Download ONE1_02_Postural_Assessment

Chapter 2
 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…
 A) provide stability to the trunk.
 B) produce movement during physiologic activity.
 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.
 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.
 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.
 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.
 There is no “normal” posture.
 Ideal posture serves as a reference point.
 Ideal posture…
 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.
 Good habits contribute to a strong and stable posture.
 Bad habits contribute to poor posture and instability.
 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.
 Overstressed muscles tighten.
 Favored muscles weaken.
 This imbalance perpetuates the poor posture.
 Anterior to posterior.
 Lateral.
 Helical.
 Foundational distortions create changes above.
 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 describes muscles on one side of
a joint relaxing to accommodate contraction of
muscles on the other side of a joint.
 Postural (tend to
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hyperactivity)
Triceps surae
Hamstrings
Adductors
Rectus femoris
Tensor fascia latae (TFL)
Psoas
Erector spinae
 Phasic (tend to
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hypoactivity)
Tibialis anterior
Gluteus maximus
Gluteus medius
Rectus abdominus
Lower / middle trapezius
Longus capitus and colli
Deltoids
Digastrics
 Postural (tend to
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hyperactivity)
Quadratus lumborum (QL)
Pectoralis
Upper Trapezius
Sternocleidomastoid
Suboccipital
Masticatories
 Obtain pertinent history.
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Description of symptoms.
Fractures.
Injuries.
Congenital anomalies.
Dominant hand.
 Note gross structural asymmetries such as scoliosis.
 Occipital protruberance.
 Cervical, thoracic, and lumbar spinous processes.
 Coccyx.
 Gluteal folds.
 Arms should hang equally with palms slightly visible.
 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).
 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.
 Evaluate from both sides.
 Landmarks.
 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.
 Balanced posture should appear equal from left to
right.
 Landmarks.
 Bridge of nose.
 Center of chin.
 Episternal notch.
 Xiphoid process.
 Umbilicus.
 Pubes.
 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
 Feet aligned b/l
 No pronation / supination
 No inversion of eversion
 Knees forward and symmetric b/l
 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
 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.
 Postural finding
 Dysfunction
 Rounded shoulders
 Shortened pectorals
 Forward-drawn head
 Kyphotic t-spine
 C0-C1 hyperextension
 Winging of scapulae
 Elevation of shoulders
 Short suboccipitals
 Weak serratus anterior,
weak rhomboids
 Shortened upper trap,
shortened levator
scapulae, weak lower and
middle trap
 Tight-short muscles
 Weak-long muscles
 Suboccipitals
 Mid to lower trapezius
 Pectorals
 Serratus anterior
 Anterior shoulder
 Rhomboids
 Upper trapezius
 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.
 Weak gluteus maximus and short hip flexors.
 Weak abdominals and short lumbar erector spinae.
 Weak gluteus medius and short TFL and QL.
 Postural finding
 Dysfunction
 Lumbar hyperlordosis
 Shortened erector spinae
 Anterior pelvic tilt
 Weak gluteus maximus
 Protruding abdomen
 Weak abdominals
 Foot turned out
 Shortened piriformis
 Hypertrophy of
 Hypermobile lumbosacral
thoracolumbar junction
 Groove in iliotibial band
junction
 Shortened tensor fascia
latae
 Layered syndrome is a combination of the muscle
imbalances seen in both upper and lower crossed
syndrome.
 It develops with chronic cases.