Incorrect posture and spinal deformities among pupils in the USA

Lying on the back with the lower legs resting on a chair with the arms folded across the chest. Lifting the hips a few inches off the floor first letting the weight rest on the shoulder blades, returning the hips to the floor, taking deep breaths. Then by slowly exhaling the air the spinal curvatures will be strengthend. Another exercise in this same position can be achieved by extending the legs on the floor, taking a deep breath, and then raising the chest high and contracting the abdomen.

Bicycle exercises can be done with the legs in the air, using first one leg and then the other to pedal in large circles. The legs must be kept in the same plane and the knees must not touch as they pass from one to another. The legs should not swing sideways in their movement.

To exercise the spine and to remove curves, one can lie on the back and bend the knees over the body, bringing the forearms up around the knees and claspign the tips of the hands together to hold the legs together then rocking the body from side to side like a cradle.

Excellent posture can be obtained by regular exercise as stated above and by just being aware of the need for practicing good posture habits. The quality of a person's life especially in later years can be determined by a lifetime of good posture.

 

 

 

 

 

 

 

Posture is Important

 
Your Mother Was Right - Posture is Important!

"Sit up straight!" "Don't slouch!" I'm sure we've all heard those admonishing words more than once from our mother when we were growing up. And most of us begrudgingly complied with her command having no concept of the anatomical and biomechanical rationale behind her persistent prodding. In fact she probably wasn't aware of all the implications of poor posture herself! But somehow, some way your mother always seemed to know best.

  What is good posture anyway and why is it so important? Basically posture refers to the body's alignment and positioning with respect to the ever-present force of gravity. Whether we are standing, sitting or lying down gravity exerts a force on our joints, ligaments and muscles. Good posture entails distributing the force of gravity through our body so no one structure is overstressed. 
An architect has to take these same laws of gravity and weight distribution into account when he or she designs a building. And like a building with a poor foundation a body with poor posture is less resistant to the strains and stresses we experience over the months, years and decades of life. 
 When doctors or therapists look at someone's posture they generally first look at the alignment of the weight bearing joints in standing. Ideally from a back view the spine should have no lateral curvature and the legs should be symmetrical without undue angulation at the knees or ankles. From a side view the spine should form a smooth S-shaped curve, bisected by an imaginary plumb line dropped from the apex of the head through the center of gravity of the body. This same plumb line should pass through the tip of the shoulder, the center of the hip joint and ankle joint and slightly behind the knee joint. With this ideal alignment the body weight is balanced over the spine and lower extremity joints requiring minimum muscular effort. This alignment also evenly distributes pressure on the intervertebral discs and avoids excessive stress on the ligaments. 
 The sitting position is where most of us get into trouble with poor postural habits. This is especially true when driving or using a computer. As we focus on the activity in front of us we tend to protrude the head and neck forward. Because the body follows the head, the thoracic and lumbar spine tends to round forward as well. When this occurs, the weight of the head and upper body is no longer balanced over the spinal column but instead must be supported by increased muscular energy and placing spinal ligaments on stretch. Over time this leads to fatigue and eventually even pain in the neck and upper back. Shoulders rounded forward which occurs for example when your car seat is too far away from the steering wheel further contributes to this pattern of imbalance. Ideally then, the S-shaped curvature of the spine that is characteristic of good standing posture should be maintained in sitting as well. This is best accomplished by sitting all the way back in a straight-backed chair and placing a folded towel or small pillow in the arch of the low back. Fortunately, many new office chairs and car seats come with built-in lumbar supports and other adjustable features. 
 Sitting and standing with proper postural alignment will allow one to work more efficiently with less fatigue and strain on your body's ligaments and muscles. Being aware of good posture is the first step to breaking old poor postural habits and reducing stress and strain on your spine. By putting this knowledge into practice one can prevent the structural anatomical changes that can develop if poor posture is left uncorrected for many years. So to repeat an old adage you may also have heard from your mother: "An ounce of prevention is worth a pound of cure." Thanks Mom!

