BIOMECHANICS

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Biomechanics
Definition The area of study where the knowledge and methods of mechanics are applied to the structure and function of the human body. What is the Purpose of Biomechanics? The internal and external forces acting on a human body determine how the parts of the body move during performance of a motor skill. Biomechanics provides a sound logical basis upon which to evaluate various techniques that might be used. Basic Concepts of Human Skeletal Articulations The body is generally seen as a series of rigid segments connected by joints. The joints largely determine the directional motion capabilities of the body. Also, the anatomical structure of a joint varies little from person to person. The variations in joint ranges occur due to differences in tightness and laxity of the surrounding soft tissues. Joint Stability Joint stability refers to the ability of a joint to resist dislocation. Factors that affect joint stability: Shape of articulating surfaces Congruence (closeness) of the articulating surfaces These surfaces are often not symmetrical and there is often one position of best fit in which the area of contact is maximal. This is called a closed packed position. Any movement away from this position results in a reduced area of contact known as a loose packed position. Slight variations in shapes and sizes of the articulating bone surfaces occur in individuals.

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Arrangement of ligaments and muscles: Ligaments, muscles and muscle tendons affect the relative stability of joints. Strong ligaments and tendons often increase joint stability (eg the knee joint). Tension in muscles is divided into: Rotary component: - muscle tension perpendicular to the long axis of the attached bone contributes to rotation. Stabilising component: - line of force is angled towards the joint centre. Dislocating component - line of the muscle is angled away from the joint centre. Joint Flexibility This refers to range of motion and is joint specific. Factors influencing joint flexibility include: Shapes of articulating bone surfaces Intervening muscle and fat In most individuals, range of movement is determined by laxity of tissues crossing the joint. Research shows that risk of injury is increased when joint flexibility is: Extremely low Extremely high When theres significant imbalances on sides of the body

Biomechanics of the Upper Extremity Shoulder Movements of the shoulder joint: Movement of the humerus commonly involves actions within four joints (glenohumeral, scapulothoracic, acromioclavicular (AC) and sternoclavicular) As the arm is elevated in both abduction and flexion, the rotation of the scapula assists in increasing the total range of motion

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Although the positions of the humerus and scapula vary during movements, a general pattern exists. This is called the scapulahumeral rhythm.

In the first 30 degrees, contribution of the scapula is only a fifth that of the glenohumeral joint. Beyond 30 degrees, the scapula rotates one degree for every 2 degrees of humeral movement. This enables a greater range of motion at the shoulder.

Loads on the Shoulder: All of the bones making up the shoulder joint act as one unit. However, as the glenohumeral joint provides direct mechanical support for the arm, it sustains greater loads. The arm only accounts for 5% of body weight, but when the arm is extended horizontally, the weight of the arm increases the torque of the joint. The muscles around the region must contract to support the extended arm. This results in compressive forces at the glenohumeral joint of up to 50% of body weight. Biomechanics of the Lower Extremity - Hip The shoulder is suited to activities requiring a large range of movement whereas the hip is well suited to the functions of weight bearing and locomotion. Movements of the Hip: Flexion Extension Abduction Adduction Medial and lateral rotation Horizontal abduction and adduction

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Loads on the hip: The hip is the major weight bearing joint of the body. When the body weight is evenly distributed across both legs, the weight at each hip is one half the weight of the body segments above the hip or one third of total body weight. The weight at each hip is approximately the same as body weight during the swing phase of walking. During the support phase at normal walking speed, peak forces can range from 300 - 400% of body weight and 550% during fast walking and jogging and up to 870% during stumbling. The use of a cane or crutch on the side of an injured hip is beneficial as it serves to more evenly distribute the load on the hips during the gait cycle. Biomechanics of the Lower Extremity Knee Movements at the knee: Flexion and extension Rotation (slight) Passive abduction and adduction

Loads on the knee: The knee is a weight bearing joint that is positioned between two of the longest bones in the body, therefore potential to develop torque is large. Tibiofemoral Joint The compression forces at this joint are reported to be greater than 3 times body weight during stance phase and 4 times during stair climbing. The medial tibial plateau bears most of the load during stance when the knee is extended. The medial plateau has a joint surface 60% larger than that of the lateral plateau. Menisci act to distribute the loads over a broader area, thus reducing the magnitude of joint stress. Menisci also act to assist in force dissipation at the knee, bearing as much as 45% of the total load.

