POSTURAL ASSESSMENT

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.

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.

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

Body Types

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

Assessing the Spine

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

Gravity / Reference Line

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

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

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

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

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

Forward Head Posture

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

Flattened Lordotic Cervical Curve

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

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

Forward Shoulder Posture

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

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)

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

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

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

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

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

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

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

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

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