What is posturology ?
Posturology is a multidisciplinary medical discipline that examines the major plumb lines in the human body. Postural pathology is an imbalance of these plumb lines, producing excess stress that causes musculoarticular pathologies and changes in the motor pattern.
Postural imbalance is caused by asynchronism in one or more postural sensors :
- Foot sensors
- Mandibular sensors
- Visual sensors
- Proprioceptive articular sensors
- Skin sensors
- Vestibular sensors
The causes of postural imbalance
We are all asymmetrical, owing to our physical composition, habits and lifestyle. Some of us compensate for this condition and are free of disorders. The same does not apply for some others.
In actual fact, some circumstances such as work conditions (prolonged, repetitive poor posture) or trauma can decompensate the postural system. In addition, asynchronism in the postural sensors, as for example mandibular or visual asymmetry or even asymmetry in postural support, will produce a postural imbalance responsible for a number of pathologies.
Postural Deficiency Syndrome occurs when the regulatory centres are unable to effect a congruent synthesis of the information received by the various sensors. This syndrome indicates the discovery of damage to the sensory, transmission or information integration systems required to effect postural balance.
What is a Postural Deficiency Syndrome (P.D.S.) ?
Postural Deficiency Syndrome (or Plumb Line Postural Disorder) was described by Dr. Martins Da Cuhna in 1979. This syndrome occurs as a result of an alteration in muscle tone balance and postural balance.
P.D.S. is characterised by a clinical picture comprising stabilometric and clinical symtoms and signs :
- The patient complains of feeling ill on standing : he either staggers or experiences pain in this posture.
- The stabilometric recoring confirms that his performance falls outside of normal limits (control of postural ocillations is abnormal).
- The clinical examination reveals abnormal symmetry of his postural muscle tone (regulation of his muscle tone activity is abnormal).
However, there is a fourth criterion which is indispensable for diagnosis and which clearly distinguishes the approach taken by the posturologist from the conventional approach : by manipulating one or more sensory inputs from the system, certain signs of asymmetry are immediately modified before the signs and symptoms of the syndrome are eventually eliminated.
What are the pathologies frequently encountered in posturology?
A widely varying symptomatology is the effect of postural imbalance. In addition to frequent musculoskeletal discomfort (neck pain, headaches, lumbar pain, etc.), there may also be symptoms of perception deficit (dizziness, loss of balance, clumsiness, etc.) and cognitive problems (poor concentration, dyslexic disorders, fatigue, etc.).
Many pathologies are related to postural imbalance. These include:
- Chronic lumbar pain, recurring sciatica, herniated disc
- Gonalgia, scapulalgia, frequently asymmetrical coxalgia
- Repetitive neck pain with torticollis, back pain -- Repetitive muscle injury
- Polyalgesia and other fibromyalgic clinical representations
- Persistent pain following articular prothesis
- “ 5 or 6 times a year, my osteopath realigns my vertebrae ”
- Dyslexia, dysgraphia
- Repetitive tendinopathy
- Repetitive sprains
- Postural vertigo
- Irritating heel spurs
- Morton's syndrome
- Hallux valgus
- Plantar fasciitis
- Reduced performance
- Localised painful muscle hypertonia that is resistant to treatment
What are tests currently conducted in Posturology ?
- Barré vertical axis test
- Scapular test
- Bassani's foam test
- Rotator test
- Podoscope test
- Tonic convergence test
- Cover test
- Maddox test
- Eye-hand test
- Scar test
- Romberg test
- Downing test
- Synoptophore test
- Stepping test
- Passive antepulsion test
- Rotation test and head extension test
How should a " postural imbalance " patient be treated ?
The aim of postural treatment is to modify system input by manipulating the postural sensors for optimal reprogramming of the muscle tone. The objective is to relieve the stress pathologies and to improve sensor performance.
Treatment of patients with postural imbalance is often multidisciplinary.
