Posture disorders

Not every person has a beautiful royal posture. Nowadays, when a sedentary lifestyle is becoming more and more widespread, every second person has a posture disorder. Below are the most common posture disorders in humans.

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Flat back

A flat back is characterized by smooth physiological curves of the spinal column; the shoulder blades have a wing-shaped form (the inner edges and lower angles of the shoulder blades diverge to the sides). The rib cage is not convex enough, shifted forward; the lower part of the abdomen protrudes forward.

Having identified this type of posture disorder in a child, it is necessary to examine his back in a horizontal plane (forward bend test) in order to determine the presence or absence of signs of rotation of the spinal column around the vertical axis (rotation), manifested by a muscular or costal-muscular ridge.

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Flat-concave back

Flat-concave back - this type of posture is rare. In children, this type of posture is impaired by a relatively flat back, the buttocks protrude sharply backwards; the pelvis is tilted strongly forward; the line of the body's center of gravity passes in front of the hip joints; the cervical lordosis and thoracic kyphosis are flattened, and the lumbar region of the spinal column is retracted.

When posture disorders occur, in particular, a round and round-concave back, children experience a decrease in the function of the cardiovascular and respiratory systems, digestion, retardation of physical development, and with a flat and flat-concave back - also a violation of the spring function of the spinal column.

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Scoliosis

Posture disorders in the frontal plane - scoliosis. This is a severe progressive disease of the spinal column, characterized by its lateral curvature and twisting of the vertebrae around the vertical axis - torsion. Depending on the arc of curvature of the spinal column, several types of scoliosis are distinguished.

Cervicothoracic scoliosis

The peak of the curvature of the spinal column is at the level of the T4-T5 vertebrae, accompanied by early deformations in the chest area and changes in the facial skeleton.

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Thoracic scoliosis

The apex of the spinal curvature in thoracic scoliosis is located at the level of the T8-T9 vertebrae. Curvatures can be right- and left-sided. As a rule, thoracic scoliosis in most patients is accompanied by chest deformations, the development of a costal hump, pronounced functional disorders of external respiration and blood circulation. Characteristic signs of this type of scoliosis are: the shoulder on the side of the convexity is raised, the scapula is located higher, the spinal column in the thoracic region is curved, the costal arches are asymmetrical, the pelvis is displaced towards the curvature, the abdomen is protruded forward.

C-shaped scoliosis is formed by shortening of muscles that have attachment points on a large area of the spinal column and ribs. For example, the external oblique muscle is attached from the ilium to the 6th rib. This form of scoliosis is accompanied by pronounced asymmetry (lateral flexion) of the boundaries of the C-shaped scoliosis sections and lesser deformation of the ribs.

S-shaped scoliosis

Combined or S-shaped scoliosis is characterized by two primary arcs of curvature - at the level of T8-T9 and L1-L2 vertebrae. This progressive disease manifests itself not only in the deformation of the spinal column, but also in the disruption of the function of external respiration, blood circulation and characteristic pain in the lumbosacral region.

S-shaped scoliosis is characterized by the fact that the lumbar region forms a scoliosis convexity to the right, and the thoracic region to the left with shortening of the internal oblique abdominal muscle. Such scoliosis of the spinal column is often accompanied by costal scoliosis, the so-called "costal hump", which is especially well diagnosed in the sagittal plane, while the S-shaped deformation is accompanied by slight lateroflexion of the boundaries of the spinal column sections.

Often, S-shaped scoliosis is formed by a combination of C-shaped scoliosis of adjacent sections with their opposite direction.

Congenital scoliosis is rarely detected before the age of five, and, as a rule, changes in the spinal column are localized in the transitional areas: lumbosacral, lumbosacral, cervicothoracic; affects a small number of vertebrae, has a small radius of curvature; causes small compensatory deformations.

Kazmin et al. (1989) propose classifying scoliosis into two groups:

1. 1st group - discogenic scoliosis arising on the basis of dysplastic syndrome;
2. 2nd group - gravitational scoliosis.

