Posture

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Posture

• PTP 565 Fundamentals of Tests and Measures

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Make vs Break Test

• Make test
• Try to do this motion
• Make a msucle contract

• Break test
• Hold a muscle contraction
• Dont let me move you

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Exam 2

• Posture
• Gait
• Balance
• Assistive devices

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• 4-point (2 assistive aids) Modified 4point, two
  touching at a time, opposite hand and foot
  together. 1 assistive devise is used.
• Patient Care
• Pg. 232-233
• Use for Exam

• 2 point (using a cane or hemi-walker) assistive
  aid and opposite leg touch together

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What is Posture?

• Posture A position of the body
• Good lifting up entire body
• Bad relaxation-use of ligaments, and natural
  bony shape, anterior trunk shortening/
  tightening, posterior trunk lengtheningleads to
  muscle imbalances, which creates more pain for
  individual.
• Emotional Aspect of Posture get a read off of
  how someone holds themselves.

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Factors Affecting Posture

• Age
• Physiological state of being at any one time can
  have a postural effect
• Structural Factors scoliosis, extra ribs, leg
  length discrepancies
• Occupational Factors
• Social and Cultural
• Recreational
• Environmental

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• Muscle Strength
• Emotional
• Protective posture (UE bent at 90 held against
  body), rotator cuff tear (elevated shoulder)
• Pathological
• Illness
• Pain
• Mal-alignment after a fracture
• Muscle tone floopy vs hypertonic
• Osteoporosis fractures of vertebral spine

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Soda Pop Model of Respiration and Postural Control

• Every muscle of the trunk is a respiratory muscle
  AND a postural muscle.
• Diaphragm is very important
• Breathing is compromised exercise etc, posture
  response is reduced so as to focus on the needs
  of the respiratory system
• When faced with conflict, diaphragm will always
  choose respiration over posture

Massery, M. Musculoskeletal and Neuromuscular
Interventions a physical approach to Cystic
Fribrosis. J Royal Soc of Med. 2005
98(Sup)55-66.
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• Aluminum Shell
• Unopened
• Opened
• Trunk
• Muscular contractions protect the skeleton from
  being crushed by outside forces

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Diaphragm

• Separates the two chambers of the body thoracic
  and abdominal
• Primary pressure regulator
• Sealed at top by vocal folds

• Sealed at bottom by pelvic floor
• Regulated by the muscles of the trunk and pelvic
  floor which gives pressure regulation
• Allows multi-tasking

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• Function of internal organs is supported by this
  pressure

• Take the muscle function away and the pressure
  collapse has an effect on the function of the
  internal organs

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Posture

• Static
• Kneeling, standing, lying, sitting
• Dynamic
• Walking, running, jumping, etc.
• Analysis
• X-Ray (Scoliosis), Photography, EMG
• Force Plates
• Plumb Line?-divide body in half

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Good Posture

• In a standing position
• Straight vertical alignment
• Through top of head
• Through body center
• To bottom of feet

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Key Points Ext. Auditory Meatus Acromion,
bisect Ant. Thoracic spine Bisect Lumbar
Spine Posterior to hip joint Anterior to knee
joint Ant. To lateral malleolusvery anterior
tip of bone
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Sagittal View Questions

• Are the normal spinal curves exaggerated or
  reversed?
• Is the body displaced relative to the center of
  gravity?
• Is the head position balanced over the body?

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Forward Head Posture

• Sagittal View
• Upper cervical
• Lower cervical
• Thoracic spine
• Facet joints
• Intervertebral foramen
• Extensor mm.
• TMJ
• Scapula, GH joint.

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Forward Head Posture

• Muscles
• Upper Cervical Spine extensors are tight if the
  chin looks tilted in the air or is leading the
  body

• Levator Scapula muscles are weak, lengthened

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3) Upper Cross Shoulder Syndrome

• Affects the functional capacity of the cervical
  spine and upper extremity
• Muscles which are weak and inhibited
• lower trapezius and serratus anterior, deep neck
  flexors

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• Muscles which are shortened and hypertonic
• upper trapezius, levator scapulae, scalene
  muscles
• Muscles which are short and tight pectoralis
  major and minor, interscapular muscles,
  sternocleidomastoid, suboccipital muscles

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UCS cont.

• Results
• Forward head posture
• Loss of lower cervical lordosis
• Extension of upper cervical spine
• Increase kyphosis of cervical thoracic junction
• Internal rotation of shoulder girdles

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C-T junction Dowager's hump

• 1-3 thoracic vertebrae fracture
• Increase in soft tissue around the CT junction
• Osteoporosis is the main cause

• Anterior wedging of the vertebrae, height
  anterior is less then posterior

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Shoulder Position

• Anterior Shoulders
• Humerus is in front of acromion rather than
  centered
• Creates a rounded anterior position of shoulder
  girdle
• Leads to impingement syndromes of the shoulder

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Faulty Thoracic Spine and Chest Postures

• Kyphotic Posture
• Shortened pectorals
• Tight intercostals
• Flat T Spine
• Hypermobility
• Spinous processes are more approximated
• Less shock absorption

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T-Spine Round Back (kyphosis)

• Most begin with a decrease in pelvic inclination
  (angle of inclinationless of an angle then less
  shock absorption.
• Body compensates by rounding out the thoracic or
  thoracolumbar spine

