The strategy is to find the action of the shoulder blades, to take the pressure off the neck muscles.

Posture How To Instructions

So first, touch them. Just wrap your arm around yourself so that your hand touches the flat triangular bone in the back. Through the medium of touch, notice things about it – the size shape, where the boarders are, etc. There’s a tip at the bottom, and from there you can move over to the side, which is next to the spine. Then reach over and touch the outside. There’s a boarder on top, too, although that’s not actually the technical top of the shoulder blade. Just the same it’s important, so touch that area of the bone, too.

Repeat on other side.

Now lift both arms up so they are in front of you, perpendicular to your body. Don’t lock your elbows. Keep them straight with a bit of bend.

The first shoulder blade movement we’ll do is called protraction/retraction. Bring those blades forward and then squeeze them in back. Repeat a few times. Apply awareness to this simple movement. Notice what your arms do when you concentrate on the action of your shoulder blades in back. This is a basic therapeutic movement for the upper back.

By squeezing in back you build up the rhomboids. This helps keep the upper back straight, tall and pain free. It addresses kyphosis, which is that hump in the back you may have seen, particularly in people who are older. Congrats, you just retracted your shoulder blades.

Now for protraction, the opposite movement from retraction. In protraction, you actually increase that kyphosis. So pay attention to how that feels when you protract your shoulder blades. Congrats, not only did you protract your shoulders, you also developed some awareness about the way in which your body moves. It’s the attention to the feeling that develops exquisite skill in motion and stillness. And it’s the basis for using motions to heal your posture and pain.

Try this again, and check that the action is started and continued from those shoulder blades. Too often we lose track of how we move our shoulders. Then it becomes an exercise that stresses the muscles on the tops of the shoulders – not your best mechanical advantage, that’s for sure.

Renaissance artists were medical illustrators in their own right.  Along with cutting the trees down to make their canvases, grinding their own pigments and who knows what else, they also dissected cadavers and drew what they saw for practice.  Michaelangelo’s David is thought to be very accurate anatomically for this reason, as an example.

But not all Michaelangelo’s works portray such accuracy.  A neurosurgeon and a modern day medical illustrator from Johns Hopkins Medical School recently found that in a figure of God in a fresco called “Dividing Light from Darkenss” the neck contains a form that looks much like the brainstem (from an obsure angle). And there’s two line like shapes painted down the front of the figure, which looks a lot like the spinal cord.

In reality, the brainstem is located at the back of the brain (approximately the center of the head, not the neck).  It controls many basic functions such as sleep and wakefulness, movement coordination and much more.  The spinal cord runs down the center of the of the spinal column.  They are both a part of the central nervous system.

Leg length differences can cause back pain and other body problems.

Seeing movement therapy clients is a source of fascination for me. For one thing, I get to observe the attitudes people harbor in relationship to their condition. And how vastly different these attitudes can be between people – for the very same body problem.

Let’s take leg length difference as an example. A leg length difference, called leg length discrepancy in the clinical realm, occurs when one leg is shorter than the other. Uneven leg length problems come in two types.

First there’s the type you can often do something about. This type of leg length difference is due to your body’s adaptation to some change in alignment. The change in alignment is often introduced by a shift in positioning (to help you balance or stay out of back pain, for example) or a condition like scoliosis.

Generally the alignment change begins as a compensation for a lack of support or balance somewhere in your body. In other words, the functional leg length discrepancy (aka functional shortening) as it’s called is due not to your biomechanical structure, but to something you did along the way. Your legs really are the same lengths, but your structure took a shift in alignment and made it (and/or its repercussions) a part of your posture. For example, sometimes scoliosis creates or contributes to a leg length difference. Because the spine curves to the side (abnormally) in a scoliosis, the muscles on the convex side tighten, which causes the pelvis on that side to lift up. The leg on that hip also rises and result is that it can look like one leg is shorter than the other.

Note: this has nothing to do with guilt! It’s about musculoskeletal adaptation, a natural process for all of us.

So, if you have a functional leg length difference, you’ll probably have one hip hiked up higher than the other.

