The word posture conjures up many thoughts.  Mom and Dad “saying stand up straight” or a picture of yourself hunched over a desk and computer attached to the phone. 

 The word posture as per Webster is (1) the position or carriage of the body in standing or sitting; bearing (2) an attitude of mind; frame of mind (3) the habitual or assumed disposition of the parts of the body in a standing, sitting, etc.  What relationship does physical posture have on our overall health?

Developing how we see the body is one of the first steps in assessing posture. A comprehensive view of the body and how it moves as a result of the posture is needed to evaluate the body.  Here are some key point to tune into when looking at posture.

Front View

1. Look at the feet. Are the arches falling?  Are the toes clenched? Is the weight on the outside, inside of the feet or balanced over the ankles? Does each foot look the same or are they different? Are the feet pointed in or out?
2. Are the ankles falling in?  Is one ankle falling in?
3. The knees.  Do the knees point in the same direction? Does one point out or in more? Are they directly under the hips or closer together than the hips?
4. When the person is standing with feet hip width apart and asked to bring the knees forward as if they were going to sit, do the knees remain in the same plane or do they move outward or inward?
5. The hips.  Is one hip bone higher than the other?  Is one hip bone farther forward than the other or farther back?
6. Waistline. Is the waistline straight or is one side higher than the other? Is the navel off to one side or on the midline?
7. Shoulders.  Is one shoulder higher than the other? Is one side more forward than the other?
8. Arms.  Do the arms hang evenly?  Are the height of the hands even or does one lie higher on the side of the body? How far away from the body do they hang? Is one farther away from the trunk than the other?
9. Neck/head.  Does the head tilt to one side or the other? Does the neck go one way and the head the other way?
10. Can you draw a straight line from the top of the head through the nose, chin, navel to the mid point between the feet?
11. If you have the person roll slowly forward to touch their toes (letting their hands hang) does the length of their hands vary as they roll down?
12. After having the person march in place, where do their feet fall naturally?

Side View

1. How does the weight look on the feet?  Does it look like the person is going to spring off a diving board or fall over backwards?
2. Are the knees locked? Straight? Slightly bent?
3. Are the hips forward over the feet or behind the feet? If the pelvis were a bowl would the contents spill out the front or back or remain in the bowl?
4. Does the low back sway forward or is it straight as a board?
5. Is the upper back rounded forward or are the shoulder blades pulled back?
6. Is the head forward or right over the shoulders?

Back View

1. Are the achilles tendons straight or curved inward or outward? Are the heels closer together and toes pointed out more?  How do the arches look? Are they high or falling?
2. Are the calf muscles equally developed?
3. Are the knees locked or slightly bent?
4. Are the iliac crests even or is one higher than the other?
5. How does the tissue on the back look?  Is there more draping on one side than the other? Do the scapulas stick out or are they close to the back?
6. Do the arms hang closely to the sides?  In which direction do the elbows point?
7. Are the shoulders even or is one higher than the other?
8. Is the head on straight or off to one side or the other?

The ideal alignment is to have the feet directly under the hips and knees and have the torso, shoulders and neck balanced over the hips with minimal muscular activity going on to hold this upright position. The knees should be straight ahead. The feet should not be turned out.  The weight should be balanced over the feet evenly not with more weight on the heels or balls of the feet. From the side you should be able to draw a straight line through the ear, shoulder, hip, ankle perpendicular to the floor.

Misalignment and imbalance leads to more stress in certain areas of the body, just as in a case of tires on a car that are not balanced.  The areas involved will wear out faster especially under stress or trauma.

How do we get misaligned or imbalanced?  Muscular tightness, muscular weakness,  having a dominant side, moving in habitual patterns, emotional stress and trauma, birth, being in the womb, repetitive activities, lack of or decreasing awareness, food allergies or intolerances – you name it -it is all a part of who we are physically.

