On the problems of posture. Why posture correctors rarely help
Reading Geektimes, I regularly find something new and interesting for myself, paying special attention to everything related to medicine and health. It so happened that my main interest in high-tech limb prostheses is that I am an orthopedic traumatologist by training. According to my second education, I am a manual therapist. And I am a bore and I like to understand what I do. It is because of my profile education, tediousness, and also because of the increasing interest of the audience to geektimes posture correctors (I often meet articles on this subject ), I realized that I have something to tell, to share my vision of posture correction, as well as to tell why posture correctors in the form in which they exist now will help only in a very limited number of cases, and in certain situations they can be harmful.
The human spine consists of the departments: cervical, thoracic, lumbar, sacral and coccyx.
Also in the spine is what is called physiological curves. The sacral bend (kyphosis) is curved back, the lumbar bend (lordosis) is curved forward, the thoracic bend (kyphosis) is curved back, the cervical bend (again, lordosis) is curved forward. At the same time, the side bends of the spine (scoliosis) are normally absent or very insignificant.
If we present the spine as the main mast of our ship, the complex “pelvic bones + sacrum” will serve as the deck of the ship.
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Many factors are responsible for a correct and beautiful posture. The main role in it is played by the so-called. postural nervous system (from the Latin positura - body position in space). It is the postural nervous system that is responsible for the preservation and maintenance of the body in space, both in statics and in dynamics. It should be understood that the postural nervous system is a rather conditional thing. That is, everyone has it, but it is rather difficult to single out its core. It also depends strongly not only on signals from muscles and joints, but also on signals coming from various human organs and senses. In France, such a direction of medicine as “Posturology” is rather actively developing, which identifies the “inputs” of the postural nervous system (hereinafter referred to as PNS) - i.e. all those receptors, information from which gives the human brain an understanding of its being in space. Posturology identifies the following "inputs" of the postural system - skin sensitivity (proprioception), bone and joint feeling (deep proprioception), vision, vestibular apparatus, temporomandibular joint (and occlusal plane of the teeth), foot feeling.
In case of violations on the part of any "entry" of PNS, a person may experience an imbalance in maintaining balance, up to the phenomena of dizziness, a sense of disorientation in space - although these are already quite serious phenomena. Most often, patients will come to the doctor with the main and main complaint of pain and tiredness in the back.
Let's try to figure out why and why these very pains occur.
Take a person whose work is associated with a long sitting posture at the computer. “Doctor, I have a very sore back / neck / thoracic after a working day. Yes, 7-8 hours at the computer per day. No, when I go home standing on the bus, it hurts not so much. ”- I hear this in my second job (manual therapist) in every other patient, if not more often.
A long sitting posture, often also behind an improperly organized workplace (I doubt that all monitors are at eye level, and the armrests of the chair are correctly chosen), leads to a decrease in blood flow and incorrect pelvic muscles. Women often notice that their pelvic wings are at different levels (men look at themselves less and less often mention this). The incorrect work of the muscles leads to different variants of the “skewing” of the pelvis - and if the ship has a curved deck, then the mast will never stand exactly on it. It appears that I, as a manual therapist, like to call “pelvic instability,” and from what I, as an orthopedic traumatologist, disown (in traumatology, pelvic instability is usually called certain types of bone traumatic injury - fractures, ligament ruptures and etc.). In this case, instability is only a consequence of muscle imbalance.
Distortion of the pelvic bones inevitably leads to the formation of scoliosis in the overlying sections of the spine. Changes in the tonus-power balance of the muscles, under the influence of irregular muscular thrust, the vertebrae are fixed in an offset position. The nervous system, being very intelligent, understands that if the muscle starts to work at full strength, the vertebra will move even more, as a result of which the muscle is given the command “to work less”. "Expel" a poorly working muscle from its position as a careless employee, the body cannot - therefore, someone will recycle for it. Most often, the one who performs a similar function (all as in life).
A classic example that can be cited is a slightly forward and downward displacement of the head (most often with increased kyphosis in the thoracic region), as a result of which the vertebrae in the cervical and cervicothoracic transition are fixed in the wrong position, long neck extensors begin to work worse, and their function trying to take on the muscles of the shoulder girdle - most often it is the upper portion of the trapezius muscles. In which there are pains.
