Body Posture & Muscles Functions: (Part 6)

In this post, I will start off with brief explanation about back extensors' test. Once we are done reviewing the test, I will discuss about the simple tests for glutes and QLO. This back extensor test, can be apply to general population and even professional athletes.

In the trunk extension test for the back extensors, the erector spinae muscles are assisted by the latissimus dorsi, quadratus lumborum, and trapezius. In the prone position, the low back will assume a normal anterior curve. To avoid false interpretations of the test results, it may be necessary to perform some preliminary tests. It is not necessary to do so routinely, however, because close observation of the subject in a prone position and of the movements taking place during trunk extension will indicate if preliminary tests for length of hip flexors and strength of the hip extensors are needed. Now, let me present to you the back extensor test. 

Patient: Prone, with hands clasped behind the buttocks (or behind the head).

Fixation: Hip extensors must give fixation of the pelvis to the thighs. The examiner stabilizes the legs firmly on the table.

Test Movement: Trunk extension to the subject's full range of motion.

Resistance: Gravity. Hands behind the head, or hands behind the lower back.

Grading: The ability to complete the movement and hold the position with hands behind the head or behind the back may be considered as normal strength. The low back muscles are seldom weak, but if there appears to be weakness, then hip flexor tightness and/or hip extensor weakness must be ruled out first. Actual weakness can usually be determined by having the examiner raise the subject's trunk in extension (to the subject's maximum range) and then asking the subject to hold the completed test position. Inability to hold this position will indicate weakness. Weakness is best described as slight, moderate, or marked based on the judgment of the examiner.

If the hip extensors are weak, it is possible that the examiner can stabilize the pelvis firmly in the direction of posterior tilt toward the thighs, provided that the legs are also firmly held down by another person or by straps. Alternatively, the subject may be placed at the end of the table, with the trunk in a prone position and legs hanging down with knees bent as needed. The examiner then stabilizes the pelvis and asks subject to raise the trunk in extension and hold it against pressure. In the presence of tight hip flexors, the back will assume a degree of extension (e.g lordosis) commensurate with the amount of hip flexor tightness. In other words, the low back will be in extension before beginning the trunk extension movement. In such a case, the subject will be limited in the height to which the trunk can be raised, and the mistaken interpretation may be that the back muscles are weak.

A similar situation may arise if the hip extensor muscles are weak. For strong extension of the back, the hip extensors must stabilize the pelvis toward the thighs. If the hip extensors cannot provide this stabilization, the pelvis will be pulled upward by the back extensors into a position of back extension. Again, as in the case of hip flexor tightness, if the back is already in some extension before the trunk-raising movement is started, the trunk will not be raised as high off the table as it would be if the pelvis were fixed in extension on the thighs.

Gluteus Maximus (How weak is your glutes?)

Lying prone on a table, this subject exhibits a normal anterior curve in the

lower back

The moment that back extension is initiated, the curve in the lower back increases

because of weakness in the gluteus maximus.

When extension is continued, the subject can raise the trunk higher, but not to

completion of the range of motion.

Holding the pelvis in the direction of posterior pelvic tilt, in the manner provided

by a strong gluteus maximus, enables the subject to complete the full

range of motion.

We've covered back extensors and glutes tests. Now, let's move on to a quick test on the quadratus lumborum. The quadratus lumborum acts with other muscles in lateral trunk flexion. It is difficult to palpate this muscle because it lies deep beneath the erector spinae. Although the quadratus lumborum enters into the motion of elevation of the pelvis in the standing position or in walking, the standing position does not offer a satisfactory position for testing. Elevation of the right side of the pelvis in standing, for example, depends as much (if not more) on the downward pull by the abductors of the left hip joint as it does on the upward pull of the right lateral abdominals.

Quadratus Lumborum (QLO)

Origin: Iliolumbar ligament, iliac crest. Occasionally from upper borders of the transverse processes of the lower three or four lumbar vertebrae. 

Insertion: Inferior border of the last rib and transverse processes of the upper four lumbar vertebrae.

Action: Assists in extension, laterally flexes the lumbar vertebral column, and depresses the last rib. Bilaterally, when acting together with the diaphragm, fixes the last two ribs during respiration.

Nerve: Lumbar plexus, T12, LI, 2, 3.

Patient: Prone.

Fixation: By muscles that hold the femur firmly in the

acetabulum.

Test Movement: Lateral elevation of the pelvis. The extremity is placed in slight extension and in the degree of abduction that corresponds with the line of fibers of the quadratus lumborum.

