PTP 565 Fundamentals of Tests and Measures Posture PTP 565 Fundamentals of Tests and Measures

Make vs Break Test Make test Break test Try to do this motion Make a msucle contract Break test Hold a muscle contraction Don’t let me move you

Exam 2 Posture Gait Balance Assistive devices

4-point (2 assistive aids) Modified 4point, two touching at a time, opposite hand and foot together. 1 assistive devise is used. Patient Care Pg. 232-233 Use for Exam 2 point (using a cane or hemi-walker) assistive aid and opposite leg touch together

What is Posture? Posture: A position of the body Good: “lifting up entire body” Bad: relaxation-use of ligaments, and natural bony shape, anterior trunk shortening/ tightening, posterior trunk lengthening==leads to muscle imbalances, which creates more pain for individual. Emotional Aspect of Posture: get a read off of how someone holds themselves.

Factors Affecting Posture Age Physiological: state of being at any one time can have a postural effect Structural Factors: scoliosis, extra ribs, leg length discrepancies Occupational Factors Social and Cultural Recreational Environmental

Muscle Strength Emotional Pathological: Protective posture (UE bent at 90 held against body), rotator cuff tear (elevated shoulder) Pathological: Illness Pain Mal-alignment after a fracture Muscle tone: floopy vs hypertonic Osteoporosis: fractures of vertebral spine

Soda Pop Model of Respiration and Postural Control Every muscle of the trunk is a respiratory muscle AND a postural muscle. Diaphragm is very important Breathing is compromised – exercise etc, posture response is reduced so as to focus on the needs of the respiratory system When faced with conflict, diaphragm will always choose respiration over posture Paul Hodges- respiratory will always win over posture. Massery, M. Musculoskeletal and Neuromuscular Interventions: a physical approach to Cystic Fribrosis. J Royal Soc of Med. 2005 98(Sup):55-66.

Aluminum Shell Unopened Opened Trunk Muscular contractions protect the skeleton from being crushed by outside forces Mary Massery

Diaphragm Separates the two chambers of the body: thoracic and abdominal Primary pressure regulator Sealed at top by vocal folds Sealed at bottom by pelvic floor Regulated by the muscles of the trunk and pelvic floor which gives pressure regulation Allows multi-tasking

Function of internal organs is supported by this pressure Take the muscle function away and the pressure collapse has an effect on the function of the internal organs Too high HR, then will passout from lack of blood pumping.

Posture Static Dynamic Analysis Kneeling, standing, lying, sitting Walking, running, jumping, etc. Analysis X-Ray (Scoliosis), Photography, EMG Force Plates Plumb Line?-divide body in half

Good Posture In a standing position: Straight vertical alignment Through top of head Through body center To bottom of feet

Muscle Testing and Function, 3rd ed. Key Points Ext. Auditory Meatus Acromion, bisect Ant. Thoracic spine Bisect Lumbar Spine Posterior to hip joint Anterior to knee joint Ant. To lateral malleolus=very anterior tip of bone Muscle Testing and Function, 3rd ed.

Sagittal View: Questions Are the normal spinal curves exaggerated or reversed? Is the body displaced relative to the center of gravity? Is the head position balanced over the body?

Forward Head Posture Sagittal View Upper cervical Lower cervical Thoracic spine Facet joints Intervertebral foramen Extensor mm. TMJ Scapula, GH joint. Tighten erector spinea, superior/inferior rectus capitis, and obliques capitis Stretches levator scapula, so to compensate will elevate and downwardly rotate, but to perform movement will depress and upwardly rotate Fig. 9-50

Forward Head Posture Muscles: Upper Cervical Spine extensors are tight if the chin looks tilted in the air or is leading the body Levator Scapula muscles are weak, lengthened

3) Upper Cross Shoulder Syndrome Affects the functional capacity of the cervical spine and upper extremity Muscles which are weak and inhibited; lower trapezius and serratus anterior, deep neck flexors Tight Upper trap/levator scapula so elevates shoulder, so makes pecs tight ( minor into protraction, tight major IR) so weakness in lower trap/serratus anterior, and deep neck flexors and weakness in rhomboids.