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As knee flexion occurs, and the angle at the joint increases to 90 degrees the shear forces increase. These are the forces which draw the tibia forwards or

backwards relative to the femur. They are resisted by the ligaments and
tendons crossing the knee. These structures are placed under differing degrees of stress during full squats involving deep knee bends. Therefore for some clients, these movements should be avoided. Patellofemoral Joint Compressive forces are approximately half body weight during normal walking gait, increasing to over three times during stair climbing. Patellofemoral forces increase with knee flexion during weight bearing due to increased compressive forces and a larger amount of quad tension required to prevent knee from buckling against gravity. The squat produces 7.6 times body weight compressive forces and, given the small surface of the patella, the transmitted stress is high. Lower Extremity Postures The tightness or laxity of ligaments, as well as the relative strengths and weaknesses of muscles produce lower extremity postures that are unique to each individual. Ideal Alignments of Body Segments This is discussed in further detail in the next section on posture. Generally, normal alignment does not necessarily mean ideal alignment. What is normal is a measure of what occurs on the average, not necessarily an ideal measure. In fact, most people do not have ideal alignments for one reason or another. For example, the ideal alignment of the legs is likened to that of a column that supports a roof. Such a column should be as straight and as vertical as possible. However, in reality the alignment of the femur is largely dependent on hip width; wider hips result in a greater angle of the femur.
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Principles of Posture and Functional Movement

The term posture is used to describe the alignment of the skeletal system when stationery or moving. It is called static and dynamic posture, respectively. Regular exercise helps to maintain the balance between strength and range of movement of muscles. However, there are a number of factors that can upset postural balance. These factors include: Biomechanics changes due to injury Poor seated posture Poor ergonomics during work Disuse Training in poor movement patterns Over training

Poor posture can be quite detrimental to health as it contributes to inefficient movement and places additional stress on the organs and systems of the body. As a Personal Trainer you may not be able to fix all of your clients postural issues, however it is still important that you analyse each client separately and assess their movement patterns to ensure you do not prescribe exercises to exacerbate postural imbalances. There are also some simple principals that Personal Trainers can follow to help correct muscle imbalances. Personal trainers need to have an awareness of: The characteristics of good posture static and dynamic Common postural problems Exercises and cues that may assist in correcting postural problems

Note there are some postural conditions that occur because of structural deformities. For example, the spinal condition known as scoliosis is usually due to a structural problem within the vertebra rather than any muscle

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imbalances. Therefore it is difficult to provide exercises that will correct the problem. It is recommended that trainers assess the posture of clients either through a structured assessment or by observing dynamic posture throughout movement. The following section of the manual provides information on postural conditions and exercises that may be used to correct them. Assessment Guidelines Assessment of basic posture should be done in a format that has practical application to the individuals circumstances. For example an elite gymnast has different types of postural requirements than someone in a sedentary office position. It should be emphasized that posture is often related to habits and by providing cues or signals to modify the habit it is possible to amend the posture. The personal trainer should regularly provide postural cues when the client is performing exercise to reinforce the correct movement pattern and body position. By making gradual, small changes to the individuals average work day or training day, permanent improvements will occur. Static Assessment To assess static posture: Explain to your client you are going to have a look at their posture so that you can provide a program tailored to their needs Have the client stand in a normal, relaxed stance with arms by their side.

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Observe the client from a variety of angles; anteriorly, posteriorly and laterally

For the clearest observation, the client would be wearing minimal clothing (shorts and singlet top).

Lateral View Correct standing posture when viewed laterally is as follows. A vertical line would pass: through the middle of the ear slightly anterior to the point of the shoulder through the middle of the head of the femur at the hip joint slightly anterior to the middle of the knee through the lateral malleolus of the fibula

Lateral View

Anterior View

Posterior View

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Anterior and Posterior View When viewed anteriorly or posteriorly, a vertical line would pass directly through the mid-line of the body dividing it symmetrically into left and right sides. Horizontal lines should pass through: The left and right acromion process (point of the shoulder) Left and right anterior and posterior superior iliac spines (top of the hips) Left and right patella (knee caps) Note, the Achilles tendon should essentially be vertical

Be mindful that some clients when asked to stand for a static posture assessment will not stand naturally they will assume a stance with good posture. Therefore it is important you observe your client throughout movement as well because you will pick up on postural deficiencies not identified in the static assessment.

