1. POSTURAL ASSESSMENT

2. POSTURAL EVALUATION
Requires a lot of skill on the part of the examiner because most postural abnormalities are extremely subtle in appearance
Need to separate the parts of the body from the whole and then assess the sum of the parts in reference to their interaction in the entire anatomical structure.

3. Inspection
Use a systematic approach when assessing posture to avoid overlooking a specific region
Whenever possible place your eyes at the same level as the region you are observing.
Do not alert the patient that posture is being assessed at this time.
First component of assessment is determining the patient’s body type.

4. Body Types
Ectomorph: slender, thin build, minimal muscle bulk, with a low BMI
increased joint mobility with decreased joint stability
Mesomorph: medium, athletic build, with average BMI
joint mobility and stability WNL
Endomorph: stocky build, thick muscle mass, with high BMI
decreased joint mobility with increased joint stability

5. Body Types

6. Views of Postural Inspection
Posture is inspected from all views or planes
Lateral view: involes making determinations of the anterior and posterior alignment relative to the frontal plane.
Anterior and Posterior view: major regions of the body are observed from this view and symmetry is compared bilaterally

7. Assessing the Spine

8. Gravity / Reference Line
In correct posture, the gravity line passes through the axes of all major joints with the body segments aligned vertically
Gravity line is represented by a vertical line drawn through the body’s center of gravity located at the S2. It is the reference point from which from which gravitational effects on individual body segments are assessed

9. Gravity / Reference Line

10. Gravity / Reference Line
Changes in responds to the constantly altering body position during upright posture.
People with excellent posture come close to having the line of reference pass through all the joints axes affording them less gravitational stress being placed on the soft tissue components of the supporting system

11. Soft Tissue Balance and Posture
Important for muscles, ligaments, and other soft tissue structures about the joint to be balanced
The head, trunk, shoulders, and pelvic girdle are the most important segments to have in muscular and mechanical balance. They are the foundation from which forces are directed to the limbs

12. LATERAL POSTURAL VIEW
Perform from both sides to detect rotational abnormalities
Head position: plumb line should pass through the ear lobe and acromion process

13. Lateral Postural View Anatomical landmarks:
Head: External Auditory Meatus
Cervical Spine (Neck): Lower cervical vertebral bodies
Shoulder Joint: Acromion process
Thorax: Mid-thorax
Hip: Greater trochanter
Knee: Lateral epicondyle
Ankle: anterior to lateral malleolus

14. Common Head Faults
Head lies anterior to the plumb line (Forward Head Posture)
Causes:
Excessive cervical lordosis
Weak cervical extensor, upper trapezius, and levator scapulae muscles
Tight pectoralis muscles.
Need for glasses
Sitting improperly with shoulders rounded and back hunched

15. Forward Head Posture

16. Common Neck Faults
Flattened Lordotic Cervical Curve : the plumb line lies anterior to the vertebral bodies.
Causes:
Stretched posterior cervical ligaments and extensor muscles
Tight cervical flexor muscles

17. Flattened Lordotic Cervical Curve

18. Common Neck Faults Torticollis
Head is bent or rotated sideways due to a congenital deformation or acute spasm of the sternocleidomastoid muscle

19. Shoulder Postural Faults
Forward Shoulder: The acromion process lies anterior to the plumb line; the scapulae are elevated and protracted
Causes:
Poor postural sense
Tight pectoralis major and minor, serratus anterior, and intercostal muscles
Excessive thoracic kyphosis and forward head
Weakness of thoracic extensor, middle trapezius, and rhomboid muscles
Lengthened middle and lower trapezius muscles

20. Forward Shoulder Posture

21. Shoulder Postural Faults
Lumbar Lordosis: The lumbar region is flat as the subject raises arms overhead:
Causes:
Tightness of the latissimus dorsi muscle and thoracolumbar fasciae

22. Scapula (Posterior view)
Common Faults
Winging:  the medial border of the scapula is rotated outward and laterally, causing the scapula to give the appearance of “wings” on the patient’s back
Causes
Disruption of the serratus anterior muscle or long thoracic nerve
Desynchronization of periscapular muscles (pseudowinging)

23. Spinal Column Common Faults:
Hyperkyphotic Posture (Kyphosis): increased posterior convexity of the vertebrae
Common Causes:
Compression of intervetebral disks anteriorly
Stretched thoracic extensors, middle and lower trapezius muscles, and posterior ligaments
Tightness of anterior longitudinal ligament, upper abdominal, and anterior chest muscles

24. Spinal Column Common Faults:
Hyperlordotic Posture (Lordosis): Increase in the lumbar curvature
Common Causes:
Shortening of the hip flexors
Pregnancy
Obesity
Poor postural awareness

25. Spinal Column (Posterior View)
Common Faults:
Scoliosis: lateral curvature of the spinal column.
Causes:
Functional
Muscle imbalance
Limb length discrepancy
Structural
Congenital bony anomaly of the vertebrae
Idiopathic
Unclear

26. Hip (Anterior/Posterior View)
Common Faults
Assymetric hip height: Assymetry in the height of the Iliac crests
Causes
Possible leg length discrepancy
Scoliosis

27. Knees (Lateral view) Common Faults:
Genu Recurvatum: Lateral epicondyle is significantly posterior relative the plumb line.
Causes
Congenital
Combined tear of the anterior and posterior cruciate ligaments

28. Knee (Anterior View) Common Faults:
Genu valgum: medial angulation of the femur and tibia, “knock-kneed”
Causes
Structural anomalies at the hip
Muscular weakness at the hip
Hyperpronation of the feet

29. Knee (Anterior View) Common Faults:
Genu varum: lateral angulation of the femur and tibia occurring at the knee, “bow legged”
Causes
Structural anomalies at the hip
Excessive supination of the feet

30. Feet (Anterior view) Common faults
Internally rotated feet (Pigeon toed)
Causes:
Internally rotated tibia
Femoral anteversion
Sub Talar joint pronation

31. Feet (Anterior view) Common Faults Externally rotated feet (Duck feet)
Causes:
Externally rotated tibia
Femoral retroversion
Sub-talar joint supination