Postural Assessment 0910 Student

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:
• 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
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
POSTURE
BIOMECHANICS
G. Maximus
Abductors Abductors SIRT Hamstrings
Adductors Hamstrings
Adductors Quadriceps Gastrocs
Popliteus
Tibialis anterior Peroneals
Dorsiflexors Plantarflexors
BIOMECHANICS
Rectus abdominis ES, QL

Ext. oblique 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
STANDARD POSTURE Plumb
line
Line of alignment
Gravity Through
EAM Through ear lobes
Posterior to apex & dens
of coronal suture Through bodies CV
Through shouder jt.
Through Through trunk

VB of LV
Through
sacral
Posterior to the promontory Through GT
center of the
hip jt
Ant. To Anterior to midline

knee knee
joint axis
Through
calcaneocuboid jt Anterior to lat
malleolus
FAULTY POSTURE
• Any deviation from the normal/proper
posture
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
FAULTY POSTURE:
Standing
• Head and neck

• Shoulder and scapula
• Head, neck, shoulder and scapula
• Trunk
• Feet and knees
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
Head and Neck
• Flat neck
▫ Dec cervical lordosis
▫ Inc flexion of the
occiput on the atlas
▫ Retraction of the
mandible
▫ Exaggerated
military posture
Head and Neck
Head Head Marked Forward

Posterior Anterior Anterior Head with
Tilt Tilt Tilt Attempted
Correction
Shoulders and Scapula
Shoulders and scapula Scapula Abducted Scapula Adducted

Good position Slightly Elevated Slightly Elevated
Shoulders and scapula
Shoulders and scapula Shoulders Elevated Shoulder Depressed

Good position Scapula Adducted Scapula Abducted
Shoulders and Scapula
Shoulders and scapula Scapula depressed Winging of

Good position the Scapula
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
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)
Trunk • Kyphosis-Lordosis
Forward head
Increased
cervical lordosis Short and Tight:
• Neck extensors
Scapula Abducted
• Hip flexors
Increased • Low back
thoracic kyphosis
Increased lumbar
lordosis Lengthened and
Weak:
Anterior pelvic tilt • Neck flexors
• Hamstrings
Knees slightly • Erector spinae
hyperextended • Possibly
abdominals
Ankles slightly
plantarflexed
Trunk • Sway-back
Forward head
Increased
cervical lordosis
Short and Tight:
Increased • Upper abdominals
thoracic kyphosis • Intercostals
Decreased • Hamstrings
lumbar lordosis
Posterior pelvic tilt Lengthened and
Weak:
• Neck flexors
• Hip flexors
Knees slightly • Thoracic
hyperextended extensors
• Lower abdominals
Ankles neutral
Trunk • Military type
Normal-slightly
posterior
Normal
Normal kyphosis
Short and Tight:
• Lumbar extensors
Increased lumbar
• Hip flexors
lordosis
Anterior pelvic tilt

Lengthened and
Weak:
• Abdominals
Knees slightly
• Hamstrings
hyperextended
Ankles slightly
plantarflexed
Trunk • Flat back
Forward head
Increased
cervical lordosis
Decreased
Short and Tight:
kyphosis
• Neck extensors
Decreased • Abdominals
lumbar lordosis • Hamstrings
Posterior pelvic tilt

Lengthened and
Weak:
• Neck flexors
Knees slightly • Back extensors
hyperextended • Hip flexors
Ankles slightly
plantarflexed
Trunk
• Lower crossed syndrome

▫ Tight muscles:
Erector Spinae, Iliopsoas
▫ Weak muscles:
Gluteus maximus,
Abdominals
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
How is scoliosis detected?
Forward bending test
Skyline view
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
How is severity of scoliosis measured?
• Angle of curvature
Risser-Ferguson method Cobb method