What specifically might create a functional leg length difference in your body? Contracture is a big one. Contracture may be present in the spine, legs or butt. Taking the hip hiking example further, if your inner thigh muscles (adductors) are tight, it will tend to bring the pelvis on that side closer to the leg, lifting the hip –and leg- on that side. Especially if you happen to be standing on that leg.

If your muscles are weak, and/or you are obese, it may be more difficult to accurately measure and determine a leg length difference. But physical therapists and orthopedic doctors have their ways, and are usually able to accurately determine if you have a leg length discrepancy.

The other type of leg length discrepancy is the true leg length discrepancy. This one is actual – your thigh or leg bones are not the same length. It’s due to a congenital problem. In other words you were born with it.

The American Academy of Orthopedic Surgeons says that once the leg length difference is 1.66” or 3.5-4% of your other leg, you may start getting problems walking, etc. They also note that while some people think their back pain and/or susceptibility to back injury is due to a leg length discrepancy, study results are mixed. What this means is they really can’t say definitively if a leg length difference causes a bad back or not.

So what’s so fascinating about all this?

Some people don’t take the time to understand the distinction between the types of leg length differences, and therefore are unclear about what’s causing theirs. These people just want a fix. Is that how you are?

My circle of acquaintances generally does not include the type of people who automatically elect surgery, although I know they’re out there. The American Academy of Orthopedic Surgeons backs me up on this. They say the risks of surgery outweigh the possible benefits.

Another possible cure is either a shoe lift or custom orthotics. My observations fall into 2 categories:

• Orthotics for Leg Length Difference
• Leg Length Discrepancy Common Sense

Some people with extreme attitudes on the other side of the question from those who prefer surgery are convinced that they can move and exercise their leg length difference away. I believe they are correct, as long as their leg length difference is the functional type. These die hards won’t consider an orthotic or shoe lift no matter how uncomfortable they are without them. To them I say – be sure you understand exactly how your leg length discrepancy is created in your body. We all have different configurations, and by knowing which muscles are tight and which are weak, you’ll better be able to determine how to go about releasing yourself from your leg length difference.

Also, the body learns by doing and feeling. You might want to reconsider your adamant resistance to a shoe lift or custom orthotic – it isn’t the worst idea in the world. A shoe lift or custom orthotic may help your body experience and adapt to the more balanced aligned configuration, and make it easier for you to completely stretch and strengthen out of your leg length difference.

For those who want the quick fix, beware of the surgery. Remember, even the orthopedic doctors say the surgery is risky, and to operate is their business.

Wearing a custom orthotic or shoe lift may be an effective quick fix. I’ve had experience with Foot Levelers and I liked them a lot. Again, you really need to know how your leg length difference is created in your body to effectively determine if, for example, a shoe lift is the most appropriate aid, or if you need custom orthotics. It will also help you pick out the best shoe lift for you, if that’s what you decide to do.

Source:
Kinser, C., Colby, LA, Therapeutic Exercise: Foundations and Techniques. 4th ed. F.A. Davis Company. Philadelphia. 2002.

Magee, D.J. Orthopedic Physical Assessment. 4th ed. Elsevier Sciences. 2006. St. Louis MO.

Vaccaro, A. Spine: Core Knowledge in Orthopaedics. Elsevier Mosby.2005. Philadelphia PA.

Limb Length Discrepancy. Your Orthopedic Connection. AAOS website. Last Reviewed and Updated: July 2007. Accessed: June 29, 2010.

For example, the term contracture describes a response that muscles, their tendons, and other nearby soft tissues can have to stimuli. (Stimuli can take many forms. An injury such as a muscle tear, comes to mind.) Contracture may be one of the things affecting your posture.

Contracture

In a contracture, the soft tissues of different types shorten, and thereby limit range of motion, or the amount of movement you can get in a joint. The joint is composed of 2 bones that fit together. Right where they fit is space, which is where movement happens. The shape and tightness of the fit is only one thing that determines range of motion. The condition of the soft tissue, i.e. the joint capsule, tendons, ligaments and muscles all go into this equation, as well.