 

 

 

 

 

Incorrect posture

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, latissimusdorsi, quadratuslumborum (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 ( quadratuslumborum) 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, lattisimusdorsi (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. 
 
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.

 

Scoliosis

Incorrect posture, if people don’t pay attention on problems connected with incorrect posture can become more serious, if person couldn’t stop the developing of incorrect posture  
What is Scoliosis?

Everyone’s spine has natural curves. These curves round our shoulders and make our lower back curve slightly inward. But some people have spines that also curve from side to side, and rotate. Unlike poor posture, these curves can’t be corrected simply by learning to stand up straight.

This condition of side-to-side spinal curves is called “scoliosis”. On an x-ray, the spine of a person with scoliosis looks more like an “S” or a “C” than a straight line. These curves can make the person’s shoulders or waist appear uneven. Some of these bones may also be rotated slightly, making one shoulder blade more prominent than the other.

Scoliosis is a descriptive term and not a diagnosis. In more than 80% of cases, a specific cause is not known. Such cases are termed “idiopathic”, meaning “of undetermined cause”. This is particularly common in adolescent girls. Idiopathic scoliosis is typically called “infantile” in children 0-3 years old, “juvenile”  in children 4-10 years old, “adolescent” in adolescents 11-18 years old, and “adult” in patients over 18 years old. Conditions known to cause spinal deformity are congenital spinal column abnormalities (present at birth – called congenital scoliosis), neurologic disorders (neuromuscular scoliosis), genetic conditions, and many other causes.

Do I have scoliosis?

Determining whether or not you have scoliosis is best done by a physician who performs a physical examination of your back. The examination is done with you standing in a relaxed position with your arms at your sides. The physician will view you from behind looking for curvature of the spine, shoulder blade asymmetry, waistline asymmetry and any trunk shift. You will then bend forward at the waist and the physician will view your back once again to look for the rotational aspect of the scoliosis in the upper part of the back (rib prominence) or in the lower part of your back (flank or waist prominence). Following this simple examination, the physician will usually initial radiographs of the spine viewed from the back and the side to see the entire spine from the neck to the pelvis. If scoliosis is present, the physician will measure the radiographs and provide you with a numerical value, in degrees, to help describe the scoliosis.

What Are My Treatment Options?

1. Observation 
   This is for curves that have a small degree measurement when you are growing (adolescent scoliosis), or for moderate size curves (< 40-45 degrees) when you are done growing. For adults, observation and physical therapy are for those patients who have mild symptoms and have curves which are not large.
2. Bracing 
   This is for curves between 25 and 45 degrees in growing children to prevent further progression of the curve while growth of the spine remains. The goal of bracing is to prevent further progression since the brace cannot correct curves.
3. Surgical Treatment 
   This reserved for curves which are generally greater than 50 degrees for adolescent patients and adults. Surgery can be performed for smaller curves if the appearance of the curvature is bothersome to the patient or if symptoms are associated with the scoliosis in the adult patient. The goals of surgical treatment are to obtain curve correction and to prevent curve progression. This is generally achieved by placing metal implants onto the spine which are then attached to rods which correct the spine curvature and hold it in the corrected position until fusion, or knitting of the spine elements together.

 

Idiopathic scoliosis

The most widespread type of scoliosis is idiopathic scoliosis. Reasons for developing idiopathic scoliosis haven’t been investigated yet. According to researchers, the main reason for the development of idiopathic scoliosis is bad posture and body position. Idiopathic scoliosis is divided into four age range. We consider the second and the third: Juvenile and Adolescent.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Juvenile

Juvenile scoliosis is classically defined as scoliosis that is first diagnosed in a child between 4 and 10 years old. This category comprises about 10-15% of all idiopathic scoliosis. Some juvenile curves will resolve without treatment, especially at the earlier end of the age spectrum. Juveniles behave similar to infants in the younger ages, making them more common in boys than girls, and left-sided curves are common. The older children behave more like adolescent idiopathic scoliosis- most common in girls with right-sided thoracic curves.

