Spinal posture

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Spinal posture is the position of the spine in the human body. It is debated what the optimal spinal posture is, [1] and whether poor spinal posture causes lower back pain. [2] Good spinal posture may help develop balance, strength and flexibility. [3] [4]

Contents

Neutral spine

Looking directly at the front or back of the body, the 33 vertebrae in the spinal column should appear completely vertical. From a side view, the cervical (neck) region of the spine (C1–C7) is bent inward, the thoracic (upper back) region (T1–T12) bends outward, and the lumbar (lower back) region (L1–L5) bends inward. The sacrum (tailbone area) (S1–S5 fused) and coccyx (on average 4 fused) rest between the pelvic bones. [5] A neutral pelvis is in fact slightly anteriorly rotated which means the anterior superior iliac spines should be just in front of the pubic symphysis not in the same vertical line. [6]

Posture abnormalities

In medicine and occupations concerned with physical fitness, the concept of good posture is referred to as "neutral spine". [7] In this context, proper posture or "neutral spine", is the proper alignment of the body between postural extremes. Deviations from neutral alignment are identified as excessive curvature or reduction in curvature. Rarely do these deviations in curvature occur in only one plane; however, they are typically referred to in this manner. [8] In the anterior/posterior view, deviation from vertical results in abnormal lateral curvature of the spine called scoliosis. In the sagittal view, excessive curvature in the cervical region is cervical lordosis, in the thoracic region thoracic kyphosis, and in the lumbar region lumbar lordosis. Reduction in curvature is typically termed flat back if present in the thoracic region and lumbar kyphosis if present in the lumbar region. [5] In posture analysis, the spine is compared to a plumb line to detect the aforementioned abnormalities. From the anterior/posterior view this plumb line should run vertically down the midline of the body dividing it symmetrically into right and left halves indicating even weight distribution on left and right sides. From the sagittal view the plumb line should bisect the ear, odontoid process of C2, the cervical vertebral bodies, the center of the glenohumeral joint, the lumbar vertebral bodies, the center of the acetabulum, just posterior to the patella, and through the tarsals of the feet. [9] This sagittal line of reference theoretically indicates even distribution of weight between the front and the back of the body.

Quantifying abnormalities

Scoliosis is well established and even evaluated at an early age. It is typically quantified using the standardized Cobb angle method. This method consists of measuring the degree of deformity by the angle between two successive vertebrae. The Cobb method was accepted by the Scoliosis Research Society (SRS) in 1966. It serves as the standard method for quantification of scoliosis deformities. [8] Sagittal plane posture aberrations such as cervical and lumbar lordosis and thoracic kyphosis have yet to be quantified due to considerable inter-individual variability in normal sagittal curvature. [10] The Cobb method was also one of the first techniques used to quantify sagittal deformity. As a 2D measurement technique it has limitations and new techniques are being proposed for measurement of these curvatures. [8] Most recently, 3D imaging techniques using computed tomography (CT) and magnetic resonance (MR) have been attempted. These techniques are promising but lack the reliability and validity necessary to be used as a reference for clinical purposes. [8]

Related Research Articles

<span class="mw-page-title-main">Scoliosis</span> Irregular curvature of the spine

Scoliosis is a condition in which a person's spine has an irregular curve. The curve is usually S- or C-shaped over three dimensions. In some, the degree of curve is stable, while in others, it increases over time. Mild scoliosis does not typically cause problems, but more severe cases can affect breathing and movement. Pain is usually present in adults, and can worsen with age. As the condition progresses, it may alter a person's life, and hence can also be considered a disability.

<span class="mw-page-title-main">Intervertebral disc</span> Cartilage of spine

An intervertebral disc lies between adjacent vertebrae in the vertebral column. Each disc forms a fibrocartilaginous joint, to allow slight movement of the vertebrae, to act as a ligament to hold the vertebrae together, and to function as a shock absorber for the spine.

<span class="mw-page-title-main">Kyphosis</span> Medical condition

Kyphosis is an abnormally excessive convex curvature of the spine as it occurs in the thoracic and sacral regions. Abnormal inward concave lordotic curving of the cervical and lumbar regions of the spine is called lordosis.

<span class="mw-page-title-main">Laminectomy</span> Surgical removal of a lamina

A laminectomy is a surgical procedure that removes a portion of a vertebra called the lamina, which is the roof of the spinal canal. It is a major spine operation with residual scar tissue and may result in postlaminectomy syndrome. Depending on the problem, more conservative treatments may be viable.

<span class="mw-page-title-main">Lordosis</span> Abnormal inward curvature of the lower spine

Lordosis is historically defined as an abnormal inward curvature of the lumbar spine. However, the terms lordosis and lordotic are also used to refer to the normal inward curvature of the lumbar and cervical regions of the human spine. Similarly, kyphosis historically refers to abnormal convex curvature of the spine. The normal outward (convex) curvature in the thoracic and sacral regions is also termed kyphosis or kyphotic. The term comes from Greek lordos 'bent backward'.

