Developmental Essentials by IYCA, (03) Posture and Physical Development, Notes

Post date: Apr 20, 2016 1:14:43 PM

Developmental Essentials by IYCA

Posture and Physical Development

• 1. Study questions

     1. Relationship between posture and performance.

     2. Verbal and tactile cues for neutral spine.

     3. Common posture faults.

     4. Consequences of poor posture as it relates to back problems.

     5. Force coupling?

     6. Plan of action for sedentary students with round back and tight hamstrings.

  2. Introduction

• • 1. Movement is common factor in all athletes and in life.

    2. The higher the specificity of activity, the higher the specificity needed for movement.

    3. Movement requires coordination of musculoskeletal fascial and cardiovascular systems.

    4. Role of youth fitness specialist: optimization of movement ability

    5. Position of musculoskeletal-fascial system plays a critical role in movement quality.

    6. Postural development, components of optimal posture and common postural alterations and correctives.

• 3. Postural Development

• • 1. Develops as a result of adaptation of the musculoskeletal system to stresses placed on it:

       1. First/Primary curve

          1. ‘C’ shaped

          2. Eventually makes up kyphotic forward thoracic spine and sacrum.

       2. Secondary curves develop as child orients body in relation to gravity.

       3. Around 3 mos. Weight of head develops backward lordosis of cervical spine.

       4. 6 mos. Lumbar curve develops as child begins to sit up and crawl

       5. Center of gravity is located near vertebra t12. As child develops, switches to s2.

       6. As standing and walking commences feet are wide apart, knees in varus (bow-legged) to maintain balance.

       7. As child grows, knees shift more valgus.

       8. Tend to be flat footed due to large foot pads and underdeveloped intrinsic foot musculature.

       9. Lumbar lordosis due to weak abdominals. Posture improves as child develops core strength.

       10. Abnormal spinal curvature can be result of genetic disorder or acquired from poor postural habits.

• • • • 1. Kyphotic - over hunched

        2. Lordotic - over arched

        3. Scoliotic - lateral

• • 2. Scoliosis

• • • 1. Developed scoliosis - classified as structural or functional

      2. Structural causes

         1. genetics

         2. spinal diseases

            1. poliomyelitis

            2. muscular dystrophy

         3. congenital

• • • • • 1. malformed vertebrae

             1. wedged vertebrae

             2. hemivertebra

• • • 2. 4. idiopathic (most common)

• • • • • 1. no known cause

          2. common during adolescence

             1. around puberty, more common in females

             2. familial tendency (present in more than one generation)

• • • 3. Functional causes - postural dysfunction and faulty movement patterns

• • • • 1. postural alterations

        2. leg length discrepancies or muscle imbalances

           1. improved with corrective strategies

        3. present in 80% of elite athletes involved in asymmetrical sports (throwing and racquet sports)

        4. Adam’s test

• • • • • 1. stand behind individual and observe spin initiate forward bend

          2. knees remain straight

          3. functional will improve/structural will remain unchanged

             1. structural - refer to medical professional

• • • • 5. Appropriate conditioning can improve functional scoliosis

• • • • • 1. Needs to involve a team approach with medical professional to measure improvement

          2. Test/retest - check to make certain curvature is improving. If not progressing.

             1. Monitor increase in curve, increase in pain or discomfort in movement pattern.

             2. Depending on age, location of curve, sex of athlete (females 5x more likely to have)

          3. Some cases respond to progressive care

• • • • • • 1. Strengthening/stretching

            2. Early detection and careful monitoring will ensure a productive life.

• • • • • 4. Curvatures developed in thoracic and lumbar spine can occur in athletes who specialize (hence the need for a movement practice that complements the sport by addressing the asymmetry)

• • • • • • 1. gymnastics

            2. downhill skiing

            3. cycling

• 4. Components of postural control

• • 1. Sensory motor integration. The process by which the central nervous system functions to constantly monitor and coordinate input from all of the different regions of the body in order to make the specific adjustments that are required to create different movements through an analysis of each component.

