Human posture is completely different from the posture of vertebrates, which (mostly quadrupeds) always use their upper extremities along with them for locomotion. Some vertebrates are able to walk or stand upright at times, but the upright gait is by no means their sole mode of locomotion. In posture, the ape comes closest to the human being, but it also uses its arms for locomotion in the branches of trees or on the ground. Its front limbs are considerably longer, and the trunk posture is much more forward inclined than in humans.
Functioning of the body and spine
The condition of the spine and its active and passive restraints are especially important for posture, which depends on many factors. Our body, on the other hand, is such that the legs are exclusively for walking and standing, while we use the arms and hands to perform all the minor and major tasks that arise every day. As a result, the bones and joints of the legs are primarily designed for support and locomotion, while the arms and hands can perform much more extensive and delicate movements. A basic prerequisite for the proper interaction of the various organs of the human postural and locomotor system is a free and upright posture. For posture, which depends on many factors, the condition of the spine as well as its active and passive support devices are of decisive importance. The shape of our spine is essentially determined by the position of the pelvis, which is normally slightly tilted forward. If the spine were fully extended, it would slope forward and the upper body would fall over in the same direction. Our body is kept upright by the spine bending backward in a gentle arc in the lumbar section, thus describing a slight forward curve (lordosis) here, and curving slightly backward above the lumbar spine.
Development of the spine in children
This backward curvature (kyphosis) of the thoracic spine is now in turn balanced by a forward curvature of the cervical spine that carries the head. The normal spine therefore has a slightly S-shaped curve when viewed from the side. Seen from behind, it forms a straight vertical line. Man does not have his upright posture from birth. He must acquire it only in the first two decades of life. In a child in the womb, the spine is curved backwards, the chin rests against the rib cage, and the legs are strongly bent at the hip joints. Even in infancy, this prenatal position is clearly visible. Only when the infant lifts its head upward in the prone position at the age of two to three months does the cervical spine curve slightly forward for the first time. Then, when the child sits at around six months of age, later makes its first attempts to stand and finally begins to walk, the spine straightens further. But in most cases, a child does not have an upright posture until the end of the second year of life. However, this is subject to many changes in the following years. As we know, the posture of a human being is largely dependent on the condition of the musculature and ligaments. We distinguish between a resting posture and a working posture. While the ligaments keep the resting body upright, the trunk musculature ensures the straightening of the body for the working posture. However, the muscles not only serve to straighten the spine, but also serve its mobility. The abdominal muscles act as counterparts to the back muscles, acting on the spine from the pelvis via the rib cage from the front. Therefore, the development of the back and abdominal muscles is of decisive importance for a normal posture. If the developmental tendencies of the musculature are inhibited by external influences, muscle weakness cannot be avoided. As a result, posture and physical performance suffer in turn.
Developmental disorder of the musculature
Therefore, everything must be done to promote the development of the musculature and the entire postural and locomotor system in every way possible. The principle of “you snooze, you rust” applies even in childhood. Muscles that are not regularly stressed do not grow with the child and remain underperforming.Sections of the body that are immobilized for long periods of time, for example by a plaster cast, regularly show atrophy of their musculature and lag behind in growth. Excessive stimuli, however, also lead to functional disorders, because all organs only work properly when they are stimulated by external or internal influences in a way that is conducive to their normal function. We must therefore be constantly vigilant to ensure that the growing organism is only exposed to stimuli that serve the most normal development possible. Bones, ligaments and muscles of the spine should therefore be stressed to a reasonable extent, because normal function is always also the best stimulus for healthy development. It must be taken into account that the growing organism is more irritable than the adult one.
Growth and posture of the spine
In the 5th to 7th years of life and in the 11th to 15th, in the periods of increased growth in length, the irritability of the tissues is particularly increased, and therefore it is precisely in these periods of life that there is a risk of overstraining. These are the years when the child enters school and the teenager transitions into professional life. Accelerated growth during puberty is – as is generally known – quite normal, but too rapid growth at this developmental age can very easily lead to a reduction in the performance of the supporting tissues, especially if the biologically determined growth tendency of the bone system is not accompanied by muscular demands. The supporting tissues then fail to keep pace with the increased growth in length and are therefore quickly overtaxed. The young person is then no longer able to maintain a normal upright posture; and postural deterioration or postural damage occurs. Constant overstressing then quickly leads to permanent damage. It is impossible to say with absolute certainty which stimuli damage the child’s body and which promote its development. However, we know from experience that continuous stress of all kinds is harmful to a child. Better are short-duration, medium-strength stimuli whose intensity can be increased over time.
