assessment of posture

7/31/2019 Assessment of Posture

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ASSESSMENT OF

POSTURE

Prepared by: Floriza P. de Leon, PTRP


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Erect position

Advantage: enables the hands to be free andthe eyes to be farther from the ground so thatthe individual can see farther ahead

Disadvantage: increased strain on the spineand lower limbs and comparative difficulties inrespiration and transport of the blood to the

brain


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Ideal Postural Alignment

Straight line (line of gravity) that passesthrough the ear lobe, the bodies of the cervicalvertebrae, the tip of the shoulder, midway

through the thorax, through the bodies of thelumbar vertebrae, slightly posterior to the hip

joint, slightly anterior to the axis of the knee joint, and just anterior to the lateral malleolus


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Correct PosturePosition in which minimum stress is applied toeach joint

Faulty Posture Any position that increases the stress to the joints


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Evolution of Posture

At birth, the entire spine is concave forward, or flexedCurves of the spine found at birth are called primary curves.(thoracic spine and sacrum)Secondary curves appear at 3 months, the cervical spinebecomes convex forward, producing the cervical lordosis. In thelumbar spine, the secondary curve develops slightly later (6-8mos)In the child, the center of gravity is at the level of the 12 th thoracic vertebra.

Adults COG is at the 2 nd sacral vertebraChild stands with a wide base to maintain balance, and the kneeare flexed. The knees are slightly bowed (genu varum) untilabout 18 mos of age. The child then becomes slightly knockkneed (genu valgum) until the age of 3 yrs. By the age of 6years, the legs should naturally straighten. The lumbar spine inthe child has an exaggerated lumbar spine, or excessivelordosis. The accentuated curve is caused by the presence of the lar e abdominal contents weakness of the abdominal


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Evolution of Posture

Initially, a child is flatfooted or appears to be asthe result of the minimal development of themedial longitudinal arch and the fat pat that isfound in the arch. As the child grows, the fatpad slowly decreases in size, making themedial arch more evident. In addition, as thefoot develops and the muscles strengthen, thearches of the feet develop normally andbecome more evident


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Factors Affecting CorrectPosture

Bony contours (hemivertebra)Laxity of ligamentous structuresFascial and musculotendinous tightness(tensor fascia latae, pectoralis, hip flexors)Muscle tonus (gluteus maximus) abdominals,erector spinae)Pelvic angle (normal is 30 o)Joint position and mobilityNeurogenic outflow and inflow


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Cause of Poor Posture

Postural (positional) factorsMost common postural problem is poor postural habit. Thistype of posture is often seen in the person who stands or sitsfor long periods and begins to slouchnot wanting to appear taller than ones peers. Muscle imbalance or muscle contracturesPain may also cause poor postureRespiratory conditions (emphysema), general weakness,excess weight, loss of proprioception, or muscle spasm mayalso lead to poor postureTreatment involves strengthening weak muscles, stretchingtight structures, and patient education

Structural factorsResults of congenital anomalies


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Common Spinal Deformities

LordosisExcessive anterior curvature of the spineExaggeration of the normal curves found in the cervical andlumbar spines.

Causes: postural deformity; lax muscles especially theabdominal muscles; heavy abdomen (excess weight or pregnancy); compensatory mechanisms that result fromanother deformity, such as kyphosis; hip flexion contracture;spondylolisthesis; congenital problems, such as bilateralcongenital dislocation of the hip; failure of segmentation of

the neural arch of a facet joint segment; fashionIn pathological lordosis, one may observe sagging shoulders,medial rotation of the legs, and poking forward of the head sothat it is in front of the center of gravity (most commonpostural deviation seen)


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LordosisPelvic angle (normal is 30 0) is increased with lordosisaccompanied by a mobile spine and an anterior pelvic tilt.

Accompanied by tight hip flexors, tensor fascia latae, and hipflexors combined with weak abdominalsSwayback deformities, there is an increased pelvic inclinationto approximately 40 0, and the thoracolumbar spine exhibits akyphosis . Results in the spines bending back rather sharplyat the lumbosacral angle. With this postural deformity, theentire pelvis shifts anteriorly, causing the hips to move into

extension. There is an increase in the lumbar and thoraciccurves. Such deformity may be associated with tight hipextensors, lower lumbar extensors, and upper abdominals,along with weak hip flexors, lower abdominals, and lower thoracic extensors


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KyphosisExcessive posterior curvature of the spinePathologically, it is an exaggeration of the normal curve found in thethoracic spineCauses includes tuberculosis, vertebral compression fractures,scheuermanns disease, ankylosing spondylitis, senile osteoporosis,tumors, compensation in conjunction with lordosis, and congenitalanomalies.Scheuermanns vertebral osteochondritisResults in a structural kyphosis

Inflammation of the bone and cartilage occurs around the ringepiphysis of the vertebral bodyLeads to an anterior wedging of the vertebraIt is a growth disorder that affects approximately 10% of thepopulationCommon area for the disease to occur is between T10 and L2


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Types of kyphosisRound backPx with a round back has a long, rounded curve with decreased pelvicinclination (


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ScoliosisLateral curvature of the spineMost famous example of scoliosis is the hunchback of notredame

Torticollis: scoliosis of the cervical spineCan be structural or non structuralNon-Structural scoliosis caused by postural problems,hysteria, nerve root irritation, inflammation, or compensationcaused by leg length discrepancy or contracture (in thelumbar spine).Structural Scoliosis primarily involves body deformity, whichmay be congenital or acquired. This may be caused bywedge vertebra, hemivertebra, or failure of segmentation. Itmay be idiopathic (genetic), neuromuscular, resulting from anupper or lower motor neuron lesion; or myopathic, resulting

from muscular dystrophy. Or, it may caused byarthrogryposis, resulting from persistent joint flexure or


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Idiopathic Scoliosis accounts for 75-85% of allcases of structural scoliosis. The vertebral bodiesrotate into the convexity of the curve, with thespinous processes going toward the concavity of

the curve. There is a fixed rotational prominenceon the convex side, which is best seen on forwardflexion from the skyline view (razorback spine).Disc spaces are narrowed on the concave sideand widened on the convex side. There is

distortion of the vertebral body, and vital capacityis considerably lowered if the lateral curvatureexceeds 60 0; compression and malposition of theorgans within the rib cage also occur


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Patient History

History of injuryExacerbation or relief of symptoms in certain positonsFamily historyHistory of previous illness, surgery or severe injuriesFootwear makes a difference

Age of the patientPresence of growth spurtPresence of deformity, progressive vs stationaryNeurological symptomsNature, extent, type and duration of pain

Positions or activities increase the pain or discomfortDifficulty in breathingDominant handPrevious treatment


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Observation

Body types (ectomorph, mesomorph,endomorph)Standing position (anterior view, lateral view,posterior view


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Anterior viewHead is straight on the shoulders (in midline)Posture of the jaw is normalTip of the nose is in line with the manubrium sternum, xiphisternum, and umbilicus(anterior line of reference)Trapezius neck line is equal on both sidesShoulders are level (dominant side is slightly lower)Clavicles and acromioclavicular joints are level and equalNo protrusion, depression, or lateralization of the sternum, ribs or costocartilage.Waist angles are equal, and the arms are equidistant from the waistCarrying angle at each elbow is equalHigh points of the iliac crest are the same height on each side

ASIS are levelPubic bones are level at the symphysis pubisPatellae of the knees point straight ahead. (frog eyes patellae or squinting patellae)Knees are straight (genu varum or genu valgum)Heads of the fibulae are levelMedial and lateral malleoli of the ankle are level

assessment of posture

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