Postural  exercises&

Upper  and  Lower  Cross  Syndromes  and  exercises  to  help  

by  Janda

Kyphosis  (with  forward  head  and  rounded  shoulders):Alignment May  be  tight May  be  weak ExercisesMid  back  flexion Upper  abdominals Thoracic  extensors  

Mid  and  lower  trapeziusActive  &  passive  thoracic  extension  

Protracted  scapulae Serratus  anterior  Shoulder  adductors  Shoulder  internal  rotators

Mid  &  lower  trapezius  Rhomboids  

Serratus    Pectoralis  minor  

Narrowed  intercostal  spaces

Intercostals Deep  breathing  Multifidus  Quadratus  lumborum

Titled  scapulae Pectoralis  minor Lower  trapezius Pectoralis  major  Latissimus  dorsi

Elevated  scapulae Upper  trapezius    Levator  scapulae

Lower  trapezius Middle  &  lower  trapezius  

Extreme  neck  extension  (Hyperextension)

Long  Cervical  Extensors Short  neck  flexors Strengthen  neck  flexors

Lordosis:Alignment May  be  tight May  be  weak Exercises

Anterior  tilt Hip  flexors Abdominals Stretch  hip  flexors  Strengthen  obliques  for  stabilization  Avoid  full  sit  ups

Hip  flexion Hip  extensors Strengthen  gluteals

Extreme    L    extension

Low  back  extensors

Stretch  low  back  extensors

Flat  Back:

Alignment May  be  tight

May  be  weak

Exercises

Posterior  Pelvic  tilt

Hamstrings Stretch  hamstrings

Low  back  flexion   Back  extensors   Stretch  back  extensors

Hip  extension Hip  flexors   Strengthen  hip  flexors  

Sway  Back:Alignment May  be  tight May  be  weak ExercisesPosterior  pelvic  tilt Hamstrings Hip  flexors Stretch  hamstrings  

Strengthen  hip  flexors

Long  kyphosis Upper  abdominals External  obliques  Upper  back  extensors

Strengthen  upper  back  extensors  Stretch  and  strengthen  abdominals

Narrowed  intercostal  spaces

Intercostals Deep  breathing

Hip  extension Strengthen  hip  flexors

Extreme  neck  extension  (Hyperextension)

Upper  trapezius  Levator  scapulae  High  cervical  extensors

Neck  flexors Stretch  upper  traps  &  levator,  strengthen  mid  &  lower  traps,  strengthen  neck  flexors

Extreme  knee  extension  (Hyperextension)

Hamstrings  Calf

Strengthen  hamstrings  and  calf

“when  muscle  imbalances  occur  some  muscles  become  inhibited  and  weak,  while  others  become  tight.  Such  imbalances  lead  to  tissue  changes  that  may  result  in  inappropriate  patterns  of  movement”

Vladimir  Janda,  MD,  DSc

Janda’s  syndromes  are  based  on:

Different  types  of  muscles  responding  to  faulty  loading  in  different  ways.  

Different  types  of  muscles  have  predominance  of  slow  and  fast  twitch  fibres.  

Slow  twitch  -­‐  postural  -­‐  tend  to  lengthen  and  weaken  under  faulty  loading  

Fast  twitch  -­‐  tend  to  shorten  and  tighten  under  faulty  loading.  

Sub-­‐types  of  muscles  fibres  are  still  being  discovered.  

Faulty  loading  -­‐  can  be  through  activity  which  predominantly  targets  certain  muscle  groups  or  through  deconditioning  

A  good  reference  for  an  overview  of  postural  analysis  is  Chaitow  and  Delaney.  “Clinical  Application  of  Neuromuscular  Techniques  (Churchill  Livinsgstone)  2000”

Upper  Cross  Syndrome

Upper Body Overview: WEAK

TIGHT RESULTING IN COMMON INJURIES

Longus Capitis Pectorals Forward head Headaches & Coli Internal Rotators posture Rotator cuff Hyoid muscle Upper Trapezius Depressed sternum impingement Serratus Anterior Levator Scapulae Anterior migration of Rhomboids Sternocleidomastoid shoulder girdle Thoracic outlet Middle & Lower Anterior Scalenes Increased thoracic syndrome Trapezius Suboccipitals kyphosis Posterior Rotator Teres Major Internal rotation of Cuff Anterior Deltoid humerous Latissimus Dorsi

