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Section I: Fundamentals of Posture

Posture and Pain Body Segments

Anatomical and Zero Positions, and Axes Basic Planes and Center of Gravity Movements in the Coronal Plane Movements in the Sagittal Plane Movements in the Transverse Plane The Standard Posture

Section II: Postural Alignment

Types of Postural Alignment Segmental Alignment: Side View Abdominal Muscles in Relation to Posture Sway-Back Posture Ideal Alignment: Posterior View Faulty Alignment: Posterior View Handedness: Effect on Posture Faulty Posture: Side and Back Views Shoulders and Scapulae Posture of Feet, Knees and Legs Radiograph of Legs Sitting Posture


Section III: Postural Examinations


Procedure for Postural Examination




Postural Examination Chart




Good and Faulty Posture: Summary Chart

Faulty Posture: Analysis and Treatment,





Faulty Leg, Knee, and Foot Positions, Chart



Acquired Postural Weakness




Section IV: Posture of Children



Factors Influencing Children's Posture


Good and Faulty Posture of Children



Normal Flexibility According to Age Level



Flexibility Tests: Charts



Problems with "Physical Fitness Tests"





Section V: Scoliosis




74, 75

Scoliosis from Neuromuscular Disease



Postural Examination, and Chart



Functional Scoliosis


78, 79

Exercises and Supports

113, n


Early Intervention



Corrective Exercises




Good posture is a good habit that contributes to the well-being of the individual. The structure and function of the body provide the potential for attaining and maintaining good posture.

Conversely, bad posture is a bad habit and, unfortunately, is all too common (I). Postural faults have their origin in the misuse of the capacities provided by the body, not in the structure and function of the normal body.

If faulty posture were merely an aesthetic problem, the concerns about it might be limited to those regarding appearance. However, postural faults that persist can give rise to discomfort, pain, or disability (1-5). The range of effects, from discomfort to incapacitating disability, is often related to the severity and persistence of the faults.

Discussion of the importance of good posture springs from a recognition of the prevalence of postural problems, associated painful conditions and wasted human resources. This text attempts to define the concepts of good posture, to analyze postural faults, to present treatments, and to discuss some of the developmental factors and environmental influences that affect posture. The objective is to help decrease the incidence of postural faults resulting in painful conditions.

Cultural patterns of modern civilization add to the stresses on the basic structures of the human body by imposing increasingly specialized activities. It is necessary to provide compensatory influences to achieve optimum function under our mode of life.

The high incidence of postural faults in adults is related to this tendency toward a highly specialized or repetitive pattern of activity (1,3). Correction of the existing conditions depends on understanding the underlying influences and implementing a program of positive and preventive educational measures. Both require an understanding of the mechanics of the body and its response to the stresses and strains imposed on it.

Inherent in the concept of good body mechanics are the inseparable qualities of alignment and muscle balance. Examination and treatment procedures are directed toward restoration and preservation of good body mechanics in posture and movement. Therapeutic exercises to strengthen weak muscles and to stretch tight muscles are the chief means by which muscle balance is restored.

Good body mechanics requires that range ofjoint motion be adequate but not excessive. Normal flexibility is an attribute; excessive flexibility is not. A basic principle regarding joint movements can be summarized as follows: the more flexibility, the less stability; the more stability, the less flexibility. A problem arises, however, because skilled performance in a variety of sport, dance, and acrobatic activities requires excessive flexibility and muscle length. Although "the more, the better" may apply to improving the skill of performance, it may adversely affect the well-being of the performer.

The following definition of posture was included in a report by the Posture Committee of the American Academy of Orthopedic Surgeons (6). It is so well stated that it bears repeating.

"Posture is usually defined as the relative arrangement of the parts of the body. Good posture is that state of muscular and skeletal balance which protects die supporting structures of the body against injury or progressive deformity, irrespective of the attitude (erect, lying, squatting, or stooping) in which these structures are working or resting. Under such conditions the muscles will function most efficiently and the optimum positions are afforded for the thoracic and abdominal organs. Poor posture is a faulty relationship of the various parts of the body which produces increased strain on the supporting structures and in which there is less efficient balance of the body over its base of support."


Painful conditions associated with faulty body mechanics are so common that most adults have some firsthand knowledge of these problems. Painful low backs have been the most frequent complaints, although cases of neck, shoulder, and arm pain have become increasingly prevalent (1,3,5). With the current emphasis on running, foot and knee problems are common (7,8).

When discussing pain in relation to postural faults, questions are often asked about why many cases of faulty posture exist without symptoms of pain, and why seemingly mild postural defects give rise to symptoms of mechanical and muscular strain. The answer to both depends on the constancy of the fault.

A posture may appear to be very faulty, yet the individual may be flexible and the position of the body may change readily. Alternatively, a posture may appear to be good, but stiffness or muscle tightness may so limit mobility that the position of the body cannot change readily. The lack of mobility, which is not apparent as an alignment fault but which is detected in tests for flexibility and muscle length, may be the more significant factor.

Basic to an understanding of pain in relation to faulty posture is the concept that the cumulative effects of constant or repeated small stresses over a long period of time can give rise to the same kind of difficulties that occur with a sudden, severe stress.

Cases of postural pain are extremely variable in the manner of onset and in the severity of symptoms. In some cases, only acute symptoms appear, usually as a result of an unusual stress or injury. Other cases have an acute onset and develop chronically painful symptoms. Still others exhibit chronic symptoms that later become acute.