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T-Spine Hunch Back (gibbus)

• Structural
• Anterior wedging of 1-2 thoracic vertebrae
• Increased lumbar, change in width

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T Spine Pigeon Chest

• Sternum projects forward and downward
• Increase in AP diameter
• Congenital Deformity
• Restricts ventilation volume

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T Spine Funnel Chest

• Congenital deformity
• Sternum is pushed posterior by overgrowth of ribs
• A/P diameter is decreased
• Heart may be displaced
• Inspiration hollow depression

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T Spine Barrel Chest

• Sternum projects upward
• Increase in A/P diameter
• Pathological conditions emphysema

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• Exam question on last 3 pervious slides, over
  increase in A/P for two, but not for one.

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Normal and Faulty L and T Spine Alignments
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Muscles activation isometric? Endurance
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Kyphosis-Lordosis Posture
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Postural Fault/Increased Lumbar Lordosis

• Lumbar spine
• Hyperextension
• Pelvis
• Anterior tilt
• Hip joint
• Flexion

• Muscles Shortened
• Erector spinae
• Hip flexors
• Muscles Lengthened
• Abdominals
• Hip extensors

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Sway-back Posture

• Lumbar spine
• Lordosis?
• Pelvis
• Posterior tilt
• Hip joint
• Extension

• Muscles Shortened
• Abdominals
• Hip extensors
• Muscles Lengthened
• Hip flexors

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Flat back

• T spine is mobile, with Inc. flexion
• L spine flexed (straight)
• Decrease in pelvic inclination, posterior pelvic
  tilt
• Hip and Knees extended
• Ankles slight plantar flexion
• Not structural but functional

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Flat-Back Posture

• Lumbar spine
• Flexion
• Pelvis
• Posterior tilt
• Hip joint
• Extension

• Muscles Shortened
• Abdominals
• Hip extensors
• Muscles Lengthened
• Erector Spinae
• Hip flexors

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Slouched sitting posture

• C-spine
• T-Spine

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Questions to Ask

• Are the shoulders and the scapulae symmetrical?
• Is there a lateral curvature of the midspinal
  line?
• Is the head held to one side? Which side?
• Is the pelvic position asymmetrical? (are the
  iliac crests level?)
• Is there a special flatness or fullness of the
  paravertebral muscle mass?

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• Are the feet placed symmetrically or not?
• Is the body rotated as a whole?
• Are the Achilles tendons deviated or symmetrical?
• Are the positions of the malleoli symmetrical in
  relation to the heels?
• Are the arm positions symmetrical?
• Are the waist folds symmetrical?

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L. Thoracolumbar scoliosis

• T-spine
• R. lateral flexion
• Convex toward left
• Pelvis
• May or may not be affected

• Muscles Shortened
• Right lateral trunk muscles
• Left Psoas
• Muscles Lengthened
• Left lateral trunk muscles
• Right Psoas

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Scoliosis

• Functional vs. Structural
• Named superior 1st
• Wedging of vertebral bodies
• Other changes
• Sh. Height
• Scapular position
• Rib hump

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Curve Patterns
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Rib Hump

• Seen when a patient flexes forward
• Spine rotates to one side
• Ribs push out posterior, appear higher
• Narrowing of thoracic rib cage occurs

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Scoliosis
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Anterior View Questions

• Are the shoulders level symmetrical at the
  mid-sternal line?
• Is the head tilted to one side? Which side?
• Does the normal horizontal clavicular line
  deviate? Which direction?
• Is the pelvic position asymmetrical?
• Are the patella deviated laterally or medially?
• Is the femur rotated medially or laterally?

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Cock Robin Head Position

• Upper cervical joint dysfunction Rotation of the
  Occiput between C0 and C1
• Frontal plane motion about a Z axis (through the
  nose)
• Gives appearance of a tilted head to one side
• May be an indication of upper cervical trauma or
  biomechanical dysfunction

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Handedness Pattern

• Right handed
• Right shoulder lower than the left
• Pelvis deviated slightly to the right side
• Right hip appears higher than the left
• May see deviation of spine to the left side
  slightly
• Left foot is more pronated than right

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Lower Extremity

• Hip and Knee flexion contracture
• Quad activation _at_ 15 dg., up to 22 increase in
  MVC
• Genu Recurvatum
• Plantar flexed ankle

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• LE may observe patella positioning in relation
  to the LE alignment, Varus or valgus position of
  knees,

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Patella Frontal Plane

• Torsion (Hip, tibia)
• Patella tracking?

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Foot Alignment Sagittal View

• Feiss Line - blue line 1st metatarsal, through
  middle of navicular and goes to medial malleolus.
  
• Navicular drop
• Sagittal view

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Pes Planus-flat foot

• Talar Head
• Spring ligament
• Tibialis posterior

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Pronated Foot

• Affect at
• Knee joint
• Patella
• Hip joint

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Pes Cavus

• Mobility vs. Pes Planus

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Supinated Foot

• Affect at
• Knee joint
• Patella
• Hip joint

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Genu Recumvatum Ankle PF

• Affect _at_
• Knee joint
• Hip joint
• Hip
• Lumbar spine
• Tight gastroc