So a contracture can be caused by a number of things, from just being tight to arthritis, to something the nervous system is orchestrating (like spasticity in people with cerebral palsy) to scar tissue and fiber created by an injury, surgery or a long period of immobility. And contracture can affect a number of soft tissue types, as mentioned above.

Contractures and Posture Problems

Contractures can play a role in posture conditions like scoliosis and kyphosis. With only few exceptions, you can’t go wrong with stretching to release contracture and restore good posture.

Source:
Kinser, C., Colby, LA, Therapeutic Exercise: Foundations and Techniques. 4th ed. F.A. Davis Company. Philadelphia. 2002.

One school of thought, which comes from Somatics, says that people generally take one of two forms in their spine and posture. Either their posture is “green light” or “red light”. Green light is when your posture is over energized and your spine is arched. Red light is when your posture is slumped, even if it’s just a little. In red light, your spine is bent, or flexed.

Somatics people say these basic postures are due to reflexes. Red light posture is a withdrawal reaction to stress and green light is an on alert type reaction.

But I’m not going to get that deep. All I’m trying to point out is that straightening your posture or spine depends on where you’re starting from.

Most of us have a slumped spine wouldn’t you say? Our culture encourages a slumping of the spine every step of the way. From computers, desks, driving, walking and many other activities we are encouraged to look and move forward. Gravity pounds down on us as we go. How often do you walk sideways or backwards or upside down to get somewhere you need to be? If you’re like me, not often.

People with arched spines have tight back muscles. This tension is often what keeps their posture continually arched.

So depending on if your posture is slumped or arched, you may need a massage (mmmmmmmmm) and back muscle stretching, or you may need back strengthening. Everyone can benefit from getting abdominal muscles strong. Well, off to do my ab routine…

The reason bent knee sit ups aren’t all they are (or were) chalked up to be is that after a certain point in your trunk’s excursion to an upright sitting position, the abs are no longer doing the work. Much of the work to get you off the floor is done by the hip flexor muscles, namely the psoas. The psoas is a deep muscle that attaches on your femur, lays in front of your hip bone and attaches again on the vertebra of your low back. It’s really a wonder muscle, especially for posture and back health. But in this instance, most trainers and exercisers mistake the work of the psoas for the work of the abs. This cheats you of some of the benefits of the ab strengthening you think you’re getting by doing sit-ups and it can also mess with your back. American Council on Exercise says that in this position “stress to the low back is present”.

And crunches are not much better, mainly because they emphasis only one, out of 6 total ab muscles (rectus, 2 external obliques, 2 external obliques and transversus). Crunches mainly work the rectus abdominus which is the long vertical muscle in front. Think washboard abs. Crunches also tend to shorten and bunch up the abs.

Mind-body fitness techniques such as those found in yoga, Pilates and others, teach people to find their deep abdominals and work them with a lengthening contraction (called eccentric contraction). The eccentric contraction occurs when you need to control the body part in relationship to gravity. In other words, it puts on the brakes when something could easily fall or “plop” down. You land gracefully thanks to the eccentric action of (some of) your muscles. The eccentric contraction generates about 4x as much force as the other type. This means if you concentrate much of your strength training on working eccentrically, you’ll get much stronger in less time. You’ll get plenty sore while you’re building this up, though!

I forced myself to stay up longer, if for nothing else, to begin training my mind-body to coordinate productive work with an active body stance.

As I tell my Clear the Blear workshop participants, introducing new movements and mind-body challenges a little at a time is the key to long term positive changes in posture, alignment and body movability.

Focus is a double edge sword, isn’t it? I mean getting more pinpointed about interacting with my computer makes me want to sit down to work, and this traps me into inertia and deactivation. A great way to lose my natural right to my physicality. And it draws my head forward. Forward head posture encourages my thoracic spine to go into a kyphosis AGH!

Scoliosis is an abnormal side to side curve in the spine.

Scoliosis is a side-to-side curve in the spine. When you look at the back, you can see evidence of an S shape, or a C shape. (There are different types.) The giveaways are: One shoulder or hip higher than the other and/or one rib that looks like a hump.