<span class="mw-page-title-main">Harrington rod</span> Surgical implant typically used to stabilise scoliosis

The Harrington rod is a stainless steel surgical device. Historically, this rod was implanted along the spinal column to treat, among other conditions, a lateral or coronal-plane curvature of the spine, or scoliosis. Up to one million people had Harrington rods implanted for scoliosis between the early 1960s and the late 1990s.

<span class="mw-page-title-main">Back brace</span> Corrective medical device worn around a patients back

A back brace is a device designed to limit the motion of the spine in cases of bone fracture or in post-operative spinal fusiona, as well as a preventative measure against some progressive conditions or to correct patient posture.

<span class="mw-page-title-main">Spinal fusion</span> Immobilization or ankylosis of two or more vertebrae by fusion of the vertebral bodies

Spinal fusion, also called spondylodesis or spondylosyndesis, is a surgery performed by orthopaedic surgeons or neurosurgeons that joins two or more vertebrae. This procedure can be performed at any level in the spine and prevents any movement between the fused vertebrae. There are many types of spinal fusion and each technique involves using bone grafting—either from the patient (autograft), donor (allograft), or artificial bone substitutes—to help the bones heal together. Additional hardware is often used to hold the bones in place while the graft fuses the two vertebrae together. The placement of hardware can be guided by fluoroscopy, navigation systems, or robotics.

<span class="mw-page-title-main">Anterior longitudinal ligament</span> Ligament running down the front of the vertebral column

The anterior longitudinal ligament is a ligament that extends across the anterior/ventral aspect of the vertebral bodies and intervertebral discs the spine.

<span class="mw-page-title-main">Kyphoscoliosis</span> Medical condition

Kyphoscoliosis describes an abnormal curvature of the spine in both the coronal and sagittal planes. It is a combination of kyphosis and scoliosis. This musculoskeletal disorder often leads to other issues in patients, such as under-ventilation of lungs, pulmonary hypertension, difficulty in performing day-to-day activities, psychological issues emanating from anxiety about acceptance among peers, especially in young patients. It can also be seen in syringomyelia, Friedreich's ataxia, spina bifida, kyphoscoliotic Ehlers–Danlos syndrome (kEDS), and Duchenne muscular dystrophy due to asymmetric weakening of the paraspinal muscles.

<span class="mw-page-title-main">Scheuermann's disease</span> Medical condition

Scheuermann's disease is a self-limiting skeletal disorder of childhood. Scheuermann's disease describes a condition where the vertebrae grow unevenly with respect to the sagittal plane; that is, the posterior angle is often greater than the anterior. This uneven growth results in the signature "wedging" shape of the vertebrae, causing kyphosis. It is named after Danish surgeon Holger Scheuermann.

<span class="mw-page-title-main">Milwaukee brace</span>

The Milwaukee brace, also known as a cervico-thoraco-lumbo-sacral orthosis or CTLSO, is a back brace most often used in the treatment of spinal curvatures in children but also, more rarely, in adults to prevent collapse of the spine and associated pain and deformity. It is a full-torso brace that extends from the pelvis to the base of the skull. It was originally designed by Blount and Schmidt in 1946 for postoperative care when surgery required long periods of immobilization.

<span class="mw-page-title-main">Spinal disease</span>

Spinal disease refers to a condition impairing the backbone. These include various diseases of the back or spine ("dorso-"), such as kyphosis. Dorsalgia refers to back pain. Some other spinal diseases include spinal muscular atrophy, ankylosing spondylitis, scoliosis, lumbar spinal stenosis, spina bifida, spinal tumors, osteoporosis and cauda equina syndrome.

<span class="mw-page-title-main">Neuromechanics of idiopathic scoliosis</span>

The neuromechanics of idiopathic scoliosis is about the changes in the bones, muscles and joints in cases of spinal deformity consisting of a lateral curvature scoliosis and a rotation of the vertebrae within the curve, that is not explained by either congenital vertebral abnormalities, or neuromuscular disorders such as muscular dystrophy. The idiopathic scoliosis accounts for 80–90% of scoliosis cases. Its pathogenesis is unknown. However, changes in the vestibular system, a lateral shift of the hand representation and abnormal variability of erector spinae motor map location in the motor cortex may be involved in this disease. A short spinal cord and associated nerve tensions has been proposed as a cause and model for idiopathic scoliosis. Besides idiopathic scoliosis being more frequent in certain families, it is suspected to be transmitted via autosomal dominant inheritance. Estrogens could also play a crucial part in the progression of idiopathic scoliosis through their roles in bone formation, growth, maturation and turnover. Finally, collagen, intervertebral disc and muscle abnormalities have been suggested as the cause in idiopathic scoliosis, although these are perhaps results rather than causes.

