We are constantly in and out of alignment.

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When we think of our posture and our movement, we tend to acknowledge our weak and strong sides. We think in terms of our dominant and non-dominant sides. And we can usually feel the difference in our lengthened and shortened sides. 

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All of these relationships exist as we interact with the forces of physics and the biomechanics of our anatomy every single minute of every day. 

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There are tasks that we do primarily with use of our dominant sides. And there are postures and positions that we find ourselves in between lying, sitting and standing that often feel “off” when using our non-dominant sides. 

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Most of us (especially those who played sports growing up) can identify our dominant or strong side either in our upper or lower extremity. And when an injury occurs it is easy to rationalize that our weak side was to blame. 

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Some people tend to note a common pattern of always feeling pain or getting injured on one side of their body. 

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But what happens when an injury occurs on your “stronger” side. It is not uncommon to identify higher strength capacity in calf raises, single leg squats or side plank tests on the same side that was injured. 

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Could this be that asymmetries exist due to a lack of mobility or increased tightness?

In most cases, there are chances that segments below or above your pain site are to blame due to a lack of tissue extensibility, joint mobility or general control of motion. 

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Alignment is important to how our body functions, how we lift weight or participate in sport. Unnecessary strain on certain ligaments, muscles, tendons, bone and fascia over time can cause their capacity to diminish resulting in injury. Becoming more aware of your posture ultimately optimizes your performance and enhances your movement capability. 

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Before discussing how to improve upon these misalignments, let’s first consider the common postures that distribute inefficient forces across our body.

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Here's what we know about posture and the prevalence of postural abnormalities.

Abnormal or exaggerated curvatures of the spine are some of the most common postures seen with increasing age. However many functioning and fit adults ages 30-50 years old have some form of these alignment issues beginning to play on the forces of their body. 

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Let’s examine some of these common postures:

Lordosis & Pelvic Tilt

Lordosis is a term used to describe the inward curvature of the spine in the lower back region. This natural curve helps to distribute weight evenly along the spine and pelvis to maintain balance while standing, walking, and performing various activities. However, an excessive inward curvature can lead to a more pronounced anterior pelvic tilt and lumbar lordosis, also known as swayback. This can cause strain on the muscles and ligaments in the lower back, as well as decreased force output of the core musculature.

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One study found that a higher angle of proximal lordosis (the angle between L1 and L4 vertebrae) created a higher incidence of lordosis through the pelvis. This exaggerated curve is often thought to be a cause of many conditions causing low back pain. (1) It’s important to note that these findings were amongst adults who were asymptomatic. 

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Too much of anything can be associated with dysfunctional movement and pathological conditions. But let’s not get trapped thinking that lordosis is “bad” inherently. Typically multiple postures in combination will form a pattern that results in restricted or unstable movement.

Lordosis serves us during a squat to keep our back from rounding which could cause abnormal compressional forces across the vertebral discs. It can also benefit us during hinging and lifting patterns as well as our gait cycle when walking and running.

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Kyphosis

Kyphosis or an abnormal curvature in the mid back causing increased rounding or a flexed posture that causes the head to drift forwards, shoulders to round and in some cases a “Dowager’s Hump” or “hunch back” is present. 

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Angles of kyphosis greater than 40 degrees are associated with a higher risk of falling, developing pulmonary dysfunctions, and poor quality of life.(2) 

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In 2021 researchers of the Journal of Orthopedic Surgery and Research investigated 32 studies including 7,633 healthy adults 18 years and older with no known pathologies who had the degree of their kyphosis measured. 

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There was moderate-quality evidence that showed a positive correlation between age and kyphosis exists and that kyphosis does not differ between genders. 

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While the ticking of time may be a concern for your alignment, let’s not forget that the thoracic spine naturally has a rounded curvature. This ensures that you can fold forward to bend over and reach for objects on the ground. It also allows you to grasp heavy and large loads across your chest when carrying.

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Now let’s discuss two positions of the extremities that can sometimes be seen together or in isolation.

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Leg Length Discrepancy & Shoulder Height

Leg Length Discrepancies (LLD) and differences in Shoulder Height are often caused by similar alignment concerns.

The reasons for a leg length discrepancy or a drop in shoulder height can stem from contracted or tight tissues, anatomical formation (one bone longer than the other side), rotated sides of the pelvis, previous injuries, surgeries or even deformities. 

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Many of these imbalances can be the cause of joint pain or repetitive overuse tendon injuries. However many adults have functional leg length discrepancies and shoulder drops without any pain or presence of injury at all. Some of these alignment issues can fluctuate day to day depending on level of activity, the type of activity performed or the frequency and duration of time spent sedentary. 

