Incorrect posture and pain

The human body contains over 600 skeletal muscles, with important functions such as generating movement and keeping our posture correct.

All muscles attach to bones through tendons. As muscles contract, the bones are moved, generating our motion capacity. They are also crucial for posture, as we would not be able to stand erect, bend or even stay motionless without the help of specific postural muscles. Structural alignment and stabilization of the pelvis, shoulder girdle and the spine is dependent on soft tissues like muscle, tendons and ligaments. Muscles allow the spine to flex, extend, rotate or bend.

While some muscle groups flex or shorten, the opposing muscles extend or stretch in order to allow full range of motion. This process is called reciprocal inhibition. Muscle imbalance can develop when some muscles are dominant or overused  and others are weaker or underused.

Chronic overuse will cause shortening of the muscle and increased fascial build up around the area of high demand, mainly around the joints. Muscles will have less elasticity, which  increases the chance for injury. When muscle pain does not go away, and may even continue to increase, a chronic pain cycle can occur. We become more prone to injury as our flexibility diminishes. Our muscles experience weakness and fatigue, while pulling excessively on bones and joints, and compressing nerves.

The shortened muscles will continue to draw energy from the body such as ATP, oxygen and protein. An increased level of fatigue is felt throughout the body as energy is depleted. Metabolic wastes are produced and can become trapped in the tissue. As proper tissue metabolism decreases, vital nutrients and oxygen encounter problems being delivered to the tissue cells. This can cause more frequent and longer lasting illness.

Tissues may become ischemic due to the increase in toxin levels and the decrease of oxygen and nutrients. Trigger points can develop and cause pain that can be felt in other parts of the body. The shortened muscle fibers will also pull on their attachments too strongly; this can cause decreased range of motion and eventually joint pain. As muscle contractions add more pressure to certain areas, nerves could become irritated, compressed or entrapped. Irritated nerves can produce increased muscle contractions, transforming the process into a vicious cycle.

At the same time, underused muscles- many times they are the opposed muscle (antagonist) to overused or dominant ones- become weaker and lengthened. This does not allow them to function at optimal capacity, exacerbating the imbalance. These imbalances will create faulty movement patterns and  pull joints out of alignment.  In time this can result in inflammation, cartilage wear, nerve compression and chronic joint or nerve pain. If not corrected, the damage will only grow worse.

These faulty alignments are called postural distortions and are extremely common in today’s world where most people have jobs that require overuse of certain muscles, while other muscles are inactive.

Take for instance a very common case: a person who has a desk job, sits on the computer and types for extended amounts of time. Some forearm muscles get overused while the opposing ones don’t get much activity. This can lead to tight muscles that press on nerves, which could generate carpal tunnel syndrome.

Because the arms are kept in front of the body for long periods of time, the pectorals are kept in a shortened or tight position, the upper traps and lats get tight, the serratus get weak, while the rotator cuff muscles, median traps and rhomboids are kept in a stretched- lengthened position. In time this will generate imbalance across the shoulder girdle, the shoulder joint will get pulled out of alignment and the risk of shoulder and rotator cuff injury is increased. Some nerves may become compressed, generating pain. The head is held forward, leading to overused neck muscles and possible compression and obstruction of the vessels that bring blood to the brain, thus generating neck pain and headaches.

By sitting in a chair for extended periods of time, we position the hip flexors and quadriceps in a shortened position, while the glutes and hamstrings are lengthened. This can pull the pelvis and knees out of alignment, put more pressure on knee tendons and ligaments and create lower back and knee pain. The abdominal muscles are not contracted and get weaker over time, resulting in a lack of capacity to create balance along with the lower back muscles and keep the spine in alignment. Again, this can result in spine damage and chronic pain.

The body works like a unit where everything is connected. A problem starting at the feet can transfer to the knees and lower back, creating problems that sometimes seem like they make no sense.

A person could present one or even more postural distortions. Common postural distortions are:

-Lower-Extremity Postural Distortion – someone presenting this distortion will often have flat (pronated) or pointed outward feet and internal rotation of the knees (knock-kneed). Some of the common injuries resulting from these imbalances are plantar fascitis, shin splints and patellar tendonitis (jumper’s knee).
Typically, the tight muscles associated with this distortion are: soleus (one of the calf muscles), peroneals, adductors, tensor fascia lata (IT band), iliopsoas and rectus femoris (one of the quadriceps muscles). The weak muscles typically are tibialus posterior and glutes/hip muscles.

-Lumbo-Pelvic-Hip Postural Distortions
Anterior pelvic tilt- this distortion is  characterized by increased lumbar extension (increased lower back curvature) and decreased hip extension. Coincides often with forward head posture. Common injuries caused by this distortion are low back, hip pain and hamstring or groin strains.
Tight muscles generally associated are: erector spinae, iliopsoas, latissimus dorsi, quadratus lumborum (QL) adductors , rectus femoris (quad). Weak and/or elongated muscles: glutes, rectus abdominis, hamstrings.

Posterior pelvic tilt- characterized by increased lumbar flexion (flat back) and ‘tucked in’ glutes (butt). Often caused by poor mechanics when standing or slouching when seated. Common injuries: pain in lower back due to increased spinal compression, abdominal area and hamstrings due to tightness.

Tight muscles: glutes, rectus abdominis (abdominal muscles) and hamstrings. Often the weak muscles are the hip flexors and erector spinae.

Lateral pelvic tilt- this distortion makes one hip look higher than the other. Can be caused by standing unevenly or often carrying objects on one side only.  Pain is commonly felt on the side of the pelvis that is higher than the other. The QL ( quadratus lumborum) is the primary lateral flexor of the lower back. The QL on the higher side will be tight, while the QL on the opposing side will be weak.

-Upper-Extremity Postural Distortion – Computer use is a leading cause in this case. This distortion is characterized by rounded shoulders or a forward head posture and protracted shoulder blades (wing blades). Common problems include headaches, pain in the neck and upper back regions, tingling in the arms in hands due to nerve compression in the upper back or neck regions,  biceps tendonitis, shoulder and rotator cuff injuries.

Tight muscles associated with this distortion generally are: upper trapezius, lattisimus dorsi (lats), pectorals, teres major, anterior deltoid,  erector spinae closer to the neck area, scalenes, levator scapulae and SCL (neck muscles) while the weak ones are: rhomboids, lower trapezius, infraspinatus, serratus, posterior deltoid, teres minor, deep cervical flexors.

So how can these imbalances be corrected?

The answer is twofold:

1.  Relax, lengthen, stretch the tight muscles: Massage therapy in conjunction with a stretching program can be wonderful tools in addressing the first part of the equation- excellent results can be achieved in relaxing muscles and releasing fascias, moving away toxins and decompressing entrapped nerves. Foam rollers are another useful tool, especially for harder to stretch areas like the IT band or piriformis.

2.  Strengthen, tighten the weak muscles: this can be achieved through a balanced exercise program. Identify the weak muscles then target them with the appropriate exercises.

Whether you choose to lift weights, do yoga (which can help strengthen some muscles and stretch others at the same time) or perform other physical activities, a well designed exercise regimen can be crucial in strengthening the weak muscles to optimal levels.

Often times, restoring the balance makes the pain disappear. If the joints or nerves suffer too much damage , restoring balance might not make the pain disappear but it will protect from further damage.

It is important that new kinetic patterns are developed so that the old patterns don’t take over again and the imbalance resumes. This is a long term process but the benefits are great, as most people would enjoy living with less physical pain.

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