Posture: types of posture and stages of development of posture disorders

Normal posture is one of the criteria that determines the state of human health. When viewed from the front with respect to the frontal plane, it is characterized by the following features: the position of the head is straight; Shoulders, collarbones, costal archs, crests of the iliac bones are symmetrical; the abdomen is flat, pulled up; the lower extremities are straight (corners of the hip and knee joints are about 180 °); when viewed from the rear: the contours of the shoulders and the lower angles of the shoulder blades are located at one level, and the inner edges are at the same distance from the spinal column; when viewed from the side of the sagittal plane: the vertebral column has moderate physiological curves (cervical and lumbar lordosis, thoracic and sacrococcygeal kyphosis). The line, conventionally held through the center of gravity of the head, the shoulder joint, the large spit, the fibula head, the outer side of the ankle, must be continuous vertical.

Since the study of human posture, a large number of its classifications have been proposed (Kasperczyk 2000). One of the first was developed in the second half of the XIX century in Germany. It reflected the trends of the time, and the main criterion for its evaluation was the "military" stance. In view of this, the person's posture was defined as normal, free and at ease. In the early 1880s Fischer developed a somewhat different classification, singling out a military, correct and incorrect posture. Later, this classification was repeatedly repeated by many specialists in various interpretations.

The German orthopedist Staffel (1889), taking into account the peculiarities of the curves of the human spine relative to the sagittal plane, distinguished five types of posture: the normal, round back (dorsum rotundum), the flat back (dorsum planum), the concave back (dorsum cavum) and the flat-concave back (dorsum rotundo-cavum).

In 1927 Dudzinski, based on the classification of Staffel, developed four types of postural disorders inherent in children: convex, round-concave, with lateral curvature of the spinal column and with marked combined vertebral column disorders.

Types of violation of posture, Stafford (1932):

1. Posture with pronounced anteroposterior curvature of the vertebral column:
   • the back is round;
   • the back is flat;
   • back curved;
   • back convex-concave;
2. The posture is too tense.
3. Posture with lateral curvature of the vertebral column.

In other attempts to develop classifications of wastes (Haglund and Falk, 1923, Figure 3.46, Stasienkow, 1955, Wolanskiego, 1957), the classification of Staffel is strongly influenced by them.

The beginning of XX century. In America it was noted by a large number of works on the study of human posture.

So, in 1917 Brown, an orthopedist from Harvard University, developed the so-called Harvard classification of the human body's posture, the criterion for evaluating which was the magnitude of the physiological curves of the vertebral column relative to the sagittal plane. After examining 746 students of the University, the author singled out four types of wastes, denoting them with capital letters of the alphabet: A - perfect posture; B - good posture; C - bearing with minor disturbances; D - posture is bad. Later this classification was repeatedly modified and changed by different specialists. So, in Boston Klein and Thomas (1926) on the basis of the systematization of the results of studies of schoolchildren, three types of posture were distinguished: strong, medium and weak.

The classification of Wilson's human posture, developed at the University of Southern California, also relied on the typology of Brown.

Based on an analysis of one hundred photograms of human vertical positions, Brownell in 1927 developed a classification including 13 types

In 1936, Crook developed a classification for preschool children. Analyzing the data of 100 children, the author singled out 13 types of sediments typical for this age, estimating them from 0 (the worst posture) to 100 (excellent). In the developed classification, the posture was expressed on average by 50 characteristics of the human body. At the same time, the criteria for assessing posture were not limited only to the characteristics of the spinal column, but also took into account the different parameters of the OD - the degree of straightening of the knee joints, the angle of the pelvic inclination, the inclination of the head forward, the degree of equilibrium of the body,

Polish version of the classification of human posture developed by Wolanski (1957). Taking into account the physiological curves of the spinal column, the author singled out three types of posture:

• K - kyphotic posture;
• L - lordotic posture;
• R - uniform posture.

