In Posture Therapy, Form Follows Function - An excerpt from chapter 3

Chapter 3: Basic Posture Analysis

“Dysfunction is an observable condition… the body sends us a message and a picture; I suppose you could call it an anatomical postcard. But we persist in misreading the postcard. One reason is that we’ve gotten so used to seeing the characteristics of dysfunction all around us that they look normal.”

Pete Egoscue

Pete insightfully remarks that our bodies communicate with us through an “anatomical postcard,” signaling dysfunction in ways we often overlook due to its normalization in our surroundings. This chapter aims to sharpen your ability to read these messages by equipping you with metaphorical “posture therapy glasses,” enhancing your perception of your body's structural alignment, from head to toe.

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Simplifying the Problem

In math and physics, three-dimensional problems are simplified by using three different planes of motion, often referred to as the x, y, and z planes of motion. Posture therapists use the same tools to analyze posture, but we call them the front, side, and top-planes.

Think of these as different angles to view your posture.

• Front-Plane: If you take a picture while facing either directly toward or away from a camera, you are looking at the front-plane of motion.

• Side-Plane: If you take a picture with either the right or left side of your body square to the lens, you are looking at the side-plane of motion.

• Top-Plane: If you were to take a picture with the camera looking down at you from directly above the crown of your head, you’ll be looking at the top-plane of motion.

Ideally, your center of gravity and your center of mass are located together at the same point in space, and this is where your three planes of motion also intersect at 90-degree angles with one another. In practice, your three planes intersect at your center of mass, which is physically offset from your center of gravity. 

This isn't particularly important to know more about at this point, other than to understand that the closer your body gets to that ideal position, the better you'll feel!

In each plane of motion, we are looking for different kinds of posture deviations. The next few lines might have some jargon you’re not familiar with yet. That’s OK, these concepts will be explained in more detail later in this chapter.

• Front-Plane: Here, we are mostly concerned with lateral offset and elevation disparities. In other words, we are looking for asymmetries across the two sides of the body.

• Side-Plane: In this view, we're mostly looking for deviations related to center of gravity, or in other words, the vertical alignment of the load-bearing joints when seen from the side.

• Top-Plane: In this plane, our detective work mostly revolves around spotting rotational deviations and again, asymmetrical function between the two sides of the body.

. . .

--------- This isn't part of the book. I'm skipping over all the more technical talk of actual posture analysis. I'm going to skip ahead to this chapter's discussion of the case study followed in chapters 2-6.

This is the only look you'll get at this case study throughout the excerpts posted on this blog.

OK, now back to the book.

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Putting it All Together: ST's Case Study

If you don’t remember where we left off with ST, I’ll remind you. He complained of chronically tight hamstrings, and lower back pain that is only present if he is ambitious with trying to stretch the hamstrings.

I performed a posture analysis, the results of which are noted in the table below. In the interest of privacy, I will not share his photos. Review the table, and the results will be discussed directly afterward.

I’ve left out the overall impressions as that gets into Chapter 5 material about Posture Categorization. For now, let’s just discuss the most notable deviations I uncovered and my thoughts arising from ST’s analysis.

The good news is he is fairly symmetrical, with only mild deviations in the front-plane. Minimal time will be spent on front-plane corrections.

The top-plane notes spinal rotation and internal shoulder rotation in addition to the femur rotation.

The side-plane notes a moderate pelvic tilt, but there is an extreme vertical misalignment between his ankles, knees, hips, shoulders, and ears, such that his entire body has taken on a slight S-curve when viewed from the side. Hips are in front of ankles. Shoulders are behind the hips. The head is in front of the shoulders.

Based on the analysis, I hypothesized that his hip adductors compensate heavily for weak and slack hip flexor function. This means that the muscles responsible for lumbar extension do double duty, stabilizing the lumbar spine in lieu of dysfunctional hip flexors. This extra tension through the lumbar spine, in addition to the externally rotated femurs, is pulling on his hamstrings before they complete their natural range of motion, causing that sensation of tightness. How might this happen?

In the Continued Reading Appendix, I mention a book called “Anatomy Trains” by Thomas Myers. This book is a great resource for learning to recognize common compensation patterns and understanding the biomechanical connections that enable such patterns across the entire body. Myers refers to the muscles and soft connective tissues as “tracks” and the bony parts where those tissues connect, merge, and disperse as “stations.” So, soft tissue tracks that meet at bony stations make up anatomy trains.

For example, in ST’s case, we discussed how the hamstring becomes the sacrotuberous ligament, which in turn becomes the erector spinae muscles that line the spine on each side, making up one of these trains. When the hip flexors have lost the ability to help stabilize the lumbar spine, the erector spinae pull harder to pick up the slack, and that tension gets transferred to the hamstrings via the sacrotuberous ligament. 

In reality, this same anatomy train, called the superficial back line, extends from the plantar fascia along the bottom of the foot all the way up the back of the body, eventually becoming the epicranial fascia, stretching over the top of the head and ending just above the eyebrows.

You read that correctly, there is a single piece of soft tissue which can be dissected from cadavers which starts at the toes and ends at the eyebrows, and tension or damage in any one part of this train can directly cause symptoms any other parts of it.

So, armed with this collected data, background information, and hypothesis about what was happening inside his body, it was time to test that hypothesis. And that’s where we’ll pick up with ST’s case study in Chapter Four.

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