Posture is simply the relationship or alignmentbetween the various parts of the body. It isimportant from two standpoints. Firstly, goodposture underlies all exercise techniques. Yourposture is really your foundation for movement.In the same way that a building will fall downif its foundations are shaky, your whole bodywill suffer if your posture is poor. Exerciseswhich begin from the basis of poor posture tendto be awkward and clumsy. Because of this theyare less effective and, more importantly, theperson using awkward, clumsy movements islikely to be injured.

The second important point about postureis that an incorrect posture allows physicalstress to build up in certain tissues, ultimatelyleading to pain and injury. For example, aperson who is very round-shouldered maysimply have started out with tightness in the

chest muscles and weakness in the muscleswhich brace the shoulders back. If this combin -ation had been corrected at the time, the poorposture may not have built up over the years.As a consequence of poor posture, the way thatthe joints move will change. Alteration inmovement of this type will mean that jointscan be subjected to uneven stresses. When thiscontinues over the years, the eventual outcomecan be the development of wear and tear(osteoarthritis) in later life.

Poor posture then gives two importantfeatures. Firstly joint alignment is not optimalso bodyweight, which would normally bedistributed quite evenly across the joints, is takenmore by one area than another (see fig. 4.1b).This leads to increased stress on portions of thejoint. Secondly, good posture is one of balanceand very little muscle work is actually needed

37

POSTURE 4

Weight-bearing surface

Normal muscle tone

Overstretched muscle

Lax muscle

a. Optimal alignment b. Suboptimal alignment (poor posture)

Fig. 4.1 Poor posture: increased stress on portions of the joint and muscles work harderbecause body segments are out of alignment (b)

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to maintain it. With a poor posture the muscleshave to work much harder because the bodysegments are out of alignment (see fig. 4.1b).Increased muscle work of this type often leadsto aching and the development of painful triggerpoints within the muscles.

We saw earlier that fitness is really a combina-tion of various components which we called ‘S’factors. In relation to posture, two of the mostimportant fitness components are flexibility andstrength. Postural changes are often associatedwith poor muscle tone (weakness) in somemuscles together with too much tone (tight-ening) in others. This imbalance in tone givesan uneven pull from the muscles around a joint,and causes the joint to move off-centre (see fig.4.2). Our aim with exercise is to redress the

balance in muscle tone by using stretching exer-cises to lengthen tight muscles, combined withstrengthening exercises to increase the tone oflax muscles.

Optimal posture

We cannot talk about a normal posturebecause very few people are ‘normal’ in thetrue sense of the word. Equally, if we talkabout an average posture, the average may bevery poor and this type of posture is far fromideal. Instead we should talk about an‘optimal’ posture, where the various bodysegments are aligned correctly, and theminimum of stress is placed on the bodytissues. This type of posture requires little

THE COMPLETE GUIDE TO ABDOMINAL TRAINING

38

Keypoint

With poor (sub-optimal) posture, stress on thejoints is increased and the muscles have to workmuch harder.

+ ++ + ++ + +

+

+ + +

Fig. 4.2 Posture and muscle imbalance: (a) normal joint – equal muscle tone gives correctjoint alignment; (b) postural imbalance – unequal muscle tone pulls joint out of alignment

Keypoint

Your posture will affect the way you exercise, andthe exercises you choose will in turn alter yourposture.

a. b.

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muscle activity to maintain it because it isessentially balanced.

The various segments of the body worktogether like the links in a chain. Movement inone causes movement in the next link which isthen passed on to the next, and so on. Thismeans that a postural change in one part of thebody can alter the alignment of another bodypart quite far away. Alterations in the feet area good illustration of this point. Flat feet (seefig. 4.3), where the inner arch of the foot movesdownwards, will in turn twist the shinbone andthen the thighbone. Eventually these changescan be felt in the lower back, chest and neck.Because of this intimate link between bodysegments, it is important to correct any posturalfault, however minor it may seem at the time.