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Common Postural Problems

The following tables outline: common postural deficiencies how they can be identified the cause of the condition exercises affected by the condition corrective exercises

Condition / Characteristics

Hanging or protruding head the head and neck protruding forward rather than directly above the shoulders

Demonstration

Cause

Weak neck extensors (Semispinalis, Splenius) Osteoarthritis or osteoporosis in the cervical spine

Exercises to be avoided (or careful with)

Shoulder press Push press (generally, all overhead movements)

Corrective Exercises

Back extension with head in a neutral position to strengthen neck extensors

Stretching of neck flexors through controlled extension / hyperextension

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Condition / Characteristics

Rounded Shoulder (Protracted Shoulders) and Kyphosis in this condition the shoulders are medially (internally) rotated and protracted (protruding forward). Kyphosis is often associated with rounded shoulders. It is an exaggerated (kyphotic) curve in the thoracic spine. In serious cases, it appears as a hump or lump.

Demonstration

Cause

Tightness in pectoralis major and pectoralis minor Weakness in posterior deltoid, trapezius, serratus anterior and thoracic extensors (including Spinalis Dorsi and Longissimus Dorsi)

Exercises to be avoided (or careful with) Corrective Exercises

Poor shoulder stability-weak rotator cuff muscles Shoulder press Push press Seated Triceps Extension Push up Front raises (generally, all overhead movements) Seated row Single arm cable rows One arm dumbbell row Bent over row Stretching of pectoralis major and minor, anterior deltoids (eg. door frame stretch)

Scapula push ups (on all fours) Focus on retraction of the scapula during

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movements (keep the shoulders back) Condition / Characteristics Winged scapula The correct position of the scapula is when it sits flat against the ribs. In this condition, the medial border and inferior angle of the scapula flares away from the ribs. The condition is often present in adolescent males who have yet to develop strength in muscles such as the rhomboids which assist in holding the scapula flat. It is also common in people with poor control through their scapula stabilisers such as serratus anterior.

Demonstration

Neutral Scapula Cause

Winged Scapula

Weakness in rhomboids, serratus anterior and subscapularis

Exercises to be avoided (or careful with)

Shoulder press Push up Lat pulldown Dumbbell pull over External rotation movements Seated row Single arm row (theraband) One arm dumbbell row Shoulder girdle retraction (on all fours) Stretching of pectoralis major, anterior deltoids (eg. door frame stretch)

Corrective Exercises

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 Condition / Characteristics

Focus on maintaining the scapula in a retracted position throughout the movement

Lordosis It is an exaggerated lordotic curve in the lumbar spine. This is a common condition that produces a sway back appearance. It is associated with an anterior pelvic tilt (the top of the pelvis is tilted forwards).

Demonstration

Cause

Tightness in iliopsoas (hip flexor) and erector spinae

Exercises to be avoided (or careful with)

Weak abdominals (rectus abdominis and transverse abdominis)

Overhead movements in a standing position may exacerbate the condition. Shoulder press (standing) Squat Note; it is ok for the client to perform a squat, but it must be with a neutral spine stop the squat if the correct pelvic position is not maintained

Corrective Exercises

Kneeling hip flexor stretch Lower back stretch (for erector spinae) Abdominal bracing, sit ups, crunches to strengthen abdominals

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Bridging (eg.using a swissball)

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Condition / Characteristics

Anterior Pelvic Tilt The condition is often associated with lumbar lordosis. The pelvis is tilted anteriorly which results in the ischial tuberosity (attachment for the hamstrings) moving superiorly and posteriorly. It causes increased tension within the hamstrings because they are in a permanently stretched position. Anterior pelvic tilt causes strain on the lumbar apophyseal joints (between vertebra) and sacroiliac joints. It is common to have a slight anterior pelvic tilt however an excessive anterior tilt is determined by the ASIS being significantly lower than the PSIS.