Based on the analysis of goniometric and clinical research data, Gamburtsev (1973) recommends distinguishing five degrees of scoliosis:

• Grade I - minor posture disorders in the frontal plane (scoliotic posture). The curvature is unstable, barely noticeable, the total scoliosis index is 1-4°. With a weak muscular corset and unfavorable posture conditions (for example, prolonged sitting at a desk that does not correspond to height), these changes can become more stable.
• II degree - non-fixed (unstable) scoliosis. The frontal curvature of the spinal column is more pronounced, but is eliminated by unloading (when raising the arms or hanging), there is a difference in the mobility of the spinal column to the right and left, the total scoliosis index is 5-8°.
• III degree - fixed scoliosis. When unloading, only partial correction is achieved (residual deformation takes place)! Rotation of the vertebrae is outlined, the deformation of the vertebral bodies is not yet expressed and there is no costal hump, the total scoliosis index is 9-15°
• IV degree - pronounced fixed scoliosis that cannot be corrected. The vertebral bodies are deformed, often there is a pronounced rib hump and lumbar ridge. The difference in bending to the right and left is significant, the total scoliosis indicator is 16-23°
• Grade V - severe complicated forms of scoliosis with significant deformation of the vertebral bodies, pronounced vertebral torsion, costal hump and lumbar ridge, the total scoliosis index is more than 24° (can reach 45° or more).

In practical work, scoliosis is most often divided into three degrees: Degree I - non-fixed scoliosis (5-8°); Degree II - fixed scoliosis (9-15°); Degree III - pronounced fixed scoliosis (more than 16°).

The severity of scoliosis can be classified using the Chaklin and Cobb methods.

Using the Chaklin method, several straight lines are drawn between the vertebrae on the x-ray, and then the angles between them are measured.

Scoliosis severity levels	According to Chaklin (1973)	According to Cobb (1973)
I II III IV	180-175 175-155 155-100 Less than 100	Less than 15 20-40 40-60 More than 60

According to the Cobb method, an S-shaped double curvature is measured on an X-ray of the spinal column. In the upper section of the curvature, two horizontal lines are drawn using a ruler: one above the upper vertebra from which the curvature originates, the other above the lower one. If two lines are drawn perpendicular to the first, an angle is formed, which is measured. When comparing these methods, it can be seen that the principle of measurement is almost the same. The difference is that according to the Chaklin method, the more degrees in the angle being examined, the milder the degree of the disease, and according to the Cobb method, the opposite.

Posture disorders in the frontal plane lead to changes in the geometry of the human body mass. Research conducted by Belenkiy (1984) allowed determining the localization of the CG of the trunk segments relative to the frontal plane of the most typical patients with various curvatures of the spinal column. Analysis of the data obtained indicates that the CG of the horizontal segments of the trunk are grouped on the concave side of the curvatures. In the area of the curvature apices, the distance between the center of gravity of the segment and the center of the vertebra in the frontal plane is the greatest - 10-30 mm, and in neighboring segments, as they move away from the apices, this distance decreases. In addition, the CG of the segments, while maintaining their position in the middle part of the trunk, at the same time end up on the side of the longitudinal axis of the body, on which they were located before the disease. The CG of the bodies of the segments where the apices of the curvatures are located are located furthest (the distance between the center of gravity of the segment and the body axis reaches 5-15 mm).

The study of the body mass ratio in patients with scoliosis allowed the author to reveal the fact that the CG of the trunk segments, despite the significant lateral displacement of the spinal column, is localized near the longitudinal axis of the body, as a result of which the line along which the body weight acts occupies a central position, it passes away from the scoliotic curvatures of the spinal column, intersecting it only in the area of "neutral" vertebrae. This means that in the frontal plane at the level of curvatures, the body weight creates static moments that tend to increase the deformation of the spinal column.

The studies allowed us to determine the biomechanical features of the vertical posture of a patient with scoliosis, the essence of which is as follows. The curvature of the spinal column is accompanied by constant muscle tension on the side of the convexity. In order for the work of the muscles in the thoracic region to be less intense, the patient, as a rule, shifts his head to the side of the convexity of the thoracic curvature. To facilitate the work of the muscles of the lumbar region, counteracting the forces of gravity, it is necessary to shift the line of action of the body weight to the lumbar vertebrae. This is achieved by deviation of the torso to the side of the convexity of the lumbar curvature, and due to the frontal displacement of the pelvis, the body's CM is projected onto the middle of the support contour, as a result of which both legs are loaded equally. As a result, the patient takes a comfortable stance typical for scoliosis.

Postural disorders are also accompanied by functional insufficiency of the feet:

• valgus (inward bending) of the feet under load;
• weakness of the muscles of the arch of the foot;
• deterioration of the elastic properties of ligaments;
• rapid fatigue of the feet and lower legs, especially under static loads;
• feeling of heaviness in the legs;
• pastosity (swelling) of the shins;
• painful sensations.