One method of looking at posture is to compareit to the posture line. In an optimal posture thisline is similar to a plumb line dropped vertically

downwards from the top of the head. The bodyshould be evenly distributed along this line (seefig. 4.4), and ideally the line should pass just infront of the knee joint, travel through the hipand shoulder joints and through the ear. Lookingmore closely at the pelvis, optimal pelvic align-ment occurs when the front lip of the pelvis(anterior superior iliac spine) is in a directvertical line with the pubic bone in the groin.In this position there should be a gentle curveto the lumbar spine and also to the neck.However, various alterations occur from thisnormal posture line which we need to consider.

Assessing your own posture

Before you can correct posture using theprogramme in this book, you must determineyour current body alignment. Discovering yourpersonal posture acts as a baseline against which

POSTURE

39

Fig. 4.3 Flat feet

Keypoint

In an optimal posture the body segments arecorrectly aligned, so very little effort is needed tomaintain the position.

Fig. 4.4 Optimal posture: the lip of thepelvis forms a near-vertical line with thepubic bone in the groin

through ear

cervical vertebrae

shoulder joint

lumbar vertebrae

centre ofknee joint

ankle bone(lateral malleolus )

pelvic cres t

pubis hip joint

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to measure improvement as you go through thevarious exercises. You will need to work witha partner; they will assess your posture and youin turn will assess theirs. Ask your partner tostand against a straight vertical edge, such as adoorframe, or plumb line attached to a hook.Make sure that the edge of the line is slightlyin front of their anklebone (lateral malleolus)and then compare their posture to this refer-ence line. Fig. 4.4 shows the posture line,together with the optimal alignment. Photocopythis diagram, and then mark on the sheet thepositions of their knee, hip, shoulder and ear.It is the centre point of each of these that weare interested in. The next step is to determinethe position of your partner’s pelvis. Draw animaginary line from the furthest point forwardson the rim of their pelvis (anterior superior iliacspine) to their pubic bone. Determine whetherthis line is vertical or positioned at an angle.

Once you have assessed your partner’sposture from the side, turn them around so thattheir back is towards you. Their feet should beabout 10 cm (4 inches) apart. We will nowcontinue the postural assessment using Table4.1. Start by looking at their feet. The inneredge of the foot should have a gentle arch, andshould not be flat. Moving up the leg, theAchilles tendon should be vertical and the bulkof the calf muscles (gastrocnemius and soleus)should be equal. The creases on the back of theknees (popliteal crease) and the lower edge ofthe buttocks (gluteal fold) should be on the samelevel for both sides of the body. The pelvis itselfshould be level horizontally and the spinealigned vertically. One of the ways that spinalalignment can be checked is to look at the skincreases on either side of the lower trunk; theyshould be equal in number and shape. The shoulderblades should be about three finger-breadths(6–8 cm) apart, and they should lie on the samehorizontal line. The contours of the shouldersshould be on the same level and they should

appear similar in size and shape. Finally, thehead should be level and not tilted to one side.Record any changes from the optimal postureon a photocopy of Table 4.1.

The final method of posture assessment is toestablish the depth of the curve in the lowerback. Ideally, the curve should be gently hollow.When it is too deep, or too flat, the alignmentof the lumbar region changes, indicating thatthe pelvic tilt is no longer correct. Assess thedepth of the lumbar curve by standing withyour back up against a wall. Stand with the feet15–20 cm (6–8 inches) from the wall and thebuttocks and shoulders touching the wall. Haveyour partner slide their hand between the walland the small of your back. Ideally they shouldbe able to push the hand through the gap onlyas far as the fingers. If the whole hand passesthrough, your lumbar curve is too deep. If theycan only get the tips of the fingers between yourback and the wall, the lumbar curve is too flat.

Summary

In an optimal posture:• the hip, shoulder and ear lie in a vertical

line;• the pelvis is level;• the lower spine should be gently hollowed;• the inner edge of the shoulder blades are

6–8 cm (3 inches) apart.