Symptoms associated with an acute onset are often widespread. Measures to relieve pain are indicated for these patients. Only after acute symptoms have subsided can tests for underlying faults in alignment and muscle balance be done and specific therapeutic measures be instituted.

Important differences exist between treatment of an acutely painful condition and that of a chronic one. A given procedure may be recognized and accepted as therapeutic if it is applied at the proper time. Applied at the wrong time, this same procedure may be ineffective or even harmful.

Just like an injured neck, shoulder, or ankle, an injured back may need support. Nature's way of providing protection is by "protective muscle spasm," or "muscle guarding," in which the back muscles hold the back rigid to prevent painful movements. Muscles can become secondarily involved, however, when they are overburdened by the work of protecting the back. Use of an appropriate support to immobilize the back temporarily relieves the muscles of this function and permits healing of the underlying injury. When a support is applied, protective muscle spasm tends to subside rapidly, and pain diminishes.

Immobilization is often a necessary expedient for the relief of pain, but stiffness of the body part is not a desirable end result. The patient should understand that a transition from the acute stage to the recovery stage requires moving from immobilization to restoration of normal motion. Continuing use of a support that should have been discarded will perpetuate a problem that might otherwise resolve.


Evaluating and treating postural problems requires an understanding of the basic principles relating to alignment, joints and muscles:

• Faulty alignment results in undue stress and strain on bones, joints, ligaments and muscles.

•Joint positions indicate which muscles appear to be elongated and which appear to be shortened.

•A relationship exists between alignment and muscle test findings if posture is habitual.

• Muscle shortness holds the origin and insertion of the muscle closer together.

•Adaptive shortening can develop in muscles that remain in a shortened condition.

• Muscle weakness allows separation of the origin and insertion of the muscle.

• Stretch weakness can occur in one-joint muscles that remain in an elongated condition.


Posture is a composite of the positions of all the joints of the body at any given moment, and static postural alignment is best described in terms of the positions of the various joints and body segments. This chapter pro vides basic information about anatomical positions, axes, planes and movements of joints. This information is essential when analyzing postural alignment.

Posture may also be described in terms of muscle balance. This chapter describes the muscle balance or imbalance associated with static postural positions.



The anatomical position of the body is an erect posture, with face forward, arms at sides, palms forward and fingers and thumb in extension. This is the position of reference for definitions and descriptions of body planes and axes.

The zero position is the same as the anatomical position, except that the hands face toward the body and the fore arms are midway between supination and pronation.


Axes are lines, real or imaginary, about which movement takes place. Related to the planes of reference seen on the next page are three basic types of axes at right angles to each other: (9)

1. A sagittal axis lies in the sagittal plane and extends horizontally from front to back. The movements of abduction and adduction take place about this axis in a coronal plane.

2. A coronal axis lies in the coronal plane and extends horizontally from side to side. The movements of flexion and extension take place about this axis in a sagittal plane.

3. A longitudinal axis extends vertically in a cranial-caudal direction. The movements of medial and lateral rotation and horizontal abduction and adduction of the shoulder take place about this axis in a transverse plane.

The exceptions to these general definitions occur with respect to movements of the scapula, clavicle and thumb.

Sagittal plane
Coronal plane


The three basic planes of reference are derived from the dimensions in space and are at right angles to each other: (9)

1. A sagittal plane is vertical and extends from front to back, deriving its name from the direction of the sagittal suture of the skull. It may also be called an antero-posterior plane. The median sagittal plane, or mid-sagittal, divides the body into right and left halves.

2. A coronal plane is vertical and extends from side to side, deriving its name from the direction of the coronal suture of the skull. It is also called the frontal or lateral plane, and it divides the body into an anterior and a posterior portion.

3. A transverse plane is horizontal and divides the body into upper (cranial) and lower (caudal) portions.

The point at which the three midplanes of the body intersect is the center of gravity.

Center of Gravity: Every mass or body is composed of a multitude of small particles that are pulled toward the earth in accordance with the law of gravitation. This attraction of gravity on the particles of the body produces a system of practically parallel forces, and the result of these forces acting vertically downward is the weight of the body. It is possible to locate a point at which a single force, equal in magnitude to the weight of the body and acting vertically upward, may be applied so that the body will remain in equilibrium in any position. This point is called the center of gravity of the body, and it may be described as the point at which the entire weight of the body may be considered to be concentrated (10). In an ideally aligned posture in a so-called average adult human being, the center of gravity is considered to be slightly anterior to the first or second sacral segment.

Line of Gravity: The line of gravity is a vertical line through the center of gravity.


A coronal axis extends horizontally from side to side and lies in the coronal plane. If the coronal plane could bend at one of its axes, it would only bend forward and backward. It would not bend sideways or twist on itself.

The coronal plane cannot bend, but the body can bend. In moving forward and backward from this plane (i.e., in a sagittal direction), the body movements of ilex-ion and extension occur.

Flexion is the movement of bending forward (i.e., in an anterior direction) for the head, neck, trunk, upper ex-

Hyperextension is the term used to describe excessive movement in the direction of extension, as in hyperextension of the knees. It is also used in reference to the increased lumbar curvature as in a lordosis with anterior pelvic tilt, or an increased cervical curvature as in a forward head position. In such instances, the range of motion through which the lumbar or cervical spine moves is not excessive, but the position of extension is greater than desirable from a postural standpoint. (See p. 67 and Figure D, p. 153.)


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