POSTURAL ASSESSMENT

1. POSTURAL ASSESSMENT • Advanced Assessment • By: Dr. Sue Shapiro

2. Assessing the Spine

3. POSTURAL EVALUATION • Requires a lot of skill o the part of the examiner because most postural abnormalities are extremely subtle in appearance • Need to separate the parts of the body from the whole and then assess the sum of the parts in reference to their interaction in the entire anatomical structure.

4. Gravity / Reference Line • In correct posture, the gravity line passes through the axes of all joints with the body segments aligned vertically • Gravity line is represented by a vertical line drawn through the body’s center of gravity located at the S2. It is the reference point from which from which gravitational effects on individual body segments are assessed

5. Gravity / Reference Line

6. Gravity / Reference Line • Changes in responds to the constantly altering body position during upright posture. • People with excellent posture come close to having the line of reference pass through all the joints axes affording them less gravitational stress being placed on the soft tissue components of the supporting system

7. Soft Tissue Balance and Posture • Important for muscles, ligaments, and other soft tissue structures about the joint to be balanced • Balance is based on force couple (2 or more translatory forces that in combination produce rotation) principles among muscles involved in the 3 cardinal planes of motion • When couple force is out of balance, the segment moves off its axis of rotation and there is faulty joint motion. • The head, trunk, shoulders, and pelvic girdle are the most important segments to have in muscular and mechanical balance. They are the foundation from which forces are directed to the limbs

8. LATERAL POSTURAL VIEW • Perform from both sides to detect rotational abnormalities • Head position: plumb line should pass through the ear lobe and acromion process

9. Common Head Faults • Head lies anterior to the plumb line • Causes: • Excessive cervical lordosis • Tight cervical extensor, upper trapezius, and levator scapulae muscles • Elongated cervical flexor muscles

10. Forward Head Posture

11. Common Neck Faults • Flattened Lordotic Cervical Curve : the plumb line lies anterior to the vertebral bodies. • Causes: • Stretched posterior cervical ligaments and extensor muscles • Tight cervical flexor muscles

12. Shoulder Postural Faults • Forward Shoulder: The acromion process lies anterior to the plumb line; the scapulae are abducted • Causes: • Tight pectoralis major and minor, serratus anterior, and intercostal muscles • Excessive thoracic kyphosis and forward head • Weakness of thoracic extensor, middle trapezius, and rhomboid muscles • Lengthened middle and lower trapezius muscles

13. Forward Shoulder Posture

14. Shoulder Postural Faults • Lumbar Lordosis: The lumbar region is flat as the subject raises arms overhead: • Causes: • Tightness of the latissimus dorsi muscle and thoracolumbar fasciae

15. Thoracic Vertebrae • Correct Posture: Plumb line should bisects the chest symmetrically • Common Faults: • Kyphosis: increased posterior convexity of the vertebrae • Common Causes: • Compression of intervetebral disks anteriorly • Stretched thoracic extensors, middle and lower trapezius muscles, and posterior ligaments • Tightness of anterior longitudinal ligament, upper abdominal, and anterior chest muscles

16. Body Types • Ectomorph: slender, thin build with a low BMI • increased joint mobility with decreased joint stability • Mesomorph: medium, athletic build, with average BMI • joint mobility and stability WNL • Endomorph: stocky build with high BMI • decreased joint mobility with increased joint stability