Postural Rehabilitation
SPORTS CHIROPRACTIC
Addressing Musculoskeletal Imbalances to Prevent Recurrent and Chronic Injuries
Devon Ackroyd
DC, MS, DACBSP, Cert. MDT
WITH THE RISE OF SEDENTARY LIFESTYLES, technology use, and intensive athletic training, postural rehabilitation has become increasingly important in musculoskeletal health. It focuses on restoring proper mass distribution and joint function to relieve stress on tissues, promote optimal use, and improve functional movement.
Poor weight distribution and musculoskeletal imbalances contribute to chronic pain, mobility issues, and increased injury risk in daily life, sports, and work. By utilizing targeted assessments and identifying how imbalances develop, rehabilitation experts can determine appropriate treatment strategies to maintain a healthy body.
When in a static position, the body’s center of mass should ideally be centered between our feet and positioned near the midpoint of the anterior-posterior plane. While an individual’s center of mass is dynamic and continuously changes, data helps identify a general location. Measurements taken using a force plate — a device that records the forces exerted by a person standing or moving on it — suggest that the average for an individual tends to be in a specific area over time.
Multiple factors may move the body’s center of mass away from the midline, resulting in compensatory biomechanical changes throughout the body. Muscle-length-tension relationships are affected as well, altering functional properties.
Chronically shortened or lengthened muscles impact force production capacity and delay activation timing for every muscle, decreasing maximal force production or limiting the ability to sustain a prolonged load. A proper assessment and treatment of these visual asymmetries can reduce the risk of injury and chronic pain.
Common causes of musculoskeletal imbalances include prolonged poor posture and repetitive movements, with both linked to sedentary work or actions. Without proper ergonomics or strength training, these can lead to imbalances, such as forward-head posture, rounded shoulders, and imbalanced muscle use across the body.
Previous injuries are another contributor, often resulting in compensatory movement patterns that place extra strain on other muscles and joints. It’s important to thoroughly discuss your patient’s history and note any events that may have altered their weight distribution, such as ankle sprains, fractures, and surgeries. Additionally, some individuals are predisposed to certain postural tendencies and altered weight distributions because of conditions such as scoliosis, congenital fusions, or leg length discrepancies, all of which can contribute to musculoskeletal imbalances.
When left unaddressed, these factors can lead to dysfunctional movement patterns, placing additional stress on joints, ligaments, and soft tissues, ultimately increasing the risk of pain, degeneration, and injury.
Common Postural Dysfunctions and Their Effects
Postural dysfunctions can have a profound effect on athletic performance and overall well-being. It’s important to understand how these dysfunctions contribute to discomfort, injury, and long-term issues if left unaddressed.
Some postural dysfunctions include:
• Anterior Head Carriage: Also known as forward-head posture, this occurs when the head juts forward, often because of excessive screen time, poor workstation setup, or habitual slouching. It increases strain on neck muscles, leading to pain, stiffness, headaches, cervical disc degeneration, rounded shoulders, and upper back tightness.
• Upper Crossed Syndrome (UCS): UCS involves tightness in the upper trapezius and pectorals with weakness in the deep neck flexors and lower trapezius, leading to shoulder impingement, reduced thoracic mobility, and an increased risk of rotator cuff injuries.
• Lower Crossed Syndrome (LCS): LCS occurs when tight hip flexors and lower back muscles are paired with weak glutes and core muscles. It often leads to anterior pelvic tilt, lower back pain, and a higher risk of knee injuries.
• Flat Feet (Pes Planus) and Hyperpronation: Collapsed arches or excessive foot pronation affect knee alignment, hip stability, and posture, often resulting in plantar fasciitis, knee pain (patellofemoral syndrome), shin splints, and stress fractures.
• Scoliosis and Structural Asymmetries: Conditions such as scoliosis create imbalanced movement patterns, causing chronic discomfort and increased joint stress. Proper rehabilitation can help manage symptoms.
When the body operates in a state of imbalance, it compensates by shifting stress to other areas, leading to overuse, strain, and eventual injury. Musculoskeletal imbalances contribute to injury via:
• Increased Joint Stress and Degeneration: Poor posture alters static loading, placing excessive stress on joints, leading to accelerated wear and tear often seen in osteoarthritis. Uneven loading, especially in the knee or hip, can cause asymmetrical degeneration.
• Muscle Overuse and Fatigue: When muscles compensate for weak or inactive counterparts, they become overworked, leading to strains, tendinitis, and chronic tension, such as IT band syndrome or Achilles tendinitis/ osis. A thorough assessment of muscle length-tension relationships is essential to identify overstretched or contracted muscles. For example, hamstring muscles are often overstretched because of anterior pelvic tilt, leading to tendinosis.
• Impaired Movement Patterns: Imbalances can cause inefficient and injury-prone movement mechanics. For example, weak core and glutes can cause knees to collapse inward when squatting or running, increasing the risk of ACL injuries by altering movement patterns.
• Poor Shock Absorption and Stability: Weak stabilizing muscles impair shock absorption, which the body relies on for balanced muscle activation during activities such as running or jumping, increasing the risk of stress fractures or joint injuries. High arches or a fixated supinated foot can also prevent proper impact dissipation.
The Role of Postural Rehabilitation in Injury Prevention
Postural rehabilitation focuses on a combination of strengthening, mobility work, and neuromuscular reeducation to identify and correct imbalances. A few key components of postural rehabilitation include:
“Previous injuries are another contributor, often resulting in compensatory movement patterns that place extra strain on other muscles and joints.”
• Postural Assessments and Movement Analysis: A thorough postural assessment helps identify the center of mass and its role in movement dysfunctions. Tools such as filmed gait analysis, functional movement screening, and muscle testing provide insights into postural imbalances.
• Targeted Strengthening Exercises: Strengthening weak muscles restores balance and function. Essential corrective exercises include deep neck flexor activation, scapular retraction, glute bridges, core stabilization, and foot arch strengthening, often prescribed unilaterally for symmetry.
• Mobility and Flexibility Training: Stretching and mobility exercises release tight muscles and improve joint range of motion. Key areas for mobility work include chest and shoulders for rounded posture, hip flexors and hamstrings for anterior pelvic tilt, and calves and ankles for foot imbalances. When combined with an adequate functional movement assessment, rehabilitation specialists might also prescribe stretches unilaterally.
• Chiropractic and Manual Therapy Interventions: Techniques such as chiropractic care, myofascial release, and Active Release Technique (ART) help address restrictions and improve static loading, which enhances movement efficiency.
• Neuromuscular Reeducation and Proprioceptive Training: Proprioceptive exercises and movement retraining reinforce proper posture and mechanics, especially for injury recovery or chronic pain management.
• Ergonomic and Lifestyle Modifications: Adjusting daily habits and workstation setups supports long-term postural health, including ergonomic furniture, regular movement breaks, and footwear tailored to individual needs.
Addressing imbalances through targeted exercise, mobility work, manual therapy, and movement retraining can improve posture and ultimately enhance performance. When working with athletes and active individuals, postural rehabilitation plays a crucial role in injury prevention and long-term musculoskeletal health. When rehabilitation specialists take the time to assess and correct these imbalances, individuals can move more efficiently in daily life and athletic pursuits.
Devon Ackroyd, DC, MS, DACBSP, Cert. MDT, is an assistant professor at Logan University and the team chiropractor for the UFL St. Louis Battlehawks. He holds degrees from Canadian Memorial Chiropractic College and Logan University, and he maintains a private practice in Ladue, Missouri. Contact Dr. Ackroyd by calling 636-230-1948 or emailing [email protected].