Manual therapy (in the classic "narrow-minded" sense) is engaged in “crunching the spine”, hoping that when the doctor removes the pathological fixation of the vertebrae, the person’s muscles will “feel” healthy and able to contract normally, and the person will immediately keep his back straight. This works well when a person is young enough, or when the body’s compensatory abilities are enough to recover. However, when the problem lasts for a long time, the muscles themselves quite unaccustomed to work normally, and without their recovery and subsequent strengthening in the form of exercises, it becomes rather difficult to get rid of the problem.
I considered only the small and brief features of individual cases. You can talk endlessly about the effect of vision on the progression of scoliosis, problems with the muscles of the feet (flat feet) that lead to spinal deformities, etc. ... At the end of the article I will attach a list of books on which I relied (together with clinical experience) . And I deliberately simplified some things, I hope my dear audience will forgive me.
Briefly from the above, we can formulate the following conclusion: a violation of the stereotype of correct posture maintenance is not the only reason for the actual violations of this very posture.
In this, in fact, lies the imperfection and inconsistency of posture correctors. If a person's long neck extensors do not work properly, for example, due to the fixation or displacement of the vertebrae in the thoracic spine, different things can happen from the fact that the person tries to keep his neck straight. First of all, no matter how strange it may be, over and over again teaching you to keep your head level, muscles can “turn on” - if the fixation of the vertebrae is recent, instability in the cervical region did not have time to develop, and the compensatory capabilities of the body allow it. Secondly, nothing can happen. Those. and a person’s own neck will not learn to keep even, and nothing bad will happen (again, if the body’s compensatory abilities allow it). Thirdly, a person may experience a deterioration - either compensatory play for other parts of the spine, or aggravated pain in the shoulder girdle (muscles that "process for loafers" will process even more).
But in a global sense, the chances that a person will be better is not enough. And the same problems with muscular instability of the pelvis in a person do not go absolutely nowhere - the posture corrector simply physically cannot make properly and friendly work the complex “average gluteus muscles - obliques - abdominal muscles - big buttocks” (if we consider muscle stabilization of the pelvic bones).
Muscles can also be damaged in different ways (overload, compensatory shortening, etc.), but this is a topic for a completely separate discussion.
References, which I somehow relied:
- Gage PM., Weber B. - Posturology. Regulation and imbalance of the human body.
- Kashuba V.A. - Posture biomechanics
- Kapanji A.I. - Physiology of the joints (volume "Spine")
- Travell D., Symons D. - Myofascial pain and dysfunction
- Gurfinkel VS - Regulation of human posture
- Lawrence Jones - Strain Counter Counter
The human spine consists of the departments: cervical, thoracic, lumbar, sacral and coccyx.
Also in the spine is what is called physiological curves. The sacral bend (kyphosis) is curved back, the lumbar bend (lordosis) is curved forward, the thoracic bend (kyphosis) is curved back, the cervical bend (again, lordosis) is curved forward. At the same time, the side bends of the spine (scoliosis) are normally absent or very insignificant.
If we present the spine as the main mast of our ship, the complex “pelvic bones + sacrum” will serve as the deck of the ship.
')
Many factors are responsible for a correct and beautiful posture. The main role in it is played by the so-called. postural nervous system (from the Latin positura - body position in space). It is the postural nervous system that is responsible for the preservation and maintenance of the body in space, both in statics and in dynamics. It should be understood that the postural nervous system is a rather conditional thing. That is, everyone has it, but it is rather difficult to single out its core. It also depends strongly not only on signals from muscles and joints, but also on signals coming from various human organs and senses. In France, such a direction of medicine as “Posturology” is rather actively developing, which identifies the “inputs” of the postural nervous system (hereinafter referred to as PNS) - i.e. all those receptors, information from which gives the human brain an understanding of its being in space. Posturology identifies the following "inputs" of the postural system - skin sensitivity (proprioception), bone and joint feeling (deep proprioception), vision, vestibular apparatus, temporomandibular joint (and occlusal plane of the teeth), foot feeling.
In case of violations on the part of any "entry" of PNS, a person may experience an imbalance in maintaining balance, up to the phenomena of dizziness, a sense of disorientation in space - although these are already quite serious phenomena. Most often, patients will come to the doctor with the main and main complaint of pain and tiredness in the back.
Let's try to figure out why and why these very pains occur.
Take a person whose work is associated with a long sitting posture at the computer. “Doctor, I have a very sore back / neck / thoracic after a working day. Yes, 7-8 hours at the computer per day. No, when I go home standing on the bus, it hurts not so much. ”- I hear this in my second job (manual therapist) in every other patient, if not more often.
