In this Muscle and Motion blog, we’ll explore what mobility really means, how it differs from flexibility, and why practicing controlled movement patterns is far more effective than stretching alone. We’ll also break down practical examples and exercises you can use to improve your mobility, helping you move better, reduce injury risk, and perform at your best in both daily life and sports.

Understanding mobility

The concept of mobility originates from the general ability to move freely, including basic actions like walking, turning, or changing direction. In sports and exercise, the meaning becomes more specific: mobility is the capacity of joints and surrounding tissues to move through a controlled, functional range of motion.

This involves not just muscles but also ligaments, tendons, and the neuromuscular system. All these elements work together to support smooth, coordinated, and efficient movement. Unlike flexibility, which focuses primarily on muscle length, mobility emphasizes control, strength, and stability.

Mobility vs. flexibility

Many people confuse mobility and flexibility, or assume that simply being flexible automatically leads to better performance. It’s essential to understand a key point: mobility requires flexibility, but being flexible does not necessarily mean you have mobility.

Flexibility refers to the passive ability of a muscle to lengthen. You may have very long hamstrings, for example, but without the strength, control, and coordination to actively move your hip joint through its full range of motion, you may struggle with functional movements like squats, L-Sits, or lunges. In other words, flexibility gives you the potential for movement, but mobility allows you to use that potential efficiently and safely.

Mobility is the active control of a joint through its full range of motion, combining strength, stability, and coordination. Flexibility is the passive ability of a muscle to lengthen without causing injury. In simpler terms, flexibility allows your muscles to stretch, while mobility ensures your joints can move through their full range of motion efficiently and safely. Both are important, but mobility is the bridge between muscle length and functional movement.

Let’s review a few examples to help you better understand the difference between mobility and flexibility.

• Example 1: L-Sit 

The L-sit requires the ability to actively control the end range of hip flexion, which is an example of mobility in the hip joint. You need to move the hip freely and with control while maintaining stability in the body.

On the other hand, flexibility refers to the range that muscles, particularly the hamstrings, can stretch. To perform the L-sit, sufficient hamstring flexibility is required to allow the legs to extend fully in forward flexion.

The ability to hold the legs in this position using the hip flexors demonstrates mobility. In contrast, the ability of the hamstrings to lengthen and stretch is a key example of flexibility.

• Example 2: Tibialis raise

Another example is the tibialis raise, which focuses on ankle dorsiflexion. To perform this exercise correctly, you need sufficient passive dorsiflexion in the ankle, which depends on the flexibility of the calves and surrounding tissues. However, the ability to actively lift the foot into dorsiflexion relies on the strength of the tibialis anterior.

Even if you have excellent passive dorsiflexion, able to stretch against a wall for a deep range, you may struggle to achieve the same range actively during the exercise. This highlights an important principle: our active range of motion (mobility) is usually smaller than our passive range (flexibility). Mobility requires not only muscle length but also control, strength, and coordination to move joints through their full functional range safely and efficiently.

Mobility training: How to do it right

While many exercises are specifically designed to improve mobility, it’s essential to understand that mobility training is more than just performing stretches or drills – it’s about practicing movement itself. The goal is to develop control, strength, and coordination within the joint’s full range of motion, not just to lengthen the muscles.

Focus on challenging movements

A simple approach to mobility training is to identify movements that are challenging for you and practice those specific patterns. By doing so, your body learns to move efficiently and safely through its full range of motion.

• Example 1: Back squat

If you struggle with a back squat, the most effective way to improve mobility is to practice the deepest part of the squat itself repeatedly. One way to do this is by using the one-and-a-quarter back squat, focusing on proper mechanics and control rather than relying solely on stretching your hips or calves. This trains your muscles, joints, and nervous system to move efficiently through the full range of motion.

• Example 2: Snatch

Another example is the snatch. Even if you stretch your shoulders, hips, and upper back, having a passive range of motion does not guarantee that you can perform the exercise successfully. Practicing the full movement pattern, such as a snatch press in squat position, improves mobility across all relevant joints simultaneously, developing strength, coordination, and control in addition to flexibility.

In summary, mobility is more than just flexibility; it is the ability to actively and safely control your joints through their full range of motion, combining strength, stability, and coordination.

By focusing on functional movement patterns and challenging exercises, rather than only stretching, you train your body to move efficiently, reduce injury risk, and enhance performance in both daily life and sports. Incorporating mobility training into your routine bridges the gap between passive flexibility and active, controlled movement, allowing you to move freely, confidently, and without limitation.

At Muscle and Motion, we believe that knowledge is power, and understanding the ‘why’ behind any exercise is essential for your long-term success.

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This Muscle and Motion article will review the latest evidence about why lifting with a flexed spine is not harmful. We hope we will encourage you to try different lifting techniques that will enable you to more comfortably lift objects and will help you find a way to continue functioning even if you’re having pain during a certain lift.

Tracing the belief: Where did the idea of harmful spinal flexion during lifting begin?

The idea that spinal flexion can be harmful came from biomechanical studies on corpses (humans and animals). Those studies showed that loading a spinal motion segment when it is out of neutral appears to be more damaging to the disc than loading it in neutral.[1,2,3,4] Because of those studies, for years, we told people to squat and lift with a “straight back,” but low back pain still remained quite common.[5]

Defining a neutral spine

Before reviewing studies on living humans and exploring if spinal flexion leads to injuries, we should ask what lifting with a neutral spine looks like and if it is even possible. To assess spinal flexion, we need to measure the difference in flexion of the sacrum versus the amount of flexion at L1.

