Mechanical stress and dysfunction, affecting the musculo-skeletal system can often be traced to habitual mis-use of the body. Other causes, including congenital faults, such as supernumary vertebrae, cervical ribs, congenital short leg etc, or traumatic events such as whiplash injuries, or blows and falls, or the effects of long standing emotional stress (see previous chapter), should also be considered.
The daily habits of posture and use, at work and leisure, are frequently the unobtrusive, non-violent, yet persistent factors which mitigate towards somatic dysfunction and the consequences of general ill-health. Posture represents the sum of the mechanical efficiency of the body. It may be read as a book, to assess the integrity, potential, and to some extent, the history of the individual.
The ideal posture is one in which the different segments of the body, the head, neck chest and abdomen are balanced vertically one upon the other so that the weight is borne mainly by the bony framework with a minimum of effort and strain on muscles and ligaments. For such posture to be maintained, special postural muscles must be in a state of constant activity. These have a special physiological property called ‘postural activity’. Correct posture is one in which the head is centered over the pelvis the face directed forwards, and the shoulder girdle approximately on the same plane as the pelvis.
The position of the bony framework is determined by the soft tissues which invest, support, bind and move it. Faulty tensions in these soft tissues will lead to abnormalities in the skeletal structures, and therefore to function itself. This may also result in changes in the organs and functions (circulation) which are supported by soft tissues. Not only are the soft tissues subject to gravitational stress, but also to a battery of postural and occupational stresses overlaid with the normal contraction that come with age.
Goldthwait  points to the importance of posture in the maintenance of health:
It has been shown that the main factors which determine the maintenance of the abdominal viscera in position are the diaphragm and abdominal muscles, both of which are relaxed and cease to support in faulty posture. The disturbances in circulation from a low diaphragm and ptosis (sagging organs) may give rise to chronic passive congestion on one or all of the organs of the abdomen and pelvis, since the local as well as general venous drainage may be impeded by the failure of the diaphragmatic pump to do its full work in the drooped body. Furthermore, the drag of these congested organs on their nerve supply, as well as the pressure on the sympathetic ganglia and plexuses (nerve centres), probably causes many irregularities in their function, varying from partial paralysis to overstimulation. Faulty body mechanics in early life, then, become a vital factor in the production of the vicious cycle of chronic diseases and present the chief point of attack in its prevention …. In this upright position, as one becomes older, the tendency is for the abdomen to relax and sag more and more allowing a ptosic condition of the abdominal and pelvic organs unless the supporting lower abdominal muscles are taught to contract properly. As the abdomen relaxes, there is a great tendency to a drooped chest, with a narrowed rib angle, forward shoulders, prominent shoulder blades, a forward position of the head, and probably prorated feet. When the human machine is out of balance physiological function cannot be perfect; muscles and ligaments are in an abnormal state of tension and strain. A well poised body means a machine working perfectly, with the least amount of muscular effort, and therefore better health and strength in daily life.
Thus an orthodox medical scientist reiterated the osteopathic message. Soft tissues which have been subjected to stresses, of a postural nature, may become chronically stretched or shortened. Normalization, where possible, must involve treatment (soft tissues and joint manipulation), exercise, and above all re-education, to prevent recurrence. A combination of osteopathy and a system of postural re-education, such as Alexander technique, would seem to be the ideal.
Modern man constantly abuses his body. Consider the compound effects of repetitive industrial or clerical occupations; of driving; of accommodating the body to ill-designed, mass produced furniture or equipment; of physiologically damaging footwear, such as shoes with high heels; and of restrictive undergarments; of habits such as crosslegged sitting, or standing with the weight on only one leg, etc. Just for a moment consider what the body has to cope with in a ‘normal day’. Having slept on a too soft bed, the body is obliged to bend or stretch itself through the rigours of washing, shaving and dressing. Wash basins being of uniform size and bodies growing to random lengths can cause stress, even in the simple act of washing the face. The body next finds itself seated in a car, a train or a bus, and then subjected to hours of repetitive duties, either at a desk, at a workbench or in the home, etc. All this is being done on high heels or at a too low or too high desk, or in a seat too deep or too shallow, and in an habitually one-sided manner, with a slouch or stoop. It is not surprising that man has been described as ‘a biped animal with backache’.