Most scoliosis is idiopathic, meaning they don’t know what causes it. The other 2 types are neuromuscular (caused by a disease such as polio) and congenital (you were born with it). You can see congenital scoliosis earlier than the idiopathic type. If your baby has congenital scoliosis, a new technique called scoliosis stapling may be worth looking into. But it’s reserved for very young children.

Scoliosis curves can range from mild (about 10-12 degrees), to so severe that it interrupts the lungs and heart. If a child’s curve grows rapidly or if the curve is over 50 degrees, it may be time for surgery. Of course, a licensed MD specializing in spine will be the best person to help you decide, as they have in depth knowledge on these things. I wouldn’t trust my child’s scoliosis to a chiropractor. Don’t get me wrong, chiropractors have their place – I go to one, and I couldn’t be happier with the results, but with a severe scoliosis, chiropractic treatment just hasn’t proven itself.

Most people who have scoliosis have the mild type. I have the mild type. I’ve had really good luck with exercises. Other than the Scroth Method, I am not aware of anything in the clinical realm that has the potential to actually reverse the curve and help the spine approach straight. But when the spine deforms like it does with a scoliosis, it often creates a situation where muscles on one side get super tight, and muscles on the other side get overstretched and weak. So for me, doing specialized exercises that target the curves has really helped to establish balance through my body. More specifics in future posts.

Source:
Scoliosis Research Foundation. Scoliosis Media Guide. Accessed Feb 2010. http://sites.google.com/site/wwwscoliosisorgawareness/scoliosis-media-community-guide

Recently, I learned (in my dance class) that carrying weight alters body posture in a way that shuts down my desire to be active. It also de-shapes the hip and backside area – an effect I do not need. The extra weight, especially in my belly, has me leaning forward.

Ideal alignment is about balancing through the bones. In a well-aligned body, weight is transferred from top to bottom through the center of the joints. (It’s a gravity thing.) This engages posture muscles such as the hamstrings (back of leg). I feel ready for action, and movement is delicious.

But by leaning forward, I am no longer balancing my weight through the bones. Instead I arch my back (which tightens the muscles) and my hips tighten up. I get stuck at the pelvis, but its not fun. No, this is movement stoppage! Sadly, I lose track of the feeling of my body, and I begin to identify with being overweight.

I found that key is to gently lean back. At first it feels weird because habit has me used to the forward position. But the idea is to get to a place where the pelvis drops down easily, releasing unnecessary muscle tension as it does. I practice this every day now, and it’s freeing.

Non-Neutral Work Positions can Cause Muscle Tension and Pain.

Work related pain often comes from holding yourself in what ergonomists call non-neutral positions. These positions are ones in which the joints are not centered, i.e., the two bones that make up a joint are not aligned with one another. The fit just isn’t right. This reduces how much support you can get for the position you are in. Non-neutral positions create a tremendous amount of tension (and pain!) in the body, because the muscles become like bones in order to scaffold the joint’s position.

After 18 months, improvement was seen in those who not only received new desks and chairs, but also received the benefit of professional help in setting them up. These workers had less muscuolskeletal pain and less eyestrain than the comparison group. Results from this study apply only to workers who began the study with pain. Those who started pain free didn’t seem to benefit from the ergonomic perks provided by the study.

“Just providing new office furniture and written instructions is not sufficient to achieve proper accommodation,” the authors conclude. “Good office equipment is a poor substitute for good working positions.”

Sources:
Laestadius, Jasminka Goldoni; Ye, Jian; Cai, Xiaodong; Ross, Sandra; Dimberg, Lennart; Klekner, Meg.
The Proactive Approach-Is It Worthwhile? A Prospective Controlled Ergonomic Intervention Study in Office Workers. Journal of Occupational and Environmental Medicine. 51(10):1116-1124, October 2009. Date Accessed. Jan 12 10. doi: 10.1097/JOM.0b013e3181bae19d.

Newswise. Press Release. The Proactive Approach-Is It Worthwhile? A Prospective Controlled Ergonomic Intervention Study in Office Workers. Oct 21 09. Date Accessed. Jan 12 10. http://newswise.com/articles/proactive-approach-to-ergonomics-reduces-pain-in-office-workers.