A neutral spine zone is typically breached if the spine is flexed more than 35% of its range of motion. Given that the average human has an active lumbar flexion range of 55 degrees, approximately 19 degrees represents the threshold at which spines exit the neutral zone. Studies have shown that even when individuals attempt to maintain a neutral or lordotic spine during exercises, a significant degree of spinal flexion occurs.[6]

Inevitability of spinal flexion

Even if it appears that a person is exercising with a neutral spine, they are often inadvertently flexing it, and avoiding this flexion is virtually impossible.[7] For instance, individuals attempting to squat with a neutral spine typically achieve about 50% of maximal spinal flexion, while those deadlifting with a neutral spine can still exhibit around 80% of maximal spinal flexion.[8]

Many studies have shown that even when people try to maintain a neutral or lordotic spine during different exercises, they have a lot of flexion in the spine.[8] 

Absence of evidence for harm

To date, there is no conclusive data linking spinal flexion to disc herniation in living human subjects. In fact, available evidence suggests that discs can herniate at similar rates in both spinal flexion and neutral spine positions.[9] A systematic review conducted in 2020 found that all the cross-sectional studies detected no difference in lumbar spine positioning during lifting between participants with and without lower back pain.

Furthermore, there was no difference in peak lumbar flexion, increased disc compression, or shear forces when lifting with more spinal flexion. Consequently, the researchers concluded that there was no longitudinal relationship between increased spinal flexion and either the persistence or onset of lower back pain.[10]

Can we visually discern lower lumbar flexion with our naked eyes?

Here is a question for you: Can you see which of the lifting styles in the picture have more flexion in the lower lumbar spine? The stoop or the squat style?

If you guessed that one of the styles has more flexion in the lower lumbar region, you were incorrect! Both styles exhibit similar levels of flexion in the lower lumbar region. Any additional spinal flexion observed predominantly arises from the upper lumbar or thoracic regions. [11]

Considering that over 90% of herniated discs occur in the L4-L5 or L5-S1 discs, which are in the lower lumbar region, it implies that the specific lifting movement may not have a substantial impact.[12]

In summary, achieving a truly neutral spine during lifting seems unattainable, as even attempts to do so result in some degree of flexion. Contrary to previous beliefs, flexing the spine during various exercises is not a risk factor for lower back pain or injury in living individuals. In fact, flexing the spine is sometimes employed as a rehabilitation exercise. 

It’s crucial to recognize that everyone’s spine is unique, and there is no universally applicable lifting technique.

Before you modify your lifting technique or introduce new movement patterns into your routine, taking a gradual approach is highly recommended. Allowing your body to strengthen progressively as you move forward is safer than attempting to adopt a completely different lifting style with heavy weights right from the start.

Ever wondered what makes our anatomical animations so accurate and engaging? Click here to learn about our Quality Commitment and the experts behind our content.

At Muscle and Motion, we believe that knowledge is power, and understanding the ‘why’ behind any exercise is essential for your long-term success.
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Reference:

1. Schollum, M. L., Wade, K. R., Shan, Z., Robertson, P. A., Thambyah, A., & Broom, N. D. (2018). The influence of concordant complex posture and loading rate on motion segment failure: A mechanical and microstructural investigation. Spine, 43(19), E1116–E1126.

2. Wade, K. R., Schollum, M. L., Robertson, P. A., Thambyah, A., & Broom, N. D. (2017). A more realistic disc herniation model incorporating compression, flexion and facet-constrained shear: a mechanical and microstructural analysis. Part I: Low rate loading. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 26(10), 2616–2628.

3. Wade, K. R., Robertson, P. A., Thambyah, A., & Broom, N. D. (2014). How healthy discs herniate: a biomechanical and microstructural study investigating the combined effects of compression rate and flexion. Spine, 39(13), 1018–1028.

4. Berger-Roscher, N., Casaroli, G., Rasche, V., Villa, T., Galbusera, F., & Wilke, H.-J. (2017). Influence of complex loading conditions on intervertebral disc failure. Spine, 42(2), E78–E85

5. van Dieën, J. H., Hoozemans, M. J., & Toussaint, H. M. (1999). Stoop or squat: a review of biomechanical studies on lifting technique. Clinical Biomechanics (Bristol, Avon), 14(10), 685–696.

6. Callaghan, J. P., & McGill, S. M. (2001). Intervertebral disc herniation: studies on a porcine model exposed to highly repetitive flexion/extension motion with compressive force. Clinical Biomechanics (Bristol, Avon), 16(1), 28–37.

7. Montgomery, T., Boocock, M., & Hing, W. (2011). The effects of spinal posture and pelvic fixation on trunk rotation range of motion. Clinical Biomechanics (Bristol, Avon), 26(7), 707–712.

8. Edington C. “Lumbar spine kinematics and kinetics during heavy barbell squat and deadlift variations” (Doctoral dissertation), University of Saskatchewan Saskatoon; 2017.

9. Veres, S. P., Robertson, P. A., & Broom, N. D. (2010). ISSLS prize winner: how loading rate influences disc failure mechanics: a microstructural assessment of internal disruption. Spine, 35(21), 1897–1908. 

10. Saraceni, N., Kent, P., Ng, L., Campbell, A., Straker, L., & O’Sullivan, P. (2020). To flex or not to flex? Is there a relationship between lumbar spine flexion during lifting and low back pain? A systematic review with meta-analysis. The Journal of Orthopaedic and Sports Physical Therapy, 50(3), 121–130.

11. van Dieën, J. H., Hoozemans, M. J., & Toussaint, H. M. (1999). Stoop or squat: a review of biomechanical studies on lifting technique. Clinical Biomechanics (Bristol, Avon), 14(10), 685–696.