       1. Nervous system is able to interpret information from the vestibular, ocular, proprioceptive, muscular, ligamentous and articular systems in order to choose movement strategy.

    2. Optimal Posture

• • • 1. Coordinated activity of neuromusculoskeletal system, allowing ideal alignment of the kinetic chain to enable optimal function while minimizing stress throughout the entire system

      2. Length-tension relationship

         1. Point at which actin and myosin filaments of the muscle fibers are optimally aligned and at which length provides the optimal strength in contraction.

         2. If there is an imbalance in tension, force coupling is altered - compression forces around the joint are compromised. Leads to decreased performance and eventual injury.

            1. If unable to create maximum tension muscle may be:

               1. muscle too short - overactive or adaptive shortening

               2. too long - inhibition or adaptive lengthening

      3. Force Coupling

• • • • 1. Force couples are muscles that work in tandem to create rotation of a joint and maintain an optimal instantaneous axis of rotation (usually pulling in opposite directions). Coupling refers to the sum of parts to make the whole machine stronger than the individual parts.

        2. Examples

           1. scapulothoracic

              1. upper and lower traps upwardly rotate scapula

              2. pectoralis a levator scapula function create downward rotation of the scapula (fg.3-5 p.79)

              3. collectively all four function to maintain downward rotation of the scapula in order to provide upper extremities a stable platform

              4. stability is required when producing any movements of upper limbs

              5. any imbalance can cause impingement syndromes (common complaint of throwers)

           2. postural dysfunction due to prolonged sitting

• • • • • • 1. lengthening of lumbar erectors and hip flexors (psoas)

            2. shortening of hip rotators and abdominus (external obliques)

            3. exacerbated by common cues and sports where aesthetics are important

               1. pull in abdominals, stand tall, squeeze glutes tight

               2. dancing, gymnastics

            4. Ramifications on function

• • • • • • • 1. increased activation of the local system of the core (transverse abdominus) when pelvis is in neutral

              2. increased activation when in a slightiy anteriorly tilted position

              3. posterior tilting of pelvis

                 1. altered recruitment strategies

                 2. less ability to control forces throughout entire lumbopelvic region

                 3. decreased function through kinetic chain

                 4. decreased force production of gluteus maximus secondary to decrease in length / tension of the muscle

                 5. decreased ability to generate extension force during any event that requires maximum hip extension (running and jumping)

                 6. decrease in force reduction in deceleration phase (major cause of MCL ACL injury, especially in females)

• • • • • • 5. Demonstrates the necessity of screening posture in youth prior to performance training

• • • • • • • 1. postural alterations do not improve without direct intervention (corrective strategy) and vivid cueing

              2. postural improvements often lead to increases in performance and decreases in pains

              3. any time a movement is performed from a compromised position there is a decrease in movement efficiency and increase of stress on the compromised region

                 1. example - overhead athlete cued to have a more upright posture--extends upper thoracic spine to compensate

                 2. although posture may appear to improve, this position locks the spine (close pack) limiting spinal flexion and rotation - which is crucial for throwing- in turn creating compensation the low back and shoulders leading to decrease in performance and increase in pain and dysfunction -- feeds the cycle

                 3. respiration is limited due to inability to expand rib cage which leads to overactivity of accessory respiratory muscles (sternocleidomastoid, scalenes and pectoralis minor). Performance decreases secondary to respiratory substitution and decreased oxygenation of tissues--over activation of accessory breathing muscle encourages forward head posture and shoulder position -- feeding the cycle-leading to chronic fatigue syndrome and myofascial pain associated to prolonged exposure to this type of posture

                 4. fig. 3-7 - cumulative injury cycles resultant of altered length/tension, force couples, arthrokinematic (joint mechanics)

                 5. ineffective load transfer leads to biomechanical dysfunction and manifests itself as increased loads on spine and skeletal structures; increase in tensile loads on soft tissue; decrease in performance and increase in pain.