Demonstration

Cause

Weak abdominals and hamstrings Tightness in lower back (erector spinae), iliopsoas and rectus femoris

Causes tightness in hamstrings because they are permanently stretched

Exercises to be avoided (or careful with)

Overhead movements in a standing position may exacerbate the condition.

Squat

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Hack squat Shoulder press (standing) Knee extension movements due to tight hamstrings (including running and kicking)

Forces on the knee can also be greater than normal during foot strike in walking / running. The increased eccentric loading on the knee can lead to patella tendon injury.

Corrective Exercises

Kneeling hip flexor stretch Lower back stretch (for erector spinae) Quadriceps stretch (specifically to stretch rectus femoris)

Hamstring stretch and strengthen Abdominal bracing, sit ups, crunches to strengthen abdominals

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Condition / Characteristics

Posterior Pelvic Tilt The condition is sometimes called flat back because there is a reduction in the lumbar lordotic curve. The pelvis is tilted posteriorly which has the effect of pushing the hips forward. It is identified when the ASIS is higher than the PSIS as viewed from the side.

Demonstration

Cause

Weak iliopsoas Tight abdominals and gluteus maximus (causing hip extension / hyperextension)

Exercises to be avoided (or careful with)

Shortened hamstrings

Leg Press Squat Deadlift Hip flexion movements due to weakness in iliopsoas (including running and kicking)

Corrective Exercises

Hamstring stretch Gluteal stretch Abdominal stretch Hip flexor exercises (for strength)

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Condition / Characteristics

Pelvic Lateral Tilt Poor control of the hip abductors and adductors allows the contra-lateral hip to drop during the swing phase in walking and running leading to excessive lateral tilt. It causes tightness in the hip rotators (such as piriformis) and increased tension within the tensor fasciae latae, and iliotibial band. Often it is a major contributor to knee injuries (including patellar tracking syndrome). To assess for pelvic lateral tilt, locate the right and left anterior superior iliac spines to check they are level.

Demonstration

Cause

Imbalances (weakness or tightness) in adductors and abductors (gluteus medius)

Tightness in quadratus lumborum (either right or left side)

May also be caused by structural abnormalities such as leg length inequalities.

Exercises to be avoided (or careful with)

Walking Running Squats Lunges

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Corrective Exercises

Hip adduction or abduction exercises Stretching of hip abductors and adductors Stretching of quadratus lumborum One legged squats focusing on pelvic control and maintaining knee and ankle alignment. No hip drop on opposing side

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Condition / Characteristics

Scoliosis Scoliosis is characterised by a C or S shaped curve in the spine when viewed posteriorly. The curve may occur along the length of the spine from the cervical to the lumbar region.

Demonstration

Cause

Usually caused by a structural condition, osteoarthritis, osteoporosis or poor lifting and carrying habits

May be associated with imbalances in strength and flexibility of erector spinae, latissimus dorsi, quadratus lumborum and trapezius specifically between the right and left sides

Exercises Affected by the Condition

Dependent on the severity of the condition may impact on most movements, particularly:

Lateral flexion (side bends) Overhead exercises Running Dependent on the severity of the condition and the cause

Corrective Exercises

Lateral flexion side bends to stretch and strengthen and to correct imbalances.

Rotation of the trunk twisting movements to stretch and strengthen and to correct imbalances

In many cases where there is an underlying structural problem, exercise cannot be used to correct the condition.

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Posture and Range of Movement

Good posture enables people to move through a normal range of movement. The following information clarifies the normal range of movement through some of the main joints of the body. Keep in mind some people will have a greater range of movement if they: regularly perform exercises for flexibility have bones that are less congruent at the joints (dont fit as snugly) have ligaments that are slightly lax (dont hold the bones together as firmly) Hips The normal range of movement for the hip is: 120 flexion and 20 extension (in the sagittal plane) 40 abduction and 25 adduction (frontal plane) 45 internal rotation and 45 external rotation (transverse plane)

Normally, there should be no change in the degree of rotation of the hip with hip flexion or extension. Knees The normal range of movement for the knee is: 135 -145 flexion and 180 extension - the knee is considered in neutral position when fully extended. No hyperextension or abduction / adduction (frontal plane) movement normally exists. The fully extended knee has no rotation (transverse plane). When the knee is flexed at 70 -90 up to 45 of rotation may occur. ,