12. Donnally, C. J., III, Butler, A. J., & Varacallo, M. (2022). Lumbosacral Disc Injuries. In StatPearls [Internet]. StatPearls Publishing.

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Clients, patients, and athletes may develop static and dynamic postural deviations for many different reasons. Postural deviations may be due to repetitive movements associated with the client or patient’s occupation, hobbies, or sport. These deviations could also be due to prolonged periods of static postures, such as standing or sitting. These repetitive movements and/or prolonged static postures can lead to muscular imbalances, and in turn, may lead to tissue trauma, inflammation, and pain over time.

This Muscle & Motion article will explore a common static postural deviation termed upper crossed syndrome.[1]

We will also cover the muscular imbalances associated with upper crossed syndrome. As well as an effective strength training exercise to assist with correcting these muscular imbalances and static postural deviation in an attempt to decrease risk of injury and improve performance.

Upper Crossed Syndrome

It is crucial to note that not all cases of upper crossed syndrome result in pain. The causes of back and neck pain are multifaceted and cannot be attributed solely to a single factor. Instead, they involve a complex interaction of biological, psychological, and social factors that vary from person to person. These factors are not mutually exclusive and can influence one another. Let’s dive into the mechanical theory behind upper crossed syndrome:

When assessing static posture from a lateral view, the ideal posture of the thoracic spine, shoulder girdle, shoulder joint, and head and neck are to be in a neutral position. This neutral position is characterized by: a normal kyphotic curve of the thoracic spine, neutrally positioned scapulae (i.e., not protracted and/or anteriorly tilted), shoulder joint in line with the hip, knee, and ankle joints and not internally rotated, and the ear in line with the shoulders.[2]

Individuals with upper crossed syndrome commonly exhibit an excessive kyphotic curve, protracted and/or anteriorly tilted scapulae (i.e., rounded shoulders), possibly internally rotated shoulders (i.e., elbows pointed laterally and palms facing posteriorly), and a forward head where there is excessive cervical flexion and capital/cranial extension with the head jutting forward and the ear falling in front of the shoulder joint.[1] 

Please note that some clients may not exhibit all of these postural deviations of upper crossed syndrome together. For example, a client may exhibit an ideal kyphotic curve and scapulae and shoulder joint posture, but exhibit forward head posture.

With upper crossed syndrome, the pectoralis major and minor, the latissimus dorsi, teres major, and subscapularis are commonly in a shortened position, along with the suboccipital muscles, upper trapezius, and levator scapulae. Whereas the deep cervical flexors that draw the chin in towards the spine, as well as the rhomboids and middle fibers of the trapezius, are commonly in a lengthened position.[1] Thus, this static posture deviation being termed by Vladimir Janda as “upper crossed syndrome”.[1]

Upper crossed syndrome has been associated with rotator cuff pathologies, biceps tendonitis, and shoulder joint instability.[1] Whereas forward head posture may lead to mid- to upper-back pain, neck pain, thoracic outlet syndrome, temporomandibular disorders, and tension headaches.[1]

Effects of Upper Crossed Syndrome on the Musculoskeletal System

With upper crossed syndrome the protractors of the scapulothoracic articulation/scapulae (i.e., specifically the pectoralis minor) and the internal rotators of the shoulder joint (i.e., pectoralis major, latissimus dorsi, teres major, and subscapularis) are commonly in a shortened position, it may be advisable to try to address this with utilizing modalities to assist in increasing muscle flexibility and joint range of motion, such as self-myofascial rolling, static stretching, and dynamic stretching. 

Conversely, on the back side of the body, the retractors of the scapulothoracic articulation/scapulae (i.e., rhomboids and middle fibers of the trapezius), as well as the external rotators of the shoulder joint (i.e., infraspinatus, teres minor, and fibers of the posterior deltoid) are commonly lengthened and should be addressed through strengthening exercises. Due to the synergistic relationship between the scapulothoracic articulation of the scapulae on the ribcage and the shoulder joints, scapular protraction naturally accompanies shoulder external rotation, specifically during greater degrees of external rotation.[3]

Because individuals with upper crossed syndrome exhibit rounded shoulders, exercises that focus on strengthening the scapular retractors and shoulder external rotators could be beneficial to include in these individuals’ exercise programs. Retraction can be accomplished with isolated scapular retraction exercises or any multi-joint horizontal pulling/rowing exercises (e.g., seated rows, inverted rows, and reverse flys).

Whereas shoulder external rotation can be accomplished through a variety of strength training exercises within various planes of motion utilizing multiple modalities, such as bands, dumbbells, weighted balls, and even suspension trainers.

Shoulder External Rotation (Mini Band) with Scapular Retraction 

Many shoulder external rotation exercises are commonly performed unilaterally. However, if a fitness professional is looking for an exercise that strengthens both shoulders’ external rotators, as well as the scapular retractors simultaneously, the bilateral shoulder external rotation with scapular retraction exercise with a band can be the perfect exercise. 

