Posture and well-being

an ergonomic approach

Edited by Dr. Giovanni Chetta

In podomechanical pathology, the "foot-helix assimilation is always the basic reference for the purpose of" adequate diagnostic processing and therapeutic programming. In fact, when making contact with the support surface, the foot acquires the meaning of shock absorbing device, able to absorb and neutralize the forces and moments of force applied instantaneously in the form of impact, in order to protect its integrity. The foot is able to achieve this thanks to its gradual helical unwinding; while wrapping itself realizes the anti-gravity action. These are interventions that engage the foot to the maximum, proof of this is the frequency of the podo-pathological manifestations of hyperstress (metatarsalgia, Morton's neuroma, heel spur, callosity for example), even for modest degrees of postural alteration that make the foot unsuitable for regulating the relationship between internal and external forces. The faster the impact, the more likely damage to the breech structure is.
Turning attention to the surfaces (flat terrain) and to the envelopes (shoes) with which the foot comes into contact, from the very first steps and throughout life, often unsuitable but that civilization and fashion impose on us, the relationship between information genetics, revealed by the original morphostructures, and the environmental information, instead of a harmonious encounter, takes on the aspects of a dispute which, in later ages, is traced back through the marks left on the foot and posture. Primary gravity insufficiency arises from anomalies of the genetic-environmental information integration and is usually expressed as the inability of the breech helix to function in a physiological way.
The flatfoot usually results from a stiffening defect, caused by a lack of rotation of the segments anterior to the talus (the breech helix wraps in an insufficient manner), which gives rise, in chronological succession, to compliance in the infantile foot, valgus-flat foot in adolescence and arthritic flat foot in adults. On the contrary, in the cavus foot we will have an excess of rotation (pronation) of the segments anterior to the talus (and therefore a lack of relaxation and an excessive breech elication). It is necessary to consider that the organism normally reacts on the flat ground trying to cling to it by caving the foot (the same reason favors the alteration in hammer or claw or claw fingers). Given the common postural asymmetry, different attitudes of the two feet are frequently found. Baropodometry, in static and walking, is an extremely important tool for the correct diagnosis of flat / hollow foot.
Another frequent breech pathology is the "hallux valgus, which is accompanied by dislocation of the relative sesamoid bones and lateral exostosis of the first metatarsal head (covered with calluses due to continuous rubbing with the shoe). The causes of hallux valgus are to be found in the unbalanced loads on the foot, especially on the forefoot during the propulsive phase of the step, to which is added the contribution of inadequate shoes (high heels, narrow toe) and genetic predisposition.
It should not be overlooked that the foot is also a sense organ, that is, the gateway to environmental stimuli. Consequently, the structural anomalies of the foot not only make the motor response precarious (ie the "winding of the helix") but are also an obstacle to the correct reception of environmental stimulation. The receptivity of the gravity receptors, present in large numbers in the muscles and in the articular and aponeurotic formations of the foot, is altered as the disposition and the circulatory condition of the tissues that host them are abnormal. The ligaments and muscle-tendon formations, in fact, are stressed by abnormal tensions. As a consequence of this, the gravity control circuit is at least partially occluded.
It is clear that an incorrect support can cause the consequences to be felt in the ankle, knee, hip, the entire spine, up to affecting the positioning of the head. In reality, as we will see in the next two chapters, these effects affect the whole organism. By normalizing the reception of environmental information, the integration of genetic-environmental information will be enhanced, thus favoring the evolutionary process as well as the well-being of the whole person. The importance of the design and use of ergonomic systems capable of acting as an ideal ground-foot interface is thus evident.

Musculoskeletal problems of postural origin

In the previous chapters we have illustrated the reasons why flat ground is a primary cause of our postural alterations. We have also seen that our postural system reacts to the flat ground by creating a lumbar hyperlordosis that must be compensated, first of all, at the dorsal level with a dorsal hyperkyphosis and then with a straightening of the cervical tract. But of course it does not end here, because this vertebral misalignment will lead to an adaptation, through possible rotations on all planes, of all four limbs, of the trunk and of the head (with consequent alteration of the stomatognathic system). Each of us will compensate in different ways. ways, based on numerous factors (genetic heritage, environment, activity, etc.), and will have his own personal posture (which, as a rule, will tend to worsen over time, unless "appropriate prevention is carried out). All this naturally through initially hypertonicity, hypotonicity, retractions and then muscle fibrosis with possible reflexes, as described below, throughout our body.
Postural alterations involve non-physiological tensions and loads to the detriment of muscles, tendons, ligaments, joint capsules, joints, nerves, periosteum, etc.
The joints subjected to the gravitational load in an unbalanced manner will present areas that will be overloaded, thus facing arthrosis early and formation of osteophytes, and areas subjected to a load defect, which will lead to a "osteoporosis early.
Hypersollecitations stress on tendons and joints will also favor the onset of tendinitis, tenosynovitis, arthrosynovitis, bursitis, ligamentopathies, neuropathies, calcifications, synovial cysts, lipomas etc.
An inappropriate alignment of the head implies, given its weight (over 4 kg in an adult) and its position, compensations of the whole body thus potentially triggering a vicious circle of ascending-descending perturbing effects. In addition to this, anomalous lateralizations, rotations and ante-repulsions of the head involve a compensatory structural and functional misalignment on the occlusal plane, therefore on the stomatognathic apparatus. teeth that the child forms, starting from the first year of age, is formed according to his posture, which he gradually assumes, and the use of the tongue which, together with the foot, turns out to be the most important organ-functional conformator; in fact, the tongue directly influences the mandibular and maxillary growth and the morphogenesis of the dental arches.The functionality of the masticatory muscles will inevitably have to support the disharmony present with reflections on the most important muscle chains.
In any case, if the posture of the skull (and therefore of the whole body) is not aligned also the occlusal plane, consequently, will not be aligned but will be, as far as possible, functional to that specific and unique situation. An ideal straightening of the occlusal plane, not accompanied by an "appropriate postural re-education program, thus runs the risk of being an intervention with excellent aesthetic results, at the level of the mouth, but with negative implications of the spine, and therefore of posture in general. On the contrary, the" dental intervention, as part of a postural re-education team work, is often of precious and decisive utility.