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Ankle / Foot Tibia, fibula and talus The normal range of movement of the ankle joint is: 45 plantar flexion and 10-15 dorsi flexion 10 of ankle dorsi flexion is required for normal walking biomechanics. Abduction of the foot occurs with dorsi flexion and adduction of the foot occurs with plantar flexion. Subtalar joint The normal range of movement between the talus and calcaneus bones is: Pronation and supination Pronation includes eversion, dorsi flexion and abduction of the foot The calcaneus inverts and everts with subtalar joint motion The amount of inversion is normally twice that of eversion, with approximately 20 of inversion possible and approximately 10 of eversion possible. Mid tarsal joint Consists of the calcaneocuboid and the talonavicular joints The mid tarsal joint has two axes of movement, which are the oblique and longitudinal axes The oblique axis allows dorsi flexion and abduction (with pronation) and plantar flexion and adduction (with supination) For every 1 of abduction, there is 1 of dorsi flexion and for every 1 of adduction there is 1 of plantar flexion The longitudinal axis consists of a small amount of forefoot inversion and eversion The range of movement of the mid tarsal joint is dependent on the subtalar joint Pronation of the subtalar joint increases the range of movement of the mid tarsal joint

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Supination of the subtalar joint decreases mid tarsal range of movement

Metatarsophalangeal joint The normal range of movement between the toe and foot is: 65-70 dorsi flexion to assist with the push off when walking.

Shoulder The normal range of movement for the shoulder is: 180 flexion and 60 extension (hyperextension) full extension is the normal position Elbow The normal range of movement for the elbow is: Wrist The normal range of movement for the wrist is: 80 flexion and 70 extension 150 flexion and 0 extension full extension is the normal position 80 pronation and 80 supination 180 abduction and 50 adduction (past the midline in the frontal plane) 90 lateral (external) rotation and 70 medial (internal) rotation

Vertebral Column The normal range of movement for the vertebral column varies between segments. In total over the 3 segments (cervical, thoracic, lumbar) it is: 110 flexion (when standing) and 25 extension (hyperextension) full extension is the normal position 90 rotation

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Biomechanics of Movement
The science of analysing range of movement at a joint during movement is known as biomechanics. If a person has poor biomechanics as they move it means that: Their body is not working efficiently They may be at an increased risk of injury

It is not expected that personal trainers will be able to perform biomechanical analysis on clients. Generally this requires complex equipment. The personal trainer should be aware of correct technique and movement patterns and should carefully observe the clients to ensure this occurs during exercise. The following section provides information on biomechanical abnormalities and some of the common injuries associated with them.

Lower Limb Biomechanics

The three main biomechanical abnormalities of the lower limb include: 1. Excessive Pronation 2. Excessive Supination 3. Abnormal Pelvic Movement Excessive Pronation

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Pronation of the foot occurs at the subtalar joint. Abnormal pronation occurs when the amount of pronation is excessive or when pronation exists at a phase in the gait when the foot should be supinating. An excessively pronated foot may lead to excessive internal rotation of the lower limb during weight bearing. Greater demands are therefore placed on the ligaments and muscles of the foot and lower limb. Excessive pronation causes increased ground reaction forces on the medial side of the foot which leads to: first metatarsophalangeal joint problems such as hallux valgus and exostoses. corns and callus build up abnormal flattening of the longitudinal arch of the foot and increased strain on the plantar fascia and other plantar musculature. strain on the gastrocnemius and soleus as well as tibialis posterior as these muscles need to contract harder and for longer to achieve plantar flexion and supination of the foot. This can lead to tendinitis of the achilles and posterior tibialis. increased internal rotation of the tibia, which can then tighten the iliotibial band. stress fractures in the tibia and tarsals (particularly the navicular) due to uneven weight distribution and excessive movement of the metatarsals during forefoot loading. Excessive Supination