Types of Movements of the Joints

1. Flexion and Extension – Extension occurs when the surfaces get farther apart and the bones straighten. Flexion results in a decrease of the angle at the joint and brings the bones closer together. They occur in the sagittal plane around a frontal coronal axis.  Examples include the flexion of the arm at the elbow, hand at the wrist, leg at the knee. Foot at ankle is dorsiflexion which is lifting the foot upward and plantar flexion which is moving the food downward from the ankle.
2. Lateral Flexion – side bending of the axial skeleton.  Examples are lateral flexion of the head at the neck and trunk.
3. Abduction and Adduction – frontal plane movements around a sagittal axis occur at multiaxial joints like the bal and socket joint of the shoulder or ellipsoid joints. Abduction is movement away from the midline of the trunk of the body.  Adduction is movement medically toward the midline of the body.  (Tip to remember – Add – as in add to the body.)
4. diagonal abduction  – Movement of a limb through a diagonal plane directly across and away from the midline of the body. moving the right arm from in front of the left hip to in front of the right shoulder
   diagonal adduction – movement by a limb through a diagonal plane toward and cross the midline of the body.
5. Horizontal abduction – movement of the humerus in the horizontal plane away from the midline of the body: horizontal extension or transverse adduction.
   Horizontal adduction – movement of the humerus in the horizontal plane of the body toward the midline of the body. horizontal flexion or transverse adduction.
6. Internal and external rotation – movement around an axis through a line on a structure, movement on a transverse plane around a longitudinal axis.  Rotation occurs at ball and socket joints.  Examples include rotation of the atlanoaxial joint (C1 and C2 of the neck). Internal rotation of the humerus at the shoulder and femur of the hip.
7. Circumduction is a combination of abduction and adduction, flexion/extension and rotation and occurs at multiaxial joints.  It follows a pine cone shaped path of movement. Examples are the movement of the humerus at the shoulder and the femur at the hip.
8. Pronation and Supination are movements of the forearm.  Turning the forearm from the supine position which is palm up to prone which is palm down.
9. Inversion and Eversion – Movements of the foot that occur within the foot or ankle complex.  The reference surface is the planar surface (bottom of the foot ) when the foot faced inward. When the sole faces out it is eversion.
10. Elevation and depression, protraction and retraction include the movement of the clavicle and scapula at the shoulder girdle.  Elevation is upward, depression is downward, protracation is forward, retraction is backwards.
11. Hyperextension – beyond the anatomical position as the arm at the shoulder or leg at the hip.

Functions of the Lymphatic System for Massage Therapists/Students:

• Draining interstitial fluid

• Protecting against invasion – immune response involving the Tand B lymphocytes and also phagocytes

• Transporting dietary fats – carry lipids and lipid soluble vitamins from the gastrointestional system into the blood

• Returns nutrients and proteins to the blood

Lymphatic Vessels and Lymph

Lymphatic Capillaries – close ended vessels in the spaces between the cells of the body which are slightly larger than blood capillaries.  Allows interstitial fluid to flow into them but not out.  The ends of the endothelial cells overlap acting as one way valves. Found throughout the body except in avascular tissue, the CNS and bone marrow.   Capillaries converge into lymphatic vessels.

Components of Lymph – water, oxygen, nutrients, proteins, some fats, hormones

Lymphatic Circulation- Lymph is moved via skeletal muscle pump and the respiratory pump.  Lymphatic vessels lie in the subcutaneous tissue and generally follow veins.  Lymphatic vessels of the viscera generally follow arteries forming plexuses around them.

Lymphatic Vessels: (from smallest to largest)

1. Lymphatic Capillaries

2. Lymphatic Vessels

3. Lymphatic trunks – named for the area of the body that they drain – lumbar, intestinal, bronchomediastinal, subclavian and jugular trunks

4. Lymphatic ducts:
   Right lymphatic duct – approximately 1/2 inch long, drains the right upper side of the body and empties into the subclavian vein
   Thoracic (left lymphatic) duct – approximately 18 inches long.  Starts as a narrowing of the cisterna chyli in front of second lumbar vertebra.  Cisterna chyli receives lymph from the right and left lumbar trunks and from the intestinal trunk. All of the body that is not drained by the right duct.

Lymph Nodes

Nodes are oval or bean shaped and are found around lymphatic vessels.  They range from .04 inches to 1 inch in length.  Found in groups scattered throughout the body.  Usually a superficial set and a deep set.

Most important lymph nodes: Cervical, axillary, tracheobronchial nodes, messenteric nodes

Other lymphatic tissues:

Tonsils – pharyngeal, palatine, lingual

Spleen – phagocytosis of worn out or damaged Red Blood Cells and platelets

Thymus gland – in front of the heart

Health Conditions:

Metastisis – cancer may travel though lymphatic system

Edema- from increased permeability of capillaries from infections or drugs or damage. Increased venous pressure from cardiac problems or blood clots.

Resources:

Books:

Milady’s Guide to Lymph Drainage Massage

Foundations of Manual Lymph Drainage

The Lymphatic System on bartelby.com

Articles Online: