Posture disorders

Not everyone has a beautiful royal posture. In our time, when the sedentary lifestyle is becoming more common, every second has a violation of posture. Below are the most common violations of posture in humans.

[1], [2], [3], [4],

Flat Back

Flat back is characterized by a smoothness of the physiological curves of the spinal column; The blades are wing-shaped (the inner edges and the lower angles of the blades diverge to the sides). The thorax is not convex enough, shifted forward; the lower abdomen is protruding forward.

Having determined this type of posture disability in a child, it is necessary to examine his back in the horizontal plane (forward tilt test) to determine whether there are signs of rotation of the vertebral column around the vertical axis (rotation) manifested by the muscular or costal muscle shaft.

[5], [6]

Flat back concave

Flat-bent back - this type of posture is rare. In children, such a violation of posture with a relatively flat back of the buttocks protrude sharply back; the pelvis is tilted forward; the line of the OCT of the trunk passes in front of the hip joints; cervical lordosis and thoracic kyphosis are flattened, and the lumbar region of the spinal column is retracted.

If there are disorders of posture, in particular, round and round-concave back, in children, there is a decrease in the function of the cardiovascular and respiratory systems, digestion, retardation of physical development, and with a flat and flattened back, a violation of the spring function of the spinal column.

[7], [8], [9], [10]

Scoliosis

Disorders of posture in the frontal plane - scoliosis. This is a serious progressive disease of the spinal column, characterized by its lateral curvature and twisting of the vertebrae around the vertical axis - torsion. Depending on the arch of the curvature of the spine, several types of scoliosis are distinguished.

Cervico-thoracic scoliosis

The vertex of the curvature of the spinal column is at the level of the T4-T5 vertebrae, accompanied by early deformations in the thoracic region, changes in the facial skeleton.

[11], [12], [13]

Thoracic scoliosis

The vertex of the curvature of the spine in thoracic scoliosis is located at the level of the T8-T9 vertebrae. Curvatures are right-handed and left-handed. As a rule, thoracic scoliosis in most patients is accompanied by deformations of the thorax, development of the costal hump, expressed functional disturbances of external respiration and blood circulation. Characteristic signs of this type of scoliosis are: the shoulder on the convex side is raised, the scapula is located higher, the vertebral column in the thoracic region is curved, the rib arches are asymmetric, the pelvis is biased towards the curvature, the stomach is protruded forward.

C-shaped scoliosis is formed by shortening the muscles that have attachment sites on a large area of the spinal column and ribs. For example, the external oblique muscle is attached from the ilium to the VI rib. This form of scoliosis is accompanied by a pronounced asymmetry (lateroflexia) of the boundaries of the sections of C-shaped scoliosis and less 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 violation of the function of external respiration, blood circulation and characteristic pain in the sacral-lumbar region.

S-shaped scoliosis is characterized by the fact that the lumbar spine forms the convexity of the scoliosis to the right, and the thoracic - to the left with a shortening of the inner oblique abdominal muscle. Such a scoliosis of the spinal column is often accompanied by a costal scoliosis, the so-called "rib hump", which is especially well diagnosed in the sagittal plane, while the S-shaped deformation is accompanied by a minor lateral flexion of the boundaries of the vertebral column.

Often S-shaped scoliosis is formed by the combination of C-shaped scoliosis of neighboring departments with their opposite orientation.

Congenital scoliosis is rarely detected until the age of five, and as a rule, changes in the spinal column are localized in the transitional regions: lumbosacral, lumbosacral, cervico-thoracic; captures a small number of vertebrae, has a small radius of curvature; causes small compensatory deformations.

Kazmin and co-authors (1989) propose to classify scoliosis into two groups:

1. 1-st group - discogenic scoliosis, arising on the basis of dysplastic syndrome;
2. The second group is gravitational scoliosis.