General principles of posturalexercise

To modify posture using exercise therapy, wemust stretch tight muscle to allow correct move-ment to take place. If we simply try to exerciseagainst a tight muscle it becomes self defeating– the exercise tries to move the body in one

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40

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POSTURE

41

Part of the body Changes Part of the body ChangesEar level/hair line Skin creases

Shoulder level – Levels of pelvic rim,

cervical spine ASIS, belt line

Inferior angle Buttock creases

of scapula

Overall spinal alignment Knee creases/

Muscle bulk

Keyhole Mid-line/Achilles angle

Adam’s position Foot position

Assessing standing posture from behindTable 4.1

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The exercises used in this book are based onmodern training methods developed for bothcutting edge rehabilitation and high level sportstraining. These have gradually filtered down tothe general public. Because discoveries arebeing made constantly, however, our know -ledge must continually be updated. By lookingat some of the research into abdominal trainingwe can see at first hand how the developmentsbegin and how they will affect our normaltraining programmes.

Effects of core stability ongeneral abdominal training

We saw in chapter 2 that the core stabilitymuscles (transversus and internal oblique espe-cially) tighten and pull the abdominal wall flat,while the external oblique and rectus musclesactually move the trunk against resistance. But,if we practise core stability and perfect theabdominal hollowing technique (exercises14–18, pages 91–5) how will this change the waywe perform normal abdominal exercises in thegym such as sit-up, crunches, and leg raises? Partof the answer to this question was discussed inchapter 6 when we saw that abdominal domingis caused by performing an abdominal exercisewithout firstly hollowing the abdominal wall byworking the core stabilisers. Researchers at

James Cook University in Australia1 used EMGrecording of the abdominal muscles to determinethe difference between performing a standardabdominal exercise, and of performing the sameexercise but using abdominal hollowing first.They found that by initiating the exercise withhollowing, subjects did indeed activate theirtransversus and internal obliques muscles beforetheir rectus. This process is called selective recruit-ment and is an important method of dictatingthe order in which a group of muscles contracts.It confirms the importance of hollowing to ‘set’the stability of the trunk before performing anysit-up type exercise.

How effective are newabdominal exercises?

Exercises such as sit-ups and leg raises havebeen used since Victorian times, and crunchesand trunk curls became fashionable in the late1960s and early 1970s. The 1980s saw researchinto spinal stabilisation and the gradual adoption

ABDOMINAL MUSCLE RESEARCH 17

Keypoint

Use the core muscles to ‘set’ the abdomen beforeall general abdominal exercise actions.

1 Barnett, F., and Gilleard, W. (2005), ‘The use of spinal stabilisation techniques during the performance ofabdominal strengthening exercise variations’, Journal of Sports Medicine and Physical Fitness, 45(1), pp. 38–43

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of these exercises into the fitness world underthe general term ‘core exercise’. Instructors andmanufacturers are continually inventing newexercises and training devices in the search forbetter movements, but are these exercises reallybetter, or just more of the same? This was thesubject of research from California StateUniversity in Sacramento2.

These researchers looked at three exercises:an abdominal frame (exercise 47, page 128);hanging knee raise (exercise 73, page 158) usingstraps; and a ‘powerwheel’ which is a commer-cial exercise similar to exercise 56, page 138.They found that the powerwheel gave the mostintense muscle contraction and used the spinalmuscles and latissimus dorsi as well, indicatingits use as an overall stabilising movement. Thepowerwheel also activated the hip muscles dueto the leg motion involved. These new exercisesare effective for general stabilising movements,but not for muscle isolation actions.

Abdominal exercise dangers

Many physiotherapists and personal trainersstress the importance of correctly performedabdominal exercises, and in chapter 7 we sawsome of the potential dangers of poor exercisetechnique. But does research support thisapproach?

One of the most important teaching points ofsit-up type exercises is to warn users not to linktheir hands behind their neck and pull the headforwards (cervical flexion). Neurosurgeons in

Denton, USA3 described the tragic case of a14-year-old boy who was a competitive wrestler.This subject performed sit-ups with his handsbehind his head as part of a daily fitness routine.After one such workout he suddenly experiencedtotal loss of movement (paresis) of his arms andweakness of his legs. He was rushed to hospitaland underwent an MRI scan. One of the liga-ments (ligamentum flavum) in his neck had beenstretched so forcefully that it compressed hisspinal cord, effectively cutting off its blood supply.This type of injury is normally only ever seen inolder people who have severe degeneration ofthe bones in their neck. Thankfully the teenagerrecovered, but this case should sound a warningbell in every gym. Had this boy pulled a little bitharder or exercised slightly longer in this workouthe may have been permanently paralysed.