Step by step on how to do this exercise:

• To perform this strength training exercise, the client will stand with the feet shoulders’ width apart 
• The client should tuck the chin in towards the spine (not down towards their chest) to where the ears are in line with their shoulders. 
• The client should then draw the belly button in towards the spine while bracing the abdominals to restrict any compensatory movement at the lumbar spine (e.g., excessive lumbar extension or lordosis) while performing the exercise due to relative flexibility. 
• The client will stabilize the scapulae by bringing them back and down (i.e., slight retraction with depression). 
• Then the client will grab the band with both hands and firmly tuck their elbows into their sides as if they were holding a playing card between their upper arm and their torso.
• The client will externally rotate both shoulders, while simultaneously retracting their scapulae when approaching the end range of motion of shoulder external rotation.
• The client can use a one- to two-second concentric contraction (i.e., external rotation and retraction), a two-second isometric contraction while in external rotation and retraction, and a two-second eccentric contraction returning to the start position. 
• Due to the scapular retractors and shoulder external rotators being primarily responsible for muscular endurance and stabilization, as opposed to strength or power, it is recommended that 1-2 sets of 12-15 repetitions be performed. 
• Please note that this exercise can serve as a great movement preparation exercise prior to common upper-body resistance training exercises (e.g., chest press, shoulder press, lat pulldowns, and seated rows).

Common Movement Compensations

One common compensation seen while performing this exercise is the client performing excessive retraction to compensate for a lack of or weakness of shoulder external rotation. Although the client does want to retract the scapulae during initial shoulder external rotation, it should be a natural synergistic movement towards the end of shoulder external rotation range of motion. Therefore, shoulder external rotation should not be compromised in leu of excessive or exaggerated protraction and retraction of the scapula.

Another common compensation, possibly due to a lack of shoulder external rotation range of motion and/or strength, is the client performing shoulder abduction while attempting to externally rotate their shoulders.

The fitness professional will know if the client is abducting their shoulder joints if their elbows come away from the sides of their torso while performing external rotation and the imaginary playing card would fall to the floor. A good way to control for this compensation may be placing something like a folded towel under each arm between the client’s upper arm and torso. If the towel falls to the floor, the client is most likely abducting their shoulder joint too much.

If the client lacks the final degrees of scapular retraction during maximal shoulder external rotation, the client may exhibit excessive extension/lordosis in the lumbar spine due to relative flexibility.

Another compensation seen in the spine during this exercise may be a jutting movement of the head forward into cervical flexion with capital/cranial extension during the final degrees of shoulder external rotation and scapular retraction. 

Again, the client may exhibit this movement compensation due to a lack of scapular retraction toward the final degrees of the movement.

A Great Exercise for Pretty Much Everyone

Although this is just one of many exercises to assist in addressing upper crossed syndrome, it is a great exercise. This exercise can be extremely useful for individuals who sit for extended periods of time, as well as overhead athletes (e.g., baseball, softball, and volleyball) whose sports require forceful shoulder internal rotation with scapular protraction and anterior tilting.

1. Page, P., Frank, C., & Lardner, R. (2010). Assessment and treatment of muscle imbalance: The Janda approach (pp. 52-53). Human Kinetics.
2. Conroy, V. M., Murray, B., Alexopulos, Q. T., & McCreary, J. B. (2024). Kendall’s muscles: Testing and function with posture and pain (6th ed.) (pp. 37). Wolters Kluwer
3.  Floyd, R. T. (2021). Manual of structural kinesiology (21st ed.) (pp. 120). McGraw Hill.

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In this detailed Muscle and Motion article, we will delve into the significance of postural assessment, its key components, and how you can implement it into your practice.

What Is Posture?

Posture refers to the relative positioning of the body’s joints at a given moment. Each joint’s position influences the positions of other joints.

The “best posture” is the position that applies minimal stress to each joint, promoting optimal alignment and balance. On the other hand, faulty posture refers to any static position that increases pressure on the joints.

Posture can be classified into two categories: static posture and dynamic posture.

• Static posture involves maintaining specific positions of the body and its segments, such as standing, sitting, lying, or kneeling. 
• Dynamic posture, on the other hand, involves movement of the body or its segments, such as walking, running, jumping, throwing, or lifting.
  

How Should Optimal Posture Look?

Proper posture relies on the alignment of the spine, which includes four natural curves in the sagittal plane: the cervical curve, thoracic curve, lumbar curve, and sacral curve. It is essential to maintain these curves without exaggeration to achieve correct posture. In this position, the head should be directly above the shoulders, and the top of the shoulders should align with the hips.

Achieving proper alignment and balance is crucial for maintaining good posture. The line of gravity plays a significant role in determining the optimal positioning of the body. It should pass through specific points, ensuring even weight distribution.

The following points indicate where the line of gravity passes in the sagittal plane:

• Ear: Passes through the ear lobe.
• Shoulder: Passes through the shoulder joint.
• Hip: Passes through the hip joint.
• Femur: Passes through the greater trochanter of the femur.
• Knee: Slightly anterior to the midline of the knee joint.
• Ankle: Anterior to the lateral malleolus.

It is essential to distribute body weight evenly over both feet to maintain proper alignment and balance. These guidelines serve as a valuable reference for assessing and maintaining ideal posture. To learn more about the ideal posture in each plane, check out our Posture APP.

How To Assess Posture? 

Assessing posture involves a comprehensive evaluation of the alignment and positioning of various body parts. Here are some common methods used to assess posture

• Visual Observation
  The first step is to visually observe the individual’s posture from different angles, including standing, lying on the stomach, or lying on the back. Look for any asymmetry, misalignments, or deviations from the ideal posture.

• Plumb Line
  Using a plumb line or a vertical reference, align it with specific anatomical landmarks, such as the earlobe, shoulder joint, hip joint, knee joint, and ankle joint. Assess whether these landmarks fall in line with the plumb line or deviate from it. To learn more about the anatomical landmarks, check out our video on Ideal Postural Alignment in the Median Axis.

• Functional Movement Assessment
  Evaluate how the individual moves and performs functional movements, such as squatting, bending, side flexing, spine rotation, or walking. Observe for any compensations, limitations, or imbalances during these movements.