Resistance: Given in the form of traction on the extremity, directly opposing the line of pull of the quadratus lumborum. If the hip muscles are weak, pressure may be given against the posterolateral iliac crest opposite the line of pull of the muscle.

Grading: Grading the strength of this muscle numerically is not recommended. Simply record whether it appears to be weak or strong.

The coming weeks will be very busy on my schedule, stay tuned as I will try to finish off a couple more posts on this discussion.

Body Posture & Muscles Functions: (Part 5)

For some of you personal trainers and coaches out there, you may heard of anterior and posterior pelvic tilt during your fitness or CPT courses. And for some of you people, you may be aware of 'donald duck and pink panther syndrome'. What does these terms have in common? Well, if you notice people especially women with lower back arch, we call that posture 'Donald Duck' or also known as anterior pelvic tilt. As for people with 'pink panther syndrome' or 'butt dissapearing syndrome', it is also known as posterior pelvic tilt. 

Now, let's talk about the pelvic. An area which not many people show great interest, it plays an important role in biomechanics and postural alignment. The neutral position of the pelvis is one in which the anterosuperior-iliac spines are in the same transverse plane, and in which the spines and the symphysis pubis are in the same vertical plane. An anterior pelvic tilt is a position of the pelvis in which the vertical plane through the antero-superior-iliac spines is anterior to a vertical plane through the symphysis pubis. A posterior pelvic tilt is a position of the pelvis in which the vertical plane through the antero-superior iliac spines is posterior to a vertical plane through the symphysis pubis. In a standing position, an anterior pelvic tilt is associated with hyperextension of the lumbar spine and flexion of the hip joints, whereas a posterior pelvic tilt is associated with flexion of the lumbar spine and extension of the hip joints.

Now, let's take a look at the illustration below. 

In lateral pelvic tilt, the pelvis is not level from side to side, rather, one anterosuperior spine is higher than the other. In standing postition, a lateral tilt is associated with lateral flexion of the lumbar spine and with adduction and abduction of the hip joints. For example, in a lateral tilt of the pelvis in which the right side is higher than the left, the lumbar spine is laterally flexed resulting in a curve that is convex toward the left. The right hip joint is in adduction and the left in abduction. Please see illustration below.

I will show you a measurement test which requires minimal tool (only a ruler) to determine the length of the posterior muscles. Below are details of the measurement test and illustration of different common postural status.

Equipment: Same as for hamstring length test, plus a ruler. The ruler is used to measure the distance of the fingertips either from or beyond the base of the big toe. This measurement is used only as a record to show the overall forward bending; it in no way indicates where limitation or excessive motion has taken place.

Starting Position: Sitting with legs extended (long-sitting) and feet at, or slightly below, right angles.

Reason: To standardize the position of the feet and knees.

Test Movement: Reach forward, with knees straight, and try to touch the fingertips to the base of the big toe or beyond, reaching as far as the range of muscle length permits.

Reason: Both the back and hamstrings will elongate to their maximum.

Normal length of back, hamstring, and gastroc-soleus muscles

Excessive length of back muscles, short hamstrings and 

normal length of the gastroc-soleus.

Excessive length of the upper back muscles, slight shortness of the muscles in the mid back and in gastrocsoleus. Hamstrings and low back are normal in length

Normal length of the upper back muscles and short lower

back, hamstring and gastroc-soleus muscles.

Bear in mind, trunk muscles consist of back extensors that bend the trunk backward, lateral flexors that bend it sideways, anterior abdominals that bend it forward or tilt posteriorly, and combinations of these muscles that rotate the trunk in a clockwise or a counter-clockwise manner. All these muscles play a role in stabilizing the trunk, but the back extensors are the most important in this regard. The loss of stability that accompanies paralysis or marked weakness of the back muscles offers dramatic evidence of their importance. Fortunately, marked weakness of these muscles seldom occurs.

The term weak back, as frequently used in connection with low back pain, mistakenly suggests a weakness

of the low back muscles. The feeling of weakness that occurs with a painful back is associated with the faulty alignment the body assumes, and it is often caused by weakness of the abdominal muscles. Persons who have faulty posture with roundness of the upper back may exhibit weakness in the upper back extensors but have normal strength in those of the low back.

Despite the fact that the low back muscles are the most important trunk stabilizers, relatively little space will be devoted to them in this chapter compared to the detailed discussion of the abdominal muscles. Testing back muscles is less complicated than testing abdominal muscles, and in the field of exercise, few errors occur regarding back exercises. Many misconceptions and errors, however, occur regarding proper abdominal exercises. Furthermore, in contrast to the back muscles, weakness of the abdominal muscles is more prevalent. It is important to know how to test for strength and how to prescribe proper exercises for the abdominal muscles because of the effect that weakness of these muscles has on overall posture and the relationship of such weakness to painful postural problems.