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Structural foot abnormalities can cause supination of the subtalar joint as the subtalar joint attempts to correct or compensate for these abnormalities. Excessive supination can also occur due to weak peroneals or as a result of spasming or tightness of the tibialis posterior and gastrocnemius or soleus. Whereas a pronated foot is very unstable, a supinated foot is quite rigid and stiff. This results in decreased shock absorption during movement. The leads to: tibia, fibula, calcaneus and metatarsal stress fractures lateral instability of the foot and ankle resulting in an increased incidence of sprains tightness of the iliotibial band and bursitis at the femoral epicondyle

Pelvic Biomechanics
A certain amount of pelvic rotation, anterior-posterior tilt and lateral tilt is required during running. Excessive movements in any plane (sagittal, frontal and transverse) can occur due to poor control of the surrounding stabilising muscles. Less efficient movement and less effective transmission of forces through the pelvis may result. Lack of stability in one plane of movement can affect other planes of movement as well. The most common abnormalities associated with pelvic movement are: excessive anterior tilt excessive lateral tilt asymmetrical (rotated) pelvis

Excessive Anterior Tilt Poor muscle control in the abdominals, gluteus medius and minimus, hamstrings and external hip rotators in conjunction with tight hip flexors can increase the anterior pelvic tilt especially in running. This increases the length and tension of the hamstrings and abdominal muscles.

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The external rotator muscles need to work harder to provide pelvic stability to compensate for the reduced contribution of the gluteal muscles. This leads to: tightening in the external rotators of the hips Increased lumbar lordosis and strain on the lumbar and sacroiliac joints Increased forces on the knee causing patella tendon injury Tightness in hamstrings and increased risk of strain

Excessive Anterior Tilt

Excessive Lateral Tilt Poor control of the hip abductors and adductors of the weight bearing limbs allows the contra-lateral (opposite) hip to drop during the swing phase in walking / running therefore leading to excessive lateral tilt of the hip. This can lead to: Tightness and inflammation of the adductors, tensor fasciae latae, iliotibial band and lumbar spine

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Asymmetrical (rotated) Pelvis This occurs when the pelvis is twisted or one side is in a position slightly forward of the opposite side. It is caused by: tight / shortened muscles attaching to the pelvis weakening of the surrounding muscles supporting the pelvis leg length inequalities, scoliosis and other structural abnormalities

This may occur as an adaptation to a previous injury and can be exacerbated by running. Osteitis pubis and overuse injuries of the lower limb are often associated with this condition.

Common Structural Abnormalities

The following information clarifies some common structural problems of the lower limb that can predispose a client to injury. The personal trainer is not able to correct the problems because they are structural but may work with other health professionals such as a podiatrist to assist in the rehabilitation of the problem. Genu Valgum (or valgus) also known as knock knees causes excessive pronation of the feet, as the centre of gravity is medial to the subtalar joint. Genu Varum (or varus) also known as bow legs causes increased varus heel strike and greater lateral stress on the knees may lead to the development of patellofemoral pain excessive pronation of the subtalar joint may result to allow the medial aspect of the foot to make contact with the ground.

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Genu V lgus a

Genu Varum

Leg Length Inequalities

Differences in leg length can be structural or functional Functional differences can occur due to pelvic asymmetry or asymmetrical pronation or supination (occurring in one foot more than the other)

The following are signs the client may have leg length differences: Head tilt and shoulder drop often towards the longer leg Asymmetry of arm swing including an abducted arm towards the longer side Increased elbow flexion and increased speed of arm swing indicating the pelvis at the opposite side is moving faster Pelvis is higher on the long limb side Increased stresses on the short side as more weight is borne through that side External rotation of hip, widening the gait to increase support on the short side Pronation or supination of one foot

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The following table summarises some of the causes of common lower limb injuries: Injury Plantar fasciitis Achilles tendonitis Peroneal tendinitis Medial shin pain Patellar tendinitis Biomechanical Abnormality Pronated foot Pronated foot Pronated foot at toe-off phase Pronated foot Pronated foot Tight quadriceps, hamstrings and calves Anterior pelvic tilt Pronated foot Anterior pelvic tilt Varus alignment of knees Pronated foot Varus alignment Anterior pelvic tilt Pronated foot Supinated foot Pronated foot Varus alignment Supinated foot Pronated foot Varus alignment