To deepen your knowledge of postural assessment, biomechanics, and the treatment of various postural disorders, we recommend exploring our Posture APP.

Our app offers comprehensive instructions for each assessment test and provides valuable insights for their application in a professional context. Using our Posture APP, you can gain practical expertise and enhance your ability to evaluate and address postural issues effectively.

Use our app today to expand your understanding and improve your professional practice.

At Muscle and Motion, we believe that good posture is essential for your long-term health and well-being.
Our Posture App can help you improve your posture and reduce pain. Sign up for free today!

Written by:

Uriah Turkel, Physical Therapist and Content Creator at Muscle and Motion.
Uriah’s areas of expertise are anatomy, kinesiology, sports rehabilitation, gait analysis, and rheumatology.

Dr. Gill Solberg, “Muscle and Motion” Posture & Yoga apps Co-Founder.

The post Postural Assessment appeared first on Muscle & Motion | Visual Anatomy & Biomechanics.

The Importance of Performing a Static Postural Assessment With Clients 

Over the last decade or so, assessing clients’, patients’, and athletes’ static and dynamic posture has become a common practice during initial and follow-up health and fitness assessments. This has been a great step forward for the field of health and fitness and assisting practitioners (e.g., personal trainers, strength and conditioning coaches, athletic trainers, etc.) in spotting possible static postural deviations and/or movement compensations that may eventually lead to injury and/or performance decrements.

This Muscle and Motion article briefly describes how to assess the foot and ankle region during a static postural assessment to prevent the chain effects of foot overpronation. As well as how static deviations, such as foot overpronation, can lead to unwanted and potentially dangerous static postural deviations throughout the kinetic chain (i.e., knees, hips, pelvis, and lumbar spine) that may result in both acute and/or chronic musculoskeletal conditions.  

How to Assess Static Ankle and Foot Posture 

When assessing the foot and ankle region, the practitioner should assess the client primarily from the anterior view (Figure 1). Please note, assessing the client from the posterior view could assist the practitioner in confirming findings from the anterior view (Figure 2). The use of a plumb line as a point of reference could assist with assessing other regions of the body and identifying deviations and asymmetries. If a plumb line is unavailable, a posture grid or even lining the client up to a vertical line on the wall behind them can also work.  

A plumb line is a cord or string with a plumb bob suspended from the ceiling to create an absolute vertical line. When using the plumb line from the anterior and posterior views, the plumb line should be aligned with the bob suspended midway between the feet and should divide the client equally into left and right halves.[1] The client should be asked to step up to the plumb line (if used) and to stand naturally. Some practitioners have used techniques such as having the client “shake out their body” or perform a few miniature squats to help the client feel more comfortable and relaxed in an attempt to have the client exhibit a more natural, everyday posture.  

Figure 1

Figure 2

What is an “Ideal” Foot and Ankle Static Posture?

When assessing the foot and ankle region from the anterior view, the client should be unshod (i.e., no footwear, but socks are acceptable), their feet should be straight or slightly pointed outward, the foot should exhibit a neutral medial longitudinal arch (i.e., not too high of an arch and not too low or flattening of the arch), and the ankle should be in a neutral position (i.e., not plantar or dorsiflexed) (Figure 3). It is important to mention that foot pronation during movements like gait, squatting, and lunging is completely natural.

Figure 3

Foot Pronation vs. Overpronation

Pronation is a tri-planar static position or movement resulting from a combination of ankle
dorsiflexion, subtalar eversion, and forefoot abduction (i.e., toes slightly turning out).[2] However, when the foot has too much of these joint actions, either statically or dynamically, it is known as foot overpronation (Figure 4). Foot overpronation has been coined “pronation distortion syndrome” and “pes planus distortion syndrome”, which is commonly referred to as “flatfeet” due to the decrease or flattening of the medial longitudinal arch of the foot.[3]

Figure 4

Be Patient When Assessing Static Posture

Deviations from a normal foot and ankle static posture from an anterior and posterior view could be subjectively described as slight, moderate, or marked.[4] However, if the practitioner feels conflicted as to if the foot overpronation is slight or even moderate, the practitioner need not panic. Signs of foot overpronation will become much more apparent during further assessment via movement screens like the overhead squat assessment, single-leg squat assessment, and gait. If the practitioner witnesses either unilateral or bilateral overpronation, they should note this in their health and fitness assessment documentation and keep this information in mind as they continue their static and dynamic postural assessments.

Their Effects Foot Overpronation on the Kinetic Chain: Knees and Hips 

Because the human body is comprised of an interlinked skeletal system chain, as well as subsystems consisting of muscles, tendons, and fascia, a postural deviation at one region of the body can in some cases have an effect on the region above and/or below that region. This has been referred to as the “regional interdependence model” or “RI”. [5] For example, foot overpronation can lead to compensations upward throughout the kinetic chain. With foot overpronation, it is common for the client’s knees to move inward within the frontal plane, also referred to as knee or genu valgus or valgum, also known as “knock knees” (Figure 5). Moving up from the knee joints, the client’s hips will commonly adduct and internally rotate creating an excessive inward angle of the femur from the hip joint to the knee joint. Individuals, specifically women, naturally have an inward angle of the femur, also known as the quadriceps or Q-angle, due to a naturally wider pelvis when compared to males. However, foot overpronation can lead to an even greater angle, increasing the risk of both acute (e.g., ACL tears, MCL tears, and meniscus injuries) and chronic (e.g., patellar tendonopathy, patellofemoral pain syndrome, chondromalacia, and osteoarthritis) knee injuries. [6] 

