postural assessment
DESCRIPTION
Postural Assessment. Chapter 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. - PowerPoint PPT PresentationTRANSCRIPT
Chapter 2
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.
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.
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.
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.
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.
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.
Good habits contribute to a strong and stable posture.
Bad habits contribute to poor posture and instability.
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.
Overstressed muscles tighten.Favored muscles weaken.This imbalance perpetuates the poor posture.
Anterior to posterior.Lateral.Helical.Foundational distortions create changes
above.
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 describes muscles on one side of a joint relaxing to accommodate contraction of muscles on the other side of a joint.
Postural (tend to hyperactivity)
Triceps suraeHamstringsAdductorsRectus femorisTensor fascia latae
(TFL)PsoasErector spinae
Phasic (tend to hypoactivity)
Tibialis anteriorGluteus maximusGluteus mediusRectus abdominusLower / middle
trapeziusLongus capitus and
colliDeltoidsDigastrics
Postural (tend to hyperactivity)
Quadratus lumborum (QL)
PectoralisUpper TrapeziusSternocleidomastoidSuboccipitalMasticatories
Obtain pertinent history.Description of symptoms.Fractures.Injuries.Congenital anomalies.Dominant hand.
Note gross structural asymmetries such as scoliosis.
Occipital protruberance.Cervical, thoracic, and lumbar spinous
processes.Coccyx.Gluteal folds.Arms should hang equally with palms slightly
visible.
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).
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.
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.
Balanced posture should appear equal from left to right.
Landmarks.Bridge of nose.Center of chin.Episternal notch.Xiphoid process.Umbilicus.Pubes.
Arms should hang similarly with palms at the side of the thighs
Shoulder girdle symmetryHands should show similar rotation and
placement on the bodyLegs should appear equally abducted from
the center line
Feet aligned b/lNo pronation / supinationNo inversion of eversion
Knees forward and symmetric b/l
Structures that should be equal b/l and levelEyesClaviclesLower margins of the ribcageAnterior superior iliac spines (ASIS)Femoral trochantersKneesAnkles
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.
Postural findingRounded shouldersForward-drawn headC0-C1
hyperextensionWinging of scapulaeElevation of
shoulders
DysfunctionShortened pectoralsKyphotic t-spineShort suboccipitalsWeak serratus
anterior, weak rhomboids
Shortened upper trap, shortened levator scapulae, weak lower and middle trap
Tight-short musclesSuboccipitalsPectoralsAnterior shoulderUpper trapezius
Weak-long musclesMid to lower
trapeziusSerratus anteriorRhomboids
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.
Weak gluteus maximus and short hip flexors. Weak abdominals and short lumbar erector
spinae. Weak gluteus medius and short TFL and QL.
Postural findingLumbar hyperlordosisAnterior pelvic tiltProtruding abdomenFoot turned outHypertrophy of
thoracolumbar junction
Groove in iliotibial band
DysfunctionShortened erector
spinaeWeak gluteus maximusWeak abdominalsShortened piriformisHypermobile
lumbosacral junctionShortened tensor
fascia latae
Layered syndrome is a combination of the muscle imbalances seen in both upper and lower crossed syndrome.
It develops with chronic cases.