Illustrations, definitions, and descriptions of basic concepts are used to help achieve this purpose. Both the illustrations of the trunk muscles that follow and the accompanying text provide information in detail about the origins, insertions and actions of these muscles. This information is essential to understanding the functions of these important trunk muscles.

Now, let's discuss about back extensors and neck. For back extensors, to raise the trunk from a prone position, the hip extensors must fix the pelvis in extension on the thigh. Normally, extension of the hip joints and extension of the lumbar spine are initiated simultaneously, not as two separate movements. If slight tightness exists in the hip flexors, there is no range of extension in the hip joint, and all the movement in the direction of raising the leg backward is accomplished by lumbar spine hyperextension and pelvic tilt. Please see illustrations below.

For hip extensors to raise the extremity backward

from a prone position through the few degrees of true

hip joint extension, the back extensors must stabilize

the pelvis to the trunk.

A subject with strong back extensor muscles and strong

hip extensor muscles can raise the trunk in extension.

A subject with weak or paralyzed back extensor muscles

and strong hip extensor muscles cannot raise the trunk

in extension. The hip extensors, in their action to fix the

pelvis, are unopposed. The pelvis tilts posteriorly, and

the lumbar spine flexes.

In the next post, I will discuss about the back extensors test as well as glutes and quadratus lumborum. Stay tuned. 

Body Posture & Muscles Functions: (Part 4)

Does any of you encountered low back pain? How about inability to perform full push up exercise? How about doing excessive knee bent sit up exercise regularly? In today's post, I will discuss about the trunk, primarily about vertebral column.

Innervation to the trunk muscles does not include an intervening plexus between the spinal cord and the peripheral nerves like the cervical, brachial, lumbar and sacral plexus. Abdominal muscles receive their innervation from the thoracic branches of the ventral divisions of the spinal nerves.

Based on the skeletal structures, the trunk is composed of two parts. The thoracic spine and the ribcage constitute the upper part; the lumbar spine and the pelvis constitute the lower part. The spinal column, together with the extensor muscles govern, to a great extent, the posture and movements of the trunk. This chapter examines the role of trunk muscles in movement and support of the trunk, and the role of hip muscles that act simultaneously with trunk muscles in movements and support of the pelvis.

It is interesting to note that muscles that act in unison for certain movements act in opposition to each other in support of good alignment. For example, in the prone position during the movement of spine extension, hip extensors assist by stabilizing the pelvis to the femur. In the supine position during the movement of spine flexion, the hip flexors act to stabilize the pelvis. On the other hand, in support of good postural alignment in standing, the hip extensors act with the abdominal muscles, and the hip flexors act with the back extensors. In the movement of raising the trunk up sideways, lateral trunk muscles laterally flex the trunk as the hip abductors stabilize the pelvis. In support of good alignment in standing, lateral trunk muscles are assisted by hip abductors on the opposite side.

In relation to the trunk, one of the major concerns is the painful low back. It is common knowledge that a high percentage of the adult population has suffered from low back pain at one time or another. For many, the treatment of choice consists of restoring good postural alignment and muscle balance.

The lungs and diaphragm are located in the trunk. Faulty alignment of the skeletal structures and problems of muscle imbalance can adversely affect the respiratory system. The Respiratory muscles lists the twenty three muscles (each of which has a right and left component) plus the diaphragm as the muscles of respiration. Most of these muscles also have a function related to posture and muscle balance.

The trunk, or torso, is the body excluding the head, neck, and limbs. The thorax, the abdomen, the pelvis, and the low back are all parts of the trunk. The term trunk raising may be used to describe raising the trunk against gravity from various positions, from face-lying (prone position), trunk raising backward, from side lying, trunk raising sideways, and from back lying (supine position), trunk raising forward. The term may also apply, in standing, to raising the trunk from positions of forward bending, side bending, or backward bending to the erect position.

The thorax is elevated (chest lifted upward and forward) by straightening the upper back, bringing the rib cage out of a slumped position. The thorax is depressed when sitting or standing in a slumped position, or it may be pulled downward by the action of certain abdominal muscles.

The trunk is joined to the thighs at the hip joints. The movement of hip flexion means bending forward at the hip joint. It may be done by bringing the front of the thigh toward the pelvis, as in forward leg raising, or by tilting the pelvis forward toward the thigh, as in the sit up movement.

