Posts tagged posture
Should I Stretch My Pectoral Muscles To Relieve My Shoulder Pain?
shoulder-pain-posture-stretching-pectorals

Our current understanding of posture has changed dramatically over the past 20 years due to the influx of scientific literature on posture and muscle and joint pain. Previously, posture was thought to be strongly associated with muscles imbalances including tightness or weakness. For example, forward shoulders were thought to be associated with shortened pectoral muscles. Our current understanding has reduced the importance of posture on both clinical decision making and an association with a patient’s current symptoms. Patient’s with poor posture can demonstrate normal muscle function and those with great posture can demonstrate significant muscle imbalances and pain. A recent research paper highlights these concepts on patient’s with shoulder pain.

Navarro-Ledesma and colleagues examined the muscle length and available joint space in patients with shoulder pain compared to their pain free peers (PT in Sport. 2018). Each participant’s pectoral minor length and shoulder joint (subacromial) space was measured clinically with ultrasound. The authors reported pectoral muscle length was poorly associated with both shoulder joint space and the presence of shoulder pain. These findings are consistent with our currently held belief on the limited importance of pectoral muscle length or flexibility and the presence or development of shoulder pain. Patient’s are encouraged to work with a local Physical Therapist on a shoulder and shoulder blade strengthening program instead of stretching their pectoral or chest muscles.

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Impact of Posture on Rotator Cuff Injury
Boulder-posture-treatment

Posture has a controversial and complex role in musculoskeletal pain.  Some research studies have found zero to weak correlations between posture and pain while other studies have shown it can both impact pain and function.  One area of the body where posture may have a larger role is with shoulder function.  Individuals with limited mid back mobility often demonstrate increased rates of neck and shoulder pain.  A recent study examined the impact of posture on rotator cuff injury and symptoms.

A recent study in the Journal of Shoulder and Elbow Surgery examined 379 individuals during an annual physical (Yamamoto et al. 2014).  Participants were examined for posture, shoulder function, and also underwent an ultrasound examination of their rotator cuffs.  The average age of the participants was 62 years old and consistent with previous research 25% showed a rotator cuff tear in one shoulder and 12% showed a rotator cuff tear in both shoulders.  The authors concluded postural abnormalities were an independent risk factor for both symptomatic or non symptomatic rotator cuff tears.  This study highlights the importance of thoracic posture and mobility for patients with shoulder pain.

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Influence of Posture on Shoulder Function and Pain
shoulder pain-posture-range of motion-strength

Shoulder pain is the 2nd most common orthopedic reason patients seek out medical care behind low back pain.  Shoulder pain has many causes including lack of mobility, shoulder blade and rotator cuff weakness, but posture is often criticized as a risk factor for shoulder pain.  Clinicians and patients believe a poor posture places structures such as the rotator cuff at risk for injury or the posture changes the function of muscles in the upper body.  In our practice, we often find stiffness or a lack of mobility in the middle back (thoracic spine) either precipitates or perpetuates a patient's shoulder symptoms.  Poor mobility in the thoracic spine requires more of the neck and shoulder during a given functional movement.

A recent review article searched the available evidence to determine posture's role on shoulder pain and function.  Barrett and colleagues examined 10 studies to determine if posture influences shoulder range of motion or the development of shoulder pain (Man Ther. 2016).  They found moderate evidence showing no difference in thoracic posture between those with and without shoulder pain.  Conversely, the did find strong support that better posture allows for greater shoulder range of motion compared to a slumped posture.  Their final conclusion stated no significant contribution of thoracic posture on the development of future shoulder pain, but further research is needed.  

Leg Alignment and Running Injuries
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In the examination of healthy or injured runners it is tempting to focus on an individual's leg alignment and posture.  The hope of these tests and measures is it will help a clinician identify the source of client's symptoms or a risk factor for injury.  The limitation of these examination items is their inability to tell us how an individual moves dynamically.   Earlier in the year we described the failure of static tests of the foot and ankle to predict a runner's gait pattern.  A recent article reviewed the ability of static tests of leg alignment and posture to predict future running injury.

A journal article in the European Journal of Sports Science examined 89 runners for leg alignment including leg length, knee angles, as well as, ankle and foot alignment.  The runners were then followed over time to determine if any of these clinical measurements predicted future injury.  Not surprising given the high rate of injury in runners, 1 in 2 runners developed a running related injury (mostly muscle and tendon)  over the study period.  The authors found no significant association between lower leg alignment and postural tests and the development of future injury.

Can We Predict Dynamic Foot Function from Static Physical Therapy Tests

After hearing a patient's history, Physical Therapists decide on known tests and measures to assess for impairments such as a loss of joint range of motion or muscle weakness which either precipitated or perpetuated a patient's symptoms or injury.  The foot and ankle are commonly assessed as a contributing factor to lower quarter injuries and pain because of their ability to influence the mechanics of proximal joints.  One method of static assessment is the Foot Posture Index (FPI), a 6 item tool which allows the clinician to visually examine the foot structure.  This assessment tool has demonstrated some effectiveness at predicting lower quarter overuse injuries (Burns et al. 2005, Yates et al. 2004). 

foot posture index, lower extremity physical therapy examination

A recent study by Paterson et al. examined the predictive ability of the FPI, motion analysis, and a depth camera on dynamic foot function.  The authors found the majority of static foot measurements (85%) did not correlate with the dynamic foot and ankle motion they found during walking.  The authors concluded that static measures of foot posture have limited diagnostic utility to predict mechanics noted during a gait analysis.  Similar to other postural assessments, a static foot assessment does little to help us determine how an individual moves or if this posture is related to their current symptoms.  Whenever possible a dynamic assessment including functional testing and walking or running gait should be used to provide a better assessment of a patient's injury or pain.