Figure 5

Their Effects Foot Overpronation on the Kinetic Chain: Lumbo-Pelvic Hip Complex 

In addition to knee valgus, hip adduction, and hip internal rotation, clients with foot overpronation may exhibit slightly flexed hips, combined with an excessive anterior pelvic tilt and excessive lordosis of the lumbar spine when assessing the client’s static posture from a lateral view (Figure 6). Although it is common for asymptomatic individuals to possess a slight anterior pelvic tilt and a natural lordosis of the lumbar spine, an excessive pelvic tilt and lumbar lordosis, also known as “lower crossed syndrome” or “pelvic crossed syndrome”, may lead to multiple musculoskeletal conditions within those regions, including multiple low back pain syndromes.[7] This is once again an example of the concept of the regional interdependence model with something believed to be as simple as foot overpronation leading to a possible debilitating condition such as chronic nonspecific low back pain.[8]  

Figure 6

A Static Posture Assessment is Just the Beginning 

Although assessing the static posture of the foot and ankle region is just the beginning of a comprehensive assessment of the human body both statically and dynamically, it is a key element to the static postural assessment. Therefore, if practitioners do not currently assess their clients’ static and dynamic postures, it would benefit both the practitioner and their clients by incorporating static and dynamic postural assessments into their health and fitness assessments. This will assist the practitioner in developing an individualized exercise program for their client in an attempt to decrease the risk of injury and improve performance.  

At Muscle and Motion, we believe that good posture is essential for your long-term health and well-being. Our Posture App can help you improve your posture and reduce pain. Sign up for free today!

References: 

1. Cameron, M. H. & Monroe, L. J. (2007). Physical rehabilitation: Evidence-based examination, evaluation, and intervention. Elsevier.  
2. Floyd, R. T. (2024). Manual of structural kinesiology (22nd ed.). McGraw Hill. 
3. National Academy of Sports Medicine (2022). Static assessment. In R. Fahmy (Ed.), NASM essentials of corrective exercise training (pp. 184-210). (2nd ed.). Jones & Bartlett Learning. 
4. Kendall, F. P., McCreary, E. K., Provance, P. G., Rodgers, M. M., & Romani, W. A. (2005). Muscles: Testing and function with posture and pain (5th ed.). Lippincott Williams & Wilkins. 
5. Sueki, D. G., Cleland, J. A., &Wainner, R. S. (2013). A regional interdependence model of musculoskeletal dysfunction: Research, mechanisms, and clinical implications. The Journal of Manual & Manipulative Therapy, 21(2), 90–102. https://doi.org/10.1179/2042618612Y.0000000027  
6. National Academy of Sports Medicine (2022). Corrective strategies for the knee. In R. Fahmy (Ed.), NASM essentials of corrective exercise training (pp. 320-349). (2nd ed.). Jones & Bartlett Learning. 
7. Key, J. (2010). The pelvic crossed syndromes: A reflection of imbalanced function in the myofascial envelope; A further exploration of Janda’s work. Journal of Bodywork and Movement Therapies, 14(3), 299–301. https://doi.org/10.1016/j.jbmt.2010.01.008  
8. O’Leary, C. B., Cahill, C. R., Robinson, A. W., Barnes, M. J., & Hong, J. (2013). A systematic review: the effects of podiatrical deviations on nonspecific chronic low back pain. Journal of Back and Musculoskeletal Rehabilitation, 26(2), 117–23. https://doi.org/10.3233/BMR-130367   

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Understanding flat back posture:

Flat back, or fixed sagittal imbalance, refers to a postural spinal imbalance or deformation in the sagittal plane where the normal lumbar lordotic curve is reduced. This condition affects the spine’s natural alignment and can have functional implications. Normally, the spinal curves, including cervical lordosis, thoracic kyphosis, and lumbar lordosis, provide benefits such as reducing skeletal loads, increasing range of motion, and improving balance by aligning the center of gravity on the support base of the legs.

In a flat back posture, the lumbar lordotic curve is decreased compared to the norm, leading to a greater posterior pelvic tilt and a smaller lumbosacral angle than usual. The lumbosacral angle is formed by the connection between the spine and the pelvis, specifically between vertebrae L5-S1, and typically measures around 40 degrees.

A faulty flat back position has a noticeable lumbar lordosis flattening, a prominent posterior pelvic tilt, and a reduced lumbosacral angle. This can result in a straight appearance of the lower back, even though the pelvis may be in a normal neutral position.

What causes a flat back?

The term ‘flat back syndrome’ has been broadened to encompass any patient who exhibits symptoms resulting from a reduced inward curvature of the lower spine.

Other potential causes and risk factors associated with flat back syndrome include:

• Congenital: Flatback syndrome can also be present from birth (congenital), where a baby is born with an underdeveloped vertebrae.
• Harrington rod procedure, which is a spinal fusion treatment for scoliosis, is often associated with Flatback syndrome. This procedure can result in various issues such as compensatory effects, degeneration of nearby discs, difficulties with standing, disability, and persistent back pain.
• Degenerative disc disease: Conditions such as ankylosing spondylitis and rheumatoid arthritis can contribute to the development of a flat back syndrome.
• Vertebral compression fractures: Osteoporosis can lead to fractures in the vertebrae, affecting the spine’s alignment and resulting in flatback syndrome.
• Lumbar post-laminectomy syndrome: After undergoing a laminectomy for spinal stenosis, some individuals may experience flatback syndrome as a complication.

Why does flat back posture contribute to back pain? 