The forward-bending, long-sitting position involves hip joint flexion along with back flexion. One must try to disregard the hip joint movement when observing the contour of the back. Range of motion and contour of the back may also be observed by having a subject bend forward from the standing position. As a test position, however, this has certain disadvantages. If the pelvis is not level or is rotated, the plane of forward bending will be altered, and the test will not be as satisfactory as that in the longsitting position in which the pelvis is level and rotation is better controlled.

Because the low back muscles are seldom weak, the range of back extension may be determined by the active strength test in the prone position. Please see photo below. 

Whether the range of motion is normal, limited, or excessive, the subject is capable of moving through the existing range. The anterosuperior-iliac spines should not be lifted from the table during back extension, because doing so adds hip extension to the back extension range of motion. Please see photo illustration below.

Back extension often is checked in the standing position. The test is useful as a gross evaluation, but it is not very specific. Swaying forward at the hips is almost a necessity for balance when bending backward, but doing so adds the element of hip extension to the test, or the knees must bend somewhat if the hip does not extend.

Similar to the test to determine range of motion in spine flexion, a test can be done to determine the range in spine extension. The subject lies prone on a table, resting on the forearms with elbows bent at right angles and arms close to the body. If the subject can extend the spine enough to prop up on the forearms with the pelvis flat on the table, the range of motion in extension is considered to be good.

Now, let's talk a little bit about flexion. In the cervical region, flexion of the spine is movement in the direction of decreasing the normal forward curve. Movement continues to the point of straightening or flattening this region of the spine, but it normally does not progress to the point of the spine curving convexly backward.

In the thoracic region, flexion of the spine is movement in the direction of increasing the normal backward curve. In normal flexion, the spine curves convexly backward, producing a continuous, gently rounded contour throughout the thoracic area. Next, in the lumbar region, flexion of the spine is movement in the direction of decreasing the normal forward curve. It progresses to the point of straightening or flattening the lower back. Normally, the lumbar spine should not curve convexly backward, but excessive flexion in the low back is not uncommon. Certain types of activities or exercises  such as knee bent sit ups, can cause flexion beyond the normal range and make the back vulnerable to strain from heavy lifting movements. I've wrote about this before in previous post. 

Moving on, let's discuss about extension. Extension of the spine is movement of the head and trunk in a backward direction, while the spine moves in the direction of curving convexly forward. In the cervical region, extension is movement in the direction of increasing the normal forward curve. It occurs by tilting the head back, bringing the occiput toward the seventh cervical vertebra. It may occur, in sitting or standing, by slumping into a round upper back, and forward-head position that results in approximating the seventh cervical vertebra toward the occiput.

In the thoracic region, extension is movement of the spine in the direction of decreasing the normal backward

curve by straightening the upper back. Movement may progress to, but normally not beyond, the straight or flat position. In the lumbar region, extension is movement in the direction of increasing the normal forward curve. It occurs by bending the trunk backward or by tilting the pelvis forward. 

In the next post, I will discuss about the posterior muscles including hamstring and spine, as well as pelvis. Stay tuned.

Body Posture & Muscles Functions: (Part 3)

In today's modern work environment, desk jockeys arguably have the most complaints and problems with posture and pains or mobility restriction in the joints. Poor biomechanics such as khyphosis, tight hip flexors, gluteal inhibition, and lower back problems. Long hours of sitting, especially from poor posture, will contribute to poor biomechanics, leading to muscles dsyfunctions and joints problems. 

Apart from desk jockeys, most of us spend many hours daily using computers, watching TV and even driving on the road. Increased dependence on computers in many work situations is frequently the cause of neck and upper back discomfort and headaches if basic ergonomic rules are ignored. The office set up below was chosen as an example of how to correct alignment and relieve strain. The key to improving posture is a well-fitting chair that adjusts for proper height, arm support and back support. Use of a phone headset to relieves neck strain.

Incorrect

Incorrect

    

Phone on shoulder, desktop computer and monitor in corner on a platform. Neck tilted left, rotated right and extended; shoulders elevated with pressure on elbows and wrists, feet propped on chair legs.

Correct

Correct

Computer placed under desk, monitor moved from comer, and platform removed. Monitor at or below eye level. Use of phone headset to relieve neck strain. Chair has proper back support and armrests to remove weight of arms from neck and shoulders. Legs supported by footrest under desk.

Now, let's discuss about massage, particularly the type of massages which aid or help on neck muscles. I know there are various forms of neck massages you may know or heard of, or even some of the common massage therapy you had enjoyed. 

Massage is an important modality in the treatment of painful neck conditions. The soothing effects of gentle massage can help relax tense muscles. Neck extensor muscles often become short from a faulty forward head posture. Massage, along with appropriate exercises, can be used to help relax and stretch the tight muscles and restore normal range of motion.

