Download Postural Assessment

 Why do we do it?
 Is it all that important?
 Can it be changed?
 Injury prevention?
 Pain reduction?
 Aesthetics?
 Performance?
 The importance of normal upright posture has been
proposed since the early 1900s when it was described
as a state of balance requiring minimal muscular effort
to maintain.
 Points of reference consisting of the lobe of the ear, the
seventh cervical vertebra, the acromial process, the
greater trochanter, just anterior to midline of the knee,
and slightly anterior to the lateral malleolous which
form a theoretical line around which the body is
balanced in perfect skeletal alignment, yielding equal
weight distribution and maximum joint stability .
 Unbalanced biomechanical joint stresses that result
from muscle imbalance may lead to joint damage,
setting up a vicious cycle of pain and inflammation.
The structural inflammation then affects the
neuromuscular system of the joint, creating further
dysfunction. Eventually the body adapts the motor
program for movement to compensate for the
dysfunction
Muscle
imbalance
tightness
with
weakness
Impaired
movement
patterns and
postural
changes
Faulty motor
program /
altered joint
forces and
altered
proprioceptio
n
Pain and
Inflammation
Joint
degeneration
and postural
changes
Dominant
spinal
erectors
Hip flexors
tight they
pull down
Dominant and
tight external
obliques
Tight
hamstrings
 Misalignments can “impose excessive stress on the
spine leading to degeneration/damage or dysfunction
and eventually to painful back conditions
 In this model, the imbalances and symmetries increase
the abnormal mechanical/physical stresses imposed
on the musculoskeletal system. This may lead
recurrent injury or the development chronic
conditions through a gradual process of wear-and-tear
 Solid theory?
 Is B really caused by A
 Is pain and dysfunction really caused by ‘poor posture’
Impaired
movement
patterns
and
postural
changes
Muscle
imbalance
(tightness/
weakness
Faulty motor
program /
altered joint
forces and
altered
proprioceptio
n
Pain and
Inflammation
Joint
degeneration
and postural
changes
 Lumbar lordosis induced by…
 These muscle impairments lead to increased lumbar
lordosis and might cause chronic low back pain.
 No significant differences in the degree of lumbar
lordosis in subjects with and without short
hamstrings.
 No significant difference in the degree of lumbar
lordosis and in the length of hip flexor muscles.
 No association between the angle of pelvic inclination,
the size of the lumbar lordosis and abdominal muscle
strength
 No association between the length of abdominal
muscles and the size of lumbar lordosis.
 Pain changes movement but does posture change
movement patterns?
 2009
 34,902 Danish twins 20-71 years old
 No meaningful differences in frequency in LBP
between younger and older individuals, although
greater joint degeneration changes are expected in
older individuals.
 In the biomechanical model the musculoskeletal
system is seen as a precision engine where every
system, organ and cell works in perfect harmony
within itself and other body systems.
 All joints and body masses are in some anatomically
ideal relation with one another.
 120 asymptomatic participants the experimenters
found that “ Out of the 65 male subjects tested 55
(85%) presented with an anterior tilt, 4 with a
posterior tilt and 6 presented as neutral. Across the
sample of female subjects 41 presented with an
anterior tilt (75%), 4 with a posterior tilt and 10
presented as neutral.” (9).
 patients with chronic low back pain had no more
standing lumbar lordosis or pelvic inclination than
their counterparts with healthy backs..” (2)
 the correlations between all measurements were so
low that abdominal muscle function, pelvic tilt, and
lumbar lordosis do not appear to be linked as
inextricably as has been proposed” (3).
 “A number of individuals with normal posture were
found to have significant pain, whereas some
individuals with more severe postural deviations in the
thoracocervical- shoulder region were found to have
minimal pain.” (5)
 Within the biological dimension the structure (spine)
is capable of self repair and is able to adapt and change
according to needs and demands.
 Our structure is within our awareness and highly in
tune with our emotions.
 The spine can undergo profound physical changes that
are well tolerated without the development of a
symptomatic condition.
 Multivariate analysis show that correcting posture may
not be the answer to improving LBP
 improvements in posture lead to variable increases in
shoulder ROM but intensity of pain is not affected.
Subjects respond individually to the effects of posture
change.
 Some support to the belief that reducing the thoracic
kyphosis can contribute to improving arm elevation
 No studies that have looked at changing kyphosis in
people with SIS to determine if it decreases pain.
 Estimated that 90 percent of the population has a leg
length inequality with a mean of 5.2mm
 Significant if magnitude reaches 20 mm.
 No correlation to LBP
 Perthe’s disease
 Does static posture translate over to dynamic
movement?
 Posture is structural strength is neural
 Increased ROM with postural corrections although
this is variable
 No significant relationship between lumbar lordosis
and isometric strength of the trunk flexors and
extensors and hip flexors and extensors.
 Abdominal muscle strength not significantly
associated with lumbar lordosis.
 Weak and lengthened agonist vs strong and tight
antagonist proposed cause. So what would one do?
 Strengthening and stretching exercises have been
prescribed according to deviation.
 Strengthening = shortening?
 Stretching = lengthening?
 Does an increase in muscular strength allow a better
posture to be held? If this were the case it would not
be unreasonable to expect that individuals with poor
posture had weak muscles; however this is not the
general finding.
 Back muscle length was not significantly associated
with lumbar lordosis for men or women.
 Weakly associated with abdominal length not strength
 Exercise programs are insufficient in duration and
frequency to induce adaptive changes in muscletendon length.
 “In the context of postural-structural-biomechanical
(PSB) factors, it is expected that tremendous forces,
well above the daily physical stresses, would be
required to reposition/adjust/correct any structural
misalignments. These would have to be applied on a
daily basis over several months or even years. A
termination of treatment is likely to result in rapid
reversal of PSB gains, unless the individual is able to
self maintain them by specific exercise. The winner in
the competition-in-adaptation, is ultimately the one
most practiced, that is, the default PSB state/behavior
of the individual”
 Incidence of pain increased in subjects with more
severe postural abnormalities
 However, posture is individual: a number of
individuals with normal posture were found to have
significant pain, whereas some individuals with more
severe postural deviations in the TCS region were
found to have minimal pain. Causality cannot be
determined.
 Impairs mobility and increases risk of falls and
fractures.
 a kyphosis angle greater than 40 degrees is defined as
hyperkyphosis.
 Women with hyperkyphotic posture demonstrate
difficulty rising from a chair repeatedly without using
their arms.
 Hyperkyphotic posture has been associated with
increased mortality, with higher mortality rates
associated with the severity of kyphosis.
 Reduced vital capacity is associated with
hyperkyphosis, and severe hyperkyphosis is predictive
of pulmonary death among community dwelling
women.
 Women in the highest quartile of kyphosis were more
likely to die of pulmonary death compared with those
in the lower quartiles of kyphosis.
 http://saveyourself.ca/articles/posture.php#sec_risks2
 http://www.bettermovement.org/2010/back-pain-
myths-posture-core-strength-bulging-discs/
 http://bloodandiron315.com/2013/11/05/the-hips-dontlie-why-your-pelvic-tilt-doesnt-cause-pain/
 http://www.bboyscience.com/outdated-pain-theoriespart-2/
 http://www.ted.com/talks/amy_cuddy_your_body_lan
guage_shapes_who_you_are.html