Download ONE2_02_Postural_Assessment

Postural Assessment
Chapter 2
Posture
Posture is how the body balances.
Muscles, bones, and ligaments all work together to
exert postural control.
The nervous system innervates these structures to
regulate growth and function.
Muscles and their nerves…
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A) provide stability to the trunk.
B) produce movement during physiologic activity.
Postural Analysis
The motor system consists of bones,
muscles, and ligaments.
The nervous system controls the motor
system.
Postural analysis is an assessment of the
function of the motor system as well as the
nervous system.
Pain Cycle
Neutral Posture
The brain and nervous system utilize
information from three sources to balance
the body in space.
Sources of balance…
Eyes – level.
 Ears – vestibular apparatus.
 Muscles and joints – proprioceptive pathways.
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Righting Reflex
A postural reaction that turns a falling
animal's body in space so that its paws or
feet are pointed at the ground.
Returns the animal to sternal recumbency
after being placed on its back or side.
A normal reaction is dependent on normal
vestibular, visual and proprioceptive
functions.
Causality
Postural changes can be the cause of a clinical
problem.
Postural changes can be the effect of a clinical
problem.
Orthopedic problems can cause a postural change,
which can worsen the orthopedic problem.
Asymptomatic postural problems can produce
mechanical stress, which can predispose an
individual to injury.
Ideal Posture
There is no “normal” posture.
Ideal posture serves as a reference point.
Ideal posture…
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Distributes gravitational stress for balanced muscle
function.
Allows joints to move in their mid range to minimize
stress on ligaments and articular surfaces.
Effective for the individual’s activities of daily living.
Allows the individual to avoid injury.
Balanced Posture
Effect of Habits on Posture
Good habits contribute to a strong and
stable posture.
Bad habits contribute to poor posture and
instability.
Examples of Poor Postural Habits
Excessive sitting.
Carrying a heavy backpack.
Slumping.
Poor sleeping positions.
One-sided activities…
Carrying a heavy purse.
 Sitting on a wallet.
 Sitting in a twisted position.
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Postural Changes
Effects of Poor Posture on
Muscles
Overstressed muscles tighten.
Favored muscles weaken.
This imbalance perpetuates the poor
posture.
Spinal Distortions
Anterior to posterior.
Lateral.
Helical.
Foundational distortions create changes
above.
Spinal Column Views
Helical Spinal Distortion
Muscle Palpation
Palpate for hypertonic (overused) muscles.
Palpate for weak / inhibited muscles.
A muscle is weak because it is unstressed
and should be strengthened with exercise.
An inhibited muscle is not being used
because it’s antagonistic muscle is being
overused.
Reciprocal Inhibition
Reciprocal inhibition describes muscles on
one side of a joint relaxing to accommodate
contraction of muscles on the other side of a
joint.
Reciprocal Inhibition
Postural and Phasic Muscles
Postural (tend to
hyperactivity)
Triceps surae
Hamstrings
Adductors
Rectus femoris
Tensor fascia latae (TFL)
Psoas
Erector spinae
Phasic (tend to
hypoactivity)
Tibialis anterior
Gluteus maximus
Gluteus medius
Rectus abdominus
Lower / middle trapezius
Longus capitus and colli
Deltoids
Digastrics
Postural and Phasic Muscles
Postural (tend to
hyperactivity)
Quadratus lumborum (QL)
Pectoralis
Upper Trapezius
Sternocleidomastoid
Suboccipital
Masticatories
Posture Blocks
Prior To Postural Evaluation
Obtain pertinent history.
Description of symptoms.
 Fractures.
 Injuries.
 Congenital anomalies.
 Dominant hand.