The photos below show the various positions for effectively applying massage to help relieve neck tension and stiffness. The subject is seated on a stool beside the treatment table. Pillows on the table are adjusted to a level that is comfortable for the subject when leaning forward to rest the head on the hands. Massage is applied to posterior and lateral neck muscles, primarily the upper trapezius.

Neck Massages & Stretching 

Start the massage at the occipital attachments of the upper trapezius. Begin with a smooth, firm stroking massage.

Continue the massage along the trapezius to the attachments of the clavicle and scapulae.

Repeat the massage using a kneading technique to the left and right upper trapezius

With face turned left to put a mild stretch on the left trapezius, repeat the stroking and kneading massage

With the face turned right to stretch right trapezius, repeat the stroking and kneading massage

Stretch Neck Rotators - Sit on a chair with hands grasping seat to keep shoulders down and level. Sit without tilting head, turn towards each side.

Stretch Lateral Neck Flexors - Sit on a chair with shoulders back and hands grasping seat to hold shoulders down and level. Tilt head directly sideways to stretch opposite lateral neck flexors.

Fitness Trends 2013

Decided to share some information regarding current trend in fitness industry. From most popular fitness equipments to most demanded types of trainings, data below obtained from IDEA World Fitness Equipments and Programs Trends Report 2013. Since few years back till present day, personal training one on one, still top the chart, and fitness tools such as TRX (suspension trainer), Combat/Heavy Ropes and even bodyweight exercises ranked most popular equipments.

Foam rollers and massage balls used primarily in myofascial release is also very popular, ranked 2nd. I must stress how important incorporating myofascial release routines in your daily/weekly program. It will help with muscular dsyfunctions/imbalances, tissue scarring, adhesion, poor biomechanics, etc. It will also help reduce the risk of injuries, especially for those who are fitness enthusiasts, professional athletes or even people who are just playing recreational sports. Others apply this routine as part of lactic acid flush during post workout. It is very important, if you want to improve mobility and performance relating to sports, training, or even daily functional movement. In my program, I use it regularly with my clients. Think of myofascial release as servicing a car, and workout/exercise as on the road car driving/racing. 

Heavy/Resistance ropes, amongst the most popular tools in 2013

Personal training 1 on 1 top the chart as the most popular type of training offered in 2013.

Bodyweight leverage equipments still top the chart, most popular tools.

Body Posture & Muscles Functions: (Part 2)

In this post, I want to discuss further about muscles functions in the body, particularly the neck muscles. This topic may seem to be quite 'dry and anatomical' for some of you readers out there, but I can guarantee you that it is an important topic for physical and overall health. For me, this is a rare yet cool knowledge anyone can possess, and to know your body better, comes a beneficial advantage to yourself.

Now, let's get to know our neck much better. The cervical spine and the muscles of the neck form a remarkable structure that provides for movement of the head in all directions, and for stability in various positions. The neck supports the weight of the head in the upright position. For the gymnast who performs a headstand, the neck supports the weight of the body momentarily! The neck is in a position of slight anterior curve, and the upper back is in a position of slight posterior curve.

In typical faulty posture, the alignment of the head does not change, but the alignment of the neck changes in response to altered upper back positions. If the upper back is straight, the neck will be straight. If the upper back curves posteriorly into a kyphotic position, the neck extension increases correspondingly to the extent that a marked kyphosis may result in a position of full neck extension with the head maintaining a level position. Please have a look at the photos below.

kyphotic posture

Now, we tend to notice a huge number of people (especially desk jockeys) who suffer from kyphosis @ hunchback posture. A lot of hours in poor sitting position during working hours, driving and also at home watching TV, usage of computers, etc. What about most people in the gym (especially guys) who are obsessed doing bench press and also chronic push up routines? I have met huge amount of guys who would do easily 50-100 reps of push ups every single day. Without correcting the already kyphotic posture, these chronic pushing movements will further aggravate problem, leading to muscular imbalances and even poorer biomechanics. Over developed chest muscle group will lead to tight pectoral major and minor as well, if proper myofascial release is not integrated regularly, and missing out on proper functional pulling movements is critical to avoid muscles imbalances and increased risk of injury.

Bear in mind, chronic problems of the neck may result from faulty posture of the upper back. Along with many attributes, the neck is also vulnerable to stress and serious injury. Occupational or recreational activities may demand positions of the head that result in alignment and muscle imbalance problems. 

Emotional stress may cause an acute onset of pain with spasm of the neck muscles. The problem may be only temporary or the stress may be long-standing and result in chronic problems. The appropriate use of massage in the early stages can be an important part of treatment.

