(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