How is progression of scoliosis measured?
• Nash-Moe Scale
Feet and Knees
• Ideal alignment
▫ Patella faces forward
▫ Feet are in good
alignment
▫ Hips and feet neutral
Feet and Knees
• Genu Varum
▫ Knee separation
▫ Hyperextension of the knee
▫ Axis of knee is oblique
▫ Hindfoot Supination
▫ Forefoot pronation
Squinting
Patella
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
Feet and Knees
• Patella alta • Patella baja
FAULTY POSTURE:
Sitting
Weak support
Ideal Lordosis from low back
POSTURE IN LYING DOWN
• Supine accentuates kyphosis
• Prone position accentuates lordosis
• Sidelying position straightens spine
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
POSTURAL ANALYSIS
EVALUATION PROCEDURE
History-taking
Past musculoskeletal condition / congenital

problems
Respiratory problems
Dominant hand
Growth history
Neurologic signs and symptoms
OI/ Postural Evaluation

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
DOCUMENTATION
Ambulatory using BAC

Alert, coherent,cooperative
Ectomorphic
(+)Dysarthria
(+) postural deviation(see postural
assessment
(+) gait deviation (see gait analysis)
EVALUATION PROCEDURE
Anterior view Posterior view Lateral view
Head Trapezius Earlobes and
Nose Shoulders shoulder
Shoulders Scapulae Chin
Clavicles Spinal alignment Shoulder
Sternum PSIS Breast
Carrying angle Gluteal folds Thoracic curve
Waist angle Popliteal line Lumbar curve
Iliac crests Malleoli Knees
ASIS Achille’s tendon
Greater trochanter Calcaneus
Patella
Knees
Fibular head
Malleoli
Medial arch
Forefoot
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
EVALUATION TOOL
• Posture boards
• Plumb line
• Dermatograph
• Tape measure
• Posture grid
• Appropriate clothing
• Chart for recording
EVALUATION TOOLS
• video and
photographs in
orthogonal planes
• images, computer
softwares to identify
the alignment of the
body
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
APPLICATION TO WORK
• five dimensions relevant to the definition

of a posture in relation to workloads:
1.angular relationship between body parts
2.distribution of the masses of the body parts
3.forces exerted on the environment during the
posture
4.length of time that the posture is held
5.effects on the person of maintaining the
posture
APPLICATION TO WORK
• OWAS
• RULA
• PATH
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
RULA
• Rapid Upper Limb Assessment
• Assessment of upper body parts applicable to
sedentary work
• Severity of postural loading in the following
body parts
▫ Head
▫ Trunk
▫ Upper arm
▫ Lower arm
▫ Wrist
• Looks into static or repetitive muscle work and
the force exertion
PATH
• Postures, Activities, Tools, and Handling
• Measure the frequency of exposure to manual
materials handling
• For non-routine work
• Real time observations concerning
▫ Task
▫ Body postures
▫ Tools used
▫ Loads handled
• Manual materials handling activities are those
involving at least 4.5 kg
▫ Lift
▫ Lower
▫ Carry
▫ Push/pull
▫ Move/place
REFERENCES
• Kendall,McCreary, Provance (1993), Muscles
Testing and Function: Williams and Wilkins:
Maryland USA
• Magee, DJ.(1997), Orthopedic Physical
Assessment : WB Saunders Co: PA
• Lecture notes by Professor CMCapio and
Professor MGBEncabo

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Postural

PT 142: Assessment in Physical Therapy

Rectus abdominis ES, QL

Through shouder jt.

Through Through trunk

Ant. To Anterior to midline

• Head and neck

Head Head Marked Forward

Shoulders and scapula Scapula Abducted Scapula Adducted

Shoulders and scapula Shoulders Elevated Shoulder Depressed

Shoulders and scapula Scapula depressed Winging of

• Upper crossed syndrome

• Upper crossed syndrome

Anterior pelvic tilt

Posterior pelvic tilt

• Lower crossed syndrome

Risser-Ferguson method Cobb method

Past musculoskeletal condition / congenital

OI/ Postural Evaluation

Ambulatory using BAC

▫ Acromion process anterior to the earlobes

Significance: Rounded shoulders posture probably

• used as a basis of controls and limits that

• five dimensions relevant to the definition

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