Download Postural Evaluation: Spinal Column

Postural Evaluation:
Spinal Column
Orthopedic Assessment III – Head,
Spine, and Trunk with Lab
PET 5609C
Postural Evaluation
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Hyperlordotic Posture:
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Joints involved:
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Lumbar spine, pelvis, hip
Possible cause:
Tightened or shortened hip flexor muscles
 Weakened or elongated hip extensors or abdominals
 Poor postural sense
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Adverse effects:
↑ lumbar lordosis
 Anterior pelvic tilt
 Hips assuming a flexed position
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Postural Evaluation
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Hyperlordotic Posture:
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Pathological conditions:
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↑ shear forces on lumbar vertebral
bodies secondary to psoas
tightness
↑ compressive forces on facet
joints
Adaptive shortening of posterior
lumbar spine ligaments and
anterior hip ligaments
Elongation of anterior lumbar
spine ligaments and posterior hip
ligaments
Narrowing of lumber intervertebral
foramen
Postural Evaluation
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Kypholordotic Posture:
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Similar to hyperlordotic posture:
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↑ total lumbar lordosis
Differences:
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Compensatory ↑ in thoracic kyphosis:
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Attempt to maintain spine in position of equilibrium
Cervical spine: ↑ in lordosis (Forward head posture)
Joints involved:
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Pelvis, hip joint, lumbar spine, thoracic spine,
cervical spine
Postural Evaluation
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Kypholordotic Posture:
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Possible causes:
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Poor postural sense
Muscle imbalance:
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Tightened/shortened hip flexors
Weakened or elongated hip
extensors or trunk flexors
Adverse effects:
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Anterior pelvic tilt
Hip joint flexion
↑ lumbar lordosis
↑ thoracic kyphosis
Postural Evaluation
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Kypholordotic Posture:
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Pathological conditions:
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Adaptive shortening of anterior
chest muscles
Elongation of thoracic paraspinal
muscles
↑ compressive forces on anterior
thoracic vertebrae and posterior
lumbar vertebrae
↑ tensile forces on ligamentous
structures in posterior thoracic
spine and anterior lumbar spine
↑ facet joint compression
Forward head posture
Forward shoulder posture
Postural Evaluation
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Swayback Posture:
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Key: ↑ reliance on ligaments for postural stability
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Joints involved:
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Joints at end ROM (excessive stress on ligaments)
Knees, hips, lumbar spine, lower thoracic spine, cervical
spine
Possible causes:
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Ectomorph body: hypomobility of joints
Poor postural sense
Tightened/shortened hip extensors
Weakened or elongated hip flexors or lower abdominals
↓ general muscular strength
Postural Evaluation
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Swayback Posture:
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Adverse Effects:
Genu recurvatum
 Hip joint extension
 Posterior pelvic tilt
 Lumbar spine in neutral or
minimal flexed position
 ↑ in lower thoracic,
thoracolumbar curvature
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Postural Evaluation
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Swayback Posture:
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Pathological Conditions:
Elongated or ↑ tensile forces on
anterior hip ligaments and
posterior aspect of lower
thoracic spine
 Adapted/shortened or ↑
compressive forces on posterior
hip ligaments and anterior
lower thoracic spine
 ↑ tensile force on posterior knee
and compressive force on
anterior knee
 ↑ shearing forces on L5/S1
 Forward head and shoulder
posture
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Postural Evaluation
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Flat Back Posture:
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Key: Lost normal “S” shape spine curvature in the
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Joints:
sagital plane
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Possible causes:
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Hip joint, lumbar spine, thoracic spine, cervical spine
Shortened/tightened hip extensors, abdominal musculature
Weakened, elongated hip flexors
Poor posture
Adverse effects:
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Extended hip joint / posterior pelvic tilt
Extended thoracic spine
Flexed middle and lower cervical spine, extended upper cervical
spine
Postural Evaluation
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Flat Back Posture:
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Pathological
conditions:
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Compressive forces in
posterior hip joint,
anterior lumber and
mid-low cervical
spines, posterior
thoracic and upper
cervical spines
Elongation of soft
tissue
Forward head posture
(compensation for
posterior spine
displacement)
Postural Evaluation
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Scoliosis:
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Lateral curvature of spinal
column
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Functional: spine attempts
to compensate to maintain
the head in a neutral
position and keep eyes level
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Muscular imbalance,
pelvic obliquity, limblength discrepancy
Structural: defect or
congenital bony abnormality
of vertebrae
Postural Evaluation
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General Inspection: Scoliosis
 Signs and symptoms:
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Uneven shoulders
One shoulder blade appears more
prominent
Uneven waist / 1 hip higher vs.
