Postural reeducation

Good posture is an integral component of one’s health, wellness and good aesthetics. Acquiring and maintaining good posture is paramount for spinal health and emotional wellness.

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What is posture?

Posture is an ability to maintain upright symmetrical position of the spine (head, neck, pelvis and limbs) during static positions such as sitting and standing as well as during movement. In other words, posture is an actively stabilized definite orientation of the body and its segments in space in relation to each other. Lets note that the orientation is space refers to steady base of support be it on the feet, pelvis or knees.

To put it in more precise medical language, posture is an ability to maintain balanced activity of variety of muscular groups and in antigravitational mode, so that grounding and verticalization is achieved simultaneously. Antigravitational mode can also be compared with buoyancy. The effect of buoyancy is achieved by shifting vector of muscle force up the spine. This type of muscle activity is called eccentric contraction.

Bad posture Green man

Grounding is an ability to establish and maintain position from base of support such as feet while standing or sit bones while seating.

Verticalization is an ability to keep the spine upright and as tall as it possible.

How does body achieve simultaneous grounding and verticalization.
For example:

in sitting, if the alignment of the head, rib cage and pelvis is optimal the muscles of the pelvic floor can relax and body weight falls symmetrically onto the sit bones.

When the deep spinal stabilizing system (core) works optimally, it allows reversal of muscle contraction in opposite directions while relaxing big superficial muscles in order to establish base of support.

This maximum body weight distribution into the supporting surface (such as floor or a chair, etc..) allows the brain to activate small intrinsic muscles of the pelvis, spine, diaphragm and the abdomen to lengthen up. This lengthening up is called eccentric contraction. This eccentric contraction is not possible without all described actions. The ability of slow twitch muscle fibers (aka postural muscles) to maintain the achieved upright position is necessary to maintain upright posture. The endurance of these type of muscle fibers is what constitutes sustainability of proper physiological posture. In other words, these slow twitch muscle fibers are responsible for maintaining posture once grounding and verticalization is achieved.

Postural muscle

Postural muscle

There are specific muscles that piece us together which could be referred to postural muscles. The goal and role of the postural muscles is to support us during functions where we are unaware of our movements. We rely on these muscles to perform every day activities which we don’t pay attention to such as sitting, standing or laying down or not doing anything specific. There is something called slow twitch fibers which primarily compose the postural muscles. The slow twitch muscles work endlessly with an “off” switch due to always being in demand. Not only do the slow twitch muscles keep us together, the deep core postural muscles located on the trunk of the “butt” of a person know where our gravitational field is and it communicates with the central nervous system by means of sensory coding with responds to the rest of the muscle system of the body. There are also muscles that ground us. These postural support muscles are basically weigh down and control the movements of the lower extremity.

Posture and Body Awareness

Body awareness is the ability to sense position of the body in space (gravitational field), while maintaining static position or during movement. Body awareness is necessary for the brain to control movement. It provides a reference point of where the movement begins, where it is in a certain moment and where it ends.

Magnus said: “Posture follows movement like a shadow”.

Good movement is not possible without good posture. One of the biggest pathways of the brain is to realize where the body is in a certain moment through small receptors located in these postural slow twitch type muscles. These small receptors are able to sense orientation of the body in relation to gravitational field. These receptors signal the brain of the status of each muscle and collectively the body (relation of all segments) by reporting change in length of muscle fibers.


Posture and mind over matter

People live in an world where its matter of mind versus mind over matter.

Meaning a person is not in-tune or aware what its own body is doing or how it is functioning. When a person is unaware of it muscle functions there tends to be conditions of strains and pains due to not realizing how you are using your body. For example, a person that is repeatedly using a computer will be immersed in their work and lack the ability to control ones movements and actions, resulting in strains and poor posture. The problem actually arises from an early age such as school children. Where they will fill their bags with heavy books and carry them on one shoulder resulting in poor posture and strains of the neck, shoulder, elbow etc… A persons mind is all over the place meaning they do not take proper time to focus and the brain to muscle functions become manipulated, that manipulation causes lots of harm to a person’s movement, posture and overall function. Even doing everyday activities without being aware of how they are performed is harmful to one’s body as well. When a person is unfocused or not paying attention we are unaware of our surroundings. Most time we realize to late that we are abusing our movements and posture, and that realization comes with pain and to correct it will take time determination awareness and effort.

Bad postural alignment
Posture and mind over matter

Poor Posture and Pain

When we slouch while sitting and try to lift ourselves up with our arms by pushing out from a chair or weight shifting from one leg to the other, the fast twitch muscles are being tricked into utilizing the role of the slow twitch muscles. The sudden feeling of being tired shows how in-accordingly we utilize our fatigue muscles for certain functions. The slow twitch muscles that are responsible for supporting us in an upright position are weak and less powerful due to the incorrect muscles being used and activated. As previously stated one of the functions of the slow twitch muscles is to coordinate with the central nervous system by indicating where out gravitational field is and where our location is per say.

But since the muscles are being confused and they are in a less prominent state they are confused and distorted. Gravity is a stronger fighter then our bodies are when are not focused and unaware of our functions. Since the fast and slow twitch muscles are confused that results in some muscles putting in too much work and others not enough. Remember this phrase, if you don’t use it you loose it, which is ultimately what’s happening. In conclusion, our bodies as a whole are no longer balanced and have no even distribution of muscles. This results in over use, pain, pressure and strains not only on the muscles but the joints, ligaments and tissues as well.

Most common pain areas

So why people develop poor posture

Statistically only thirty percent of humans are born with perfect posture. The foundation of posture is developed during first year of life.

This process is called ontogenesis. In this process the motor programs of the brain establish all the muscular chains necessary for the child to verticalize, stand up and walk.

During this process in the childhood as well as during early adulthood many things can interfere and disrupt the motor programs responsible for posture. Excessive and improper seating, improper breathing stereotypes, certain sporting activity, gym activities, trauma, stress and etc.

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Is it possible
to reverse bad posture?

Dr. Kalika
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If caught early enough bad posture is reversible into hands of experienced practitioner. More chronically disabling postural states can be greatly improved under proper care.

Postural reeducation at NYDNR

At NYDNRehab we use a blend of three different European methods to train proper posture. These methods are DNS (Dynamic Neuromuscular Stabilization ), Klapp crawling and Postural Reprograming by Bernard Bricot. Dr. Kalika is the only practitioner on East coast certified for all those three methods.
We also use our C.A.R.E.N ( computer assisted rehabilitation environment) system to facilitate feedback during postural reprogramming. We have been featured in various magazines and news as experts in postural reeducation.

Professional associations and memberships

Dr. Kalika is currently a certified member of:


American Institute of Ultrasound Medicine


Active member of ISMST

International Society of Extra Corporeal Shockwave Therapy


Active member of GCMAS

Gait and Clinical Movement Analysis Society


Active member of NASS

North American Spine Society


Active member of IADMS

International Association of Dance Medicine and Science


Active member of Virtual Rehabilitation Society


Active member of ASRA

American Society of Regional Anesthesia and Pain Medicine

Video of postural therapy for adolescent patient
Straighten up!

Research at NYDNRehab

Conference: the 12th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2018)At: Paris, France
Probiotics and aerobic physical activity improve symptoms of MetS, muscle and nerves structure and posture in overweight patients
Probiotic treatment and aerobic physical activity effects on visceral fat and posture in overweight patients with asthma
Whole-Body Neuromuscular Ultrasound for Evaluating Posture and Targeted Management of Muscle Spasticity and Pain

In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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