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

2. 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

3. Exam 2
Posture
Gait
Balance
Assistive devices

4. 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
Use for Exam
2 point (using a cane or hemi-walker) assistive aid and opposite leg touch together

5. 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.

6. 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

7. 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

8. 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 (Sup):55-66.

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

10. 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

11. 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.

12. 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

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

14. 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.

15. 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?

16. 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

17. 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

18. 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.

19. 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

20. 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

21. 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.

22. 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

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

24. 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

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

26. 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

27. 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

28. 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

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

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

31. Human Movement, 5th ed

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

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

34. 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

35. Mechanical Low Back Pain, 2nd ed.

36. Muscle Testing and Function, 3rd ed.

37. 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

38. 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

39. 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

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

41. Muscle Testing and Function, 3rd ed.

42. 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?

43. 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?

44. Muscle Testing and Function, 3rd ed.

45. Muscle Testing and Function, 3rd ed.

46. Muscle Testing and Function, 3rd ed.

47. 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

48. 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.

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

50. 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

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

52. Scoliosis
Right rotation of vertebrae
Fig. 9-59

53. 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?

54. 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

55. 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

56. 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.

57. 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

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

59. 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.

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

61. Pronated Foot
Affect at:
Knee joint
Patella
Hip joint
Fig

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

63. Supinated Foot
Affect at:
Knee joint
Patella
Hip joint
Fig

64. Genu Recumvatum Ankle PF
Knee joint
Hip joint
Hip
Lumbar spine
Tight gastroc
Fig