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Postural Analysis

Postural Analysis. Aila Nica J. Bandong, PTRP Instructor Department of Physical Therapy UP- College of Allied Medical Professions PT 142: Assessment in Physical Therapy. LEARNING OBJECTIVES. At the end of the session the learners should be able to:

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Postural Analysis

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  1. PosturalAnalysis Aila Nica J. Bandong, PTRP Instructor Department of Physical Therapy UP- College of Allied Medical Professions PT 142: Assessment in Physical Therapy

  2. LEARNING OBJECTIVES At the end of the session the learners should be able to: • Review basic biomechanics of normal posture. • Review abnormal postures in terms of clinical picture and anatomic changes • Discuss the examination procedure and related concepts • Describe the documentation format of results of postural assessment • Discuss other postural assessment procedures with technology and work applications

  3. POSTURE • Relative disposition of the body at any one moment • Composite of the positions of the different parts of the body at the time • Result of underlying processes or tensional relationship throughout the body • Affected by the integrity of the inert and dynamic structures surrounding the body

  4. POSTURE

  5. BIOMECHANICS G. Maximus Hamstrings Abductors SIRT Abductors Adductors Hamstrings Gastrocs Popliteus Adductors Quadriceps Tibialis anterior Peroneals Dorsiflexors Plantarflexors

  6. BIOMECHANICS Rectus abdominis Ext. oblique ES, QL Post. back ms Lat. trunk ms. Lat. trunk ms. Lat. trunk ms Lateral tilt Abdominals Low back ms External Rotators External Rotators Gmax & Gmed Post. Pelvic Tilt Anterior Pelvic Tilt Internal Rotators Internal Rotators SIRT Rotation Gluteus max Hams Hip adductors

  7. Plumb line alignment Line of Gravity STANDARD POSTURE Through EAM & dens Through ear lobes Posterior to apex of coronal suture Through bodies CV Through shouder jt. Through VB of LV Through trunk Through sacral promontory Through GT Posterior to the center of the hip jt Anterior to midline knee Ant. To knee joint axis Through calcaneocuboidjt Anterior to lat malleolus

  8. FAULTY POSTURE • Any deviation from the normal/proper posture

  9. FAULTY POSTURE • Postural pain syndromes • 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

  10. FAULTY POSTURE:Standing • Head and neck • Shoulder and scapula • Head, neck, shoulder and scapula • Trunk • Feet and knees

  11. Head and Neck • Forward head • Inc flexion of the lower cervical and upper thoracic regions • Inc extension of the occiput on the upper cervical vertebrae • Pr0trusion of mandible

  12. Head and Neck • Flat neck • Dec cervical lordosis • Inc flexion of the occiput on the atlas • Retraction of the mandible • Exaggerated • military posture

  13. Head and Neck Head Posterior Tilt Forward Head with Attempted Correction Head Anterior Tilt Marked Anterior Tilt

  14. Shoulders and Scapula Scapula Adducted Slightly Elevated Shoulders and scapula Good position Scapula Abducted Slightly Elevated

  15. Shoulders and scapula Shoulders and scapula Good position Shoulders Elevated Scapula Adducted Shoulder Depressed Scapula Abducted

  16. Shoulders and Scapula Winging of the Scapula Shoulders and scapula Good position Scapula depressed

  17. 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

  18. 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 (Chaitow, 2001)

  19. Trunk Forward head Increased cervical lordosis • Short and Tight: • Neck extensors • Hip flexors • Low back • Kyphosis-Lordosis 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

  20. Trunk Forward head Increased cervical lordosis • Short and Tight: • Upper abdominals • Intercostals • Hamstrings • Sway-back 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

  21. Trunk Normal-slightly posterior Normal • Military type 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

  22. Trunk Forward head Increased cervical lordosis • Flat back 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

  23. Trunk • Lower crossed syndrome • Tight muscles: • Erector Spinae, Iliopsoas • Weak muscles: Gluteus maximus, Abdominals

