are trained in erect position as people spend
most of working hours in upright positions-standing and
sitting
 In erect posture position of whole is influenced by position of
head, pelvic tilt and by state of comfort and position of feet

60.  Head: an upward thrust of the vertex in the erect positions
may be sufficient to
 achieve satisfactory alignment of the whole body.
 1. Crook lying or lying with feet support; body lengthening.
 2. Half lying, sitting or standing; head stretching upwards.

61.  The pelvic tilt:
 Voluntary control of pelvic tilt teaches patient to
recognise any deviation from normal
 In crook lying trunk is in supported position of alignment
and pelvis is free to move in anterior-posterior direction-
so this position is selected to start with
 Contraction of hip extensors, as to lift the hips off the
floor, and straight abdominal muscles-tilts pelvis
backwards
 Reverse movement by hollowing lumbar spine

63.  Once ability to adjust pelvic tilt has been learnt it can be
performed in sitting and standing
 1. Crook lying; gluteal and abdominal contraction, followed
by relaxation, then hollowing of back.
 2. Low wing sitting; pelvis tilting and adjustment.
 3 Low wing standing : pelvis tilting and adjustment

64.  The feet:
 Painless, mobile and strong feet form stable base of
support
 The arches are braced and body weight adjusted so that it
falls through summit of arch
 By str ex for intrinsic foot muscle
 Proper foot wear advice
 If LLD is there than correction by shoe modification.

65. Complete Picture
 If complete pattern of good posture by above mentioned
protocols, it must be build up gradually and progressively
 Much concentration is required at first but effort and
tension are progressively reduced by repetition and as the
passage of co-ordinating impulses on neuro-muscular
pathway is facilitated
 The new posture becomes habitual and no longer requires
voluntary efforts, it is maintained by conditional reflex

66. Taping
 Taping can correct posture by relieving stress on
overstretched tissues and by guiding soft tissues into a
new position.
 Elastic tape is advocated for use in postural correction
because it does not limit movement entirely and is more
comfortable than rigid tape.

68. Myofascial Release
 Tension in fascia restricts movement and may aggravate
abnormal postures.
 Myofascial release is a distinct therapy that acts on fascia
and may be significant in helping to correct posture by
facilitating a more optimal resting position for tissues.