Wolanski classification arose as a result of carrying out by the author of measurements of a siege of 1300 children of Warsaw at the age from 11 to 17 years. Later on, based on the research, in which 3,500 subjects aged 3 to 20 participated, the author developed a classification developed by him with the inclusion of two more subtypes in each type. Thus, a typology was obtained, which includes 9 types of human wastes.

Taking into account the severity of the physiological curves of the spinal column, Nikolaev (1954) proposed a classification of posture, including five types: normal, straightened, stooped, lordotic and kyphotic.

With normal posture, the spine bends are within the mean. With straightened posture, the vertebral column is straight, its bends are poorly expressed. The stooped posture is characterized by an enlarged cervical lordosis, in connection with which the head is somewhat advanced, the thoracic kyphosis is enlarged. The lordotic posture differs strongly expressed lumbar lordosis. At a kyphotic posture the thoracic kyphosis is sharply increased.

Nedrigailova (1962), depending on the method of fixing the joints and the position of the segments of the lower limb, normally suggests four types of posture:

• symmetrical active flexion type with a half-bent hip and knee joints, which are actively fixed by muscle tension. The body is tilted forward and About CT of the body is displaced anteriorly. Such a "protective" type of vertical posture is observed mainly in young children beginning to walk, and in elderly people with insufficient stable balance of the body;
• symmetrical active-passive type with a vertical arrangement of the trunk and lower limbs. OCT of the body is somewhat posterior or at the level of the axis of movement of the hip joint and somewhat anterior to or at the level of the axis of motion of the knee joint. Both joints are fixed mainly passively, but the muscles are in a state of constant tonic tension for more reliable blocking of the joints;
• symmetrical, extensor, predominantly passive type - hip and knee joints are in the position of overextension, the localization of the body's OCT is shifted by 3-4 cm behind the axis of rotation of the hip joint and anterior to the axis of rotation of the knee joint. Both joints are passively fixed by the tension of the ligamentous apparatus, the ankle joint is active.
• The asymmetrical type is characterized in that the supporting leg is installed in the unbending position in the hip and knee joints and these joints are closed passively. The other leg takes on a much lesser load, its biocells are in the flexion position and the joints are fixed actively.

Based on the results of the goniometry of the spinal column, Gamburtsev (1973) classified the type of posture taking into account the three signs - the angle of pelvic incline to the vertical (x), the lumbar lordosis index (a + p), the angle of the upper thoracic spine to the vertical (y), on which he singled out 27 types of posture.

Putilov (1975) grouped functional shifts of the vertebral column into 3 groups:

1. displacement in the frontal plane;
2. displacement in the sagittal plane;
3. combined displacements.

Violation of posture in the frontal plane (scoliotic posture) is characterized by displacement of the axis of the spinal column to the right and left of the median position.

Disorders of posture in the sagittal plane are divided into 2 groups: 1-st group - with an increase in physiological curvatures, 2-nd - with their flattening. With increasing thoracic kyphosis and lumbar lordosis, a posture with a round-bent back is formed . A total increase in thoracic kyphosis leads to the formation of a posture with a round back , and an increase in the lumbar lordosis - to the lordotic . When flattening physiological curves, a flat posture develops .

Combined posture in the sagittal and frontal planes is characterized by an increase or decrease in physiological bends in combination with the primary lateral displacement of the axis of the spine (left, right) at different levels. Scoliotic posture can be combined with a round, concave, round, flat and lordotic back.

Ability and inability to properly keep your body in space affects not only the appearance of a person, but also the state of his internal organs and health. Posture is formed in the process of the child's growth, changing depending on the conditions of life, study, physical education.

Smagin (1979), taking into account the position of the spinal column, the state of the feet, considering various abnormalities characteristic of the incorrect posture of school-age children, developed another approach to its classification and singled out five groups.

