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Positive Posture Changes-Chronic and Acute

Filed under: Case Studies,Posture,Uncategorized — Shon @ 7:16 pm December 1, 2011


Appropriate posture is the foundation for both upper and lower quarter functional mobility.  If you are reading this, chances are you already know this, either as a professional or as a patient.  The question is how quickly can we affect changes with our people, both in chronic, long standing cases as well as acute changes from traumatic injuries.   

Recently, I had the chance to take a few "before  and after" pictures of a few pateints.  Below is a District level high school cross country athlete who I saw for 10 visits this fall for a diagnosis of neck strain.  What we were really dealing with was a combination of  Janda's  upper and lower crossed syndrome (a quick review: upper crossed syndrome-weak deep neck flexors, overactive upper trapezius/ levator scapula, weakened sccapular depressors; lower crossed syndrome-.weak, underactive gluteals and abdominals, tight illiopsoas and erector spinae).   

The picture on the left is his first visit, while the picture on the right is at the time of his last visit:

 As you can see, there are pretty significant changes.  Lower cervical extension is better, as is thoracic extension, both passively and actively.  The thoracic spine being more upright allows a better "table" for the head and cervical spine to sit on.  His rounded shoulder position is improved by virtue of improved scapular retracion; scapular retraction is better just as a result of thoracic extension being improved. 

Just as impressive are the changes in lumbopelvic posture:

On the left (obviously, the first visit) you can see the ASIS/PSIS relationship as marked by the tape.  Arms overhead didn't help this (but were necessicary to capture the picture), as this further accentuated his lordosis secondary to his tight thoracic spine dragging his lumbar spine and pelvis into further extension.  On the right side, not only is lumbopelvic positioning more ideal, with a beautiful neutral spine posture, but the "arms overhead" position isn't a problem anymore because thoracic extension is also much better, leading indirectly to improved scapular and glenohumeral mobility. 

How did we achieve these changes?  Primarily with low load prolonged postural stretching of the thoracic spine into extension, improving mobility of lower cervical extension with concurrent upper cervical flexion,, as well as a bunch of time spent showing him "pelvis neutral" along with low load stretching of the psoas and rectus femoris.  Many of these activities can be performed concurrently, once the patient understands what is expected. 

This athlete has a bit more work to do independantly, namely get stronger.  He has done limited weight training activities with his cross country team, but hasn't performed what I would consider "proper" strength work yet.


Another patient presented recently after suffering a whiplash injury.  Below are "before"  pictures from his first visit:  

Following are pictures taken immediately afer his first  visit.  We did only low load thoracic/ cervical  passive positioning this visit to achieve these changes. You can see significantly less activity in the upper trapezius and levator scapula, as well as decreased sternocleidomastoid activity.  Needless to say, he felt a whole bunch better, at least for the first few hours post treatment.

In subsequent visits, we did hone in on more specific soft tissue work to the left upper quarter, as the left levator and rhomboid was significantly flared up.  You can also see winging of the left scapula, which we addressed aggressively with high set (10/ session) serratus activation work (30 seconds per repetition).  His levator/upper trapezius pain impairments are more than likely tied to his serratus dysfunction, as the scapula acts as a "roundhouse" for shoulder function with many significant competing vectors of pull (reference Anatomy Trains, specifically page 164 to see the relationship between serratus anterior and the rhomboids).  As his serratus improves, I believe his rhomboids and levator will improve as well.

The long term key with him is to make sure that chronic adaptations never take hold, or he may develop an upper crossed pattern.  Continued targeted soft tissue therapy, appropriate low load postural stretching, activation and strengthening of  underactive and weak musculature should be the ticket to achieving a long term improvement in his upper quarter posture.