Postural Assessment

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