Postural Restoration - Part 2 Variations

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Information about Postural Restoration - Part 2 Variations
Education

Published on October 31, 2008

Author: markmckean

Source: authorstream.com

Postural Restoration : Postural Restoration with Mark McKean Dip.T, CSCS, Level 2 ASCA, PhD Candidate Restoration : Restoration Postural restoration is the attempt to correct skeletal positioning attempt to correct muscular balance about the joints involved attempt to correct the motor behaviour of the muscles involved attempt to learn new patterns of movement using these muscles Skeletal Repositioning : Skeletal Repositioning Occurs over time. Responds to changes in muscle behaviour, soft tissue tension and neural messages, habits, growth, injury, overuse. Only needs to be changed to improve function, not because of improper appearance. Limited by our skills and our tools – professional relationship works well here. Muscular Balance : Muscular Balance Balance of three systems Local stabilisers Global stabilisers Global mobilisers Balance of strength roles of each Length tension relationships considered Cause of imbalance discussed Motor Behaviour : Motor Behaviour Tonic or phasic physiology Stabilising or mobilising behaviour Reasons for change in behaviour Methods to correct behaviour Link to pattern causing change in behaviour Patterns Of Movement : Patterns Of Movement Overall sequence of joint actions Stabilising patterns prior to movement Muscles acting in each sequence/pattern Patterns retrained or muscles imbalanced? Period of time poor patterning in existence Evolution of poor patterning Postural Positions : Postural Positions Postural Positions : Postural Positions Chest forward posture Kyphotic-lordotic posture Sway back posture Flat back posture Lateral spinal curve posture Shoulders & scapulae posture Chest forward posture : Chest forward posture Head neutral position Cervical spine normal curve with slight anterior lean Thoracic spine normal but slightly posterior Lumbar spine hyperextended Pelvis anterior tilt Knee joints slightly hyperextended Ankle joints slightly plantar flexed Chest forward behaviour : Chest forward behaviour Lengthened behaviour Abdominals, hamstrings, occasionally glutes Shortened behaviour Lumbar extensors, hip flexors, mid thoracic extensors, quads Other comments depending on the posterior lean of the thoracic spine, the spinal extensors may be short further up the spine Training approach : Training approach Strengthen weak local muscles TA, multifidus Shorten long global muscles Rectus ab, Hamstrings, Glutes Stretch tight global muscles Lumbar extensors, hip flexors, mid thoracic extensors, quads Patterns To Train : Patterns To Train Teach postural position breathe into back, increase thoracic curve lean on standing, gait increase use of hip flexors and swing phase, Use scapula retractors upper to mid traps, not lower traps Avid use of spinal extensors to stand straight Use abs/diaphragm to support rib cage Exercises : Exercises To include – Leg curls, prone leg curls, glut ext, bridge holds, squat, lumbar supported leg press To avoid – Back ext, seated rows, lat pulldowns, leg ext, unsupported ab crunch variations, Sets & reps – Kyphotic-lordotic Posture : Kyphotic-lordotic Posture Head forward Cervical spine hyperextended Scapula abducted Thoracic spine increased kyphosis Lumbar spine increased lordosis Pelvis anterior tilt Hip joints flexed Knee joints slightly hyperextended Ankle joints slightly plantar flexed Kyphotic-lordotic Behaviour : Kyphotic-lordotic Behaviour Lengthened behaviour Neck flexors, upper back extensors, external oblique, hamstrings Shortened behaviour Neck extensors, hip flexors, quads, chest? Other comments lower back may be strong but not short, hamstrings may be long but not weak, short hip flexors more common than short low back muscles, abdominal may appear short due to change in thoracic position Training Approach : Training Approach Strengthen weak local muscles TA, Multifidus Shorten long global muscles Hamstrings, external obliques, cervical flexors, upper thoracic erector spinae Stretch tight global muscles Hip flexors, quads, neck extensors, lumbar extensors Patterns To Train : Patterns To Train Neutral tilt position of pelvis Avoid slouch of thoracic spine Chin in head up posture Knee bend as part of the leg swing movement and increase stride length Avoid stiff leg and short swing phase Breathe into rib cage for chest expansion Exercises : Exercises To include – Thoracic ext, leg curls, trunk shift lateral, To avoid – Overuse of neck in back ext type movements, leg ext, hip flexion, unsupported ab crunch, overuse of chest ex, overhead actions eg. sh press, db pullover, lat pulldowns Sets & reps – Sway Back Posture : Sway Back Posture Head forward Cervical spine slightly extended Thoracic spine long kyphosis Lumbar spine flattened Hip joints hyperextended and forward of vertical Knee joints hyperextended Ankle joints neutral Sway Back Behaviour : Sway Back Behaviour Shortened behaviour Hamstrings, internal oblique, low back muscles Lengthened behaviour One joint hip flexors, external oblique, upper back extensors, neck flexors, Other comments pelvis tends to lean forwards even though it is tilted posteriorly. Training Approach : Training Approach Strengthen weak local muscles TA, multifidus Shorten long global muscles Iliacus, psoas, external obliques, neck flexors, Stretch tight global muscles Hamstrings and lower back muscles Patterns To Train : Patterns To Train Hip flexors to actively bring leg forwards Neutral position of pelvis Glutes to extend hip Chin in and upright head position Avoid slouch of thoracic spine Maintain lumbar curve Scapula positioning Exercises : Exercises To include – Hip knee synergy, hip flexion, thoracic ext, supported ab crunch ex To avoid – Deep leg press, deep squats & lunges, unsupported ab crunch, overhead ex, high step ups, overuse of shoulder rotation, leg curls Sets & reps – Flat