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The Spine and Posture Mazyad Alotaibi
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What is Posture? Posture means position
Posture is the body’s alignment and positioning with respect to COG. Attitude of the body, the relative alignment of body/limb segments Types Static posture: In which body segments aligned and maintained in certain positions (Standing, lying, sitting). No mechanical work. Dynamic posture: In which body segments are moving (Walking – running, lifting) 5/2/2011
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Postural Development The adult spine is divided into four curves:
Two primary or posterior curves because they are present in the infant and the convexity is posterior Thoracic spine Sacrum Two compensatory or anterior curves because they are Develop as the infant learns to lift the head and eventually stand, and the convexity is anterior Cervical spine Lumbar spine 5/2/2011
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POSTURAL ANALYSIS 5/2/2011 Good posture
Muscles function most efficiently Optimum conditions for internal organs Poor posture Increased strain on supporting structures Less efficient balance of the body over its base of support POSTURAL ANALYSIS 5/2/2011
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Causes of poor posture Positional factors
Muscle imbalances/contractures Pain Respiratory conditions Typically can be managed through therapeutic ex & education Structural factors Congenital deformity Developmental problems Trauma Disease Not typically easily managed 5/2/2011
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STANDARD POSTURE Line of Gravity Through ear lobes Through bodies CV
Through shouder jt. Through trunk Through GT Anterior to midline knee Anterior to lat malleolus 5/2/2011
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FAULTY POSTURE Any deviation from the normal/proper posture 5/2/2011
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Muscular Activity in Erect Standing
Foot: Only muscular activity is in the push-off phase or rising on the toes Leg: Posterior calf muscles are more active than anterior Thigh & Hip: Very little activity Swaying produces bursts of ab/adductors Iliopsoas constantly active, preventing hyperextension of the hip joint 5/2/2011
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Muscular Activity in Erect Standing
Spine: Very slight activity is sacrospinalis or abdominals Upper Extremity: low-grade activity in a number of muscles Serratus anterior & trapezius support the shoulder girdle Supraspinatus resist downward traction of the humerus No activity in elbow or wrist joints, when passively hanging 5/2/2011
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Factors affecting posture Neurologic issues Muscle weakness
Hypermobile joints Hypomobile joints Bony abnormalities Leg length Spinal column 5/2/2011
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FAULTY POSTURE Postural pain syndromes Postural dysfunctions
Posture deviates from normal alignment but no structural limitation Mechanical stress but relieved by activity or change of position No abnormalities in musculoskeletal structures Postural dysfunctions Adaptive shortening of soft tissues and muscle weakness Imbalance in strength and flexibility 5/2/2011
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FAULTY POSTURE: Standing
Head and neck Shoulder and scapula Head, neck, shoulder and scapula Trunk Feet and knees 5/2/2011
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Head and Neck Forward head
Inc flexion of the lower cervical and upper thoracic regions Inc extension of the occipital on the upper cervical vertebrae Protrusion of mandible 5/2/2011
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Head and Neck Flat neck Dec cervical lordosis
Inc flexion of the occiput on the atlas Retraction of the mandible Exaggerated military posture 5/2/2011
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Head and Neck Head Posterior Tilt Head Anterior Tilt Marked Anterior
Forward Head with Attempted Correction 5/2/2011
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Scapula Adducted Slightly Elevated
Shoulders and Scapula Shoulders and scapula Good position Scapula Abducted Slightly Elevated Scapula Adducted Slightly Elevated 5/2/2011
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Shoulders and scapula Shoulders and scapula Shoulders Elevated
Good position Shoulders Elevated Scapula Adducted Shoulder Depressed Scapula Abducted 5/2/2011
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Shoulders and Scapula Winging of the Scapula Shoulders and scapula
Good position Winging of the Scapula Scapula depressed 5/2/2011
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Head, Neck, Shoulders and Scapula
Upper crossed syndrome The occiput and C1/C2 will hyperextend with the head being pushed forward The lower cervical to 4th Thoracic vertebrae will be posturally stressed Rotation and abduction of the scapulae occurs 5/2/2011
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Head, Neck, Shoulders and Scapula
Upper crossed syndrome Tight muscles: Pectoralis major and minor, upper trapezius, Levator scapulae, SCM Weak muscles: Lower and middle trapezius, Serratus Anterior, Rhomboids 5/2/2011
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Scoliosis A medio-lateral curve of the vertebral column Exceeding 100
Types Structural Neuromuscular Idiopathic Non-structural Treatment Exercises Bracing
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Detection of Scoliosis
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Kyphosis An exaggerated curvature in the sagittal plane
Long rounded curve (round back) Sharp posterior angulation (hump back) Possible causes Wedge compression fracture Ankylosing spondylitis osteoporosis Destructive tumors of spine
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Trunk Kyphosis-Lordosis Forward head Increased cervical lordosis
Short and Tight: Neck extensors Hip flexors Low back Scapula Abducted Increased thoracic kyphosis Increased lumbar lordosis Lengthened and Weak: Neck flexors Hamstrings Erector spinae Possibly abdominals Anterior pelvic tilt Knees slightly hyperextended Ankles slightly plantarflexed 5/2/2011
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Trunk Sway-back Forward head Increased cervical lordosis
Short and Tight: Upper abdominals Intercostals Hamstrings Increased thoracic kyphosis Decreased lumbar lordosis Lengthened and Weak: Neck flexors Hip flexors Thoracic extensors Lower abdominals Posterior pelvic tilt Knees slightly hyperextended Ankles neutral 5/2/2011
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Trunk Military type Normal-slightly posterior Normal Normal kyphosis
Short and Tight: Lumbar extensors Hip flexors Increased lumbar lordosis Anterior pelvic tilt Lengthened and Weak: Abdominals Hamstrings Knees slightly hyperextended Ankles slightly plantarflexed 5/2/2011
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Trunk Flat back Forward head Increased cervical lordosis
Decreased kyphosis Short and Tight: Neck extensors Abdominals Hamstrings Decreased lumbar lordosis Posterior pelvic tilt Lengthened and Weak: Neck flexors Back extensors Hip flexors Knees slightly hyperextended Ankles slightly plantarflexed 5/2/2011
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Trunk Scoliosis Lateral deviation of the spine Deformity
Structural Fixed deformity Apical vertebrae Vertebral body on convex Spinous process on concave Non-structural Flexible deformity Positional, functional, postural 5/2/2011
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How is scoliosis detected?
Forward bending test Skyline view 5/2/2011
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Description of the curve
5/2/2011
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Feet and Knees Ideal alignment Patella faces forward
Feet are in good alignment Hips and feet neutral 5/2/2011
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Feet and Knees Genu Varum Knee separation Hyperextension of the knee
Axis of knee is oblique Hindfoot Supination Forefoot pronation Squinting Patella 5/2/2011
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Feet and Knees Genu valgum Hip adducted; IR of the femur
Patella tilted medial Hindfoot pronation Forefoot supination Hyperextension Knee is oblique Frog eyes 5/2/2011
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Feet and Knees Patella alta Patella baja 5/2/2011
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