1. The first group includes healthy children, in which the vertebral column is located symmetrically, but there are several disorders characteristic of the wrong posture: forwarded shoulders, pterygoid scapula, minor deformation of the thorax. Stop at these children - normal.
2. The second group includes children with curvatures of the vertebral column in the frontal plane to the right or to the left by up to 1 cm, which can be corrected by the child himself through the tension of the muscles of the back. The asymmetry of the shoulder lines, the lowering of the shoulder and the scapula of the same name, the pterygoid scapula and the triangles of waist that are different in shape, the flat foot is flattened (enlargement of the surface of the plantar side of the foot, slight lowering of the longitudinal arch).
3. Children of the third group notice a decrease or increase in physiological curves of the spinal column in the sagittal plane, in one or more sections. Depending on the changes in the bends, the child's back assumes a flat, round, round-bent or flat-concave shape. Frequent elements of posture disorder are a flattened or sunken chest, weak chest muscles, pterygoids, flattened buttocks.
4. The fourth group includes children with organic lesions of the bone system (curvature of the vertebral column in the frontal plane in one or several sections, in the form of an arc or arcs facing right or left for more than 1 cm (scoliosis), with twisting of the vertebrae around the vertical axis, the presence of a rib hump, asymmetry of the shoulder girdle, chest and triangles of the waist).
5. The fifth group includes children who have a persistent deformation of the vertebral column in the sagittal plane (kyphosis and kyphoscoliosis). Detecting protruding pterygoid scapula, protruding forward shoulder joints, thorax is flattened.

Gladysheva (1984), based on the ratio of the planes of the chest and abdomen, suggests four types of posture: very good, good, medium and poor.

• With a very good posture, the anterior surface of the chest somewhat protrudes forward with respect to the anterior surface of the abdomen (it is as if drawn).
• Good posture is characterized by the fact that the front surfaces of the chest and abdomen lie in the same plane, the head is slightly inclined forward.
• With an average posture, the anterior surface of the abdomen somewhat protrudes forward with respect to the front surface of the chest, the lumbar lordosis is enlarged, the longitudinal axes of the lower extremities are inclined forward.
• With poor posture, the anterior surface of the abdomen is strongly protruded, the thorax is flattened, the thoracic kyphosis and lumbar lordosis are enlarged.

Potapchuk and Didur (2001), taking into account the peculiarities of the physical development of children, suggest the allocation of the posture of a preschool child, a younger schoolchild, a young man and a girl.

Optimum posture of the preschooler: the trunk is located vertically, the thorax is symmetrical, the shoulders are unfolded, the shoulder blades protrude slightly, the abdomen is protruded forward, the lumbar lordosis is indicated. The lower extremities are straightened, the angle of the pelvis is from 22 to 25 °.

The normal posture of a schoolboy is characterized by the following signs: the head and trunk are arranged vertically, the humeral girdle is horizontal, the shoulder blades are pressed to the back. The physiological curves of the spinal column relative to the sagittal plane are moderately expressed, the spinous processes are arranged along a single line. The protrusion of the abdomen is reduced, but the anterior surface of the abdominal wall is located anterior to the chest, the angle of the pelvis is increased.

The optimal posture of the young man and the girl, according to the authors, is as follows: the head and trunk are located vertically with their legs straight. The shoulders are slightly lowered and are on the same level. The blades are pressed to the back. The thorax is symmetrical. The mammary glands in girls and the nipple mugs in young men are symmetrical and are on the same level. The abdomen is flat, drawn in relation to the thorax. The physiological curves of the spine are well expressed, the girls underline lordosis, in young men - kyphosis.

With a vertical posture, mechanical loads acting on the intervertebral discs may exceed the body weight of a person. Consider the mechanism (the occurrence of these loads). The GCM of the body of a person standing is located approximately in the area of the vertebra L1. Therefore, this vertebra is affected by the mass of the overlying parts of the body, which is approximately half the body weight.

However, the BMC of the overlying part of the body is not located directly above the intervertebral disc, but somewhat ahead of it (this also applies to the vertebra L4, which most protrudes forward), so there is a torque of the force, under the action of which the body would be bent forward if the moment of gravity did not was contrasted with the moment of force created by the muscles-extensors of the spinal column. These muscles are located close to the axis of rotation (which is located approximately in the region of the jelly core of the intervertebral disc), and therefore the shoulder of their pulling force is small. To create the necessary moment of strength, these muscles usually need to develop a greater force (the law of the lever acts: the smaller the distance, the greater the force).