Back Posture : Flat Back Posture Head forward Cervical spine slightly extended Thoracic spine upper increased curve, lower part straight Lumbar spine flattened/straight Hip joints extended Knee joints extended Ankle joints slightly plantar flexed Flat Back Behaviour : Flat Back Behaviour Shortened behaviour – hamstrings Lengthened behaviour – One joint hip flexors, occasionally back muscles Other comments Abdominals may appear weak but not short due to change in rib cage position Training Approach : Training Approach Strengthen weak local muscles TA, multifidus Shorten long global muscles Iliacus, psoas, lower back muscles Stretch tight global muscles Hamstrings, calf Patterns To Train : Patterns To Train Hip flexors to actively bring leg forwards Neutral position of pelvis Glutes to extend hip Chin in and upright head position Avoid slouch of thoracic spine Maintain lumbar curve Scapula positioning Exercises : Exercises To include – Hip knee synergy, hip flexion, thoracic ext, supported ab crunch ex To avoid – Deep leg press, deep squats & lunges, unsupported ab crunch, high step ups, leg curls Sets & reps – Lateral Spinal– Curve Posture : Lateral Spinal– Curve Posture Head erect Cervical spine straight Shoulders one side low (R) Scapulae can be adducted/elevated or adducted/depressed (R) Thoracic and lumbar spines curved to either side (L) Pelvis lateral tilt, high on one side (R) Hip joints – one side adducted and medially rotated (R) and the other side abducted (L) Lower limbs straight Lateral Spinal– Curve Behaviour : Lateral Spinal– Curve Behaviour Lengthened behaviour L QL, L obliques, R Glut med, R ITB, L hip adductors, R TFL, R evertors, L invertors Shortened behaviour R QL, R obliques, L Glut med, L ITB, R hip adductors, L TFL, L evertors, R invertors Other comments R leg is adducted slightly and may appear as being longer than the left Training Approach : Training Approach Strengthen weak local muscles TA, multifidus, mid upper traps Shorten long global muscles L QL, L obliques, R Glut med, R ITB, L hip adductors, R TFL, Stretch tight global muscles R QL, R obliques, L Glut med, L ITB, R hip adductors Exercises : Exercises To include – Unilateral ex for long muscles Spinal alignment ex, trunk rotation ex To avoid – Bilateral ex for any shortened muscles Sets & reps – Pelvic Girdle Postural Compensations : Pelvic Girdle Postural Compensations Weakness Of Unilateral Hamstrings : Weakness Of Unilateral Hamstrings Usually contributes to weak Iliacus/psoas on opposite side Gluteus medius on opposite side External hip rotators on opposite side Internal hip rotators on same side Gluteus maximus on same side Adductors on same side Weakness Of Bilateral Hamstrings : Weakness Of Bilateral Hamstrings Usually contributes to weak Iliacus/psoas Internal hip rotators Gluteus maximus Adductors Weakness Of Unilateral Gluteus Maximus : Weakness Of Unilateral Gluteus Maximus Usually contributes to weak Iliacus/psoas and VMO on opposite side External hip rotators on opposite side Internal hip rotators on same side Hamstrings on same side Abductors on opposite side Adductors on same side Weakness Of Bilateral Gluteus Maximus : Weakness Of Bilateral Gluteus Maximus Usually contributes to weak Iliacus/psoas Internal hip rotators hamstrings Abductors Adductors Weakness Of Unilateral Gluteus Medius : Weakness Of Unilateral Gluteus Medius Usually contributes to weak Iliacus/psoas on same side External hip rotators on same side Internal hip rotators on opposite side Hamstrings on opposite side Adductor Magnus on opposite side Adductor longus on same side Gluteus maximus on opposite side Weakness Of Bilateral Gluteus Medius : Weakness Of Bilateral Gluteus Medius Usually contributes to weak Iliacus/psoas External hip rotators Gluteus maximus Hamstrings Adductors Scapula Postures : Scapula Postures Shoulders & Scapulae Posture : Shoulders & Scapulae Posture Depressed / elevated Upward/downward rotated Adducted/abducted Abducted, Elevated & Inwardly Rotated : Abducted, Elevated & Inwardly Rotated Abducted – scapula moved further from centre line Inwardly rotated - medial border becomes more vertical as inferior angle rotated in May Be Associated With : May Be Associated With Round shoulders Round upper back Depressed chest Tight pec minor Longer thoracic curve Increased upper thoracic curve Forward head posture Focus Training On : Focus Training On Shortening Rhomboids and middle traps Lengthening Pec minor Lats Associated changes to Thoracic spine and head posture May Be Associated With : May Be Associated With Decreased thoracic curve Increased phasic behaviour of erector spinae in mid thoracic Medially rotated humerus Associated rotator cuff problems Focus Training On : Focus Training On Shortening/strengthening Subscapularis Serratus anterior Lengthening Pec minor Internal shoulder rotators Associated changes to Altering rib cage extension Behaviour of erector spinae Behaviour of external shoulder rotators Abducted And Depressed : Abducted And Depressed Abducted – scapula further from spine Depressed – shoulders slope downwards May Be Associated With : May Be Associated With Full broad back Long well developed erector spinae Round shoulders Internally rotated arms Depressed rib cage and protruding abdominals Focus Training On : Focus Training On Shortening Upper traps Lengthening Pec minor Associated changes to Thoracic spine curve Shoulder rotation Lumbar curve length Elevated & Abducted : Elevated & Abducted Elevated- shoulders shrugged upwards and angle of shoulders is more square Abducted – medial border of scapula closer to spine May Be Associated With : May Be Associated With Decreased curve in thoracic spine Forward head posture Externally rotated shoulders Arms behind body from side on view Focus Training On : Focus Training On Shortening Serratus anterior Lower traps Internal shoulder rotators Lengthening Upper traps Levator scapulae Associated changes to Thoracic spine Head posture

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