Note gross structural asymmetries such as
scoliosis.
Postural Views
Posture Types
Posterior View Evaluation
Occipital protruberance.
Cervical, thoracic, and lumbar spinous
processes.
Coccyx.
Gluteal folds.
Arms should hang equally with palms
slightly visible.
Posterior View Evaluation
The space between the arms and sides of the
body should be equal.
Legs should be equally abducted.
The backs of the knees should be the same.
Ankles and feet aligned b/l (no pronation or
supination).
Posterior View Evaluation
Structures that should be level and equal.
Tips of mastoid processes.
 Acromia.
 Scapula.
 Lower margins of 12th ribs.
 Iliac crests.
 Posterior superior iliac spines (PSIS).
 Ischial tuberosities.
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Ideal Posterior Alignment
Scoliosis
Pelvic Unleveling
Gothic Shoulder
Scapular Winging
Scapular Winging and Abduction
Tight Levator Scapula
High Left Shoulder
Right Head Tilt and Rotation
Lateral View
Evaluate from both sides.
Landmarks.
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External auditory canal.
Acromion process of shoulder.
Axillary line.
Mid-point of iliac crest.
Greater trochanter of hip.
Lateral condyles of femur.
Tibia slightly anterior to lateral malleolus.
Ideal Lateral Alignment
Head Alignment Lateral View
Forward Head Posture
Head and Neck Weight
Distribution
Forward Head Tilt
Abdominal Protrusion
Pelvic Tilt (Anterior and
Posterior)
Anteroposterior / Front View
Balanced posture should appear equal from left to
right.
Landmarks.
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Bridge of nose.
Center of chin.
Episternal notch.
Xiphoid process.
Umbilicus.
Pubes.
Anteroposterior / Front View
Arms should hang similarly with palms at
the side of the thighs
Shoulder girdle symmetry

Hands should show similar rotation and
placement on the body
Legs should appear equally abducted from
the center line
Anteroposterior / Front View
Feet aligned b/l
No pronation / supination
 No inversion of eversion
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Knees forward and symmetric b/l
Anteroposterior / Front View
Structures that should be equal b/l and level
Eyes
 Clavicles
 Lower margins of the ribcage
 Anterior superior iliac spines (ASIS)
 Femoral trochanters
 Knees
 Ankles
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Internal Rotation of Shoulders /
Rounded Shoulders
Genu Valga (Knock-knees)
Genu Vara (Bowlegs)
Upper Crossed Syndrome
Affects the head, neck and shoulders.
Result of long-term seated postures.
Rolled-in and forward shoulders.
Increased thoracic kyphosis.
Forward head posture.
Loss of cervical lordosis.
Upper Crossed Syndrome
Postural Signs of Upper Crossed
Syndrome
Postural finding
Rounded shoulders
Forward-drawn head
C0-C1 hyperextension
Winging of scapulae
Elevation of shoulders
Dysfunction
Shortened pectorals
Kyphotic t-spine
Short suboccipitals
Weak serratus
anterior, weak
rhomboids
Shortened upper trap,
shortened levator
scapulae, weak lower
and middle trap
Muscle Imbalances in Upper
Crossed Syndrome
Tight-short muscles
Suboccipitals
Pectorals
Anterior shoulder
Upper trapezius
Weak-long muscles
Mid to lower trapezius
Serratus anterior
Rhomboids
Lower Crossed Syndrome
Affects the lumbar spine and pelvis.
Anterior pelvis and increased lumbar
lordosis.
Tightness in the psoas and lumbar erector
spinae.
Long-term sitting contributes to this
syndrome as well.
Lower Crossed Syndrome
Imbalances in the Following
Pairs of Muscles:
Weak gluteus maximus and short hip
flexors.
Weak abdominals and short lumbar erector
spinae.
Weak gluteus medius and short TFL and
QL.
Postural Signs of Lower Crossed
Syndrome
Postural finding
Lumbar hyperlordosis
Anterior pelvic tilt
Protruding abdomen
Foot turned out
Hypertrophy of
thoracolumbar junction
Groove in iliotibial band
Dysfunction
Shortened erector spinae
Weak gluteus maximus
Weak abdominals
Shortened piriformis
Hypermobile lumbosacral
junction
Shortened tensor fascia
latae
Upper and Lower Crossed
Syndrome
Layered Syndrome
Layered syndrome is a combination of the
muscle imbalances seen in both upper and
lower crossed syndrome.
It develops with chronic cases.
Layered Syndrome