Muscles which are shortened and hypertonic: upper trapezius, levator scapulae, scalene muscles Muscles which are short and tight: pectoralis major and minor, interscapular muscles, sternocleidomastoid, suboccipital muscles

UCS cont. Results: Forward head posture Loss of lower cervical lordosis Extension of upper cervical spine Increase kyphosis of cervical thoracic junction Internal rotation of shoulder girdles

C-T junction: Dowager's hump 1-3 thoracic vertebrae fracture Increase in soft tissue around the CT junction Osteoporosis is the main cause Anterior wedging of the vertebrae, height anterior is less then posterior Thoracic spine fractures due to osteoporosis==caused by forward head posture.

Shoulder Position Anterior Shoulders Humerus is in front of acromion rather than centered Creates a rounded anterior position of shoulder girdle Leads to impingement syndromes of the shoulder

Faulty Thoracic Spine and Chest Postures Kyphotic Posture: Shortened pectorals Tight intercostals Flat T Spine Hypermobility Spinous processes are more approximated Less shock absorption

T-Spine: Round Back (kyphosis) Most begin with a decrease in pelvic inclination (angle of inclination=less of an angle then less shock absorption. Body compensates by rounding out the thoracic or thoracolumbar spine

T-Spine: Hunch Back (gibbus) Structural Anterior wedging of 1-2 thoracic vertebrae Increased lumbar, change in width

Magee D. Orthopedic Physical Assessment, 4ed T Spine: Pigeon Chest Sternum projects forward and downward Increase in AP diameter Congenital Deformity Restricts ventilation volume Magee D. Orthopedic Physical Assessment, 4ed

Magee D. Orthopedic Physical Assessment, 4ed T Spine: Funnel Chest Congenital deformity Sternum is pushed posterior by overgrowth of ribs A/P diameter is decreased Heart may be displaced Inspiration: hollow depression Magee D. Orthopedic Physical Assessment, 4ed

Magee D. Orthopedic Physical Assessment, 4ed T Spine: Barrel Chest Sternum projects upward Increase in A/P diameter Pathological conditions: emphysema Magee D. Orthopedic Physical Assessment, 4ed

Exam question on last 3 pervious slides, over increase in A/P for two, but not for one.

Normal and Faulty L and T Spine Alignments Muscle Testing & Function, 3rd ed.

Human Movement, 5th ed

Muscle Testing and Function, 3rd ed. Muscles activation: isometric? Endurance Muscle Testing and Function, 3rd ed.

Muscle Testing and Function, 3rd ed. Kyphosis-Lordosis Posture Muscle Testing and Function, 3rd ed.

Postural Fault/Increased Lumbar Lordosis Lumbar spine Hyperextension Pelvis Anterior tilt Hip joint Flexion Muscles Shortened Erector spinae Hip flexors Muscles Lengthened Abdominals Hip extensors

Mechanical Low Back Pain, 2nd ed.

Muscle Testing and Function, 3rd ed.

Sway-back Posture Lumbar spine Pelvis Hip joint Muscles Shortened Lordosis? Pelvis Posterior tilt Hip joint Extension Muscles Shortened Abdominals Hip extensors Muscles Lengthened Hip flexors

Kendall F. Muscle Testing and Function, 5ed Flat back T spine is mobile, with Inc. flexion L spine: flexed (straight) Decrease in pelvic inclination, posterior pelvic tilt Hip and Knees: extended Ankles: slight plantar flexion Not structural but functional Kendall F. Muscle Testing and Function, 5ed

Flat-Back Posture Lumbar spine Pelvis Hip joint Muscles Shortened Flexion Pelvis Posterior tilt Hip joint Extension Muscles Shortened Abdominals Hip extensors Muscles Lengthened Erector Spinae Hip flexors

“Slouched” sitting posture C-spine T-Spine Fig. 9-70

Muscle Testing and Function, 3rd ed.