Symptoms, complaints and signs
Poor posture and postural deformities in children and adolescents do not necessarily lead to symptoms quickly. Often it is the parents or the pediatrician who becomes aware of the postural defect. Even if there are no specific symptoms yet, it makes sense to treat the postural defect. If the postural defect is not corrected, the body assumes an unfavorable or physiologically permanently impossible position, which will sooner or later lead to pain. Thus, back pain in particular, which does not result from an accident, is often a sign of a postural defect that has already existed for some time. Neck pain or headaches can also stem from an untreated postural defect. Many children and adolescents show a postural defect over a long period of time and still do not experience any symptoms. However, since the body cannot maintain poor posture for years, symptoms can still occur in adulthood. Evidence of a postural defect is found particularly in children and adolescents who do little sport, have appropriately trained muscles and sit a lot. A rounded back, a forward bent posture and a shuffling, powerless gait are also early signs of a postural problem and should be discussed with the pediatrician promptly.
Diagnosis
It goes without saying that an individual approach should always be taken, because children in one age group can be quite different in their development. All deviations from normal posture that persist for a long time are called poor posture and sooner or later lead to premature wear of the bones, joints and ligaments of the spine. In the process, the muscular forces are used up prematurely, so that the person ages quickly and the dreaded early invalidity can occur. For this reason alone, all postural defects must be detected as early as possible, because only then can they be effectively combated. Detecting postural defects at an early stage is often quite difficult, because only in the rarest of cases do they cause pain right from the start. They develop insidiously and imperceptibly at the beginning. Only when they have reached a certain degree do pulling or dull back pains occur, sometimes radiating into the legs.Unfortunately, by then it is often too late for complete recovery. We must therefore constantly monitor our children and young people in order to be able to detect and combat postural deterioration or damage in good time. Deviations from normal posture can vary widely.
Hunchback
One speaks of a “hollow back” or “hollow back” when the curvatures of the spine, as described above, are increased. This pronounced backward curvature of the spine simultaneously shows an increased hollow back. Bulges of the normal S-shaped curved spine are not uncommon. In addition, the entire spine may be curved backward, with the forward curvature of the lumbar spine being completely eliminated and included in the overall curve. This form of the spine is referred to as the “total round back”.
Flat back or flat back and sloping shoulders.
Detecting postural defects at an early stage is often quite difficult, because only in the rarest cases do they cause pain at the outset. An excessively straight position of the spine, in which all curvatures are flattened, is also pathological and is called a “flat back”. Physical changes caused by slackening of those muscles that straighten the spine also belong to the realm of postural defects. In this context, drooping shoulders – whereby both shoulders may well be unequally high – and protruding shoulder blades should be mentioned. If the abdominal muscles slacken, because this phenomenon is also a postural deformity, the abdomen sags forward. This causes the upper body to shift backwards to compensate, which in turn causes the hollow back to become more pronounced. Signs of postural deformity can vary in intensity. If it is still possible for the child or adolescent to consciously straighten up from this slack to a normal posture by tensing his or her muscles, then we are talking about a “postural defect” that is still relatively easy to combat. The treatment is much more difficult when it is no longer possible to straighten up on encouragement. In such a case, it is necessary to determine whether or not a normal shape can be restored by external forces, for example by applying pressure with the hand against the affected spinal segments. If this is possible, it is a “positional defect”. If, however, it is no longer possible to change the pathological shape of the spine even by external forces, then a “form defect” is present, which unfortunately can generally no longer be corrected even by intensive medical treatment. Further aggravations must then be intensively counteracted by appropriate treatment. The transitions from postural defect to positional defect to form defect are fluid. The different prognosis of these individual degrees of severity results in the need to detect and treat these pathological changes as early as possible.
When should you see a doctor?
As a rule, postural defects and abnormalities in children and adolescents must always be examined and treated by a physician. This can prevent further complications and discomfort in the patient’s adult life. A doctor should be consulted if the parents notice a bad posture in the child. In many cases, this malposition is also associated with pain and is intended to suppress it. If the malposition does not disappear on its own within a short period of time, a doctor should be consulted in any case. A visit to the doctor is also necessary if the parents notice a defective development in the child, where especially the spine may show an unusual curvature. Likewise, pain in the muscles and in the ligaments indicate postural defects and faulty posture in children and adolescents and should be examined. The initial examination and diagnosis of postural deformities and postural abnormalities in children and adolescents may be performed by a pediatrician or general practitioner. The treatment itself usually takes place with a specialist or with the help of various exercises and therapies. Early diagnosis of these damages has a very positive effect on the further course of the disease.