Evaluation 
Your pediatric spine surgeon may suggest a magnetic resonance imaging (MRI) study to determine if there are any abnormalities of the spinal cord or spinal column. The study is more difficult in small children because sedation or even general anesthesia may be necessary to relax the child enough to obtain good images. As a rule of thumb, approximately 20% of children younger than 10 who have a curve greater than 20^o

Observation 
Observation is usually the first method of treatment for a young child with a spinal deformity. The physician will first need to determine if the curvature is progressing – that is, getting worse. In some children, the curve is stable and unchanging. However, other children have curves that progress quickly. Juvenile curves that reach 30^o tend to continue to worsen without treatment. Just because the scoliosis surgeon is “observing” you child does not mean that he/she is not treating them. During this period of observation, changes in the curve are monitored, and special tests may be ordered. These tests may include an MRI or a CT study. Your child may be referred to other specialists, such as a geneticist, cardiologist, or pulmonologist to make sure there are no other problems in other parts of the body.

The most basic way to monitor the curves is through standing X-rays. X-rays today have a small fraction of the radiation they did several years ago. Your spine surgeon will probably want to see your child every four to six months and have new front- and side view X-rays made. They will then measure the curves and compare them with prior films. It is a good idea to bring old X-rays (or discs with the images) to each evaluation. To make things simpler, it is ideal to have all the X-rays done at your scoliosis surgeon’s office so that he/she can obtain the proper studies, and compare them properly. Doctors may obtain special bending radiographs to assess the flexibility of the curve(s).

Special studies as MRI or CT are sometimes necessary to look for abnormalities in the bones or pressure on the nerves. An MRI study is often done to evaluate the spinal cord and find any abnormalities that may be causing the scoliosis or kyphosis (round back. In children, sedation or general anesthesia is usually necessary to relax the child. A CT scan may be necessary to rule out bony anomalies.

Surgical Management

When scoliosis occurs at a young age, there are several important implications for management and treatment. Young children need many years to maximize their trunk height and lung size. A fusion in a young child would prevent further growth of the instrumented segment. Furthermore, depending on the type of instrumentation used, the anterior spine may continue to grow leading to “crankshaft phenomenon”. For this reason, other treatments have been developed for the management of early onset scoliosis. These techniques take into account the growth of the spine as well as the growth of the rib cage and lungs. If implants are necessary, multiple expansions or lengthenings may be necessary (usually twice per year) to keep up with growth in the young spine.

Growing Roods 
Most operations address spinal deformity in the young child work by stopping growth. This may have unfavorable effects on the growth of the thorax, lungs, and the size of the trunk. The theory of the growing rod operation is to allow for continued, controlled growth of the spine. This is done through the back of the spine. In general, one or two rods span the curve under the skin to avoid damaging the growth tissues of the spine. The rods attach to the spine at the top and bottom of the curve with hooks or screws. The curve can usually be corrected 50% at the time of the first operation. The child then returns every six months to have the spine “lengthened” approximately one centimeter to keep up with the child’s growth. Often, the rods are kept longer than usual so lengthenings are less involved than the initial procedure and only involve opening one incision. The lengthening procedures can usually be performed on an outpatient basis. Some children will have to wear a brace to protect the instrumentation. When the child becomes older and the spine has grown, the doctor will remove the instrumentation and perform a formal spinal fusion operation.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adolescent

Scoliosis in patients between 10 and 18 years of age is termed adolescent scoliosis. By far the most common type of scoliosis is one in which the cause is not known. It is called “idiopathic”  or adolescent idiopathic scoliosis (AIS). Although significant ongoing research continues in this area, including the genetic basis for AIS, there are no identifiable causes for this condition today. Despite this, we currently have accurate methods to determine the risk for curve progression of scoliosis and good methods of treatment.