                 6. this cycle repeats in predictable patterns, perpetuating dysfunction, leading to pain and biomechanical alterations and decreased performance

• • 3. The Integrated model of function

• • • 1. optimal function equals effective transfer of load through the systems. percentage of success in proper posture and then performing movement has to do with the efficiency of the kinetic chain in transferring loads throughout the body-

         1. strong structural base

         2. adequate muscle force controlling its base

         3. necessary neural input to control system

         4. proper emotional and physiological components to support the system

         5. in control of lumbopelvic hip complex

      2. Integrated model describes interaction between

• • • • 1. control system (nervous system)

        2. passive system (articulations and ligaments)

        3. active system (myofascial)

        4. physiological (nutrition)

        5. psychological (emotions)

• • • 3. Force Control

• • • • 1. without musculofascial influence, the osseous-ligamentous skeleton would buckle under relatively small compressive forces.

        2. optimal function requires the appropriate amount of compression across all joint surfaces

        3. over or under compression will influence effectiveness of the system

           1. fig. 3-9 Corset like function of the trunk

              1. Local system-stabilization

                 1. deep smaller muscles (transverse abdominis, multifidus)

                 2. usually span one or two joint segments

                 3. intersegmental motion: rotation, translation, shear

                 4. anticipatory activity (pre programmed, feed forward)

                 5. reaction of movement is not direction specific

                 6. high resistance to fatigue

                 7. Response to stress/trauma

                    1. inhibition

                    2. timing delays

                 8. Training

• • • • • • • • 1. low loads, low effort

                2. high frequency, low duration

• • • • 3. 1. 2. Global system (gross movement)

• • • • • • • 1. larger, more superficial muscles (rectus abdominus, obliques)

              2. span many joint segments

              3. produce gross motion

              4. produce high force movements eccentric stabilization (deceleration)

              5. reaction to movement is direction specific

              6. low resistance to fatigue

              7. response to stress/trauma

                 1. increased activity (hypertonicity)

              8. training

• • • • • • • • 1. high loads and level of effort

                2. low frequency and duration

• • • • 3. 2. fig 3-2 Lumbopelvic Hip complex

• • • • • • 1. Local system

               1. diaphragm

               2. transverse abdominus

               3. pelvic floor muscles

               4. multifidus

               5. lower fiber of internal obliques

               6. deep fibers of psoas

               7. deep fibers of erector spinae

               8. medial quadratus lumborum

            2. Global System

• • • • • • • 1. rectus abdominis

              2. external and internal obliques

              3. superficial fibers of erector spinae

              4. lateral fibers of quadratus lumborum

              5. licus

              6. superficial fibers of psoas

              7. rectus femoris

              8. adductors

              9. gluteals

              10. hamstrings

              11. Piriformis

• • • • 4. Global Movement and General Stability

• • • • • 1. muscles have varying roles (mobility and stability functions)

          2. linked by fascial chains

          3. use joints as levers to transfer energy/ absorb force through the kinetic chain

          4. local and global muscles function interdependently to provide multiplanar stabilization in dynamic movement patterns

          5. necessary to train multiplanar movements in a proprioceptively rich environment page 82 - 83

             1. lumbo pelvic-hip complex chains (table 3-2)

             2. lateral, posterior oblique (table 3-3)

             3. anterior oblique, deep longitudinal (table 3-4)

• • • • 5. Motor Control - specific posture stabilization and movement strategy in response to proprioceptive information from vestibular and ocular systems.

• • • • • 1. most misunderstood aspect of youth conditioning

          2. recruitment, timing, muscle force and duration are all equally important factors in controlling forces through kinetic chain

          3. motor control is a major player in improving overall strength and coordination

          4. highly adaptable--influenced by previous experiences, injuries, emotional status, nutrition, etc.

