ertebrae, the shoulder joint, the cervical vertebrae and the earlobe (see Figure 1).
Kritz and Cronin (2008) suggest assessing the following checkpoints in standing side posture (this list describes optimal posture):
- head: neutral, with no forward or backward tilt
- cervical spine: slight anterior curve
- scapulae: flat against upper back
- thoracic spine: slight posterior curve
- lumbar spine: modest anterior curve
- pelvis: anterior superior iliac spine in same vertical plane as symphysis pubis
- hip joints: neutral, neither flexed nor extended
- knee joints: neutral, neither flexed nor hyperextended
- ankle joints: neutral, with leg vertical to sole of foot
When standing posture is viewed from the front (with feet approximately 3 inches apart), a vertical line should divide the body into two similar halves. Norris (1995) suggests that the anatomical landmarks to compare for horizontal level on both sides of the body include the lateral malleolus (ankles), patella (knees), anterior superior iliac spine (hips), acromion process (highest point of shoulders) and ears. It is also important to look for muscular or structural differences in this frontal-view assessment. Kritz and Cronin (2008) add that the feet should be in a neutral position with no signs of pronation or supination. They suggest continuing the posture check from behind, observing the following (see Figure 2):
- head: neutral, with no tilt or rotation
- shoulders: level, with no depression or elevation
- scapulae: medial borders parallel and approximately 3–4 inches apart
- thoracic spine: straight with no lateral curve
- lumbar spine: no lateral curve
- pelvis: posterior superior iliac spines in the same plane
- lower extremities: straight, not bowed or knock-kneed
- feet: facing parallel or with toes slightly out; no pronation or supination
If the body segments are out of their optimal alignment for extended periods of time, the muscles eventually adapt by either shortening or lengthening (depending on the position) (Hrysomallis & Goodman 2001). Novak (2004) adds that prolonged misalignment adversely affects nerve tissue and function and that the adaptive changes in muscle tissue (whether lengthening or shortening) result in muscle imbalances, which can have a number of health consequences. The particular health issues caused by posture dysfunction tend to vary by population.
Posture Health for All Ages: Forward-Head PostureForward-head posture (FHP) is the most common form of poor posture in all age groups. People with FHP tend to develop a habitual head misalignment while sitting at a computer workstation, working on hobbies, playing video games or driving transport vehicles.
FHP is associated with neck and shoulder pain and temporomandibular joint dysfunction (incorrect alignment of the lower jaw to the skull) (Harman, Hubley-Kozey & Butler 2005). With FHP there is excessive anterior positioning of the head with increased curvature at the cervical spine and a rounding of the shoulders (see Figure 3). In addition to the musculoskeletal imbalance caused by FHP, this condition has also been linked to fatigue, restricted motion of the neck and chronic neck pain. Harman and colleagues demonstrated that an exercise program with strengthening exercises for the cervical flexors and shoulder retractors combined with stretching of the cervical extensor and pectoral muscles was most effective in helping to correct this posture problem.
Posture Concerns: Adolescents
Normally, as a child advances into adolescence (11–12 years) compressive forces on spinal intervertebral disks and facet joints are adequately balanced through ligamentous tension, allowing modest energy expenditure from postural muscles. However, structural or functional body stressors (e.g., tension, trauma, etc.) may prevent achievement of optimum posture.
Environmental factors that contribute to faulty posture include prolonged slouched sitting, ill-fitting school desks and overloaded bags and backpacks (Britnell et al. 2005). Growth spurts and discomfort with a changing body image may also predis