Postural Assessment Chapter 2

Posture 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.

Postural Analysis 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.

Pain Cycle

Neutral Posture 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.

Righting Reflex 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.

Causality 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.

Ideal Posture 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.

Balanced Posture

Effect of Habits on Posture Good habits contribute to a strong and stable posture. Bad habits contribute to poor posture and instability.

Examples of Poor Postural Habits 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.

Postural Changes

Effects of Poor Posture on Muscles Overstressed muscles tighten. Favored muscles weaken. This imbalance perpetuates the poor posture.

Spinal Distortions Anterior to posterior. Lateral. Helical. Foundational distortions create changes above.

Spinal Column Views

Helical Spinal Distortion

Muscle Palpation 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 Reciprocal inhibition describes muscles on one side of a joint relaxing to accommodate contraction of muscles on the other side of a joint.

Reciprocal Inhibition

Postural and Phasic Muscles Postural (tend to hyperactivity) Triceps surae Hamstrings Adductors Rectus femoris Tensor fascia latae (TFL) Psoas Erector spinae Phasic (tend to hypoactivity) Tibialis anterior Gluteus maximus Gluteus medius Rectus abdominus Lower / middle trapezius Longus capitus and colli Deltoids Digastrics

Postural and Phasic Muscles Postural (tend to hyperactivity) Quadratus lumborum (QL) Pectoralis Upper Trapezius Sternocleidomastoid Suboccipital Masticatories

Posture Blocks

Prior To Postural Evaluation Obtain pertinent history. Description of symptoms. Fractures. Injuries. Congenital anomalies. Dominant hand. Note gross structural asymmetries such as scoliosis.

Postural Views

Posture Types

Posterior View Evaluation Occipital protruberance. Cervical, thoracic, and lumbar spinous processes. Coccyx. Gluteal folds. Arms should hang equally with palms slightly visible.

Posterior View Evaluation 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).

Posterior View Evaluation 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.

Ideal Posterior Alignment

Scoliosis

Pelvic Unleveling

Gothic Shoulder

Scapular Winging

Scapular Winging and Abduction

Tight Levator Scapula

High Left Shoulder

Right Head Tilt and Rotation

Lateral View 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.

Ideal Lateral Alignment

Head Alignment Lateral View

Forward Head Posture

Head and Neck Weight Distribution

Forward Head Tilt

Abdominal Protrusion

Pelvic Tilt (Anterior and Posterior)

Anteroposterior / Front View Balanced posture should appear equal from left to right. Landmarks. Bridge of nose. Center of chin. Episternal notch. Xiphoid process. Umbilicus. Pubes.

Anteroposterior / Front View 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

Anteroposterior / Front View Feet aligned b/l No pronation / supination No inversion of eversion Knees forward and symmetric b/l

Anteroposterior / Front View 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

Internal Rotation of Shoulders / Rounded Shoulders

Genu Valga (Knock-knees)

Genu Vara (Bowlegs)

Upper Crossed Syndrome 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.

Upper Crossed Syndrome

Postural Signs of Upper Crossed Syndrome Postural finding Rounded shoulders Forward-drawn head C0-C1 hyperextension Winging of scapulae Elevation of shoulders Dysfunction Shortened pectorals Kyphotic t-spine Short suboccipitals Weak serratus anterior, weak rhomboids Shortened upper trap, shortened levator scapulae, weak lower and middle trap

Muscle Imbalances in Upper Crossed Syndrome Tight-short muscles Suboccipitals Pectorals Anterior shoulder Upper trapezius Weak-long muscles Mid to lower trapezius Serratus anterior Rhomboids

Lower Crossed Syndrome 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.

Lower Crossed Syndrome

Imbalances in the Following Pairs of Muscles: Weak gluteus maximus and short hip flexors. Weak abdominals and short lumbar erector spinae. Weak gluteus medius and short TFL and QL.

Postural Signs of Lower Crossed Syndrome Postural finding Lumbar hyperlordosis Anterior pelvic tilt Protruding abdomen Foot turned out Hypertrophy of thoracolumbar junction Groove in iliotibial band Dysfunction Shortened erector spinae Weak gluteus maximus Weak abdominals Shortened piriformis Hypermobile lumbosacral junction Shortened tensor fascia latae

Upper and Lower Crossed Syndrome

Layered Syndrome Layered syndrome is a combination of the muscle imbalances seen in both upper and lower crossed syndrome. It develops with chronic cases.

Layered Syndrome