Questions to Ask Are the shoulders and the scapulae symmetrical? Is there a lateral curvature of the midspinal line? Is the head held to one side? Which side? Is the pelvic position asymmetrical? (are the iliac crests level?) Is there a special flatness or fullness of the paravertebral muscle mass?

Are the feet placed symmetrically or not? Is the body rotated as a whole? Are the Achilles tendons deviated or symmetrical? Are the positions of the malleoli symmetrical in relation to the heels? Are the arm positions symmetrical? Are the waist folds symmetrical?

Muscle Testing and Function, 3rd ed.

Muscle Testing and Function, 3rd ed.

Muscle Testing and Function, 3rd ed.

L. Thoracolumbar scoliosis T-spine R. lateral flexion Convex toward left Pelvis May or may not be affected Muscles Shortened Right lateral trunk muscles Left Psoas Muscles Lengthened Left lateral trunk muscles Right Psoas

Joint Structure & Function, 3rd ed. Scoliosis Functional vs. Structural Named superior 1st Wedging of vertebral bodies Other changes: Sh. Height Scapular position Rib hump Joint Structure & Function, 3rd ed.

Magee D. Orthopedic Physical Assessment Curve Patterns Magee D. Orthopedic Physical Assessment

Rib Hump Seen when a patient flexes forward Spine rotates to one side Ribs push out posterior, appear higher Narrowing of thoracic rib cage occurs Covexity goes to the spine of the hump, pushes rib posetiorly CIBA 30(1) 1978

Therapeutic Exercise Moving Toward Function, 2nd Ed. Rib hump on left Therapeutic Exercise Moving Toward Function, 2nd Ed.

Scoliosis Right rotation of vertebrae Fig. 9-59

Anterior View: Questions Are the shoulders level symmetrical at the mid-sternal line? Is the head tilted to one side? Which side? Does the normal horizontal clavicular line deviate? Which direction? Is the pelvic position asymmetrical? Are the patella deviated laterally or medially? Is the femur rotated medially or laterally?

Cock Robin Head Position Upper cervical joint dysfunction: Rotation of the Occiput between C0 and C1 Frontal plane motion about a Z axis (through the nose) Gives appearance of a tilted head to one side May be an indication of upper cervical trauma or biomechanical dysfunction

Handedness Pattern Right handed: Right shoulder lower than the left Pelvis deviated slightly to the right side Right hip appears higher than the left May see deviation of spine to the left side slightly Left foot is more pronated than right

Joint Structure & Function, 3rd ed. Lower Extremity Hip and Knee flexion contracture Quad activation: @ 15 dg., up to 22% increase in MVC Genu Recurvatum Plantar flexed ankle Joint Structure & Function, 3rd ed.

LE – may observe patella positioning in relation to the LE alignment, Varus or valgus position of knees, Valgus=legs together, but feet can’t get together. Varus= feet together, but legs apart

Patella: Frontal Plane Torsion (Hip, tibia) Patella tracking? Joint Structure & Function, 3rd ed.

Foot Alignment: Sagittal View Feiss Line: - blue line 1st metatarsal, through middle of navicular and goes to medial malleolus. Navicular drop Sagittal view Joint Structure & Function, 3rd ed.

Joint Structure & Function, 3rd ed. Pes Planus-flat foot Talar Head Spring ligament Tibialis posterior Joint Structure & Function, 3rd ed.

Pronated Foot Affect at: Knee joint Patella Hip joint Fig. 14-30

Joint Structure & Function, 3rd ed. Pes Cavus Mobility vs. Pes Planus Mobile supported Rigid then shock absorption Joint Structure & Function, 3rd ed.

Supinated Foot Affect at: Knee joint Patella Hip joint Fig. 14-31

Genu Recumvatum Ankle PF Affect @ Knee joint Hip joint Hip Lumbar spine Tight gastroc Fig. 13-42