It is crucial to note that not all cases of flat-back posture result in back pain. The causes of back pain are multifaceted and cannot be attributed solely to a single factor. Instead, they involve a complex interaction of biological, psychological, and social factors that vary from person to person. These factors are not mutually exclusive and can influence one another. Let’s dive into the mechanical theory behind flat-back pain:

• Impaired shock-absorbing mechanism of the spine: 

The spine’s natural curves help absorb shocks during dynamic activities like walking, running, and jumping. In flatback posture, this mechanism is compromised, disrupting the shock absorption process and the appearance of back pain symptoms.

• Limited spinal mobility during flexion: 

In normal forward flexion, the lumbar curve integrates with the thoracic curve, allowing for a greater range of movement. However, in flatback posture, there is limited mobility and range of movement in the lower back (L1-L5 vertebrae) due to the absence of a continuous arch and integration of curves during flexion. This results in sagittal movement with large levers, increasing the load on the axis area and contributing to back pain.

To learn more about this, see the video on testing the continual arch.

• Increased pressure on the intervertebral discs in the lower back: 

The intervertebral discs in the lumbar spine serve as shock absorbers. However, in a flat-back posture, the anatomical structure of the spine is altered, causing increased pressure on the intervertebral discs. 

Want to learn more about reasons that may contribute to flat back and back pain? Check out our video about Reasons for back pains in flat back.

How to diagnose flat back 

A comprehensive medical history should be obtained to accurately diagnose flat back posture to identify any underlying causes that may contribute to this condition. During the physical examination, it is important to assess the spinal curvatures in various positions, including lying down, standing, sitting, or bending. Special tests such as Adam’s forward bend test and Schober’s test can provide additional information regarding the degree of curvature. If flat back posture is suspected, X-rays or other imaging tests might also be conducted to measure the extent of the curvature and rule out any other underlying conditions. These diagnostic procedures help to confirm the diagnosis and guide appropriate treatment options.

Common characteristics of flat back: 

Common muscular characteristics observed in individuals with flat back posture include

• Anterior and posterior pelvic tilt rigidity in the sagittal plane.
• Tight hamstrings, contributing to posterior pelvic tilt.
• Weakness in the hip flexor muscles leads to lengthening and weakness in the muscles involved in anterior pelvic tilt, such as the iliopsoas and rectus femoris.

Treatment of flat back:

Based on these characteristics, exercises for individuals with flat back posture may include:

• Exercises to improve overall mobility of the lower back vertebrae.
• Stretching exercises explicitly target the hamstring muscles to promote lengthening.
• Strengthening exercises focusing on the muscles involved in an anterior pelvic tilt.

To deepen your understanding of flat back and optimize your treatment for this condition, we highly recommend downloading our Posture APP.  Our Posture APP will provide valuable insights and practical guidance with 3D illustrations on diagnosing and treating flat back and other postural disorders. Don’t miss out on this invaluable tool to enhance your diagnostic abilities and treatment knowledge.

At Muscle and Motion, we believe that good posture is essential for your long-term health and well-being. Our Posture App can help you improve your posture and reduce pain. Sign up for free today!

Written by Uriah Turkel, Physical Therapist and Content Creator at Muscle and Motion. Uriah’s areas of expertise are anatomy, kinesiology, sports rehabilitation, gait analysis, and rheumatology.

And Dr. Gill Solberg, “Muscle and Motion” Posture & Yoga apps Co-Founder.

The post Understanding Flat Back Syndrome appeared first on Muscle & Motion | Visual Anatomy & Biomechanics.

What is Lordosis?

Lordotic position refers to an abnormal inward curvature of the lumbar spine, resulting in an exaggerated arch in the lower back.

Usually, there is a slight to moderate lordosis in the lumbar vertebrae (L1-5) with a slight anterior pelvic tilt. The lumbosacral angle, which is the angle between the lumbar vertebrae (L5-S1) and the pelvis, is typically around 40 degrees.

However, in a deformed condition of lordosis, there is a prominent concavity in the lumbar vertebrae, an increased anterior pelvic tilt, and often an increased lumbosacral angle.

The lumbosacral angle plays a significant role in lordosis. An angle greater than the norm indicates increased lordosis, while an angle less than the norm indicated reduced lumbar lordosis and is characteristic of a flat back.

What Causes Lordosis?

Lordotic posture can be caused by various factors, including:

• Lack of muscular balance: 

Imbalances in muscle tension can contribute to an anterior pelvic tilt, leading to a lordotic position. Tense muscles, such as the iliopsoas, rectus femoris, and quadratus lumborum, can cause an anterior pelvic tilt, while weak muscles can result in a posterior pelvic tilt.

• Particularly weak abdominal muscles:

Insufficient strength in the abdominal muscles can contribute to an imbalance in pelvic alignment and increase the likelihood of lordotic posture. The gluteus maximus and hamstrings should also be considered for their role in pelvic stability.

• Genetic or acquired structural changes: 

Some individuals may have structural abnormalities in the lumbar vertebrae, such as spondylolysis, spondylolisthesis, and spinal stenosis, contributing to a lordotic posture.

• Faulty movement patterns and lack of body awareness:

Poor movement habits and a lack of body awareness can contribute to adopting a lordotic posture.

• Chain reactions in the lower extremities:

Abnormalities in the lower extremities, such as hyperextension of the knees, can create a chain reaction of compensatory adjustments in the spine and pelvis, potentially leading to a lordotic posture.

How to Diagnose Lordosis? 

During a physical examination, you should check and assess the spine curvatures in various positions, such as: laying down, standing, sitting, or bending.  After you establish the patient has lumbar lordosis, you should check which is the underlying cause of the condition, including muscle weakness or shortness, vertebral deformities and more.  X-rays or other imaging tests may also be performed to measure the degree of curvature and rule out other underlying conditions.

