1. Postural Assessment
Chapter 2

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.

3. 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.

4. Pain Cycle

5. 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.

6. 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.

7. 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.

8. 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.

9. Balanced Posture

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

11. 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.

12. Postural Changes

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

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

15. Spinal Column Views

16. Helical Spinal Distortion

17. 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.

18. 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.

19. Reciprocal Inhibition

20. 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

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

22. Posture Blocks

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

24. Postural Views

25. Posture Types

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

27. 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).

28. 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.

29. Ideal Posterior Alignment

30. Scoliosis

31. Pelvic Unleveling

32. Gothic Shoulder

33. Scapular Winging

34. Scapular Winging and Abduction

35. Tight Levator Scapula

36. High Left Shoulder

37. Right Head Tilt and Rotation

38. 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.

39. Ideal Lateral Alignment

40. Head Alignment Lateral View

41. Forward Head Posture

42. Head and Neck Weight Distribution

43. Forward Head Tilt

44. Abdominal Protrusion

45. Pelvic Tilt (Anterior and Posterior)

46. 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.

47. 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

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

49. 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

50. Internal Rotation of Shoulders / Rounded Shoulders

51. Genu Valga (Knock-knees)

52. Genu Vara (Bowlegs)

53. 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.

54. Upper Crossed Syndrome

55. 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

56. 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

57. 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.

58. Lower Crossed Syndrome

59. 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.

60. 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

61. Upper and Lower Crossed Syndrome

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

63. Layered Syndrome