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

• I degree - insignificant violations of posture in the frontal plane (scoliotic posture). The curvature is unstable, barely planned, the total scoliosis index is 1-4 °. With a weak muscular corset and unfavorable posture conditions (for example, prolonged sitting at a desk not corresponding to growth), these changes can become more stable.
• II degree - non-fixed (unstable) scoliosis. The frontal curvature of the spinal column is more pronounced, but it is eliminated by unloading (with arms raised or suspended), there is a difference in the mobility of the vertebral column to the right and left, the total scoliosis index is 5-8 °.
• III degree - fixed scoliosis. When unloading, only partial correction is obtained (there is residual deformation)! Rotation of the vertebrae is planned, the deformation of the vertebral bodies is not yet expressed and the costal hump is absent, the total scoliosis index is 9-15 °
• IV degree - strongly pronounced fixed scoliosis, not amenable to correction. The vertebral bodies are deformed, often there is a pronounced rib hump and lumbar roller. The difference with inclinations to the right and left is significant, the total scoliosis index is 16-23 °
• V degree - severe complicated forms of scoliosis with significant deformation of vertebral bodies, pronounced vertebrae, rib hump and lumbar spine, total scoliosis - more than 24 ° (can reach 45 ° and more).

In practice, scoliosis is divided into three stages: I degree - non-fixed scoliosis (5-8 °); II degree - fixed scoliosis (9-15 °); III degree - a pronounced fixed scoliosis (more than 16 °).

Classify the severity of scoliosis with the help of the methods of Chaklin and Cobb.

Using Chaklin's technique, several straight lines are drawn on the roentgenogram between vertebrae, and then the angles between them are measured.

The severity of scoliosis	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 Cobb's technique, an S-shaped double curvature is measured on the x-ray of the spinal column. In the upper part of the curvature, using a ruler, two horizontal lines are drawn: one above the upper vertebra, from which the curvature comes, the other - over the lower one. If you draw two lines that run perpendicular to the first, then an angle is formed, which is measured. When comparing these methods, you can see that the principle of measurement is almost the same. The difference is that according to the Chaklin method, the more degrees in the investigated coal, the easier the degree of the disease, and by the Cobb method - on the contrary.

Disorders of posture in the frontal plane lead to a change in the geometry of the masses of the human body. The studies conducted by Belenkiy (1984) made it possible to determine the localization of the CT segments of the trunk relative to the frontal plane of the most typical patients with various spinal curvature. Analysis of the obtained data indicates that the CT of the horizontal segments of the trunk are grouped on the concave side of the curvature. In the region of the curvature vertices, the distance between the center of gravity of the segment and the center of the vertebra in the frontal plane is the largest - 10-30 mm, and in the neighboring segments this distance decreases with distance from the vertices. In addition, the CG segments, while retaining their position in the middle of the trunk, at the same time are located away from the longitudinal axis of the body on which they were placed before the disease. Next, the CT of the body of the segments is located, where the vertices of the curvatures are located (the distance between the center of gravity of the segment and the axis of the body is 5-15 mm).

Studying the correlation of body weights in patients with scoliosis allowed the author to reveal the fact that the central segment of the trunk segments, in spite of the significant lateral displacement of the spine, is localized near the longitudinal axis of the body, so that the line along which the body weight acts is central, from scoliotic curvatures of the spinal column, crossing it only in the region of the "neutral" vertebrae. This means that in the frontal plane at the level of curvature, the body weight creates static moments that tend to increase the deformation of the spinal column.

Studies have made it possible to determine the biomechanical features of the vertical posture of the patient with scoliosis, the essence of which is as follows. Curvature of the spinal column is accompanied by a constant strain of muscles on the side of the bulge. In order to work the muscles in the thoracic region would not be so intense, the patient, as a rule, shifts his head towards the convexity of the thoracic curvature. To facilitate the work of the muscles of the lumbar region, opposing the forces of gravity, it is necessary to shift the line of action of body weight to the lumbar vertebrae. This is achieved by deviating the trunk in the direction of the convexity of the lumbar curvature, and thanks to the frontal movement of the pelvis, the body's SPM is projected onto the middle of the support contour, resulting in both legs being loaded equally. As a result, the patient takes a convenient and convenient stand for scoliosis.

Violation of posture is also accompanied by functional failure of the feet:

• valging (deflection inside) stop under load;
• weakness of the muscles of the arch of the foot;
• deterioration of elastic properties of ligaments;
• rapid fatigue of the feet and tibia, especially under static loads;
• feeling of heaviness in the legs;
• pastosity (swelling) of the legs;
• painful sensations.