Postural Evaluation: Spinal Column

1. Postural Evaluation: Spinal Column Orthopedic Assessment III – Head, Spine, and Trunk with Lab PET 5609C

2. Postural Evaluation • Hyperlordotic Posture: • Joints involved: • Lumbar spine, pelvis, hip • Possible cause: • Tightened or shortened hip flexor muscles • Weakened or elongated hip extensors or abdominals • Poor postural sense • Adverse effects: • ↑ lumbar lordosis • Anterior pelvic tilt • Hips assuming a flexed position

3. Hyperlordotic Posture: Pathological conditions: ↑ shear forces on lumbar vertebral bodies secondary to psoas tightness ↑ compressive forces on facet joints Adaptive shortening of posterior lumbar spine ligaments and anterior hip ligaments Elongation of anterior lumbar spine ligaments and posterior hip ligaments Narrowing of lumber intervertebral foramen Postural Evaluation

4. Postural Evaluation • Kypholordotic Posture: • Similar to hyperlordotic posture: • ↑ total lumbar lordosis • Differences: • Compensatory ↑ in thoracic kyphosis: • Attempt to maintain spine in position of equilibrium • Cervical spine: ↑ in lordosis (Forward head posture) • Joints involved: • Pelvis, hip joint, lumbar spine, thoracic spine, cervical spine

5. Kypholordotic Posture: Possible causes: Poor postural sense Muscle imbalance: Tightened/shortened hip flexors Weakened or elongated hip extensors or trunk flexors Adverse effects: Anterior pelvic tilt Hip joint flexion ↑ lumbar lordosis ↑ thoracic kyphosis Postural Evaluation

6. Kypholordotic Posture: Pathological conditions: Adaptive shortening of anterior chest muscles Elongation of thoracic paraspinal muscles ↑ compressive forces on anterior thoracic vertebrae and posterior lumbar vertebrae ↑ tensile forces on ligamentous structures in posterior thoracic spine and anterior lumbar spine ↑ facet joint compression Forward head posture Forward shoulder posture Postural Evaluation

7. Postural Evaluation • Swayback Posture: • Key: ↑ reliance on ligaments for postural stability • Joints at end ROM (excessive stress on ligaments) • Joints involved: • Knees, hips, lumbar spine, lower thoracic spine, cervical spine • Possible causes: • Ectomorph body: hypomobility of joints • Poor postural sense • Tightened/shortened hip extensors • Weakened or elongated hip flexors or lower abdominals • ↓ general muscular strength

8. Swayback Posture: Adverse Effects: Genu recurvatum Hip joint extension Posterior pelvic tilt Lumbar spine in neutral or minimal flexed position ↑ in lower thoracic, thoracolumbar curvature Postural Evaluation

9. Swayback Posture: Pathological Conditions: Elongated or ↑ tensile forces on anterior hip ligaments and posterior aspect of lower thoracic spine Adapted/shortened or ↑ compressive forces on posterior hip ligaments and anterior lower thoracic spine ↑ tensile force on posterior knee and compressive force on anterior knee ↑ shearing forces on L5/S1 Forwardhead and shoulder posture Postural Evaluation

10. Postural Evaluation • Flat Back Posture: • Key: Lost normal “S” shape spine curvature in the sagital plane • Joints: • Hip joint, lumbar spine, thoracic spine, cervical spine • Possible causes: • Shortened/tightened hip extensors, abdominal musculature • Weakened, elongated hip flexors • Poor posture • Adverse effects: • Extended hip joint / posterior pelvic tilt • Extended thoracic spine • Flexed middle and lower cervical spine, extended upper cervical spine

11. Flat Back Posture: Pathological conditions: Compressive forces in posterior hip joint, anterior lumber and mid-low cervical spines, posterior thoracic and upper cervical spines Elongation of soft tissue Forward head posture (compensation for posterior spine displacement) Postural Evaluation

12. Scoliosis: Lateral curvature of spinal column Functional: spine attempts to compensate to maintain the head in a neutral position and keep eyes level Muscular imbalance, pelvic obliquity, limb-length discrepancy Structural: defect or congenital bony abnormality of vertebrae Postural Evaluation

13. General Inspection: Scoliosis Signs and symptoms: Uneven shoulders One shoulder blade appears more prominent Uneven waist / 1 hip higher vs. other Leaning to one side Back pain and difficulty breathing (severe scoliosis) Causes: Idiopathic (85% of cases) Underlying neuromuscular disease, leg-length discrepancy, birth defect, fetal development (congenital) Not caused by poor posture, diet, exercise, or the use of backpacks Postural Evaluation

14. Diagnosis: Angle: X-ray Normal Spine (0 degrees) Scoliosis: (> 10 degrees) Complications: (severe scoliosis) Lung and heart damage: compression of rib cage against heart, lungs > 70 degrees Back problems Postural Evaluation

15. Postural Evaluation • General Inspection: • Scoliosis Test: Adam’s Forward Bend Test • Patient Position: Standing with hands held in front (arms straight) • Evaluation Procedure: Patient bends forward, sliding hands down the front of each leg • Positive Test: • Asymmetrical hump along lateral aspect of thoracolumbar spine • One shoulder blade appears more prominent • Uneven hips • Implications: • Functional scoliosis: scoliosis present when patient stands straight, disappears during flexion • Structural scoliosis: present during both standing and with flexion

16. Postural Evaluation

17. Forward Shoulder Posture: Key: characterized by protraction and elevation of scapulae and a forward, rounded position of shoulders May include scapula winging and IR Forward head posture Joints: Scapulothoracic articulation Glenohumeral joint Thoracic spine Cervical spine Postural Evaluation

18. Forward Shoulder Posture: Possible causes: Tightened, shortened pectoral muscles Weakened or elongated scapular retractors (mid and low trapezius, rhomboids) Poor postural awareness and/or muscle fatigue Large breast development Adverse effects: Humeral head stress (displaced anteriorly) Forward head posture Postural Evaluation

19. Postural Evaluation • Forward Shoulder Posture: • Pathological conditions: • Thoracic outlet syndrome: • Adaptive shortening of pectoralis minor, anterior/middle scalenes → compression of subclavian artery, vein, and medial cord of brachial plexus • Abnormal scapulohumeral rhythm and scapular stability • Acromioclavicular degeneration • Bicipital tendonitis • Impingement syndrome • Abnormal GH biomechanics

20. Scapula Winging: Weakness of serratus anterior, middle and lower trapezius Long thoracic nerve Biomechanics of normal arm movement thrown off Postural Evaluation

21. Forward Head Posture: Key: anterior displacement of head relative to thorax Joints: Cervical spine, GH, thoracic spine Possible causes: Poor eyesight (need glasses) Muscle fatigue/weakness Poor postural sense Adverse effects: Flexion of lower cervical spine Flattening of mid cervical spine GH motion affected Postural Evaluation

22. Postural Evaluation • Forward Head Posture: • Pathological conditions: • Shortened suboccipital muscles, scalenes, upper trapezius, levator scapula • Hypomobile upper cervical region • Abnormal GH biomechanics • TMJ dysfunction • Thoracic outlet syndrome (scalene involvement) • Forward shoulder posture • Myofascial pain (posterior cervical muscles)