With this constant repetitive stress we can see why the degeneration of the spinal joints is well advanced by middle-age and why backache, stiff necks and general signs of ‘wear and tear’ are the rule rather than the exception.
When standing correctly the weight of the body is evenly distributed. A line drawn downwards from the ear should run through the centre of the ankle bone. If it falls in front of this point then the muscles of the neck and spine will be under stress in order to support the head. As the head is held forward of its correct position there occur compensating changes in the normal curves of the spine. These changes, if prolonged, produce permanent alterations which will have their effect on every aspect of body mechanics. Similar problems occur if the head is held to one side or if the pelvis is in a position of forward or backward tilting. The problem is to know how to correct these habitual postural mistakes.
It is interesting to realize that the position of the head and neck in relation to the trunk has a determining effect on the whole economy of the body. The position of the organs of the body is maintained by the fascial bands that support them. The fascia that decides the relative position of the heart, the liver or the spleen, for example, is attached directly to the fascia of the neck, which is joined to the base of the skull. Thus any permanent deviation from normal in this area will have widespread ramifications. Once again we see how the body parts interrelate.
Two examples of poor posture together with one showing correct alignment. In the two incorrect examples it can be seen how bad body mechanics can lead to permanent alteration of muscle tone, organ displacement and stress on the spinal joints.
|Correct Sitting Position|
Note: Knees higher than hips.
|Wrong Sitting Position|
Note: Knees lower than hips. General sagging of body.
|The Effect of Wearing High Heels:|
When standing, the crown of the head should be the highest point, not—as is most common—the front of the head. When sitting, the spine should be supported and not allowed to sag. The slope of the upper leg, when sitting, should be from the knee to the hip. That is to say, the knee should be higher than the hip. If this is the case and the buttocks are well back in the chair, the spine will be relaxed and supported. The feet should be so placed that by leaning forward from the sitting position and then straightening the knees, the upright position can be achieved with a minimum of effort. Crosslegged sitting produces twisting strain on the pelvic-lumbar area. It will do no harm for short periods but the danger exists of a habit pattern developing which can help to produce permanent changes in the low-back area.
When walking the head should be held ‘tall’, not held forward of the centre of gravity of the body. In this way the head becomes less of a heavy weight, which appears to be in danger of falling off its perch on the neck, and more of a ‘balloon’ floating above the erect body. Think of the graceful movement of a cat or of a ballet dancer; in both examples the head leads and the body appears to follow. Contrast them with the sagging, heavy, round-shouldered appearance so often apparent to any observer. Not only is the appearance so much more pleasing but the effects on general health and energy are demonstrably improved. Bending is essentially produced by the flexion of the knees and hips. A minimum of spinal movement should be required to get down to lift or move an object. If this could be clearly understood and practiced there would be a great reduction in spinal problems.
In one-sided, repetitive activities such as digging or sweeping every effort should be made to break the pattern frequently so that other muscles can be used, and those involved in the repetitive movement given a rest.
In one’s work it will pay dividends to examine the way simple repetitive activities are performed. For example, I know of a case of severe neck pain which was produced by the habit of holding a telephone receiver between ear and shoulder, thus tilting the head to one side and leaving both hands free. This, when repeated many times a day for some years, resulted in chronic strain.
Ideal Sleeping Position
Sleep should be on a firm surface. The ideal position is to lie on one side with the head on one medium pillow which is pulled well into the angle between neck and shoulder; thus the head and neck are supported and not allowed to sag or become pushed to one side by too thick a supporting surface. The knees should be flexed so that the lower back is resting in a slightly rounded or neutral position. Sleeping face downwards is undesirable because of the effect on the low back as well as the necessity for the head to be turned to one side.