A common cause of whiplash injury to the neck is one in which a stopped or very slow-moving vehicle is hit from the rear by a fast-moving vehicle. By the impact, the head is suddenly thrust backward resulting in hyperextension of the neck, followed immediately by a sudden thrust forward resulting in hyperflexion of the neck. Trauma caused by a whiplash may result in temporary and relatively mild symptoms, or may cause severe and long-term problems.

This post presents basic evaluation and treatment procedures in relation to faulty and painful neck conditions. The normal anterior curve of the spine in the cervical region forms a slightly extended position. Cervical spine

extension is movement in the direction of increasing the normal forward curve. It may occur by tilting the head back, bringing the occiput toward the seventh cervical vertebra. It also may occur in sitting or standing by slumping into a round-upper-back, forward-head position, bringing the seventh cervical vertebra toward the occiput.

Cervical spine flexion is movement of the spine in a posterior direction, decreasing the normal anterior curve.

Movement may continue to the point of straightening the cervical spine (e.g the end range of normal flexion), and in some instances, movement may progress to the point that the spine curves convexly backward (e.g a position of mild kyphosis).

It is important to maintain good neck range of motion. We are constantly challenged by the need to turn the head to look sideways or tilt it to look downward to avoid colliding with or tripping over something. Hence, it is advisable to establish and justify a means by which measurements can be taken to determine the range of

motion of the neck in relation to established standards. Various methods have been employed to measure the

range of motion of the cervical spine, such as radiographs, goniometers, electrogoniometers, inclinometers, tape measures, Cervical ROM devices as well as ultrasound. If the upper back is rigid in a position of kyphosis, treatment of the tight neck extensors with massage and gentle stretching may acceptable but still worthwhile. 

If the posture of the upper back is habitually faulty but the person is able to assume a normal alignment, efforts should be directed toward maintaining good alignment. Temporary use of a support to help correct faulty posture of the shoulder and upper back may be beneficial as well. 

Faulty Head and Neck Positions:

 

Cervical Spine, Good and Faulty Positions: For the radiograph on the left, the subject sat erect, with the head and upper trunk in good alignment. For the radiograph on the right, the same subject sat in a typically slumped position, with a round upper back and a forward head. As illustrated, the cervical spine is in extension.

Now, let's discuss about neck muscles testing. There will be several variations to test the neck flexors primarily anterior, posterior and anterolateral. 

Anterior Neck Flexor

Patient: Supine, with the elbows bent and the hands overhead, resting on the table.

Fixation: Anterior abdominal muscles must be strong enough to give anterior fixation from the thorax to the pelvis before the head can be raised by the neck flexors. If the abdominal muscles are weak, the examiner can provide fixation by exerting firm, downward pressure on the thorax. Children approximately 5 years of age and younger should have fixation of the thorax provided by the examiner.

Test: Flexion of the cervical spine by lifting the head from the table, with the chin depressed and approximated toward the sternum.

Pressure: Against the forehead in a posterior direction.

Weakness: Hyperextension of the cervical spine, resulting in a forward-head position.

Anterolateral Neck Flexor

Patient: Supine, with elbows bent and hands beside the head, resting on table.

Fixation: If the anterior abdominal muscles are weak, the examiner can provide fixation by exerting firm, downward pressure on the thorax.

Test: Anterolateral neck flexion.

Pressure: Against the temporal region of the head in an obliquely posterior direction.

Weakness: A contracture of the right sternocleidomastoid produces a right torticollis. The face is turned toward the left, and the head is tilted toward the right. Thus, a right torticollis produces a cervical scoliosis that is convex toward the left with the left sternocleidomastoid elongated and weak. In a patient with habitually faulty posture and forward head, the sternocleidomastoid muscles remain shortened position and tend to develop shortness.

Posterolateral Neck Extensors

Patient: Prone, with elbows bent and hands overhead, resting on the table.

Fixation: None necessary.

Test: Posterolateral neck extension, with the face turned toward the side being tested.

Pressure: Against the posterolateral aspect of the head in an anterolateral direction.

Shortness: The right splenius capitis and left upper trapezius are usually short, along with the sternocleidomastoid, in a left torticollis. The opposite muscles are short in a right torticollis.

Muscle problems associated with pain in the posterior neck are essentially of two types, one associated with
muscle tightness and the other with muscle strain. Symptoms and indications for treatment differ according to
the underlying fault. Both types are quite prevalent. The one associated with muscle tightness usually has a gradual onset of symptoms, whereas the one associated with muscle strain usually has an acute onset.