Common Characteristics of Lordosis: 

1. Exaggerated curvature of the lumbar spine.
2. Protruding abdomen and buttocks.
3. Anterior pelvic tilt.
4. Tight hip flexor muscles.
5. Weak abdominal muscles.
6. Limited mobility in the lumbar spine.
7. Potential discomfort or pain in the lower back.

Treatment of Lordosis:

The treatment approach for lordosis depends on the underlying cause and the physical findings observed during the examination. It typically involves targeting weak muscles for strengthening and stretching shortened muscles to alleviate pain and improve functionality. While exercises cannot fix lordosis, research has indicated their effectiveness in relieving pain and enhancing overall function. 

To enhance your understanding of physical assessment for lordosis and other postural disorders, as well as improve your ability to provide effective treatment to your clients, we suggest exploring our Posture APP.

Our Posture APP provides detailed instructions on each test and offers practical insights for their implementation in your professional setting. 

At Muscle and Motion, we believe that good posture is essential for your long-term health and well-being. Our Posture App can help you improve your posture and reduce pain. Sign up for free today!

Written by Uriah Turkel, Physical Therapist and Content Creator at Muscle and Motion.
And Dr. Gill Solberg, “Muscle and Motion” Posture & Yoga apps Co-Founder

The post Lordosis appeared first on Muscle & Motion | Visual Anatomy & Biomechanics.

What is kyphosis?

Kyphotic position refers to a condition with excessive curvature in the thoracic vertebrae that may lead to a rounded back and other associated postural changes. Kyphosis is also likely to create increased curvatures in the cervical and lumbar areas of the spine as a result of compensatory processes by the body. The therapeutic approach and potential for improvement depend on a systematic diagnostic procedure that considers the severity of the deformity and identifies whether it is structural or functional in nature.

What causes kyphosis?

Depending on the type, Kyphosis can be caused by various factors:

• Postural: Poor posture, such as frequently leaning back in chairs or carrying heavy bags.
• Structural: Structural issues in the spine such as Scheuermann’s disease
• Congenital: Abnormal spine development that occurs before birth.

Furthermore, kyphosis can arise from two additional causes:

• Aging: As individuals age, there is a natural tendency for the spine to develop a more pronounced curvature.
• Spinal injury: Trauma or damage to the spine can contribute to the development of kyphosis.

How to diagnose kyphosis

In a normal situation, the spine exhibits a range of normal curves. Typically, there is a slight to moderate kyphosis, which is a natural curvature observed in the thoracic vertebrae (T1-12). Kyphosis may first be detected during a general postural screening at school or by adolescents or their parents noticing a spine rounding.

During a physical examination, a healthcare provider will assess the spine. This may include the “Adam’s forward bend test,” where you are asked to bend forward with feet together, knees straight, and arms hanging freely. This test helps the clinician identify spinal curves or any other spine-related issues, such as scoliosis (a sideways curvature of the spine). In such cases, seeking a complete diagnosis from a healthcare provider is advisable. Check out this video to see how kyphosis would look in this test.

To accurately measure the spinal curve, a spine X-ray may be performed. The normal range for spinal kyphosis falls between 30 and 40 degrees. In cases of hyperkyphosis, excessive convexity measures 45 degrees or more.

Common characteristics of kyphosis: 

1. Rounded back with an exaggerated thoracic curve.
2. Forward-slouched shoulders and protracted scapulae.
3. Forward head posture.
4. Thoracic rigidity or stiffness, particularly in extension and rotation.
5. Difficulty in straightening and extending the thoracic vertebrae.
6. Compensatory actions including shoulder raising, anterior pelvic tilt, and chin elevation.
7. Scapular protraction due to shortening of the pectoralis minor muscle.
8. Anterior arm tilt, primarily caused by shortening of the pectoralis major muscle.
9. Structural kyphosis is more prominent when lying down.
10. Rigid kyphosis is also noticeable during spinal rotation in the horizontal plane.
11. Shortened chest muscles, namely the pectoralis major and pectoralis minor.
12. Weakness in the deep erector spinae muscles and scapular retractors.
13. Greater curves may develop in the cervical and lumbar vertebrae due to compensatory processes.
14. Shortened cervical extensors and sternocleidomastoid muscles (SCM).
15. Limited chest cavity mobility leads to shallow breathing.
16. Shortened hamstrings.
17. Reduced body awareness.

Treatment of Kyphosis

The therapeutic approach and determination of the potential for improvement rely on a systematic diagnostic procedure that evaluates the severity of the deformity and identifies its underlying cause, whether structural or functional.

When addressing functional kyphosis, treatment should encompass two main components: targeted mobilization of the thoracic vertebrae, either actively or passively depending on the nature of the deformity and primarily involving the extension of the vertebrae in the sagittal plane, and strengthening of the erector spinae muscles in the sagittal plane.

To deepen your understanding of kyphosis and optimize your treatment for this condition, we highly recommend downloading our Posture APP. 

Our Posture APP will provide valuable insights and practical guidance with 3D illustrations on diagnosing and treating kyphosis and other postural disorders.

Don’t miss out on this invaluable tool to enhance your diagnostic abilities and treatment knowledge.

At Muscle and Motion, we believe that good posture is essential for your long-term health and well-being. Our Posture App can help you improve your posture and reduce pain. Sign up for free today!

Written by Uriah Turkel, Physical Therapist and Content Creator at Muscle and Motion.

The post Kyphosis appeared first on Muscle & Motion | Visual Anatomy & Biomechanics.