Body Postures

The body normal posture is the optimal alignment of the patient’s body that allows the neuromuscular system to perform actions requiring the least amount of energy to achieve the desired effect.

Abnormal or bad body posture is defined as positioning that deviates from the midrange position of function.

The balance for body posture can be:

• Static: the ability of a body to maintain the static position. In this kind of balance, the spinal column is stretched upwards from the base of the sacrum, on the midsagittal plane, with three physiological curvatures which are formed along the line of the center of gravity.
• Dynamic: the ability of a body to maintain the stable condition during the different daily activities.

See Also: Postural Assessment

Arms and shoulders Posture

Normal Posture

Arms hang relaxed at the sides with palms facing toward the body.

Elbows are slightly bent, so the forearms hang slightly forward.

Shoulders are level, and neither one is more forward or backward than the other when seen from the side. Shoulder blades lie flat against the rib cage. They are neither too close together nor too wide apart. In adults, a separation of about 4 inches is average.

Bad Posture

• Arms:
  • Holding the arms stiffly in any position forward, backward, or out from the body. Arms turned so that palms face backward.

• Shoulders:
  1. One shoulder higher than the other.
  2. Both shoulders hiked-up.
  3. One or both shoulders drooping forward or sloping.
  4. Shoulders rotated either clockwise or counterclockwise.
  5. Shoulder blades pulled back too hard.
  6. Shoulder blades too far apart.
  7. Shoulder blades too prominent, standing out from the rib cage (winged scapulae).

Spine and Pelvis (side view)

Good Postures

The front of the pelvis and the thighs are in a straight line. The buttocks are not prominent in the back but slope slightly downward.

The spine has four natural curves. In the neck and lower back, the curves are forward; in the upper back and lowest part of the spine (sacral region), they are backward. The sacral curve is a fixed curve, whereas the other three are flexible.

Bad Postures

Bad back posture and hip posture include:

1. The lower back arches forward too much (lordosis).
2. The pelvis tilts forward too much.
3. The front of the thigh forms an angle with the pelvis when this tilt is present.
4. The normal forward curve in the lower back has straightened.
5. The pelvis tips backward as in sway-back and flat-back postures.
6. Increased backward curve in the upper back (kyphosis or round upper back).
7. Increased forward curve in the neck. Almost always accompanied by round upper back and seen as a forward head.
8. Lateral curve of the spine (scoliosis) toward one side (C-curve) or both sides (S-curve).

Hips, pelvis, and spine (back view)

Good Postures

Ideally, the body weight is borne evenly on both feet, and the hips are level. One side is not more prominent than the other as seen from front or back, nor is one hip more forward or backward than the other as seen from the side.

The spine does not curve toward the left or toward the right. (A slight deviation to the left in right-handed individuals and to the right in left-handed individuals is not uncommon.

Also, a tendency toward a slightly low right shoulder and slightly high right hip is frequently found in right-handed people, and vice versa in left-handed people.)

Bad Postures

One hip is higher than the other (lateral pelvic tilt). Sometimes, it is not really much higher but only appears to be so, because a sideways sway of the body has made it more prominent. (Tailors and dressmakers often notice a lateral tilt, because the hemline of skirts or the length of trousers must be adjusted to the difference.)

The hips are rotated so that one is more forward than the other (clockwise or counterclockwise rotation).

See Also: Pelvic Anatomy

Knees and legs

Normal Postures

Legs are straight up and down. Kneecaps face straight ahead when feet are in good position.

In side view, the knees are straight (i.e., neither bent forward nor locked backward).

Bad Postures

1. Knees touch when feet are apart (knock-knees).
2. Knees are apart when feet touch (bowlegs).
3. Knee curves slightly backward (hyperextended knee). “Back-knee.”
4. Knee bends slightly forward; that is, it is not as straight as it should be (flexed knee).
5. Kneecaps face slightly toward each other (medially rotated femurs).
6. Kneecaps face slightly outward (laterally rotated femurs).

Feet

Normal Postures

In standing, the longitudinal arch has the shape of a half-dome. Barefoot or in shoes without heels, the feet out toe slightly. In shoes with heels, the feet are parallel.

In walking with or without heels, the feet are parallel, and the weight is transferred from the heel along the outer border to the ball of the foot.

In sprinting, the feet are parallel or in-toe slightly. The weight is on the balls of the feet and toes, because the heels do not come in contact with the ground.

See Also: Foot Anatomy

Bad Postures

1. Low longitudinal arch or flat foot.
2. Low metatarsal arch, usually indicated by calluses under the ball of the foot.
3. Weight borne on the inner side of the foot (pronation). “Ankle rolls in.”
4. Weight borne on the outer border of the foot (supination). “Ankle rolls out.”
5. Out-toeing while walking or while standing in shoes with heels (“sluefooted”).
6. In-toeing while walking or standing (“pigeon-toed”).

Toes

Good Postures

Toes should be straight (i.e., neither curled downward nor bent upward). They should extend forward in line with the foot and not be squeezed together or overlap.

Bad Postures

• Toes bend up at the first joint and down at middle joints so that the weight rests on the tips of the toes (hammer toes). This fault is often associated with wearing shoes that are too short.
• Big toe slants inward toward the midline of the foot (hallux valgus) “Bunion.” This fault is often associated with wearing shoes that are too narrow and pointed at the toes.

Head

Head is held erect, in a position of good balance.

Bad Postures of the head include:

1. Chin up too high.
2. Head protruding forward.
3. Head tilted or rotated to one side.

Chest

A good position of the chest is one in which it is slightly up and slightly forward (with the back remaining in good alignment). The chest appears to be in a position approximately halfway between that of a full inspiration and a forced expiration.

Poor postures of the chest include:

1. Depressed (“hollow-chest”) position.
2. Lifted and held up too high, brought about by arching the back.
3. Ribs more prominent on one side than on the other.
4. Lower ribs flaring out or protruding.

Abdomen

In children up to approximately 10 years of age, the abdomen normally protrudes somewhat. In older children and adults, the abdomen should be flat.

Abnormal postures of the abdomen include:

1. Entire abdomen protrudes.
2. Lower part of the abdomen protrudes; the upper part is pulled in.

References

1. Muscles: Testing and Function with Posture and Pain. Book by F. P. Kendall, 5th Edition.
2. Carini F, Mazzola M, Fici C, Palmeri S, Messina M, Damiani P, Tomasello G. Posture and posturology, anatomical and physiological profiles: overview and current state of art. Acta Biomed. 2017 Apr 28;88(1):11-16. doi: 10.23750/abm.v88i1.5309. PMID: 28467328; PMCID: PMC6166197.