Neck pain and headaches associated with tightness in the posterior neck muscles are most often found in patients with a forward head and a round upper back. Headaches associated with this muscle tightness are essentially of two types: occipital headache and tension headache.

In a tension headache, in addition to the faulty postural position of the head and neck and the tightness of the posterior neck muscles, an element of stress is also involved. This makes the condition tend to fluctuate with times of increased or decreased stress. In any event, the tight muscles usually respond to treatment that helps these muscles to relax.

Active treatment consists of heat, massage and stretching. The massage should be gentle and relaxing at first, then progress to deeper kneading. Stretching of the tight muscles must be very gradual, using both active and assisted movements. The patient should actively try to stretch the posterior neck muscles by efforts to flatten the cervical spine.

Because the faulty head position is usually compensatory to a thoracic kyphosis, which in turn may result from postural deviations of the low back or pelvis, treatment frequently must begin with correction of the associated faults. Treatment for the neck may need to begin with exercises to strengthen the lower abdominal
muscles and with use of a good abdominal support that permits the patient to assume a better upper back and chest position.

In the next post, I will discuss about work place ergonomics, massages which will help the neck muscles, as well as exercises on how to stretch relevant muscles. Stay tuned.

Body Posture & Muscles Functions: (Part 1)

I've decided to start off with a new discussion, a topic which not many people talk alot about it. A topic about body posture and muscles functions. How both are associated to enable or disable proper biomechanics of human body. Whenever you go, either in the gyms, bootcamps or any sporting event, you may heard alot about fat loss, muscle building, cardiovascular fitness, yoga, powerlifting, crossfit training, etc. But, how often do you hear fitness professionals or enthusiasts talk about the importance of body posture/biomechanics? Rare, and it is not a popular topic amongst most of us including athletes and fitness folks.  

This topic will be important for whoever suffer from postural problems such as back pain, TMJ, hyper lordosis, thoracic kyphosis, scoliasis, 'pink panther syndrome' and much more. Could it be that specific joint or muscle which is causing the problem? Or is it something else? Would visiting orthopaedic surgeon help fix the problem? Can you improve if not eliminate the condition without involving surgery? Let's get into the fundamentals of our biomechanics and analyse in details some of our postures and muscles association.

In this post, I will mainly discuss about facial muscles in the face. As some of you would have known, good posture is a good habit that contributes to the wellbeing of the individual. The structure and function of the body provide the potential for attaining and maintaining good posture. Conversely, bad posture is a bad habit and, unfortunately, is all too common. Postural faults have their origin in the misuse of the capacities provided by the body, not in the structure and function of the normal body. If faulty posture were merely an aesthetic problem, the concerns about it might be limited to those regarding appearance. However, postural faults that persist can give rise to discomfort, pain, or disability. The range of effects, from discomfort to incapacitating disability, is often related to the severity and persistence of the faults.

Discussion of the importance of good posture springs from a recognition of the prevalence of postural problems, associated painful conditions and wasted human resources. This text attempts to define the concepts of good posture, to analyze postural faults, to present treatments, and to discuss some of the developmental factors and environmental influences that affect posture. The objective is to help decrease the incidence of postural faults resulting in painful conditions. Cultural patterns of modern civilization add to the stresses on the basic structures of the human body by imposing increasingly specialized activities. It is necessary to provide compensatory influences to achieve optimum function under our mode of life.

The high incidence of postural faults in adults is related to this tendency toward a highly specialized or repetitive pattern of activity. Correction of the existing conditions depends on understanding the underlying influences and implementing a program of positive and preventive educational measures. Both require an understanding of the mechanics of the body and its response to the stresses and strains imposed on it. Inherent in the concept of good body mechanics are the inseparable qualities of alignment and muscle balance. Examination and treatment procedures are directed toward restoration and preservation of good body mechanics in posture and movement. Therapeutic exercises to strengthen weak muscles and to stretch tight muscles are the chief means by which muscle balance is restored. Good body mechanics requires that range of joint motion be adequate but not excessive. Normal flexibility is an attribute; excessive flexibility is not. A basic principle regarding joint movements can be summarized as follows: the more flexibility, the less stability; the more stability, the less flexibility. A problem arises, however, because skilled performance in a variety of sport, dance, and acrobatic activities requires excessive flexibility and muscle length.

Posture is usually defined as the relative arrangement of the parts of the body. Good posture is that state of muscular and skeletal balance which protects die supporting structures of the body against injury or progressive deformity, irrespective of the attitude (erect, lying, squatting, or stooping) in which these structures are working or resting. Under such conditions the muscles will function most efficiently and the optimum positions are afforded for the thoracic and abdominal organs. Poor posture is a faulty relationship of the various parts of the body which produces increased strain on the supporting structures and in which there is less efficient balance of the body over its base of support.

