(2) Lecture 10: Body Alignment 101 Flashcards
Postural Evaluation
- assess STATIC posture
- observe ENTIRE body from all angles
- significant variability = only obvious asymmetries should be considered
Sagittal plane movements
Flexion and extension
spine, shoulder, hip, knee, ankle
Coronal/Frontal plane movements
Side flexion, abduction, adduction and inversion/eversion
spine, shoulder, hip and ankle
Transverse plane movements
Internal and external rotation, pronation/supination
shoulders, hips, feet
Basic Postural Observation
Sagittal Plane
- think of straight/plumb line running down entire length of body
line should pass
- thru ear lobes
- thru body of cervical spine
- thru humeral head
- thru greater trochanter (PSIS slightly higher than ASIS b/c of lordosis)
- anterior to knee but posterior to patella
- anterior to malleolus of ankle
Classic Postural Deviations in Sagittal Plane
- forward head posture
- forward rounded shoulders
- kyphosis
- lordosis
- swayback
- flatback
Forward head posture
Seen in sagittal plane
- ears in front of plumb line
- chin pokes forward
- extended upper C-spine + flexed lower C-spine
- protracted scapulae
- usually has forward rounded shoulders + possible kyphosis
Forward rounded shoulders
Seen in sagittal plane
- humeral head in front of plumb line (GH internal rotation)
- tight pec minor
- elongated/weak rhomboids + mid-trap
- restricted scapular upward rotation + posterior tipping
Shoulder problem but caused all over
Kyphosis
Seen in sagittal plane
- excessive THORACIC curve
- tight pec major + minor (on front)
- weak erector spinae, rhomboids and traps
- protracted scapulae
- associated w/ fwd head posture
- increased C- spine extension to keep eyes level
Lordosis
Seen in sagittal plane
- more than 40 degrees of tilt
- increased curve in LUMBAR spine
- increase in anterior pelvic tilt
- tight hip flexors + lumbar muscles
- elongated/weak ab muscles + hams (functionally shortened but not actually)
- shorter ROM
Is a lordosis bad?
NO, we need lordosis to give spine curves a spring
Excessive lordosis is bad
Swayback
Seen in sagittal plane
- anterior shift of entire pelvis = hip extension
- thoracic segment shifts posteriorly = flexion of thorax + kyphosis
- tight hip extensors + lower lumbar extensors
- weak hip + ab flexors
Flatback
Seen in sagittal plane
- increased posterior pelvic tilt
- decreased lumbar lordosis
- tight hip extensors
- weak/long hip flexors
- poor postural sense
- patient appears STOOPED FWD
Basic Postural Observation
Coronal Plane Posterior View
- head/ears level
- shoulders equal
- scapulae equal
- arms equal distance from body
- hips equal (gluteal fold equal)
- knee creases equal
- malleoli equal
Basic Postural Observation
Coronal Plane Anterior View
- head straight
- eyes/ears level
- shoulders (dominant side may be slightly lower)
– acromion level
– equal distance from body to arm - hips level (ASIS)
- knees level and straight – facing fwd
- malleoli equal
Scoliosis
Seen in coronal plane
Deformity in which there is one or more lateral curves of spine more than 10 degrees
- C or S curve
- may occur in thoracic, thoracolumbar or lumbar spine
- easily seen on X-ray
- rib hump is a hallmark sign of structural curve
- May be non-structural or structural
Structural vs non-structural scoliosis
Non-structural: easier for rehab (can be reversed)
Structural: can’t be reversed (goal - slow down)
Measuring Scoliosis
- physician chooses most tilted vertebrae above and below apex of curve
- angle btwn intersecting lines drawn perp is COBB ANGLE
Right thoracic curve
CONVEX to the right with apex in the thoracic spine
- curve is pointing to the right
90% of thoracic curves are to the right
Left thoracic curve
- less common
- should raise a RED FLAG
Causes
- chiari malfunctions
- spinal cord tumours
- neuromuscular disorders
Types of scoliolis
Non-structural scoliolosis and structural scoliosis
Non-structural scoliosis
- NO bony deformity
- not progressive
- can be TREATED clinically
- disappears on forward or side flexion
May be caused by
- postural problems (muscle spasm - tight on concave side + weak on convex)
- leg length discrepancy
- hip contracture (hip is tight)
Structural scoliosis
- bony deformity
- may be progressive
- hump present on fwd flexion (Adam’s Forward Bend Test)
- vertebral bodies rotate to convexity of curve
May be caused by
- genetic problems
- congenital issues
- idiopathic (unknown cause)
Adam’s Forward Bend Test
A rib hump (rotational deformity) is a hallmark sign of a curve greater than 10 degrees
Contributing factors of lower extremity overuse injuries
- Lower Chain Alignment
- static
- dynamic control (hip and knee) - Foot - interface w/ ground
- static: standing
- dynamic: walking/running
Lower Chain Alignment
- valgus
- neutral
- varus
Valgus
- knees go in together and feet apart
- more force/compression on outside part of lower leg
- lower chain alignment
force on outside of load bearing axis
Neutral lower chain alignment
axis goes through middle of knee
Varus
- knees move apart and feet together
- more force/compression on inside of lower leg
- lower chain alignment
force on inside of load bearing axis
Q-Angle
- describes the axis formed by femur and tibia
- greater Q angle = greater lateral pull on patella
- Q angle > 20 degrees increase risk of instability of patellofemoral (PF) jt
- can be a factor in PF pain syndrome, OA and ITB friction syndrome (varus)
Medial Collapse Mechanism
Poor multi-plane lumbo-pelvic/pelvo-femoral control
- typically caused by weak glut medius
problems caused:
- hip adduction
