What is good posture?
This is the ideal position of the spine when all the segments line up correctly together with the head, hips, knees and ankles. It is the position of the spine that needs very little muscle activity to maintain and places the least amount of stress on the joints and ligaments.
Any changes to the ideal spinal alignment requires the body to use muscle energy to try and stay upright. This in turn causes changes in muscle lengths and strengths and, in time, leads to muscle imbalances. This can create stress on joints and ligaments causing discomfort and pain.
Factors causing poor posture in children
Musculoskeletal system problems
This is the most common type of origin of poor posture. It happens because of continuous bad positions we use in activities of daily living that create the muscle imbalances over time. All activities have an influence on our posture including sitting, standing, walking and even sleeping.
Problems with vision can cause children to lean forward and poke their chin out to be able to see more clearly. This causes the upper back to become more rounded and causes shortening of the muscles at the back of the neck.
Hearing and balance are the 2 functions controlled by the ear and both can have an effect on posture. Hearing difficulty in 1 or both ears will result in the child adopting postures that will place the ear in a better position for hearing, but this may result in habitual movements and positions that can later develop into poor posture.
Balance is controlled by the eyes, middle ear and the feeling in the joints(proprioception). If the middle ear is not working correctly, the body has to work harder to compensate and change positions to prevent falling. These adaptions can lead to poor posture over time .
Central nervous system disorders
This is the least common cause of postural change in children. Any damage or disease of the brain or spinal chord will have an effect on posture. This system controls the way we use our senses and how the body responds to these and any changes to sensation or the muscle response will cause postural changes over time.
Peripheral nervous system disorders
Also very small cause of postural changes in children and works similarly to the changes of the central nervous system. The place where the abnormal sensation or muscle action is happening occurs outside of the spine (nerves of the arms and legs).
Common posture problems in children
When we view the spine from behind, the scoliosis can be seen with a change in curvature to one side and a compensatory curve to the other side either above or below. It is difficult to determine which was the first curve and which was the compensation.
The muscles on the side to which the spine curves are usually stronger and shorter than the corresponding muscles on the other side.this posture change can be seen when 1 shoulder is higher than the other or when there appears to be a difference in leg length.
This can be seen when we are viewing the spine from the side. The upper back should have a slight curve and the head should be positioned so that the ears and shoulders line up. In a kyphotic posture, the upper back becomes too rounded and this results in the head being placed in the incorrect position. The body then compensates by pushing the chin forward so that the eyes stay in the correct position (poking chin).
This posture is very common in children due to poor sitting and computer posture. It can also develop because of poor eyesight. This results in shortening of the chest muscles in the front and weakening of the upper back muscles. At the same time, the muscles of the front of the neck become weak and the back neck muscles shorten.
This posture is often the cause of headaches in children!
This abnormal posture is best seen from the side and appears as a “hollow” lower back. In the normal position, the hips should be straight and line up with knees and ankles. When a lordosis occurs, the hips become more flexed and the knees start to hyperextend.
This is usually due to stomach muscle weakness and can come from inactivity. As the stomach muscles weaken, the lower back muscles get stronger and thus makes the hollow back worse. At the same time the hip muscles shorten due to too much sitting and the hamstring muscles get weaker.
This posture is often the cause of lower back pain in children!
How can physiotherapy help?
Your physiotherapist will help in diagnosing the abnormal posture and then work out a specific rehabilitation program for your child. There may be a need for some hands on therapy to help decrease muscle spasm and improve joint movement, but the biggest part of the rehabilitation process should be exercise and education. Taping and strapping may be a useful technique, but only in the short term. Braces and straps are not useful for muscular postural problems as they weaken the muscles even further.
The exercises should help stretch the shortened muscles and also strengthen the weakened muscles so that balance can be restored. The education of correct sitting and sleeping positions as well as chair desk and bed setup should also be discussed.