A long sitting posture, often also behind an improperly organized workplace (I doubt that all monitors are at eye level, and the armrests of the chair are correctly chosen), leads to a decrease in blood flow and incorrect pelvic muscles. Women often notice that their pelvic wings are at different levels (men look at themselves less and less often mention this). The incorrect work of the muscles leads to different variants of the “skewing” of the pelvis - and if the ship has a curved deck, then the mast will never stand exactly on it. It appears that I, as a manual therapist, like to call “pelvic instability,” and from what I, as an orthopedic traumatologist, disown (in traumatology, pelvic instability is usually called certain types of bone traumatic injury - fractures, ligament ruptures and etc.). In this case, instability is only a consequence of muscle imbalance.
Distortion of the pelvic bones inevitably leads to the formation of scoliosis in the overlying sections of the spine. Changes in the tonus-power balance of the muscles, under the influence of irregular muscular thrust, the vertebrae are fixed in an offset position. The nervous system, being very intelligent, understands that if the muscle starts to work at full strength, the vertebra will move even more, as a result of which the muscle is given the command “to work less”. "Expel" a poorly working muscle from its position as a careless employee, the body cannot - therefore, someone will recycle for it. Most often, the one who performs a similar function (all as in life).
A classic example that can be cited is a slightly forward and downward displacement of the head (most often with increased kyphosis in the thoracic region), as a result of which the vertebrae in the cervical and cervicothoracic transition are fixed in the wrong position, long neck extensors begin to work worse, and their function trying to take on the muscles of the shoulder girdle - most often it is the upper portion of the trapezius muscles. In which there are pains.
Manual therapy (in the classic "narrow-minded" sense) is engaged in “crunching the spine”, hoping that when the doctor removes the pathological fixation of the vertebrae, the person’s muscles will “feel” healthy and able to contract normally, and the person will immediately keep his back straight. This works well when a person is young enough, or when the body’s compensatory abilities are enough to recover. However, when the problem lasts for a long time, the muscles themselves quite unaccustomed to work normally, and without their recovery and subsequent strengthening in the form of exercises, it becomes rather difficult to get rid of the problem.
I considered only the small and brief features of individual cases. You can talk endlessly about the effect of vision on the progression of scoliosis, problems with the muscles of the feet (flat feet) that lead to spinal deformities, etc. ... At the end of the article I will attach a list of books on which I relied (together with clinical experience) . And I deliberately simplified some things, I hope my dear audience will forgive me.
Briefly from the above, we can formulate the following conclusion: a violation of the stereotype of correct posture maintenance is not the only reason for the actual violations of this very posture.
In this, in fact, lies the imperfection and inconsistency of posture correctors. If a person's long neck extensors do not work properly, for example, due to the fixation or displacement of the vertebrae in the thoracic spine, different things can happen from the fact that the person tries to keep his neck straight. First of all, no matter how strange it may be, over and over again teaching you to keep your head level, muscles can “turn on” - if the fixation of the vertebrae is recent, instability in the cervical region did not have time to develop, and the compensatory capabilities of the body allow it. Secondly, nothing can happen. Those. and a person’s own neck will not learn to keep even, and nothing bad will happen (again, if the body’s compensatory abilities allow it). Thirdly, a person may experience a deterioration - either compensatory play for other parts of the spine, or aggravated pain in the shoulder girdle (muscles that "process for loafers" will process even more).
But in a global sense, the chances that a person will be better is not enough. And the same problems with muscular instability of the pelvis in a person do not go absolutely nowhere - the posture corrector simply physically cannot make properly and friendly work the complex “average gluteus muscles - obliques - abdominal muscles - big buttocks” (if we consider muscle stabilization of the pelvic bones).
Muscles can also be damaged in different ways (overload, compensatory shortening, etc.), but this is a topic for a completely separate discussion.
References, which I somehow relied:
- Gage PM., Weber B. - Posturology. Regulation and imbalance of the human body.
- Kashuba V.A. - Posture biomechanics
- Kapanji A.I. - Physiology of the joints (volume "Spine")
- Travell D., Symons D. - Myofascial pain and dysfunction
- Gurfinkel VS - Regulation of human posture
- Lawrence Jones - Strain Counter Counter
Source: https://habr.com/ru/post/367175/
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