other
Leaning to one side
Back pain and difficulty breathing
(severe scoliosis)
Causes:
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Idiopathic (85% of cases)
Underlying neuromuscular disease,
leg-length discrepancy, birth
defect, fetal development
(congenital)
Not caused by poor posture, diet,
exercise, or the use of backpacks
Postural Evaluation
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Diagnosis:
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Angle: X-ray
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Normal Spine (0
degrees)
Scoliosis: (> 10
degrees)
Complications:
(severe scoliosis)
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Lung and heart
damage:
compression of rib
cage against heart,
lungs
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> 70 degrees
Back problems
Postural Evaluation
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General Inspection:
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Scoliosis Test: Adam’s Forward Bend Test
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Patient Position: Standing with hands held in front (arms
straight)
Evaluation Procedure: Patient bends forward, sliding hands
down the front of each leg
Positive Test:
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Asymmetrical hump along lateral aspect of thoracolumbar spine
One shoulder blade appears more prominent
Uneven hips
Implications:
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Functional scoliosis: scoliosis present when patient stands
straight, disappears during flexion
Structural scoliosis: present during both standing and with
flexion
Postural Evaluation
Postural Evaluation
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Forward Shoulder Posture:
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Key: characterized by
protraction and elevation of
scapulae and a forward,
rounded position of shoulders
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May include scapula winging and
IR
Forward head posture
Joints:
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Scapulothoracic articulation
Glenohumeral joint
Thoracic spine
Cervical spine
Postural Evaluation
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Forward Shoulder Posture:
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Possible causes:
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Tightened, shortened pectoral
muscles
Weakened or elongated scapular
retractors (mid and low trapezius,
rhomboids)
Poor postural awareness and/or
muscle fatigue
Large breast development
Adverse effects:
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Humeral head stress (displaced
anteriorly)
Forward head posture
Postural Evaluation
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Forward Shoulder Posture:
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Pathological conditions:
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Thoracic outlet syndrome:
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Adaptive shortening of pectoralis minor, anterior/middle
scalenes → compression of subclavian artery, vein, and
medial cord of brachial plexus
Abnormal scapulohumeral rhythm and scapular
stability
 Acromioclavicular degeneration
 Bicipital tendonitis
 Impingement syndrome
 Abnormal GH biomechanics
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Postural Evaluation
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Scapula Winging:
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Weakness of serratus
anterior, middle and
lower trapezius
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Long thoracic nerve
Biomechanics of
normal arm
movement thrown
off
Postural Evaluation
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Forward Head Posture:
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Key: anterior displacement of
head relative to thorax
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Joints:
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Possible causes:
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Cervical spine, GH, thoracic spine
Poor eyesight (need glasses)
Muscle fatigue/weakness
Poor postural sense
Adverse effects:
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Flexion of lower cervical spine
Flattening of mid cervical spine
GH motion affected
Postural Evaluation
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Forward Head Posture:
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Pathological conditions:
Shortened suboccipital muscles, scalenes, upper
trapezius, levator scapula
 Hypomobile upper cervical region
 Abnormal GH biomechanics
 TMJ dysfunction
 Thoracic outlet syndrome (scalene involvement)
 Forward shoulder posture
 Myofascial pain (posterior cervical muscles)
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Ectomorph
Mesomorph Endomorph
Description
Slender, thin
Medium,
build; low body athletic build,
weight
average body
weight
Short, stocky
build, high
body weight
Joint shape
Small, flat joint Medium joint
surfaces
surfaces
Large, concaveconvex joint
surfaces
Muscle mass Minimal
Medium
muscle build
Thick muscle
mass
Joint mobility Increased
Within normal
limits
Decreased
Joint stability Decreased
Within normal
limits
Increased
muscle bulk,
thin muscles