<span class="mw-page-title-main">Vertebral column</span> Bony structure found in vertebrates

The vertebral column, also known as the spinal column, spine or backbone, is the core part of the axial skeleton in vertebrate animals. The vertebral column is the defining and eponymous characteristic of the vertebrate endoskeleton, where the notochord found in all chordates has been replaced by a segmented series of mineralized irregular bones called vertebrae, separated by fibrocartilaginous intervertebral discs. The dorsal portion of the vertebral column houses the spinal canal, an elongated cavity formed by alignment of the vertebral neural arches that encloses and protects the spinal cord, with spinal nerves exiting via the intervertebral foramina to innervate each body segments.

<span class="mw-page-title-main">Vertebra</span> Bone in the vertebral column

Each vertebra is an irregular bone with a complex structure composed of bone and some hyaline cartilage, that make up the vertebral column or spine, of vertebrates. The proportions of the vertebrae differ according to their spinal segment and the particular species.

Neuro biomechanics is based upon the research of bioengineering researchers, neuro-surgery, orthopedic surgery and biomechanists. Neuro Biomechanics are utilized by neurosurgeons, orthopedic surgeons and primarily by integrated physical medicine practitioners. Practitioners are focused on aiding people in the restoration of biomechanics of the skeletal system in order to measurably improve nervous system function, health, function, quality of life, reduce pain and the progression of degenerative joint and disc disease.

The management of scoliosis is complex and is determined primarily by the type of scoliosis encountered: syndromic, congenital, neuromuscular, or idiopathic. Treatment options for idiopathic scoliosis are determined in part by the severity of the curvature and skeletal maturity, which together help predict the likelihood of progression. Non-surgical treatment should be pro-active with intervention performed early as "Best results were obtained in 10-25 degrees scoliosis which is a good indication to start therapy before more structural changes within the spine establish." Treatment options have historically been categorized under the following types:

  1. Observation
  2. Bracing
  3. Specialized physical therapy
  4. Surgery

Katharina Schroth was a German physiotherapist best known for developing the Schroth Method to treat scoliosis.

References

  1. ↑ O'Sullivan, Kieran; O'Sullivan, Peter; O'Sullivan, Leonard; Dankaerts, Wim (2012). "What do physiotherapists consider to be the best sitting spinal posture?". Manual Therapy. 17 (5): 432–437. doi:10.1016/j.math.2012.04.007. PMID   22608170.
  2. ↑ Swain, Christopher T.V.; Pan, Fumin; Owen, Patrick J.; Schmidt, Hendrik; Belavy, Daniel L. (2020). "No consensus on causality of spine postures or physical exposure and low back pain: A systematic review of systematic reviews". Journal of Biomechanics. 102: 109312. doi:10.1016/j.jbiomech.2019.08.006. PMID   31451200. S2CID   201756091.
  3. ↑ "How to Correct Posture Exercises - Sydney Sports and Exercise Physiology". ssep.com.au. 2020-07-11. Retrieved 2024-02-06.
  4. ↑ https://studenthealth.sa.ucsb.edu/sites/default/files/2021-03/posture.pdf [ bare URL PDF ]
  5. 1 2 Marieb, E. N. (2001), Human Anatomy & Physiology, San Francisco, CA: Pearson Education Inc., Publishing as Benjamin Cummings, pp. 215–216
  6. ↑ Kendal, F. P.; McCreary, E. K.; Provance, P. G.; Rodgers, M. M.; Romani, W A. (2005), Muscles Testing and Function with Posture and Pain (5th Edition), Baltimore, MD: Lippincott Williams & Wilkins, pp. 49–65
  7. ↑ Webster, Deborah, The Neutral Spine, wellbridge.com, archived from the original on 2007-08-22
  8. 1 2 3 4 Vrtovec, T.; Pernus, F.; Likar, B. (2009), "A review of methods for quantitative evaluation of spinal curvature.", European Spine Journal, 18 (5): 593–605, doi:10.1007/s00586-009-0913-0, PMC   3233998 , PMID   19247697
  9. ↑ Kritz, E. N.; Croin (2008), Static Posture Assessment Screen of Athletes: Benefits and Considerations., Journal of Strength and Conditioning, pp. 18–27
  10. ↑ Roussouly, P.; Gollogly, S.; Berthonnaud, E.; Dimnet, J. (2005), "Classification of the Normal Variation in the Sagittal Alignment of the Human Lumbar Spine and Pelvis in the Standing Position", Spine, 30 (3): 346–353, doi:10.1097/01.brs.0000152379.54463.65, PMID   15682018, S2CID   20997025
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