          5. Dysfunction

             1. sequence and selection of firing patterns disrupts the load bearing capabilities of the entire system

                1. timing delay in transverse abdominals has been demonstrated in those with low back pain

                2. atrophy in local muscle system following acute injury creates selective inhibition

                3. postural alterations as a result of decreased muscle function in the local system

          6. improvements in motor control in injured and uninjured populations eventually leads to overall performance increases

• • • • 6. Psychological Influences on posture

• • • • • 1. psychosomatic - individual thoughts and emotions manifesting as nerve, bone or soft tissue pain

          2. thoughts and emotions can have a dramatic effect on neuromusculoskeletal system

          3. pressure to perform, involvement in numerous activities, school, homework, chores, etc. can be taxing both physically and emotionally

             1. posture affects mood, mood affects postures

                1. importance of a positive attitude

             2. nervous system fatigue/overload

• • • • • • • 1. decrease performance

• • • • • 3. 3. trauma - physical, mental, sexual abuse

• • • • • • • 1. demonstrate decreased ability to exert appropriate motor control

                 1. guarded posture or slumping

                 2. shoulders down and in

                 3. increase gripping through deep hip rotators

              2. beyond the scope of coaching responsibilities

• • • • 7. Integrated Model - all four components impact ability to perform: manage load and stability across kinetic chain

• • • • • 1. form closure

          2. force closure

          3. motor control

          4. nutrition and emotions

• • • 4. Postural Assessment

• • • • 1. challenges - assessment is comprehensive

           1. job is to identify and correct postural alterations

           2. working with a groups of athletes with a multitude of postural alterations

           3. its negligent to ignore but impossible to correct all of the various alterations (especially when working with medium and large groups of athletes)

        2. assimilate postural assessment into performance assessment

• • • • • 1. emphasis on overall alignment, not specific segments of musculoskeletal system

          2. cues and corrections vary

             1. example: person with posterior pelvic tilt versus person with anterior rotation of pelvis

          3. athletes with injury will require

• • • • • • 1. a more thorough assessment

            2. initial assessment done statically but monitor student in all movement patterns

• • • • • 4. those who do not respond to corrections should be referred out to physical therapist or sports medicine specialist

• • • • 3. Postural Views

• • • • • 1. viewed from front , back and 2 sides (pelvis and shoulder position can vary from side to side)

          2. visualizing straight lines and 90 degree angles helps in diagnosing dysfunction

          3. lateral view

             1. plumb line hanging from the center of the body bisecting cervical spine, shoulder, lumbar, pelvis, knee and ankle. fig. 3-12

             2. assess pelvis for any posterior or anterior rotation

             3. ASIS (anterior superior iliac spine) and pubic symphysis should be aligned along vertical axis or perpendicular to the floor

             4. ASIS is forward = anterior tilt

             5. pubic symphysis in front of aASIS = posterior tilt

• • • • 4. Anterior view fig. 3-13

• • • • • 1. plumb line bisecting head, neck, thoracic spine, pelvis and falling equidistant between feet.

          2. horizontal lines should be seen across eyes, shoulders, pelvis, patella and medial malleoli should be parallel to one another

• • • • 5. Posterior View

• • • • • 1. plumb line bisecting head, neck spine, pelvis and fall equidistant between feet. Scapulae fall flat on thoracic rib cage equidistant from the spine, fossae (back of knee) faces forward, lower extremities equally vertical

• • • • 6. Causes of postural alterations

• • • • • 1. healthy children with postural alterations display tendencies of spastic children- hypertonicity in one region and hypotonicity in antagonistic muscles

             1. fig.3-15

                1. timing delays and inhibitions

                2. inhibition of local system

                3. substitution patterns, over activity in compensating muscles

             2. corrective approach

• • • • • • • 1. postural restoration followed by recruitment of stability and mobility systems

• • • • 7. upper crossed syndrome (table 3-5)

• • • • • 1. forward head posture

          2. thoracic kyphosis

          3. scapula elevated, abducted, anteriorly tilted

          4. humerus internally rotated

• • • • 8. lower crossed syndrome (p.92, table 3-6)

