Postural Assessment

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Postural Assessment

• Dr. Michael P. Gillespie

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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.

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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.

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Pain Cycle
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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.

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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.

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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.

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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 individuals activities of
  daily living.
• Allows the individual to avoid injury.

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Balanced Posture
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Effect of Habits on Posture

• Good habits contribute to a strong and stable
  posture.
• Bad habits contribute to poor posture and
  instability.

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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.

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Postural Changes
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Effects of Poor Posture on Muscles

• Overstressed muscles tighten.
• Favored muscles weaken.
• This imbalance perpetuates the poor posture.

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Spinal Distortions

• Anterior to posterior.
• Lateral.
• Helical.
• Foundational distortions create changes above.

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Spinal Column Views
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Helical Spinal Distortion
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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
  its antagonistic muscle is being overused.

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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.

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Reciprocal Inhibition
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Postural and Phasic Muscles

• Postural (tend to hyperactivity)
• Triceps surae
• Hamstrings
• Adductors
• Rectus femoris
• Tensor fascia latae (TFL)
• Psoas
• Erector spinae

• Phasic (tend to hypoactivity)
• Tibialis anterior
• Gluteus maximus
• Gluteus medius
• Rectus abdominus
• Lower / middle trapezius
• Longus capitus and colli
• Deltoids
• Digastrics

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Postural and Phasic Muscles

• Postural (tend to hyperactivity)
• Quadratus lumborum (QL)
• Pectoralis
• Upper Trapezius
• Sternocleidomastoid
• Suboccipital
• Masticatories

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Posture Blocks
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Prior To Postural Evaluation

• Obtain pertinent history.
• Description of symptoms.
• Fractures.
• Injuries.
• Congenital anomalies.
• Dominant hand.
• Note gross structural asymmetries such as
  scoliosis.

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Postural Views
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Posture Types
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Posterior View Evaluation

• Occipital protruberance.
• Cervical, thoracic, and lumbar spinous processes.
• Coccyx.
• Gluteal folds.
• Arms should hand equally with palms slightly
  visible.

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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).

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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.

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Ideal Posterior Alignment
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Scoliosis
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Pelvic Unleveling
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Gothic Shoulder
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Scapular Winging
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Scapular Winging and Abduction
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Tight Levator Scapula
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High Left Shoulder
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Right Head Tilt and Rotation
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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.

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Ideal Lateral Alignment
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Head Alignment Lateral View
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Forward Head Posture
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Head and Neck Weight Distribution
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Forward Head Tilt
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Abdominal Protrusion
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Pelvic Tilt (Anterior and Posterior)
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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.

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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

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Anteroposterior / Front View

• Feet aligned b/l
• No pronation / supination
• No inversion of eversion
• Knees forward and symmetric b/l

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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

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Internal Rotation of Shoulders / Rounded Shoulders
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Genu Valga (Knock-knees)
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Genu Vara (Bowlegs)
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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.

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Upper Crossed Syndrome
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Postural Signs of Upper Crossed Syndrome

• Postural finding
• Rounded shoulders
• Forward-drawn head
• C0-C1 hyperextension
• Winging of scapulae
• Elevation of shoulders

• Dysfunction
• Shortened pectorals
• Kyphotic t-spine
• Short suboccipitals
• Weak serratus anterior
• Shortened upper trap, shortened levator scapulae,
  weak lower and middle trap

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Muscle Imbalances in Upper Crossed Syndrome

• Tight-short muscles
• Suboccipitals
• Pectorals
• Anterior shoulder
• Upper trapezius

• Weak-long muscles
• Mid to lower trapezius
• Serratus anterior

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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.

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Lower Crossed Syndrome
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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.

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Postural Signs of Lower Crossed Syndrome

• Postural finding
• Lumbar hyperlordosis
• Anterior pelvic tilt
• Protruding abdomen
• Foot turned out
• Hypertrophy of thoracolumbar junction
• Groove in iliotibial band

• Dysfunction
• Shortened erector spinae
• Weak gluteus maximus
• Weak abdominals
• Shortened piriformis
• Hypermobile lumbosacral junction
• Shortened tensor fascia latae

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Upper and Lower Crossed Syndrome
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Layered Syndrome

• Layered syndrome is a combination of the muscle
  imbalances seen in both upper and lower crossed
  syndrome.
• It develops with chronic cases.

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Layered Syndrome