Jan 21, 2016
Posture means position Posture is the body’s alignment and
positioning with respect to COG. Attitude of the body, the relative alignment
of body/limb segmentsTypes Static posture: In which body segments
aligned and maintained in certain positions (Standing, lying, sitting). No mechanical work.
Dynamic posture: In which body segments are moving (Walking – running, lifting)
5/2/2011 2
The adult spine is divided into four curves:
Two primary or posterior curves because they are present in the infant and the convexity is posterior
Thoracic spine Sacrum
Two compensatory or anterior curves because they are Develop as the infant learns to lift the head and eventually stand, and the convexity is anterior› Cervical spine› Lumbar spine
5/2/2011 3
5/2/2011 4
Causes of poor posture Positional factors
Muscle imbalances/contractures Pain Respiratory conditions Typically can be managed through therapeutic
ex & educationStructural factors Congenital deformity Developmental problems Trauma Disease Not typically easily managed
5/2/2011 5
Through ear lobes
Through bodies CV
Through shouder jt.
Through trunk
Through GT
Anterior to midline knee
Anterior to lat malleolus
Line of Gravity
5/2/2011 6
Any deviation from the normal/proper posture
5/2/2011 7
Factors affecting posture Neurologic issues Muscle weakness Hypermobile joints Hypomobile joints Bony abnormalities Leg length Spinal column
5/2/2011 8
• Postural pain syndromes▫Posture deviates from normal
alignment but no structurallimitation
▫Mechanical stress but relievedby 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
5/2/2011 9
Head and neck Shoulder and scapula Head, neck, shoulder and scapula Trunk Feet and knees
5/2/2011 10
Forward head› Inc flexion of the
lower cervical and upper thoracic regions
› Inc extension of the occipital on the upper cervical vertebrae
› Protrusion of mandible
5/2/2011 11
• Flat neck▫Dec cervical
lordosis▫ Inc flexion of the
occiput on the atlas
▫Retraction of the mandible
▫Exaggeratedmilitary posture
5/2/2011 12
Head Posterior Tilt
Head Anterior Tilt
MarkedAnterior Tilt
Forward Head with Attempted Correction
Head and Neck
5/2/2011 13
Shoulders and scapula Good position
Scapula AbductedSlightly Elevated
Scapula Adducted Slightly Elevated
5/2/2011 14
Shoulders and scapula Good position
Shoulders Elevated Scapula Adducted
Shoulder DepressedScapula Abducted
5/2/2011 15
Scapula depressed Winging of the Scapula
Shoulders and scapula Good position
5/2/2011 16
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
5/2/2011 17
Upper crossed syndrome
› Tight muscles: Pectoralis major and minor, upper trapezius, Levator scapulae, SCM
› Weak muscles: Lower and middle trapezius, Serratus Anterior, Rhomboids
5/2/2011 18
An exaggerated curvature in the sagittal plane
Long rounded curve (round back)
Sharp posterior angulation (hump back)
Possible causes› Wedge compression fracture› Ankylosing spondylitis› osteoporosis› Destructive tumors of spine
Trunk • Kyphosis-LordosisForward head
Increased cervical lordosis
Scapula Abducted
Increased thoracic kyphosis
Increased lumbar lordosis
Anterior pelvic tilt
Knees slightly hyperextended
Ankles slightly plantarflexed
Short and Tight:• Neck extensors• Hip flexors• Low back
Lengthened and Weak:• Neck flexors• Hamstrings• Erector spinae• Possibly abdominals
5/2/2011 20
Trunk • Sway-back Forward head
Increased cervical lordosisIncreased
thoracic kyphosis
Decreased lumbar lordosis
Posterior pelvic tilt
Knees slightly hyperextended
Ankles neutral
Short and Tight:• Upper abdominals• Intercostals• Hamstrings
Lengthened and Weak:• Neck flexors• Hip flexors• Thoracic extensors• Lower abdominals
5/2/2011 21
Trunk • Military type
Normal-slightly posterior
Normal
Normal kyphosis
Increased lumbar lordosis
Anterior pelvic tilt
Knees slightly hyperextended
Ankles slightly plantarflexed
Short and Tight:• Lumbar extensors• Hip flexors
Lengthened and Weak:• Abdominals• Hamstrings
5/2/2011 22
Trunk • Flat back Forward head
Increased cervical lordosis
Decreased kyphosis
Decreased lumbar lordosis
Posterior pelvic tilt
Knees slightly hyperextended
Ankles slightly plantarflexed
Short and Tight:• Neck extensors• Abdominals• Hamstrings
Lengthened and Weak:• Neck flexors • Back extensors• Hip flexors
5/2/2011 23
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
Trunk
5/2/2011 24
A medio-lateral curve of the vertebral column Exceeding 100
› Types Structural Neuromuscular Idiopathic Non-structural
› Treatment Exercises Bracing
Forward bending test
Skyline view5/2/2011 26
Cobb angle greater than 25-30 will require decompression and fixation surgery.
5/2/2011 27
Ideal alignment › Patella faces
forward› Feet are in good
alignment › Hips and feet
neutral
5/2/2011 28
Genu Varum› Knee separation › Hyperextension of the
knee› Axis of knee is oblique › Hindfoot Supination › Forefoot pronation
SquintingPatella
5/2/2011 29
Genu valgum› Hip adducted; IR of the femur› Patella tilted medial› Hindfoot pronation› Forefoot supination › Hyperextension › Knee is oblique
Frog eyes
5/2/2011 30
• Patella alta • Patella baja
5/2/2011 31