About the problems of posture. Why posture correctors rarely help

Reading Geektimes, I regularly find for myself something new and interesting, paying special attention to everything related to medicine and health. It just so happened that my main interest in technologically advanced limb prostheses is that I am an orthopedic trauma surgeon by training. By my second education, I am a chiropractor. I’m also a bore and I like to understand what I’m doing. It is precisely because of my specialized education, tediousness, and also because of the growing interest of the audience geektimes to posture correctors ( quite often I find articles on this subject) I realized that I have something to tell, to share my vision of posture correction, and also to tell why posture correctors in the form in which they exist now, will help only in a very limited number of cases, and in some situations they can harm .

The human spine consists of departments: cervical, thoracic, lumbar, sacral and coccygeal.

Also in the spine is what is called physiological bends. The sacral bend (kyphosis) is bent backward, the lumbar bend (lordosis) is bent forward, the thoracic bend (kyphosis) is bent backward, the cervical bend (again lordosis) is bent forward. In this case, the lateral bends of the spine (scoliosis) are normally either absent or very insignificant.

If we present the spine as the main mast of our ship, then the complex “pelvic bones + sacrum” will serve as the deck of the ship.

For a correct and beautiful posture, many factors are responsible. The main role in it is played by the so-called postural department of the nervous system (from the Latin positura - the position of the body in space). It is the postural nervous system that is responsible for maintaining and maintaining the body in space both in statics and in dynamics. It must be understood that the postural nervous system is a rather conditional thing. That is, everyone has it, but to uniquely identify its core is quite difficult. It also strictly depends not only on signals from muscles and joints, but also on signals coming from various organs and feelings of a person. In France, such a branch of medicine as “Posturology” is developing quite actively, which distinguishes the “inputs” of the postural nervous system (hereinafter - PNS) - i.e. all those receptors information from which gives the human brain an understanding of its presence in space. Posturology distinguishes the following "inputs" of the postural system - skin sensitivity (proprioception), bone-articular sensation (deep proprioception), vision, vestibular apparatus, temporomandibular joint (and occlusal plane of the teeth), foot feeling.

In case of disturbances on the part of any “input” of the PNS, a person may experience a disturbance in maintaining equilibrium up to dizziness, a sense of disorientation in space - although these are already quite serious phenomena. Most often, patients will come to the doctor with the main and main complaint of pain and a feeling of tiredness in the back.

Let's try to understand why and why these same pains occur.

Take a person whose work involves a long sitting pose at a computer. “Doctor, my lower back / neck / thoracic area is very painful after a working day. Yes, 7-8 hours at the computer per day. No, when I go home standing on the bus, it hurts not like that anymore. ”- At my second job (chiropractor) I hear this in every second patient, if not more often.

A prolonged sitting posture, most often behind an incorrectly organized workplace (I doubt that all monitors are at eye level, and the armrests of the chair are correctly selected), leads to a decrease in blood flow and malfunction of the pelvic muscles. Women often notice that their pelvic wings are at a different level (men take a closer look at themselves and less often mention this). Improper muscle function leads to different types of “skew” of the pelvis - and if the ship has a curved deck, then the mast will never stand exactly on it. There arises what I, as a manual therapist, like to call “pelvic instability,” and what I, as an orthopedic trauma surgeon, deny (in traumatology, “pelvic instability” is usually called certain variants of bone-traumatic injury - fractures, ligament ruptures and etc.).



Skewing of the pelvic bones inevitably leads to the formation of scoliosis in the overlying parts of the spine. The tonus-force balance of the muscles changes, under the influence of improper muscle traction, the vertebrae are fixed in an offset position. The nervous system, being very intelligent, understands that if the muscle begins to work at full strength, the vertebra will move even more, as a result of which the muscle is given the command to "work less." The body cannot “expel” a badly working muscle from its position as an negligent employee - therefore, someone will process it for it. Most often, one who performs a similar function (all as in life).

A classic example that can be cited is the displacement of the head slightly forward and downward (most often with increased kyphosis in the thoracic region), as a result of which the vertebrae in the cervical region and cervicothoracic junction are fixed in the wrong position, long extensors of the neck begin to work worse, and their function muscles of the shoulder girdle are trying to take over - most often these are the upper portions of the trapezius muscles. In which pains arise.



Manual therapy (in the classical "philistine" sense) is committed to "crunching the spine", hoping that when the doctor removes the pathological fixation of the vertebrae, the muscles of the person will "feel" healthy and able to contract normally, and the person will immediately begin to keep his back straight. This works well when a person is young enough, or when the body's compensatory capabilities are enough to recover. However, when the problem lasts a long time, the muscles themselves are very weaned to work normally, and without their recovery and subsequent strengthening in the form of exercises, getting rid of the problem becomes quite difficult.

I examined only the small and concise features of individual cases. You can talk endlessly about the effect of vision on the progression of scoliosis, about problems with the muscles of the feet (flat feet) that lead to spinal deformities, etc. ... At the end of the article I will attach a list of books from which I relied (along with clinical experience) . And I deliberately simplified some things, I hope the respected audience will forgive me for this.

Briefly from the above, the following conclusion can be formulated: violation of the stereotype of correct posture maintenance is not the only reason for violations of this posture itself.

In this, in fact, lies the imperfection and failure of posture correctors. If long extensors of the neck do not work properly for a person, for example, due to fixation or displacement of the vertebrae in the thoracic spine, different things can happen when a person tries to keep his neck straight. Firstly, no matter how strange it is, over and over again accustoming yourself to keeping your head straight, the muscles can “turn on” - if the vertebral fixation is recent, the instability in the cervical spine did not have time to develop, and the compensatory capabilities of the body allow this. Secondly, nothing could happen. Those. and a person will not learn to keep his neck straight, and nothing bad will happen (again, if the compensatory capabilities of the body allow). Thirdly,

But in a global sense, the chances of a person getting better are pretty small. And the same problems with pelvic muscle instability in a person will not go anywhere — the posture corrector simply cannot physically make the complex “middle gluteus muscles - oblique muscles of the abdomen - rectus femoris - gluteus maximus” work correctly (if we consider muscle pelvic bone stabilization).

Muscles can also be damaged in different ways (overloading, compensatory shortening, etc.), but this is a topic for a completely separate conversation.

List of literature on which I relied in one way or another:

- Gage PM, Weber B. - Posturology. Regulation and imbalance of the human body.
- Kashuba V.A. - Biomechanics of posture
- Kapanji A.I. - Physiology of joints (volume “Spine”)
- Travel D., Simons D. - Myofascial pain and dysfunction
- Gurfinkel V.S. - Regulation of human posture
- Lawrence Jones - Strain-counter-strain

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