Postural treatment requires the involvement of various specialists working in collaboration according to the sensors implicated in the pathology :
- Balancing of the musculoarticular system : osteopath, physiotherapist
- Production of a plantar orthosis : podiatrist
- Orthoptic rehabilitation : orthoptist
- Prescription of optical prisms : ophthalmologist
- Treatment of pathogenic scar tissue : physician, physiotherapist
- Fitting of a cap splint or occlusal treatment : dentist
- Lingual rehabilitation, phonation and ventilation : speech therapist, physiotherapist
- Vestibular rehabilitation : physiotherapist, E.N.T. specialist
- Stabilisation of the new postural state following treatment : physiotherapist, rehabilitation physician
- Advice on ergonomics in order to reduce the incidence of iatrogenic postures: posturologist
- General practitioner and rheumatologist for preliminary diagnosis and coordination
Each posturologist can therefore become the person directing the multidisciplinary postural treatment, but should never be a substitute for the expertise of any of the other specialists.
All postural treatment must be complemented by appropriate rehabilitation to stabilise the new postural state.
This rehabilitation treatment will be specific to each category of postural imbalance.
Illustration : clinical case
Example of rehabilitation of a patient with a class 4 postural imbalance :
- Sohier longitudinal and transverse decoaptation techniques for the hip
- Isometric contraction technique against internal rotator resistance
- Deep transverse massage of the contractured iliotibial band
- Stretching of the contractured psoas and lumbar quadrate muscles
- Toning of the quadriceps
- Limbering up of the dorsolumbar hinge (Sphinx exercise)
The equipment for postural diagnosis
Appropriate equipment is required for posture-related diagnosis as well as efficient follow-up of postural treatment.
EQUIPMENT - THE BARRÉ VERTICAL AXIS
The Barré vertical axis examination is based on a diagnosis of postural imbalance. It is used not only for the determination of the patient’s posture classification but also for diagnostic orientation toward the sensors involved in postural imbalance. A centring platform, a tripodal telescopic laser and a plumb line are required for this test.
EQUIPMENT - THE BASSANI FOAM TEST
The foam test orients the postural diagnosis towards the mandibular and/or visual sensors by shunting the podal afferences.
An appropriate foam cushion is required for this test.
EQUIPMENT - THE MADDOX TEST
The Maddox test orients the diagnosis towards an asynchronism in the visual sensor. It is also used to measure the effects of postural treatment on the visual sensor.
A “Maddox rod” and a light point to be positioned on the wall at a distance of between 2 and 5 metres.
EQUIPMENT - THE PODOSCOPE TEST
The podoscope test defines whether the footprints are symmetrical or asymmetrical. A suitable podoscope should have tangential lighting.
EQUIPMENT - THE SCAPULAR TEST
A manipulation table or a simple massage table are used for the scapular test.
Novalliance offers posturology equipment kits:
Measurements are necessary not only for quantifying muscle tone imbalance. They are also useful for quantifying the efficacy of a treatment during the therapeutic procedure as well as the efficacy of the treatment over time.
Measuring postural imbalance is also useful for sharing information on quantitative-based data with the various therapists involved in the postural treatment.
Lastly, there is no possibility of publishing research in scientific journals without the inclusion of measurements.
Indications of the EOS system in posturology
In posturology, the EOS system allows to :
- improve the postural diagnosis by measuring postural imbalance (pelvic and rachidian parameters)
- measure the capacity for postural compensation
- define individualised postural therapeutic objectives
- evaluate the impact of postural treatment
- facilitate multidisciplinary communication
The posturologist is especially interested in analysing the capacitites for adaptation of the spinopelvic system, including the different compensatory systems (hips, knees, ankles) in order to put into place a therapeutic strategy aiming at achieving the most economical posture for a given person.
A postural assessment will need to be performed :
- outside of a phase of pain
- In an orthonormed position : horizontal gaze, relaxed shoulders, hands resting on the front of the shoulders in order to loosen the shoulder girdle as much as possible.
The testing of orthostatic positioning has been extensively studied in France by the French Posturology Association, which recommended a platform whose standards have been published (1985).