Physical exercise should involve the use of the whole body; walking, running, cycling and swimming are all desirable. One-sided activities should not be allowed to dominate physical activity to the point of producing imbalance. Exercises of a ‘keep fit’ nature should be carefully tailored to the individual. Yoga exercises are far more desirable as they are performed in a slow, rhythmic manner rather than in violent, jerky movements so common in the daily dozen!
The way the body is carried in sitting, standing and walking is an ever varying dynamic pattern and the study of this pattern is the study of posture.
The posture of an individual is determined in childhood and the seeds of poor posture in adult life are sown in childhood. Good posture is a rarity — indeed if seen it is instantly recognizable. It is not the stiff military carriage, any more than it is the slouching, sagging posture of the fashion model! One is more likely to recognize good posture in the half naked African tribesman whose graceful carriage enables him to move in an effortless way.
Observe people as they carry out their daily tasks. Few walk well, and one is able to observe a variety of slumped, unhealthy postures when people are sitting. This is an indication of physical weakness, lack of physical exercise, and poor development. It has a direct bearing on health, both physical and mental.
A Common Postural Fault
Lordosis occurs when the pelvis is tilted forward and there is an exaggerated forward curve of the lumbar region of the spine— (high heels, incidentally, throw the pelvis into just this position). There is a corresponding exaggeration of the backward curve of the dorsal spine (kyphosis), and a forward movement of the curve of the neck. These changes of the curves of the spine result in changes in the attached structures, thus throwing strain upon the supporting ligaments, and causing malposition and crowding of the internal organs, circulatory impediments and nerve irritation. The abdominal organs are thrust forward against the wall of the abdomen, the muscles of which become stretched under the constant pressure. The intestines and other supported structures sag and assume a lower position in the abdominal cavity. The liver may rotate forward and the common bile duct may become stretched, in some cases causing interference with bile flow. The pelvic organs are also involved, leading to many of the complications which these days seem to affect women of all ages. There is a sagging of the ovaries, the uterus is tilted forwards and down, with the weight of the abdominal organs resting on it. Varicose veins of the lower bowel (haemorrhoids), and impairment of the reproductive system may result.
With the corresponding crowding of the rib cage there is a decrease in the diameter of the chest. The diaphragm is lowered, leaving the heart in a sagging position, unsupported from below. Both respiratory function and heart action are bound to be less efficient as a result.
Osteopathy can do much to correct the damage—by relaxing tense and congested muscles and joints, by mobilizing the partially immobile joint and by improving general muscle tone. But in order to overcome poor posture permanently there is only one course of action which must be obvious to any intelligent person.
Corrective exercises must firstly overcome the old habits of poor posture and secondly there must be the cultivation and establishment of new habits of good posture. The patient must do much more than exercise—he must consciously assume and maintain correct posture for long, and ever lengthening periods, until correct posture becomes a habit.
The first obstacle to overcome is that of making the individual aware of his tension (or posture). This must be accomplished before he can begin to do anything about it. So, ideally, in postural re-education an instructor is needed in the initial stages, in order to position the body so that the patient can become aware of what it feels like to be in the right position. At first this will feel wrong and it is not until the patient can realize that what feels right is not necessarily right, that progress can begin.
In the long run posture can only be corrected by the individual learning afresh how to use his body machines correctly. The breaking of old habits and the learning of new ones is not easy, but the employment of osteopathy to normalize the soft tissues and joints, will increase the individual’s awareness of his body structures, whilst at the same time removing restrictions which can often physically prevent correct use of parts of the body. If one part malfunctions then the whole will, to some extent malfunction. By breaking into the web of interconnecting factors, with skilled manipulative methods, many complex problems can be resolved.