1. Chapter 3
Assessment of Posture

2. Introduction
Posture is the position of the body at a given point in time
Correct posture can:
improve performance
decrease abnormal stresses
reduce the development of pathological conditions

3. Introduction Faulty posture:
Deviates from ideal posture
Requires an increased amount of muscular activity
Places an increased amount of stress on the joints and surrounding tissues
Restrictions in normal movement patterns may cause compensatory postures
Overtime can result in muscle imbalances and soft tissue dysfunction

4. Introduction
Pain related to postural deviations is a common clinical occurrence
Many do not seek help until pain is experienced
Postural assessment is used to determine if postural deviations are contributing factors in patient’s pain or dysfunction
Posture must be evaluated in functional and nonfunctional positions

5. Clinical Anatomy
Musculoskeletal system is designed to function in a mechanically and physiologically efficient manner to use the least possible amount of energy
Postural deviations or skeletal malalignment cause other joints in kinetic chain to undergo compensatory motions or postures to allow body to move as efficiently as possible

6. The Kinetic Chain Closed kinetic chain Open kinetic chain
Weight-bearing
Lower extremity
Distal segment meets resistance or is fixated
Interdependency of each joint = predictable changes in position
Figure 3-1A, page 53
Open kinetic chain
Non-weight-bearing
Upper extremity
Distal segment moves freely in space

7. The Kinetic Chain
A dysfunction occurring in one area may affect the proximal or distal associated joints and soft tissue structures
Causing a specific postural deviation
The body compensates for these deviations to maintain as much efficiency as possible in movement and function
Table 3-1, page 54

8. Muscular Function
Muscles produce joint motion and provide dynamic joint stability
Muscles must be of adequate length and function in a proper manner
If too short or too long
Adverse stress on joints
Work inefficiently
Create need for compensatory motions
Table 3-2, page 55

9. Muscular Length-Tension Relationships
Describes how a muscle is capable of producing different amounts of tension (force), depending on its length
Active insufficiency
Muscle is shortened and maximum tension cannot be produced
Passive insufficiency
Muscle is lengthened and cannot generate sufficient tension to be effective
Figure 3-4, page 56

10. Agonist and Antagonist Relationships
Muscle that contracts to perform the primary movement of a joint
Antagonist
Performs opposite movement of agonist and must relax to allow agonist’s motion to occur
Reciprocal inhibition
Bicep/triceps example
Co-contraction
Used for dynamic stability of joint

11. Muscular Imbalances
Impaired relationship between a muscle that is overactivated, subsequently shortened and tightened and another that is inhibited and weakened
Table 3-3, page 57
Postural vs. phasic muscles
Table 3-4, page 57
Table 3-5, page 57

12. Soft Tissue Imbalances
Joint’s capsule and surrounding ligaments undergo adaptive changes from prolonged overstressing or understressing of structure
Faulty posture can alter the position of joints, causing an increase in stress on different portions of the joint capsule and surrounding ligaments

13. Clinical Evaluation of Posture
Not an exact science
Radiographs, photographs, computer analysis
Clinical tools – plumb lines, goniometers, flexible rulers, inclinometers (fig. 3-5, page 58)
Subjective vs. objective methods
Normal, mild, moderate, severe posture
Quantifiable measurements can assess treatment plan

14. Clinical Evaluation of Posture
Commonly assessed in various positions
Standing and sitting
Sport-specific and ADLs
Orthoposition
Normal or properly aligned posture
4 movements to perform before assessment
Page 58

15. History
To determine if a postural dysfunction is contributing to the patient’s pathology
Identify any routine repetitive motions
IF injury is chronic
Explore day to day tasks and posture
If injury is acute
Determine factors that may have predisposed athlete to the injury

16. History Mechanism of injury Type, location, and severity of symptoms
Common responses
Insidious onset
Pain worsening as day progresses
Posture-specific pain
Intermittent, vague , or generalized pain
Starting as an ache and progressing
Type, location, and severity of symptoms
Side of dominance
Activities of daily living
Table 3-7, pages 60-61

17. History Driving, sitting, and sleeping postures
Table 3-8, page 62
Specific postures causing discomfort
Level and intensity of exercise
Medical History

18. Inspection Considerations Area being used is private, comfortable
Patient preparedness
Do not inform patient you are assessing posture
Use systematic approach
Start at feet and work superiorly or vice versa
Compare bilaterally for symmetry
Your eyes should be at level of region you are observing

19. Overall Impression Determine patient’s general body type
Ectomorph, mesomorph, endomorph
Inherited
Can indicate a person’s natural abilities and disabilities
Does not necessarily dictate how they may function
Box 3-1, page 64

20. Views of Postural Inspection
Inspect from lateral, anterior, posterior views
Plumb line
Feet as permanent landmark
Lateral view
Slightly anterior to lateral malleolus
Anterior and posterior view
Equidistant from both feet
Box 3-2, page 65

21. Views Lateral view Anterior view Posterior view Table 3-9, page 63

22. Inspection of Leg Length Discrepancy
Three categories
Structural (true)
Functional (apparent)
Compensatory
Table 3-12, page 68
Block method (Box 3-3, page 69)
Figure 3-6, page 68
Figure 3-7, page 70
Figure 3-8, page 70

23. Palpation
To determine specific positions (key landmarks) not necessarily for point tenderness
Lateral aspect
Pelvic position
ASIS and PSIS, 9-100
Box 3-4, page 71

24. Palpation Anterior aspect Patellar position Iliac crest heights
Figure 3-9, page 70
ASIS heights
Figure 3-10, page 70
Lateral malleolus and fibula head heights
Shoulder heights
Figure 3-11, page 72

25. Palpation Posterior aspect
Many of same landmarks used for anterior view
PSIS position
Figure 3-12, page 72
Spinal alignment
Scapular position
Box 3-5, page 73
Not important at this time

26. Common Postural Deviations
Not all postural deviations cause pathology
Clinicians must identify
Normal posture
Asymptomatic deviations
Deviations causing dysfunction and/or pain
Potential muscle imbalances can cause poor posture OR be a result of poor posture
Deviations also caused by skeletal malalignment, anomalies, or combination

27. Foot and Ankle Hyperpronation Supination Review chapter 4
Figure 3-13, page 74
Supination

28. The Knee Genu Recurvatum Genu Valgum
Knee axis of motion is posterior to plumb line
Box 3-6, page 75
Genu Valgum
Occurs due to
structural anomalies or muscular weaknesses at the hip
Secondary to hyperpronation of the feet
Can lead to
Increased pronation
Internal tibial and femoral rotation
Medial patellar positioning

29. The Knee Genu Varum Occurs due to Can lead to
Structural anomalies at the hip
Excessive supination
Can lead to
Supination
External tibial and femoral rotation
Lateral patellar positioning

30. Interrelationships Between Regions
Table 3-14, page 83
May be impossible to determine if posture is the cause or the effect
Understand relationships and importance of correcting the factors involved
Most soft tissue dysfunctions that have a gradual, insidious onset have, at least, a minimal postural component

31. Documentation of Postural Assessment
Table 3-15, page 85
As part of a SOAP note
Figure 3-14, page 84
Standard postural assessment form
Guidelines for documenting posture
Pages 83, 85