Doctors from the department of neurology atPenn State College of Medicine in America4

again looked at sit-up exercises, but this time atthe tragic effects of holding the breath (valsalvamaneuver) while straining to perform the exer-cise. An important teaching point with resistanceexercise is to keep breathing – ‘breathe out oneffort’ is an old adage still familiar to most gymusers. These two reports showed what happenedwhen exercisers did not adhere to this practice.

2 Escamilla, R.F., Babb, E., Dewitt, R. et al (2006), ‘Electromyographic analysis of traditional and non-traditionalabdominal exercises: Implications for rehabilitation and training’, Physical Therapy, 86(5), pp. 656–713 Dickerman, R.D., Mittler, M.A., Warshaw, C., and Epstein, J.A. (2005), ‘Spinal cord injury in a 14-year-old male secondary to cervical hyperflexion with exercise’, Spinal Cord, Aug 304 Uber-Zak, L.D, and Venkatesh, Y.S. (2002), ‘Neurologic complications of sit-ups associated with theValsalva manoeuvre: Two case reports’, Archives of Physical Medicine and Rehabilitation, 83(2), pp. 278–82

Keypoint

To use your hands for neck support, place themlightly at the side of your head and do not pullthe neck into flexion.

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The first report was of a 37-year-old malewho had been using rapid sit-ups withoutbreathing correctly. He suddenly developedright-sided weakness and loss of sensation andwas rushed to hospital. When there, it wasnoticed that his facial muscles on the right sidehad dropped and his strength reduced. Inshort, he had suffered a stroke! Over the nextfew days he developed a severe headache anda scan revealed that one of the most import -ant blood vessels going to his brain (posteriorcerebral artery) had been blocked. After fivedays he began to improve, but required inten-sive neurological physiotherapy to recover.

The second case was a 30 year old who trainedusing ‘hard, fast sit-ups’ for a prolonged periodwithout having time to breathe correctly. Hedeveloped neck pain, which travelled into hischest, and weakness of his arms and legs. An MRIscan showed that he had bled into the tubeprotecting his spinal cord (extradural haematoma).This blood had to be surgically removed and thesubject required intense physiotherapy to recover.This type of injury would have required signifi-cant force to produce and would normally be seenafter a car accident, for example.

These reports illustrate an important combin -ation of two actions: breath holding (Valsalva)and trunk flexion. Breath holding has been shownto change blood flow to the brain by compressingthe major blood vessels which travel inside thetrunk. Trunk flexion will also produce this effectby effectively crushing the body organs againstthe same deep blood vessels. When these twoeffects are combined, the blood pressure changescan have very serious effects.

Which muscles work?

Researchers in Brazil5 looked at 12 differentabdominal exercises to distinguish between thework done by the abdominal muscles themselves,and that done by the hip flexor muscles – inparticular the rectus femoris, which is the large‘kicking muscle’ on the front of the thigh. Theycompared the upper and lower portions of therectus abdominis muscle of the abdomen in20 physical education students, and showed that,while leg lifting activities reduced the work onthe upper rectus and emphasised the work on thelower portion of the muscle, bending the kneeshad little effect on the amount of work that thetwo portions of the muscle performed. Leg liftexercises produced the hardest workloads for therectus femoris muscle, while curl-up actionsproduced the lightest. Fixing the feet increasedthe activity of the rectus femoris still further.

Researchers in Australia6 have looked closely atthe difference between the deep stabilising muscles

Keypoint

Breathe normally throughout abdominal exercises.Do not hold your breath.