Lower  Cross  Syndrome

Lower Body Overview WEAK TIGHT RESULTING IN COMMON

INJURIES Rectus Rectus Femoris Anterior tilt/ Low back pain Abdominus Iliopsoas rotation of pelvis Knee pain Transverse & Erector Spinae Increased lumbar Hamstring strains Obliques Quadratus lordosis Gluteus maximus Lumborum Hips in flexion Guteus Medius Tensor Fascia Latae Hamstrings Adductors Knees hyper-extended

Postural  examination  tends    to  reveal  a  marked  anterior  head  carriage  upper  cervical  hyperextension  elevated  and  protracted  shoulders  (rounded)    a  hyper-­‐kyphotic  thoracic  spine    increase  of  the  lumbar  lordosis

Symptoms

• complained  of  chronic  neck  pain  and  stiffness    • chronic  upper  thoracic  pain  patterns  • symptoms  as  being  constant  • aggravated  by  reading,  poor  posture  and  by  prolonged  sitting  

• Associated  with  micro-­‐traumatic  shoulder  injuries  

Examination

• Cervical  ranges  of  motion  restrictions  with  the  report  of  pulling  muscular  pain  elicited  at  the  end  ranges  

• Positive  cervical  Kemp’s  test  bilaterally  • Thoracic  ranges  of  motion  restrictions    • Tender  myofascial  trigger  points  were  detected  in  the  suboccipital,  SCM,  levator  scapulae,  and  upper  trapezii  muscle  groups  bilaterally

Workshop  exercises• 1.  Dysphasic  recruitment  -­‐  Hamstring  substitution  – Lie  prone  – Someone  presses  flat  of  fingers  on  hamstrings  and  glut.  max.  – Perform  small  hip  extension  – Which  muscle  fires  first  – Clue:   hams.  are  mobilisers,  glut.  max.  is  a  stabiliser.    Which  should  fire  first?  

– Think  of  clinical  implications  – Problems  with  this  test?    Hams  are  eccentric  contractors  that  stabilise  a  flexed  and  wtb  knee  followed  by  concentric  contractors  for  mobilisation  at  midrange

Workshop  exercises

• 2.  Muscle  tension  control  -­‐  Gluteus  maximus  tension  test  (just  because  it’s  convenient  –  use  another  muscle  if  you  wish!)  – Stand  and  grab  buttocks  (YOUR  OWN)  – Clench  to  25%,  50%,  75%,  100%,  75%,  50%  25%  and  0%  – Who  felt  the  last  25%  was  actually  more  or  less  than  25%  on  the  way  down?  

– What  does  this  tell  you  about  your  ability  to  sense  your  muscle  force/tension/control?

Workshop  exercises

• 3.   Body  awareness  –Multisegmental  multifidus  (local  stabiliser)  – Place  fingers  at  about  L4,5,  just  lateral  to  spinous  process  

– Tense  muscle  ???  – Now  keep  fingers  there  and  raise  other  arm  in  front  of  you  

– Now  bring  it  down  and  note  when  it  switches  on  and  off  

– Now  stand  in  sway  posture  and  repeat

Workshop  exercises

• 5.    Rigidity  dysfunction  -­‐  ability  to  separate  segments  when  required  – Stand  up,  hands  on  hips  – Bend  knees  and  move  knees  from  side  to  side  

• Who  can  dissociate  rotation?    If  not  what  clinical  consequences  might  you  see?

Workshop  exercises

• 6.  Waiter’s  bow  -­‐  Postural  awareness  – Stand  up  and  place  hands  on  hips  – Bow  forward  from  hips  and  stop  when  you  think  you  are  flexing  at  your  spine  

– Repeat  with  tape  on  skin  • Who    was  right?    What  might  this  mean  to  your  patient  feedback  when  they  report  symptoms/  swear  they  have  been  doing  your  exercises?  

• 50  deg  of  hip  flexion  should  occur  prior  to  spinal  flexion

Workshop  exercises

• 7.    Finding  motion  in  the  right  place    – Stand  up  – Someone  stand  behind  you  with  their  finger  pointing  to  touch  your  lumbar  spine  

– You  aim  to  extend  your  upper  spine  without  moving  away  from  the  finger  

– If  you  can’t,  stand  with  feet  under  couch,  leaning  against  it  so  you  feel  just  balanced  

– Repeat.  – Observers  note  where  change  in  motion  occurs  – Repeat  away  from  couch…can  you  do  it  yet??