Postural Principles Useful to Consider in Voice Production
Introduction[edit | edit source]
Healthcare professionals from different disciplines may have a quite different approach to posture. Physiotherapists and other rehabilitation professionals consider overall body position, whereas dentists look at occlusal posture and speech therapists assess lingual posture. However, considering just one area in isolation can potentially affect a client's outcome. This page introduces some key postural considerations that may be useful in speech therapy.
Posture[edit | edit source]
“Posture is the position of the body in [...] space, and [it] is controlled by a set of anatomical structures”.[1]
Human posture refers to the relationship between body parts (e.g. head and neck, trunk, upper and lower limbs) in an upright position. There are three recognised reference planes when assessing posture:[2]
- Sagittal
- Coronal
- Transversal
There are also three physiological curves that act to balance the human spine:[1]
- Cervical lordosis
- Thoracic kyphosis
- Lumbar lordosis
These curves form and stabilise once there is propriceptive maturation of the foot, which occurs at around the age of 5 or 6 years.[1] They help to:[1]
- Maintain balance
- Provide support and resistance against longitudinal pressures
Posture encompasses:[1]
- Position
- Body shape
- Neuromuscular mode of operation
- Static and dynamic balance
Considering these concepts separately can lead to therapeutic failures and misunderstandings between different healthcare professionals.[2]
"Good Posture"[edit | edit source]
As quoted in Czaprowski et al., Kendall and colleagues define good posture as:
“That state of muscular and skeletal balance which protects the supporting structures of the body against the injury or progressive deformity, irrespective of the attitude (erect, lying, squatting or stooping) in which these structures are working or resting. Under such conditions, the muscles will function most efficiently, and the optimum positions are afforded for the thoracic and abdominal organs.”[3]
Good posture is proposed to have certain benefits:[3]
- Enables effective movement
- Supports the function of the internal organs
- Ergonomic advantages while standing
However, it is also important to note that very few people actually adopt this posture.[2]
The following is considered the ideal alignment:
- The head line begins at the external auditory meatus. It runs:[3]
- Vertically through the acromion, the lumbar vertebral bodies, and the promontory
- Slightly posteriorly to the hip joint axis
- Slightly anterior to the knee joint axis
- And terminates at, or slightly anterior, to the lateral malleolus
- Other points of reference: [2]
- The line of gravity should pass just anteriorly to the ear and C3 – C4, tangent to L3 - L4, cross the tibial plate and project centrally to the support polygon (i.e. slightly anterior to the line that connects the tibiotarsal joints)
- Cervical lordosis should be around 60 mm
- Dorsal kyphosis should be aligned with the gluteal muscles
- Lumbar lordosis should be around 40mm
From the frontal view, the flowing lines should be parallel and horizontal:[2]
- Bipupillar line
- Bicondilar line
- Bimammillar line
- Bistiloid line
- Biiliac line
- Bipatellar line
- Bimalleolar line
It is beneficial to observe the posture of clients with vocal or swallowing problems to detect any postural anomalies that may be contributing to their complaint. When considering the relationship with speech therapy in particular, it is important to remember that:[2]
- The neck, like the trunk, has many interdependent structures / viscera
- The vocal system is intricately linked to all structures in the neck and skull, as well as the anatomical structures that underlie phonation and swallowing (i.e. the diaphragm, viscera)
Approaches to Posture[edit | edit source]
The three most commonly used approaches to posture are:[2]
- Posturology
- Postural re-education
- Osteopathy and manual therapy
- ↑ 1.0 1.1 1.2 1.3 1.4 Carini F, Mazzola M, Fici C, Palmeri S, Messina M, Damiani P et al. Posture and posturology, anatomical and physiological profiles: overview and current state of art. Acta Biomed. 2017;88(1):11-16.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Banfi M. Postural Principles Useful in Speech Therapy. Physioplus. 2021.
- ↑ 3.0 3.1 3.2 Czaprowski D, Stoliński Ł, Tyrakowski M, Kozinoga M, Kotwicki T. Non-structural misalignments of body posture in the sagittal plane. Scoliosis Spinal Disord. 2018;13:6.