• • • • • 1. Increased lumbar lordosis

          2. anterior pelvic tilt

          3. common injuries

             1. lower back pain

             2. sacroiliac joint and hip dysfunction

             3. hamstring injuries

             4. patellar tracking and iliotibial band syndrome

          4. common movement pattern dysfunctions

• • • • • • 1. altered lumbopelvic-hip positioning

               1. abdominal protrusion

               2. hyperextension of lumbar spine

• • • • 9. inhibitions/dominance syndrome

• • • • • 1. seated posture

             1. pelvis in a posterior tilted position

             2. low spine in lengthened position

             3. upper spine in shortened position

             4. scapula in a protracted position

             5. head tilted forward

          2. exacerbated by weak core musculature

• • • • • • 1. not helped by crunches/leg lifts

• • • • • 3. additional alterations

• • • • • • 1. increased upper cervical extension

            2. increased thoracic lumbar extension

            3. increased posterior pelvic tilt

• • • • • 4. common injuries

• • • • • • 1. neck pain and headaches

            2. rotator cuff impingement

            3. bicipital tendonitis

            4. thoracic outlet syndrome

            5. low back pain

            6. sacroiliac and hip dysfunction

            7. ACL and MCL tears

            8. patella tracking and iliotibial band syndrome

            9. ankle sprains and plantar fasciitis

            10. shin splints

• • • • • 5. common movement pattern dysfunctions

• • • • • • 1. poor ability to stabilize the thoraco-scapulo-humeral and lumbo-pelvic-hip complexes

            2. poor eccentric control during upper and lower kinetic chain movement such as throwing, pulling, pushing, running and jumping

• • 4. Correcting Postural Abnormalities

• • • 1. oculo-pelvic and pelvo-ocular reflexes

         1. relationship between pelvis and eyes

      2. restoration of motor control, proper coordination along the kinetic chain and awareness of key areas have shown to be highly effective in correcting postural alterations

      3. conditioning

• • • • 1. restoration of length tensioning relationships, force couple relationships, joint arthrokinematics and functional integration of the kinetic chain

• • • 4. adjunct modalities-may be effective in addressing structural limitations

• • • • 1. chiropractic manipulation

        2. soft tissue work

• • • 5. No modality will be effective without lifestyle alterations

• • • • 1. posture during daily activity

        2. nutrition

        3. adequate rest

• • • 6. cueing improvements in posture

• • • • 1. visualization

           1. use of imagery tends to stimulate the correct neuromotor response that enables the appropriate synergy of muscle activation of deep, stabilizing muscles - feel, hold connect

           2. visual learners

        2. tactile feedback

• • • • • 1. kinesthetic learners

          2. tactile stimulation

             1. hand placement

             2. bands (DNS)

          3. reflects cue and goals of visual cue

• • • • 3. summary of cueing

• • • • • 1. neutral spine

             1. standing

                1. visual - wire connected to top of head pulling you up to the sky

                2. verbal - connect to core - feel as if you are getting taller and lighter

                3. tactile- hand on top of head, simulate hook lifting head towards ceiling

          2. thoracic kyphosis

• • • • • • 1. verbal - maintain neutral lumbar spine, lift sternum

            2. tactile - lift sternum with one hand, guide spine down with opposite hand

• • • • • 3. lumbar lordosis (p. 96 , table 3-10)

          4. lower crossed (table 3-11)

          5. cues work best prior to starting the activity and encouraged to maintain during the activity

          6. daily attention enables ‘grooving’ - (neuromuscular conditioning)

          7. improper cueing can negatively affect recruitment strategies

• • • • • • 1. common postural cues and consequences (table 3-11)

• • 5. conclusion

• • • 1. define common postural alterations

      2. focus on proper positioning of kinetic chain as the basis for movement

      3. screen for postural alterations prior to beginning a conditioning program

      4. any alteration will cause pattern overload or substitution pattern (synergistic dominance)

         1. effect of hip hanging on glute medius activation

      5. correcting deficiencies can set the stage for re-establishment of normal motor patterns

• • 6. corrective programming in addition to a progressively richer proprioceptive environment will condition the student to better deal with gravity, ground reactivity forces and external forces