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One study looking at anatomical leg length discrepancy- meaning the bone length and the thickness of cartilage significantly differs between both legs - describes interesting correlations to pain and rate of joint replacement surgeries.(3) 

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A meta-analysis of thirty-seven articles on clinical assessments and 15 studies on imaging diagnostics were reviewed identifying anatomic LLD in 90% of the population. Forty-one percent of the population had an anatomic LLD of 0–4 mm, 37% of 5–9 mm, 20% of more than 9 mm, 15% of 10–14 mm and 6.4% of more than 14 mm. 

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LLD of > 5 mm was found related to an increased risk of osteoarthritis of the hip and knee joints as well as low back pain and lumbar scoliosis. Moreover, a LLD > 6 mm was associated with an increased intensity of low back pain and > 10 mm had a higher rate of hip and knee replacements. 

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While higher levels of a LLD can make an obvious difference in pelvic height, trunk position and shoulder height it is important to consider that this study showed results pertaining to anatomical LLD whereas generally speaking, most may have a functional LLD which has more to do with the forces across your body than one bone being longer than the other.

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Depending on your unique circumstances and scenario these leg and shoulder postures may serve a function for how you step down the stairs, jump over a big puddle or even swing on a bar.

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So what should we do about these alignment issues?

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If the forces that act on us are dependent on gravity and our response to it, then what we do in weight bearing must be controlled through varying levels of load. Your postural and alignment issues may not be a problem when you need to carry all the groceries from the car to the house. Or maybe when forced to quickly run and jump down steps out of a house or building to get to safety. But if you're noticing a certain level of comfortability that only exists when you move in one methodical way, then you should consider improving these alignment issues.

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You can certainly stretch something that is tight and strengthen what is weak to build resilience in the tissues. But the long term solution will demand that you acquire stability that reprograms your body to self correct its alignment. 

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For example it is not best practice to blame your calf for achilles pain and focus only on the flexibility of your tendon and the strength of your muscles. We must include how your body interacts with itself “whole-istically”. Especially when you want to move it with speed, intensity and purpose. 

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Often this means we must begin on the floor in lying positions, crawling positions, kneeling and half kneeling positions.  Restructuring your alignment from the ground up will ensure less compensations exist and better force production is created through the joints that need it. 

Eventually these postures will progress upwards to two feet in standing and split positions of lunges, steps and single leg positions. 

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There’s no wonder why babies and young children are expert movers. We all acquired these skill sets without someone teaching us how to move or align our body simply because we had to evolve to walking, running, jumping and throwing. 

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Unfortunately today’s modern world has us sitting more and engaged with technology in a manner that does not require us to explore these natural movements. And then through our efforts to remain fit and healthy we begin to develop these shortened, weakened, and non-dominant patterns during exercise. We can all stand to benefit from simple ground based movements that encourage us to roll, sit up, and crawl. 

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These foundational building blocks will encourage you to smooth out your asymmetries and be more in tune with your postural challenges. Thanks to the work of people like Thomas Myers (Anatomy Trains), Serge Gracovetsky (Spinal Engine), Gray Cook (Movement) and countless others we have a much better understanding of how the body has interdependence and relies on a beautiful integration of the whole to effortlessly move the parts. Check out their work for further resources and education on moving your body.

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If you're constantly injuring the same spot of your body, or finding difficulty getting to the root of your pains let's discuss ways that you can create a path towards more freedom of movement. Dealing with these imbalances or, even worse, abandoning the activities you cherish, does not need to be the solution.

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Schedule a Free Discovery Call with a movement expert who can help you optimize your alignment.

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RESOURCES

1. The Amount of Proximal Lumbar Lordosis Is Related to Pelvic Incidence. Sebastien Pesenti, Renaud Lafage, Daniel Stein, Jonathan C Elysee, Lawrence G Lenke, Frank J Schwab, Han Jo Kim, Virginie Lafage. Clinical Orthopedics and related Research. 2018 Aug;476(8):1603-1611
2. The relationship between thoracic kyphosis and age, and normative values across age groups: a systematic review of healthy adults. Mattia Zappalá, Stephen Lightbourne, and Nicola R. Heneghan. Journal of Orthopedic Surgery and Research. 2021; 16: 447.
3. Leg length discrepancy: A systematic review on the validity and reliability of clinical assessments and imaging diagnostics used in clinical practice. Martin Alfuth et al. PLoS One. 2021; 16(12): e0261457.