5 Guimaraes, A. C., Vaz, M. A., De Campos, M. I., Marantes, R. (1991), ‘The contribution of the rectusabdominis and rectus femoris in 12 selected abdominal exercises: an electromyographic study’, Journal ofSports Medicine and Physical Fitness, vol. 31:2, pp. 222–306 O’Sullivan, P. B., Twomey, L. T., and Allison, G. T. (1997), ‘Evaluation of specific stabilising exercise inthe treatment of chronic low back pain with radiologic diagnosis of spondylo lysis or spondylo listhesis’,Spine, vol. 22:7, pp. 2959–67

Keypoint

Sit-up type actions emphasise the upper portion ofthe rectus abdominis, while leg lift movementsemphasise the lower portion. Fixing the feet willincrease the work on the hip flexor muscles withoutany real advantage to the abdominal muscles.

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(the transversus abdominis, multifidus and internalobliques) and the surface abdominal muscles(rectus abdominis and external obliques). Whenabdomal hollowing (see exercise 15) the internaloblique muscles work harder than the rectus abdo-minis muscle in most people. However, in peoplewho have suffered long-standing lower back pain,the internal obliques work less and the rectusworks more to try to compensate so that, as wellas being weak, an imbalance is created betweenthe two muscles (see fig. 17.1). In order to correctthis imbalance, therefore, we must increase thework of the internal oblique muscles, and reducethe work of the rectus. Strengthening both

muscles will leave them stronger, but still out ofbalance.

It is also vital to distinguish between the deepmuscles and those on the surface duringtraining. The same researchers7 looked at a 10-week programme using 15 minutes of corestability exercises (especially abdominalhollowing) daily, and compared this to a gym-based programme involving trunk curls andweights. Over the training programme, thoseusing core stability exercises showed a dramaticincrease in the activity of the internal obliquemuscles but little change in the rectus. Thoseon the gym-based programme, however,

Fig. 17.1 Abdominal muscle action in lower back pain

0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0

Rectus abdominis

Internal obliques

Normal people People suffering from

long-term back pain

7 O’Sullivan, P. B., Twomey, L. T., and Allison, G. T. (1998), ‘Altered abdominal recruitment in patientswith chronic back pain following a specific exercise intervention’, Journal of Orthopedic and Sports PhysicalTherapy, vol. 27, pp. 114–24

Str

engt

h o

f m

usc

le c

ontr

action

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ABDOMINAL MUSCLE RESEARCH

showed an improvement in both rectus andinternal oblique activity. Although in this casethe muscles were stronger after the more tradi-tional gym-based programme, the imbalancebetween the two sets of muscles still remained(see fig. 17.2).

Physiotherapists at King’s College, London8,looked at the best method to work the trans-versus muscle (see fig. 2.1). They took 20 peopleand, using the kneeling position, gave halfabdominal hollowing on its own, and the otherhalf abdominal hollowing with pelvic-floorcontraction. After six weeks the physios thenlooked at the thickness of the transversus muscleusing ultrasound scanning. Abdominalhollowing by itself increased the thickness ofthe transversus by 49.7 per cent while abdom-inal hollowing with additional pelvic-floorcontraction increased the muscle thickness by65.8 per cent, a significantly higher score.

This study clearly shows the importance oflinking the hollowing action to its normal

Fig. 17.2 Abdominal muscle usage with different types of training

1000

500

0Before After Before After

1000

500

0Before After Before After

Keypoint

A muscle imbalance exists in people with backpain whereby the stabilising muscles are not usedenough and the surface abdominal muscles areused too much. To correct this imbalance, corestability exercises rather than normal gym-basedprogrammes are required initially.

8 Critchley, D. J. (2000), ‘Instructing pelvic floor contraction increases transversus abdominis activation inlow abdominal hollowing’, Proceedings of the Chartered Society of Physiotherapy Congress (Birmingham,UK) p. 22

Rectus abdominis

Internal obliques

Musc

le a

ctiv

ity

Trunk curl Abdominal hollowing

Musc

le a

ctiv

ity

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The Complete Guide to Sports InjuriesBy Christopher M. Norris

September 2011

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AcknowledgementsCover photography © www.istockphoto.comPhotos © Grant Pritchard, except pp. 1, 2, 3, 9, 128, 143 and 144 Christopher M. NorrisIllustrations © Jeff Edwards

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