  24. 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

  25. How is scoliosis detected? Forward bending test Skyline view

  26. Description of the curve 1. Named according to convexity 2. Major curve - most significant curve 3. Minor curve - compensatory curve 4. Double major curve-2 major curves that are both structural 5. Transitional vertebrae - neutral vertebra between 2 curves 6. Apex of the curve - greatest rotation, farthest from the midline

  27. How is severity of scoliosis measured? • Angle of curvature Risser-Ferguson method Cobb method

  28. How is progression of scoliosis measured? • Nash-Moe Scale

  29. Feet and Knees • Ideal alignment • Patella faces forward • Feet are in good alignment • Hips and feet neutral

  30. Feet and Knees • Genu Varum • Knee separation • Hyperextension of the knee • Axis of knee is oblique • Hindfoot Supination • Forefoot pronation Squinting Patella

  31. Feet and Knees • Genu valgum • Hip adducted; IR of the femur • Patella tilted medial • Tracks lateral • Hindfoot pronation • Forefoot supination • Hyperextension • Knee is oblique Frog eyes

  32. Feet and Knees • Patella baja • Patella alta

  33. FAULTY POSTURE:Sitting Weak support from low back Ideal Lordosis

  34. POSTURE IN LYING DOWN • Supine accentuates kyphosis • Prone position accentuates lordosis • Sidelying position straightens spine

  35. POSTURAL ANALYSIS • System of detecting deviations from the normal posture • Principles • Faulty alignment results in undue stress and strain on inert and dynamic structures • Detection of muscles that are in an elongated and shortened position • Correlation exist between alignment and muscle test findings

  36. POSTURAL ANALYSIS

  37. History-taking Past musculoskeletal condition / congenital problems Respiratory problems Dominant hand Growth history Neurologic signs and symptoms OI/ Postural Evaluation EVALUATION PROCEDURE

  38. Ocular Inspection • Done before assessment of posture • Assessment of physique • Ectomorph/ Asthenic • Mesomorph/ Athletic • Endomorph/ Pyknic Well * Ectomesomorphic * Endomesomorphic Pediatric * Well nourished * Over nourished * Undernourished

  39. DOCUMENTATION • Ambulatory using BAC • Alert, coherent,cooperative • Ectomorphic • (+)Dysarthria • (+) postural deviation(see postural assessment • (+) gait deviation (see gait analysis)

  40. EVALUATION PROCEDURE

  41. DOCUMENTATION All landmarks in the anterior, posterior, and lateral views are level and WNL except on lateral view: • Acromion process anterior to the earlobes • Chin protruded anteriorly • Increased cervical lordosis Significance: Rounded shoulders posture probably 20 ms imbalance

  42. EVALUATION TOOL • Posture boards • Plumb line • Dermatograph • Tape measure • Posture grid • Appropriate clothing • Chart for recording

  43. EVALUATION TOOLS • video and photographs in orthogonal planes • images, computer softwares to identify the alignment of the body

  44. APPLICATION TO WORK • used as a basis of controls and limits that are aimed at preventing work-related musculoskeletal conditions • Time study based methods • Continuous description of posture and force level which is applicable to routine work • Work sampling methods • Random and fixed time intervals which is applicable to non-routine work

  45. APPLICATION TO WORK • five dimensions relevant to the definition of a posture in relation to workloads: • angular relationship between body parts • distribution of the masses of the body parts • forces exerted on the environment during the posture • length of time that the posture is held • effects on the person of maintaining the posture

  46. APPLICATION TO WORK • OWAS • RULA • PATH

  47. OWAS • Ovako Work posture Analysing System • General principles • Balance • Symmetry • No twisting • Individual scores for positions of body segments • Trunk (4 codes) • Arms (3 codes) • Legs (7 codes) • Potential for musculoskeletal discomfort is related to the amount of time in awkward postures

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