- femoral internal rotation
- knee valgus
Changes femur under patella
- DECREASE in jt. contact area
- INCREASED jt. stress
Normal knee motion
Knee flexion-extension
- happens btwn bottom of femur and top of menisci
Twisting motion
- happens btwn bottom of menisci and tibia
Screw Home Mechanism
Rotation happens during last few degrees of extension b/c medial femoral condyle is larger than lateral
- planted foot = femur medially rotates
- fixed femur = tibia laterally rotates
Locks joint to increase stability (passive)
- regulates patellar alignment
POPLITEUS then contracts to externally rotate femur on the tiba to UNLOCK the knee (active movement)
Foot arches
- longitudinal arch
- transverse arch
Longitudinal arch
Medial longitudinal arch attached to spring ligament (plantar calcaneoclavicular lig) for support
- reinforced by tibialis posterior
Lateral longitudinal arch - lower and less flexible
Foot types
Pes Planus
Pes Cavus
Pes Planus
Flat Foot
- decreased medial longitudinal arch height
- associated with excessive PRONATION
Pes Cavus
High arch
- excessive (stiff/high) medial longitudinal arch
- associated with SUPINATION
Transverse arch
- extends across TARSAL bones
- provides protection to soft tissue and increases the foot’s mobility
Plantar Fascia
- attaches on metatarsal heads
- starts from medial tubercle on plantar surface of calcaneus
- travels towards toes as a solid band of tissue dividing just before metatarsal heads into 5 slips
- ARCH SUPPORT + DYNAMIC SHOCK ABSORPTION
- responsible for transferring weight from medial to lateral side of foot during gait cycle
Plantar fascia during extension
When toes are extended, plantar fascia is functionally shortened as it wraps around metatarsal heads
Plantar fascia functions sort of like a muscle - has a DYNAMIC function
Windlass Mechanism
Windlass: apparatus for moving heavy weights
Dorsiflexing toes w./ flat foot: plantar fascia pulled around MT heads = increase in arch height and weight transfers to lateral side
Heel lift/toes dorsiflex: tightening up plantar fascia
Gait cycle
Classic gait terms:
heel strike - foot flat - midstance - heel off - toe off - midswing - heel strike
New gait terms
initial contact - loading response - mid stance - terminal stance - preswing - initial swing - mid-swing - terminal swing
Look at pictures of gait cycle
Walking Gait Cycle
- 60% stance and 40% swing
- weight bearing in Closed Kinetic Chain
- initial contact + early loading = double contact
- at mid-stance and terminal stance, body support by only a SINGLE limb
When in gait cycle, is the body supported by a single limb?
Mid-stance and terminal stance
When in gait cycle, is the body supported by both limbs?
Initial contact and early loading
What is pronation?
impact ABSORPTION phase of gait
- we either pronate too much, not enough (supinate) or just right
When does pronation occur?
Pronation occurs as foot is LOADED to allow for shock absorption, ground terrain changes and equilibrium
Tibia rotates internally w/ talus and calcaneus and acts to convert torque
- affects screwhome mechanism (unlocks foot to distribute forces)
Movements of pronation
- Eversion (transverse)
- Dorsiflexion (sagittal)
- Abduction (frontal)
Movements of supination
- Inversion (transverse)
- Adduction (frontal)
- Plantar flexion (sagittal)
Supination
- mid-tarsal jts. are locked
- foot is more stable for toe-off
- allows you to use great amount of force to propel body
- achieved with aid of CUBOID pulley
Supination during movement
- supination is needed to pull bones tight = makes foot a rigid lever and allows you to PUSH OFF
peroneus longus allows us to turn foot from a mobile adapter to a rigid lever
What are supination and pronation paired with?
Supination + external rotation
Pronation + internal rotation
Heel strike
Motion is pronation
Position is supination
To push off, you need rigid lever = re-supinate through pronated position
Foot flat
As you transition from heel strike to foot flat, you need to move into pronation (floppy foot)
- convert torque and be a SHOCK absorber
Stance phase
In pronated position but need to move into supination (rigid) by heel-off to propel yourself and push off
Flat feet and gait control
Ppl with flat feet have trouble getting to neutral phase between midstance and propulsion
- trouble trying to push off with a floppy/pronated foot
What kind of foot is floppy? Rigid?
Pronated foot = floppy
Supinated foot = rigid lever
Gait Cycle Running
with running, there is NO simultaneous foot contact w/ the ground
- at heel strike, foot acts as a shock absorber and adapts to surface
- foot is rigid lever at toe off
Runners
- 80% lateral heel strike
- sprinters forefoot strike
Role of Pronation in Gait Cycle
Foot function: MOBILE ADAPTER
Foot structure: lowered arches looser jts
Gait phase: just after heel strike to foot flat (weight acceptance/shock absorber)
Role of Supination in Gait Cycle
Foot function: RIGID LEVER
Foot structure: heightened arches, tighter jts (locks jts)
Gait phase: short period at heel strike and foot flat to toe off (push off)
Excessive Pronation
- over pronation at SUBTALAR jt = internal rotation of tibia and delayed re-supination
- affects screw-home mechanism b/c tibia doesn’t externally rotate
- femur MUST internally rorate more to get to extension
- cause of patellar tracking issues
Primary result of lower limb static + dynamic issues
Change in pressure distribution:
1. At the articulation of the bones
- could be at the jt. with faulty mechanics
- at the jt. above or below problem
- In surrounding soft tissues
Pain is secondary
