Postural Correction

Introduction

When you think about what you have been doing over the past week, how often have you been seated? The daily life of the average person is very seat bound nowadays, and this is causing significant postural issues amongst the general population. We can be sitting for up to 8 hours while at work, and then more hours once we get home and relax. When we are seated, it is easy to slip into an incorrect postural position. Consistent time spent seated and in a poor posture will affect a variety of muscles in adverse ways.

So, how do we assess posture?

A posture assessment is easy to do, but requires a good knowledge of the muscles and joints as this will help to measure which muscles are tight and which joints are being affected. Assessing posture is best done with a plumb line. A plumb line is simple to make; all you need is some string, a sinker, and something high to attach it to. The PT should ask the client to stand in 4 different positions behind the plumb line, then they can assess the client’s posture. The client should be standing in a relaxed position so that they are standing as they would daily.

The main mistake I see is that PTs don’t line up their client correctly. The anterior and posterior are easier to line up as the line goes directly through the centre of the body. With the lateral view, the plumb line should be lined up from the lateral malleolus (ankle bone) through the knee, hip, shoulder, and ear. If the line is too far forward or backwards, you could skew your results.

When doing a postural assessment, what are some issues to look out for? We will explore some of these further now. Below are some examples of common postural issues as well as some stretches and strengthening techniques that could help these issues. To begin with, let’s start with an issue that affects many office workers, but also gym-goers.

Scapula Winging

Scapula winging occurs when the pectoralis major muscles are overworked, which can lead to the opposing muscles, Rhomboids, and mid traps, becoming lengthened and weak. As the pec becomes shorter, the acromial end of the clavicle is pulled forward, leading to the scapula moving further away from the spine.

This is called scapula winging. Scapula winging is common amongst office workers, but can also occur due to injury and/or overtraining of the Pec Major and undertraining of the rhomboids and mid to low traps. The most obvious way you will notice this is that the shoulders are slumped forward, like below.

What can we do about it?

If you see this in a client, you need to use static stretches to stretch the pec major muscle. Use your favourite pec major stretch (a good option is the wall chest stretch) and hold for 30 seconds before doing any strengthening exercises. Once the pecs are stretched out, move onto an activation exercise (like a seated row) and focus on squeezing the shoulder blades together. You may be surprised; many clients will have very little control over their shoulder blades and will struggle to squeeze them together. If this is the case, use a very small amount of weight until they can get the technique. While doing this, use a 2:1 ratio of back to chest exercises.

Anterior Pelvic Tilt

Another common postural issue you will notice in clients is an anterior pelvic tilt. The pelvis anteriorly rotates due to the hip flexors being tight and shortened; the muscle is basically tugging on the pelvis. The opposing muscle, the glute, becomes lengthened and weak.

This can also be seen in the lumbar spine as the natural curve becomes accentuated. Your client will potentially have back pain because of this, and it could also affect their strength as large muscle groups like the glutes are not working efficiently.

Once you record the pelvic tilt, you can go through the same process we mentioned earlier. Use a static stretch, like the kneeling hip flexor stretch, to stretch the tight muscles, and an activation exercise to strengthen the opposing muscles. A glute bridge is a good option.

Posterior Pelvic Tilt

This issue is less common but will still be seen. More often than not, your client will have some degree of tightness in their hamstrings. This is common, and something I would notice amongst most of my clients. Increased tightness can cause a posterior pelvic tilt. This is the opposite of an anterior pelvic tilt, and often you will see the client’s back sway backwards slightly. Stretching the hamstrings with a lying hamstring stretch and strengthening the hip flexors and glutes can help. Again, using a glute bridge here is a good option.

How can correcting posture increase your PT business?

Postural issues can become worse over time. If left for years, they can become hard, if not impossible, to correct. Correcting posture is not just a matter of stretching and doing a few exercises in the gym; the client also needs to focus on correcting the habits outside of the gym that left them with a postural issue in the first place. Education for the client is almost as important as exercising. As a PT, you are going to come across postural issues more frequently as a large percentage of the population frequently use computers, cell phones and more.

This is a great area to focus your business on as you will always have clients.

Posture correction was a large focus of my business as a PT. One thing I noticed was that there was a vast difference in posture between clients who had worked at a desk their whole life and never trained, compared to those who had worked at a desk their whole life and always trained. No matter what training your clients are doing, exercise has a great effect on posture.

To finish with, here are some tips on how you can avoid postural imbalances while working at a desk:

Use a standing desk when at work and try to stand for periods throughout the day.
Split your day up with walks or moving around the office to avoid being stuck in one position.
Have a foam roller next to your desk and take foam rolling/stretching breaks.
Incorporate some form of exercise into most days.

When it comes to assessing posture, there can be other underlying issues. If you are ever unsure, refer out to a physio or other allied health professional.