In an ideal static posture is one where all body parts are aligned vertically so that the line of gravity (LoG) passes through all joint axes, however normal body structure and interpersonal deviations make this nearly impossible (Levangie & Norkin, 2011). The goal of the “ideal posture” is to minimize energy expenditure and stress on the supporting structures. Even with an ideal erect posture, swaying motions occur which change the line of gravity (LoG) over the center of pressure (CoP) (Levangie & Norkin, 2011). Postures that attempt to minimize or correct deviations from posture within normal limits is termed compensatory posture (Levangie & Norkin, 2011). As we evaluate posture, we not only need to identify the postural deviations (ie, hyperkyphosis) but also the compensatory postures and its impact on supporting structures (Levangie & Norkin, 2011). Any exercise program, corrective or not, should have aligned posture as its foundation.
Posture and goniometer assessment
Postural and goniometer assessments go hand-in-hand. Goniometer with posture assessments allows for the design of a comprehensive exercise program that will enhance range of motion (ROM), muscle balance, strength and function, posture and alignment. Abnormalities in posture will cause specific changes in joint range of motion. It has been demonstrated that goniometer assessment is a valid tool for screening thoracic kyphosis and lumbar lordosis in children, adolescents, and adults (Gravina et al., 2017; Gravina, Ferraro, Frizziero, Ferraro, & Masiero, 2012; Sawacha et al., 2012). Photogrammetric assessment of posture has been reviewed and found useful (Singla, Veqar, & Hussain, 2017). However, little in terms of standards for camera height, participant-camera distance, or evaluation software have been identified (Singla, Veqar, & Hussain, 2017). Although in-depth, a good paper addressing youth postural assessment and patient positioning, digital camera use and marking can be found at the online journal of Scoliosis and Spinal Disorders (Stolinski et al., 2017). For the exercise professional the takeaway message is establishing a protocol to improve assessment reliability is important.
Hyperkyphosis and exercise
The assessment using a goniometer of a person with hyperkyphosis might demonstrate problems with shoulder flexion, abduction, and rotation. Additionally, we may find deficits in cervical measurements such as flexion and extension or rotation. Given these deficits, we may find imbalances between upper and core division anterior and posterior muscle groups. For example, the dorsal back extensors and scapular muscles may be chronically stretched while the upper abdominal and anterior shoulder girdle muscle shorten. For people with pulmonary disorders hyperkyphosis intervers with breathing mechanics. Simply correcting the postural deviation may enhance breathing.
An exercise professional obtaining these measures will have objective information for which exercises may be beneficial (corrective) and possibly harmful. It should be noted that especially older adults with hyperkyphosis may have underlying conditions such as osteoarthritis and/or osteoporosis. Having said that, hyperkyphosis, especially with winged scapula the client may demonstrate shoulder abduction and flexion hypomobility (“Common Postural Impairments,” n.d.). If external shoulder rotation hypomobility is present the client can be at-risk with over the head exercises (“Common Postural Impairments,” n.d.). In this case, for example, appropriate ROM training such as using pectoral stretching and specific strength activities such as dumbbell chest press and cable row would help (“Common Postural Impairments,” n.d.).
Common postural impairments. (n.d.). Retrieved from http://www.exrx.net/Kinesiology/Posture.html
Gravina, A., Ferraro, C., Poli, P., Barazzuol, M., Del, A., & Masiero, S. (2017). Goniometric evaluation of the spinal sagittal curves in children and adolescents: A reliability study. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27858694
Gravina, A. R., Ferraro, C., Frizziero, A., Ferraro, M., & Masiero, S. (2012). Goniometer evaluation of thoracic kyphosis and lumbar lordosis in subjects during growth age: A validity study. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22744501
Levangie, P. K., & Norkin, C. C. (2011). Joint structure and function: A comprehensive analysis (5th ed.). Philadelphia, PA: F A Davis.
Sawacha, Z., Carraro, E., Del, S., Guiotto, A., Bonaldo, L., Punzi, L., . . . Masiero, S. (2012, August 29). Biomechanical assessment of balance and posture in subjects with ankylosing spondylitis. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22931459
Singla, D., Veqar, Z., & Hussain, M. E. (2017, June). Photogrammetric assessment of upper body posture using postural angles: A literature review. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28559753
Stolinski, L., Kozinoga, M., Czaprowski, D., Tyrakowski, M., Cerny, P., Suzuki, N., & Kotwicki, T. (2017, December 19). Two-dimensional digital photography for child body posture evaluation: Standardized technique, reliable parameters and normative data for age 7-10 years. Retrieved from https://scoliosisjournal.biomedcentral.com/articles/10.1186/s13013-017-0146-7