Since the line of action of the muscle traction force is practically parallel to the vertebral column, it, summing up with gravity, sharply increases the pressure on the intervertebral discs. Therefore, the force acting on the vertebra L, in the usual standing position, is not half of the body weight, but twice as large. With tilts, lifting weights and some other movements, external forces create a great moment about the axis of rotation passing through the lumbar intervertebral discs. The muscles and especially the ligaments of the spinal column are located close to the axis of rotation, and therefore the force exerted by them should be several times greater than the weight of the lifted load and the overlying parts of the body. It is this force that affects the mechanical load that occurs in the intervertebral discs. For example, the force acting on the L3 vertebra in a person weighing 700 N, under the following conditions (Nachemson, 1975):

• Pose or movement / Strength, H
• Lying on the back of an extension of 300 N / 100
• Lying on the back legs straight / 300
• Standing position / 700
• Walking / 850
• Torso bend to the side / 950
• Sitting without support / 1000
• Isometric exercises for abdominal muscles / 1100
• Laughter / 1200
• Tilt forward 20 ° / 1200
• Ascending from the supine position on the back, legs straightened / 1750
• Lifting the load 200 N, back straight, knees bent / 2100
• Lifting the load 200 N from the tilt forward, the legs are straightened / 3400

In most women in the standing position, due to the peculiarities of the constitution, there is still a pair of forces acting relative to the hip joint. In this case, the base of the sacrum (the site of the sacral connection with the lower surface of the vertebrae L5) in women is located posteriorly from the frontal axis of the hip joints (in men their vertical projections practically coincide). This creates additional difficulties for them when lifting weights - the lifted load for women is about 15% heavier.

In a typical stance, the projection of the body's BMF is located 7.5 ± 2.5 mm behind the vertex (10-30 mm from the frontal axis of the hip joints), 8.7 ± 0.9 mm anterior to the axis of the knee joint and 42 ± 1.8 mm anterior to the axis of the ankle.

Adams and Hutton (1986) found that in the upright position of the human, the lumbar spine is bent about 10 ° below its elastic limit. According to researchers, this restriction of movement is probably due to the protective action of muscles and the back and lumbar fascia. They also stressed that the safety margin can decrease or disappear completely with rapid movements.

Deviations from normal posture are referred to as violations of posture in the event that the results of an in-depth examination do not reveal diseases of the spinal column or other departments of the OA. Consequently, violations of posture occupy an intermediate position between the norm and pathology, and, in fact, are a condition of pre-illness. It is considered that violations of posture are not a disease, as they are accompanied only by functional disorders of the ODA. At the same time, they can be the first manifestations of serious diseases.

[1], [2], [3], [4], [5], [6], [7]

Stages of development of posture disorders

Adverse background is the stage of presence of biological defects or unfavorable conditions contributing to the violation of posture (in the absence of dynamic and static deviations).

Prebolezn is a stage of non-fixed changes in the ODA. There are initial manifestations of functional insufficiency of the systems ensuring normal posture, symptoms of impaired posture are defined, and deterioration in the indices of physical development is noted. Changes are reversible in the normalization of the process of physical education or directed kinesitherapy.

Disease - the stage of static deformations of ODA corresponds to the presence of irreversible or difficultly reversible disorders of posture.

Posture disorders are functional and fixed. In functional violation, the child can take the position of the correct posture according to the task, for a fixed posture it can not. Functional disorders most often occur because of a weak muscular corset of the trunk.

Violation of posture in preschool and school age leads to a deterioration in the work of organs and systems of a growing organism.

Violation of posture in children occurs both in the sagittal and in the frontal planes.

In the sagittal plane, the violation of posture is distinguished with an increase or decrease in the physiological curves of the spinal column.