Painful conditions associated with faulty body mechanics are so common that most adults have some firsthand knowledge of these problems. Painful low backs have been the most frequent complaints, although cases of neck, shoulder, and arm pain have become increasingly prevalent. With the current emphasis on running, foot and knee problems are common. When discussing pain in relation to postural faults, questions are often asked about why many cases of faulty posture exist without symptoms of pain, and why seemingly mild postural defects give rise to symptoms of mechanical and muscular strain. The answer to both depends on the constancy of the fault. A posture may appear to be very faulty, yet the individual may be flexible and the position of the body may change readily. Alternatively, a posture may appear to be good, but stiffness or muscle tightness may so limit mobility that the position of the body cannot change readily. The lack of mobility, which is not apparent as an alignment fault but which is detected in tests for flexibility and muscle length, may be the more significant factor. Basic to an understanding of pain in relation to faulty posture is the concept that the cumulative effects of constant or repeated small stresses over a long period

of time can give rise to the same kind of difficulties that occur with a sudden, severe stress.

Important differences exist between treatment of an acutely painful condition and that of a chronic one. A given procedure may be recognized and accepted as therapeutic if it is applied at the proper time. Applied at

the wrong time, this same procedure may be ineffective or even harmful. Just like an injured neck, shoulder, or ankle, an injured back may need support. Nature's way of providing protection is by "protective muscle spasm," or "muscle guarding," in which the back muscles hold the back rigid to prevent painful movements. Muscles can become secondarily involved, however, when they are overburdened by the work of protecting the back. Use of an appropriate support to immobilize the back temporarily relieves the muscles of this function and permits healing of the underlying injury. When a support is applied, protective muscle spasm tends to subside rapidly, and pain diminishes.

PRINCIPLES OF ALIGNMENT, JOINTS AND MUSCLES

Evaluating and treating postural problems requires an understanding of the basic principles relating to alignment, joints and muscles:

•  Faulty alignment results in undue stress and strain on bones, joints, ligaments and muscles.
•  Joint positions indicate which muscles appear to be elongated and which appear to be shortened.
•  A relationship exists between alignment and muscle test findings if posture is habitual.
•  Muscle shortness holds the origin and insertion of the muscle closer together.
•  Adaptive shortening can develop in muscles that remain in a shortened condition.
•  Muscle weakness allows separation of the origin and insertion of the muscle.
•  Stretch weakness can occur in one-joint muscles that remain in an elongated condition.

Now, let's look at muscles located in the face. Facial muscles are called the muscles of expression. The facial nerve, through its many branches, innervates most of the facial muscles. Numerous muscles may act together to create movement (e.g., as in a grimace), or movement may occur in a single area (e.g., as in raising an eyebrow). Loss of function of the facial muscles interferes with the ability to communicate feelings through facial expressions and with the ability to speak clearly. A smile, a frown, a look of surprise expressions such as these are created by the actions of muscles that insert directly into the skin. Because of the unique insertions of facial muscles, tests of these muscles differ from other manual muscle tests that require test position and fixation for the subject and pressure or resistance by the examiner. Instead, the subject is asked to imitate facial expressions while looking at photographs of a person performing the test movements or while watching the examiner perform them.

Let's talk abit about TMJ. Movements of the temporomandibular joint (TMJ) include depression of the mandible (e.g opening the mouth), protrusion of the mandible (e.g movement in a forward direction) retrusion of the mandible (e.g movement in a posterior direction) and lateral motion of the mandible (e.g side-to-side movements). Retrusion is very limited compared to protrusion. There are two primary movements of the TMJ, which includes rotation about a mediolateral axis and translation along the anteroposterior and superoinferior axes.

1. Rotation occurs first, and then translation, as the mandibular condyle moves anteriorly and inferiorly on

the temporal bone. Closing of the mouth is initiated with posterior translation of the mandible to the maximal opening. The combined translatory and rotatory movements that occur during opening of the mouth are reversed for closing to the resting position.

2. In normal jaw opening and closing, the movements of each TMJ are synchronous so that the jaw does not deviate toward either side. Asymmetrical lateral shift involves sliding the mandible to one side.

3. Disorders of the TMJ can lead to headache, facial pain and limitations of jaw opening. The muscles 

usually involved in such disorders are the pterygoids, masseters and temporalis.

4. Conservative physical therapy treatment may be sufficient to relieve pain. Various dental devices may be used to help realign or exercise these muscles.

Cranial nerves and deep facial muscles

Cranial nerves & deep superficial facial and neck muscles