Treatment and therapy
In the treatment of postural weakness or postural deformity, the focus today is primarily on active measures, that is, conscious training of the musculature that results in a normal upright posture. In the case of simple postural defects, muscle-strengthening gymnastics is generally sufficient, which is best performed in gymnastics groups. In the case of small children, these exercises have a playful character, while all the appropriate muscle groups are systematically trained through skilful physiotherapeutic guidance. During these gymnastics, a sufficiently long break between the individual exercises should also be ensured. Posture-prone children should also basically sleep hard and flat, if possible often on the stomach, as the back muscles are strengthened in this way. Swimming is also of particular importance. All children and adolescents with a postural defect require targeted orthopedic treatment, with special gymnastic and orthopedic exercises tailored to the individual case. There are numerous specific orthopedic treatment methods for this purpose, for example Klapp’s crawling exercises, which lead to excellent results. However, all these exercises must be performed regularly and consistently over a long period of time. Dry brushing of the back is also beneficial, as it stimulates muscle circulation. In the same way, the shape defects of the child and adolescent spine are treated. Under certain conditions, surgical treatment may become necessary, especially if the condition progresses. Finally, it should be emphasized once again that in children and adolescents all deviations from the normal shape of the spine require urgent medical treatment, even if they do not cause any pain. Otherwise, permanent damage can develop very quickly, which considerably impairs performance in the rest of life. If postural defects are detected at an early stage, they can be effectively combated. However, the prospects of recovery become slimmer the later treatment begins.
Outlook and prognosis
Postural deformities and abnormalities appear to be an increasing problem in children. As soon as parents themselves notice posture that appears abnormal, this should be brought up with the pediatrician. The latter can decide whether further diagnostics and, if necessary, therapy are indicated. The prognosis of a postural defect is better the earlier the problem can be recognized and treated in a targeted manner. Postural defects that persist over a longer period of time creep in and are more difficult to correct again. This in turn leads to the problem that postural errors that have existed for a long time can also lead to serious postural damage. A postural error, if it persists long enough, can cause damage to the spine, tendons and ligaments. These can be painful for the child and lead to unfavorable relieving postures. Existing damage, on the other hand, also has an overall poorer prognosis of disappearing completely. If therapy is initiated at an early stage, there is a good chance that an ergonomically correct posture can be achieved again, especially in children, who are still more malleable than adults in terms of spinal column and erection. This is also significant because postural defects in adults, caused by decades of poor posture, can often hardly be corrected and have left permanent physical damage.
Aftercare
In the case of postural damage and postural defects in children and adolescents, there are a number of aftercare measures available to those affected. In any case, the patterns that led to these damages must be avoided in order not to stress the body again. Early diagnosis of the postural damage and postural defects in children and adolescents is also very important in this regard, so parents in particular must pay attention to the symptoms and complaints and then contact a medical professional. In most cases, the treatment of these complaints is done through various exercises or physiotherapy. It is very important that the parents encourage the children to do these exercises and that the children also do the exercises regularly. They can also be done at home, which may speed up the healing process. In the same way, the parents should advise the children on a correct and healthy sitting posture and make an effort to maintain it.In the case of pain caused by the postural defects and postural deformities in children and adolescents, painkillers can be taken, although excessive and long-term use should be prevented. In general, a healthy lifestyle with a healthy diet and sports activities also has a positive effect on these complaints.
What you can do yourself
Postural defects can be corrected and thus minimized in many cases by the intervention of legal guardians in a cooperative relationship with the children and adolescents. If a friendly relationship exists with a great deal of understanding, calm and informative discussions can be held with the adolescent. Educational work makes the importance and explosive nature of postural errors clear to the youngster. Advice can be given on what a healthy posture should look like, alternative postures can be practiced and implemented together. In addition, sports activities help build muscles and stabilize the skeletal system. Carrying heavy objects should be prohibited for children and adolescents. Hard physical labor should also be avoided. If guardians lack access to the child or if the adolescent is going through a phase of defiance, adults who hold the child’s trust should provide education. These can be trusted teachers, doctors or people with a role model function from the immediate environment. The distance between the desk and the chair of a growing person should be adjusted to current requirements at regular intervals. Attention should be paid to an ergonomic workstation, since children and adolescents in particular spend a lot of time in front of a computer. Selection of healthy and appropriate footwear and means of transportation that are continuously adjusted to the child’s height should be used.
