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Posture and Pain (Part 1)

When I started my career as a physical therapist, I became fascinated by Dr. Vladamir Janda’s work on recognizing patterns of muscular imbalance, how imbalance affects posture, and contributes to pain. It helped me better understand the root causes various types of injuries and conditions. It also gave me a theoretical framework to apply a whole-body approach to rehabilitation.

One of the patterns of imbalance that Dr. Janda recognized is called lower-crossed syndrome. Lower-crossed syndrome is a muscular imbalance of the pelvic and hip girdle. It is characterized by poor engagement of the glutes, hamstrings, and abs and stiffness of the hip flexor and lumbar spine muscles.

This can create a “Donald duck” appearance of pelvic alignment and posture.

The majority of folks I treat in the rehab clinic fall into this category.

Occasionally, the opposite muscular imbalance is present. In this case, there is still poor engagement of the glutes. However, the hip flexors and lower back muscles become long and weak. Stiffness is created in the hamstrings and lower abdominals.

This can create a “Pink Panther” appearance of pelvic alignment and posture.

These types of muscular imbalance can create pain and problems at, above, and below the region of imbalance. Much like a physical chain, the body is linked together from joint to joint. If you were to dangle a chain and turn any one of the links, all the links above and below would turn to some degree. The kinetic chain works the same way. Imbalance at one region causes compensation at regions above and below.

In the case of the “Donald Duck” imbalance of the pelvic and hip girdle can cause caving in at the knees and over-pronation of the feet. This could manifest itself as low-back, hip, knee, or foot and heel pain. It can also place an athlete at risk for injury or developing the aforementioned conditions.

In the case of the “Pink Panther” imbalance, the knees are more bow-legged and the arches at the foot are high. There are a lot of compressive forces on the body with this type of presentation and the individual is predisposed to early wear and tear of lower extremity joints. All kinds of joint and muscle pain can exist, but the root imbalance is different.

The good news is that much of dysfunction attributed to muscular imbalance can be mitigated through smart training, pre-hab, and rehab. Addressing hip mobility and ankle mobility is a good place to start.

The Bridge is a great exercise that has a lot of bang for your buck. It take the hip flexors though a large range of motion while engaging the glutes.

Incorporating side and standard plank variations are also a good way to get the core to engage like it is supposed to.

Finding a good movement provider can help identify the nuances of muscular imbalances and get your body back on track to feeling and moving better.

In the next post, I will give an overview of another one of Janda’s common muscle imbalances, the upper crossed syndrome.

Physical Therapist Dr. Tim Varghese

Dr. Tim Varghese

Movement Solutions

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