Postural Assessment

Postural AssessmentDr. Michael P. Gillespie

PosturePosture 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.

Postural AnalysisThe 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.

Pain Cycle

Neutral PostureThe 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.

Righting ReflexA 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.

CausalityPostural 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.

Ideal PostureThere 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.

Balanced Posture

Effect of Habits on PostureGood habits contribute to a strong and stable

posture.

Bad habits contribute to poor posture and instability.

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.

Postural Changes

Effects of Poor Posture on Muscles

Overstressed muscles tighten.

Favored muscles weaken.

This imbalance perpetuates the poor posture.

Spinal DistortionsAnterior to posterior.

Lateral.

Helical.

Foundational distortions create changes above.

Spinal Column Views

Helical Spinal Distortion

Muscle PalpationPalpate 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 InhibitionReciprocal inhibition describes muscles on one

side of a joint relaxing to accommodate contraction of muscles on the other side of a joint.

Reciprocal Inhibition

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 anteriorGluteus maximusGluteus mediusRectus abdominusLower / middle

trapeziusLongus capitus and

colliDeltoidsDigastrics

Postural and Phasic Muscles

Postural (tend to hyperactivity)

Quadratus lumborum (QL)

Pectoralis

Upper Trapezius

Sternocleidomastoid

Suboccipital

Masticatories

Posture Blocks

Prior To Postural Evaluation

Obtain pertinent history.Description of symptoms.Fractures. Injuries.Congenital anomalies.Dominant hand.

Note gross structural asymmetries such as scoliosis.

Postural Views

Posture Types

Posterior View EvaluationOccipital protruberance.

Cervical, thoracic, and lumbar spinous processes.

Coccyx.

Gluteal folds.

Arms should hand equally with palms slightly visible.

Posterior View EvaluationThe 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).

Posterior View EvaluationStructures 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.

Ideal Posterior Alignment

Scoliosis

Pelvic Unleveling

Gothic Shoulder

Scapular Winging

Scapular Winging and Abduction

Tight Levator Scapula

High Left Shoulder

Right Head Tilt and Rotation

Lateral ViewEvaluate 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.

Ideal Lateral Alignment

Head Alignment Lateral View

Forward Head Posture

Head and Neck Weight Distribution

Forward Head Tilt

Abdominal Protrusion

Pelvic Tilt (Anterior and Posterior)

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.

Anteroposterior / Front View

Arms should hang similarly with palms at the side of the thighs

Shoulder girdle symmetryHands should show similar rotation and placement

on the body

Legs should appear equally abducted from the center line

Anteroposterior / Front View

Feet aligned b/lNo pronation / supinationNo inversion of eversion

Knees forward and symmetric b/l

Anteroposterior / Front View

Structures that should be equal b/l and levelEyesClaviclesLower margins of the ribcageAnterior superior iliac spines (ASIS)Femoral trochantersKneesAnkles

Internal Rotation of Shoulders / Rounded

Shoulders

Genu Valga (Knock-knees)

Genu Vara (Bowlegs)

Upper Crossed SyndromeAffects 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.

Upper Crossed Syndrome

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

Muscle Imbalances in Upper Crossed Syndrome

Tight-short muscles

Suboccipitals

Pectorals

Anterior shoulder

Upper trapezius

Weak-long muscles

Mid to lower trapezius

Serratus anterior

Lower Crossed SyndromeAffects 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.

Lower Crossed Syndrome

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.

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

Upper and Lower Crossed Syndrome

Layered SyndromeLayered syndrome is a combination of the

muscle imbalances seen in both upper and lower crossed syndrome.

It develops with chronic cases.

Layered Syndrome