Patellofemoral syndrome

Iliotibial band friction syndrome Hamstring strain Metatarsal stress fractures

Navicular stress fractures

Fibular stress fractures

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Functional Methods of Correcting Posture

Because posture is important in all day to day movements, it is important for the personal trainer to relate the exercises in the session to those completed in daily activities. The term kinaesthetic awareness relates to the control of muscles and position of the body in space. The ability to control muscles is more important than how strong they are. By assisting the client to develop kinaesthetic awareness it will assist them to be more aware of their posture. There are many side benefits besides the decrease in chronic and acute injuries. For example: More efficient energy use throughout the day Increased concentration span A greater awareness of self that leads to an earlier and better detection of dysfunction Lessened effects of degenerative diseases through aging effects, etc.

Some personal trainers use a static posture assessment (see the template on the next page) to identify conditions. Others will observe the client as they are moving and try to pick out postural deficiencies. From the observations try to select exercises to assist in correcting the deficiency. Also try to provide the client with tips or cues that will remind them about their posture while performing day to day activities. If you identify a postural condition that is particularly severe it is recommended you refer the client to an appropriate health professional (eg.doctor, podiatrist, physiotherapist,etc)

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Postural Assessment Chart View the client in a relaxed standing posture from the front, side and back and mark on the following record any obvious postural conditions. If the condition is excessive refer to an appropriately qualified professional. Head and Neck Rounded Shoulders Scapula Thoracic Spine Lumbar Spine O normal O normal O normal O normal O normal O protracted cervical spine (hanging head) O rounded O winged O increased kyphosis (rounded upper back) O increased lordosis (sway back) O decreased lordosis (flattened back) O scoliosis (S or C shaped curve) O anterior tilt O rotated pelvis O posterior tilt

Vertebral Column Pelvis

O normal O normal / level O lateral tilt

Knees

O normal

O knees rolled in (valgum) O knees rolled out (varum) O knees hyperextended

O left O right O left O right O left O right O left O right

Feet

O normal

O foot pronated (flat feet)

O foot supinated (high arch) O left O right Other Observations: _____________________________________________________________________ Corrective exercises: _____________________________________________________________________ _____________________________________________________________________ Red Flags = Refer On Do any of the above observations appear excessive? O Yes O No If yes, identify the condition and who you would refer the client to. _____________________________________________________________________ ___________________________________________________________________
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Exercise Guidelines to Improve Posture

Select appropriate exercises to assist in correcting the identified condition. Clarify whether the muscle needs to be strengthened, stretched or both.

As the client performs the exercise provide them with feedback on their performance to reinforce correct technique and posture. For example in a lat pulldown, you might say Well done because you are keeping your shoulders down and level throughout the movement.

Emphasize a neutral spine position in the exercise. The spine has natural curves in each segment a neutral spine refers to the maintenance of the natural curvature without exaggerating or flattening the curves. A neutral spine is recommended because it reduces stress on the joints and discs.

Activate the core muscles to control the position of the hips and lower back. The deeper abdominals (transverse abdominis) are used to stabilise and support the hips and lower back. By activating these muscles we are switching them on to ensure they are contracting. It takes practise to be able to contract these muscles. Some instructors will use cues such as pretend there is a piece of string from your belly button to your spine. Pretend you are pulling the string to pull your abdominals back toward your spine.

If the client is performing an exercise using left and right arms or legs, ensure each is contributing the same effort to the movement. Also check to ensure both sides of the body are moving through the same range of movement.

In some exercises you may be able to emphasize a particular component of the movement because it has implications for posture. For example, in a seated row, the final phase of the row is emphasized because it retracts the scapula and works the rhomboid muscles. These are important

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muscles to strengthen for clients with postural conditions associated with the scapula (eg. winged scapula).

Scapula push ups are performed by protracting the scapula in the push phase and retracting the scapula in the lower phase. Ensure lumbar spine remains neutral throughout.

In any push or pull exercise, ensure the arms work at an even height throughout the movement.

One leg squats are useful for developing core control. Activate the core muscles to support the lower back and hips. Ensure the hip, knee and ankle are always aligned during the movement. Try to eliminate side to side wobble during the movement and dropping of the opposite hip.

Fitnation

Exercise Rehabilitation Certificate 1.5

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