Postural Assessment

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.
 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.
Pain Cycle
 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.
 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.
 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.
 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.
Balanced Posture
 Effect of Habits on Posture
 Good habits contribute to a strong and stable posture.
 Bad habits contribute to poor posture and instability.
 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.
Postural Changes
 Effects of Poor Posture on
Muscles
 Overstressed muscles tighten.
 Favored muscles weaken.
 This imbalance perpetuates the poor posture.
 Spinal Distortions
 Anterior to posterior.
 Lateral.
 Helical.
 Foundational distortions create changes above.
Spinal Column Views
Helical Spinal Distortion
 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.
 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.
Reciprocal Inhibition
 Postural and Phasic Muscles
 Postural (tend to  Phasic (tend to
hyperactivity) hypoactivity)
 Triceps surae  Tibialis anterior
 Hamstrings  Gluteus maximus
 Gluteus medius
 Adductors
 Rectus abdominus
 Rectus femoris
 Lower / middle trapezius
 Tensor fascia latae (TFL)
 Longus capitus and colli
 Psoas
 Deltoids
 Erector spinae  Digastrics
 Postural and Phasic Muscles
 Postural (tend to
hyperactivity)
 Quadratus lumborum (QL)
 Pectoralis
 Upper Trapezius
 Sternocleidomastoid
 Suboccipital
 Masticatories
Posture Blocks
 Prior To Postural Evaluation
 Obtain pertinent history.
 Description of symptoms.
 Fractures.
 Injuries.
 Congenital anomalies.
 Dominant hand.
 Note gross structural asymmetries such as scoliosis.
Postural Views
Posture Types
 Posterior View Evaluation
 Occipital protruberance.
 Cervical, thoracic, and lumbar spinous processes.
 Coccyx.
 Gluteal folds.
 Arms should hand equally with palms slightly visible.
 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).
 Posterior View Evaluation
 Occipital protruberance.
 Cervical, thoracic, and lumbar spinous processes.
 Coccyx.
 Gluteal folds.
 Arms should hand equally with palms slightly visible.
 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.
Ideal Posterior Alignment
Scoliosis
Pelvic Unleveling
Gothic Shoulder
Scapular Winging
Scapular Winging and Abduction
Tight Levator Scapula
High Left Shoulder
Right Head Tilt and Rotation
 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.
Ideal Lateral Alignment
Head Alignment Lateral View
Forward Head Posture
Head and Neck Weight
Distribution
Forward Head Tilt
Abdominal Protrusion
Pelvic Tilt (Anterior and
Posterior)
 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.
 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
 Anteroposterior / Front View
 Feet aligned b/l
 No pronation / supination
 No inversion of eversion
 Knees forward and symmetric b/l
 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
Internal Rotation of Shoulders /
Rounded Shoulders
Genu Valga (Knock-knees)
Genu Vara (Bowlegs)
 Upper Crossed Syndrome
 Affects the head, neck and shoulders.
 Result of long-term seated postures.
 Rolled-in and forward shoulders.
 Increased thoracic kyphosis.
 Forward head posture.
 Loss of cervical lordosis.
Upper Crossed Syndrome
 Postural Signs of Upper Crossed
Syndrome
 Postural finding  Dysfunction
 Rounded shoulders  Shortened pectorals

 Forward-drawn head  Kyphotic t-spine

 C0-C1 hyperextension  Short suboccipitals

 Weak serratus anterior
 Winging of scapulae
 Shortened upper trap, shortened
 Elevation of shoulders levator scapulae, weak lower
and middle trap
 Muscle Imbalances in Upper
Crossed Syndrome
 Tight-short muscles  Weak-long muscles
 Suboccipitals  Mid to lower trapezius
 Pectorals  Serratus anterior
 Anterior shoulder
 Upper trapezius
 Lower Crossed Syndrome
 Affects the lumbar spine and pelvis.
 Anterior pelvis and increased lumbar lordosis.
 Tightness in the psoas and lumbar erector spinae.
 Long-term sitting contributes to this syndrome as well.
Lower Crossed Syndrome
 Imbalances in the Following
Pairs of Muscles:
 Weak gluteus maximus and short hip flexors.
 Weak abdominals and short lumbar erector spinae.
 Weak gluteus medius and short TFL and QL.
Postural Signs of Lower Crossed
Syndrome
 Postural finding  Dysfunction
 Lumbar hyperlordosis  Shortened erector spinae
 Anterior pelvic tilt  Weak gluteus maximus
 Protruding abdomen  Weak abdominals
 Foot turned out  Shortened piriformis
 Hypertrophy of  Hypermobile lumbosacral
thoracolumbar junction junction
 Groove in iliotibial band  Shortened tensor fascia latae
Upper and Lower Crossed
Syndrome
 Layered Syndrome
 Layered syndrome is a combination of the muscle
imbalances seen in both upper and lower crossed syndrome.
 It develops with chronic cases.
Layered Syndrome