Chapter 5 Static Postural Assessments

Question 1

Learning objectives

Answer 1

Upon completing this chapter, you will be able to:

• Define the function of a static postural assessment.
• Describe the kinetic chain implications for static postural alignment.
• Discuss the avenues through which static postural alignment may alter over time.
• Discuss the implications for existing postural distortions.
• Perform a static postural assessment.

Question 2

Static posture

Answer 2

How an individual physically presents themselves instance. It is reflected in the alignment of the body.

Question 3

Dynamic posture

Answer 3

How an individual is able to maintain an erect posture while performing functional tasks.

Question 4

Myofascial

Answer 4

The connective tissue in and around muscles and tendons.

Question 5

Muscle imbalance

Answer 5

Alteration in the functional relationship between pairs or groups of muscles.

The combination of tight and weak muscles can alter normal movement patterns ( 10, 11 ).

This results in an alteration of the biomechanics of joints leading to a degeneration

Question 6

chart

Question 7

Postural Imbalances

Main causes

Answer 7

The main factors that cause postural imbalance include:

1. Habitual movement patterns
2. Altered movement patterns from repetitive movement
3. Altered movement patterns from injury
4. Altered movement patterns from surgery
5. Altered movement patterns from incompletely rehabilitated injuries

Question 8

Habitual Movement Patterns

Answer 8

It is essential for the health and fitness professional to have an understanding of posture and the importance it has in our daily lives. It is even more important to realize what effects posture has on a daily basis. Individuals may have developed some poor postural habits

Question 9

Altered Movement Patterns from
Repetitive Movement

Answer 9

Repetition of movement as in chronic overuse or injury can lead to a change in the elasticity of the muscle ( 12 ). Poor posture and a lack of daily movement are also considered a contributing factor ( 13 ). The muscle that is repeatedly placed in a shortened position, as the iliopsoas complex during sitting, will eventually adapt and tend to remain short ( 10, 14 ). Stress and chronic fatigue may also result in muscle imbalances

Repetitive movements can cause imbalances by placing demands on certain muscle groups more predominantly. This is evident when looking at many athletes such as swimmers, runners, and tennis players

Question 10

Altered Movement Patterns from Injury

Answer 10

Acute injury may result in chronic muscle imbalances. An individual may assume adaptive postures to avoid pain or to create function. Often times, even after the pain has substituted and motion restrictions or strength has returned, the individual may not change their adaptive movement strategies unless reminded to return to a more normal motor pattern.

Question 11

Altered Movement Patterns from Surgery

Answer 11

Even the best of surgeries result in scar tissue. It is simply the way that tissue heals. Scar mobility is often an overlooked aspect of the rehabilitation paradigm. Lack of mobility alters the alignment and pulls on the fascia, effecting joints and muscle function. Th ere may have been some compensatory altered movement patterns utilized for functional mobility before the surgery or shortly after the surgical intervention. Balanced movement must be actively restored, or resultant muscle imbalances and postural changes will develop.

Question 12

Altered Movement Patterns from Incompletely
Rehabilitated Injuries

Answer 12

In these days of a limited number of visits for insurance-covered rehabilitation, many clients may have initiated a rehabilitative intervention after an injury, but have been discharged before return to their required functional level. Th ey then continue on their own well-intended programs that may be overlooking the imbalances that were never resolved. Or they may simply discontinue rehabilitation and be willing to live within their current limitations. In either case, the body will adapt to the available mobility and stability, creating compensatory movement patterns that are eventually reflective in postural imbalance.

By knowing what can cause improper postural habits, the health and fi tness professional can begin to properly address the client’s needs. As a common denominator, improper posture usually results from or leads to muscle imbalances

Question 13

Common Distortion Patterns

Answer 13

How individuals present themselves in a static stance is, in a sense, a road map of how the body has been used over time. Twists and turns in what should otherwise be a fairly erect and cylindrical structure are evidence of compensatory movement patterns. Something is not working as well as the body requires it to work; therefore, it has called other structures or muscle groups to “jump in and help” (synergistic dominance). Most structures and muscle groups in the body have very defined functional roles. What is interesting is that the body has a tendency to compensate in particular
patterns or by particular relationships between muscles

Question 14

The three postural distortion patterns to be assessed
during a static postural assessment

Answer 14

Lower crossed syndrome

Upper crossed syndrome

Pronation distortion syndrome

Question 15

Lower Crossed Syndrome

Answer 15

A postural distortion syndrome characterized by an anterior tilt to the pelvis and lower extremity muscle imbalances.

Question 16

Lower Crossed Syndrome Summary

Answer 16

A postural distortion syndrome characterized by an anterior tilt to the pelvis and lower extremity muscle imbalances

Question 17

Upper crossed syndrome

Answer 17

A postural distortion syndrome characterized by a forward head and rounded shoulders with upper extremity muscle imbalances.

Question 18

Pronation distortion
syndrome

Answer 18

A postural distortion syndrome characterized by foot pronation and lower extremity muscle imbalances.

Question 19

Systematic Approach to Assess
Static Posture

Answer 19

Static postural assessment requires a strong visual observation skill from the
practitioner. This can be developed with time and practice. It requires a systematic approach. Commonly, static postural assessments begin at the feet and travel upwards toward the head. We are bipedal in nature, and our feet interact with the external environment with every step we take. Often, alterations or deviations observed in the lower part of the body are then reflected in compensatory alterations or deviations, further up the kinetic chain. Many of these compensations can be identified through a comprehensive static postural assessment.

Question 20

KINETIC CHAIN CHECKPOINTS

Answer 20

1. Foot and ankle
2. Knee
3. Lumbo-pelvic-hip complex (LPHC)
4. Head/cervical spine (upper body)

Question 21

Kinetic Chain Checkpoints, Anterior View

Answer 21

ANTERIOR VIEW
◆ Foot/ankles: Straight and parallel, not flattened or externally rotated
◆ Knees: In line with toes, not adducted or abducted

◆ LPHC: Pelvis level with both posterior superior iliac spines in the same transverse plane
◆ Shoulders: Level, not elevated or rounded
◆ Head: Neutral position neither tilted nor rotated

Question 22

Kinetic Chain

Lateral View

Answer 22

◆ Foot/ankle: Neutral position, leg vertical at a right angle to the sole of the foot
◆ Knees: Neutral position, not flexed nor hyperextended
◆ LPHC: Pelvis in a neutral position, not anteriorly (lumbar extension) or posteriorly
rotated (lumbar flexion)
◆ Shoulders: Normal kyphotic curve, not excessively rounded
◆ Head: Neutral position, not in excessive extension (“jutting” forward)
Note: An imaginary line should run slightly behind the lateral malleolus, through
the middle of the femur, center of the shoulder, and middle of the ear.

Question 23

Kinetic chain checkpoint

Posterior view

Answer 23

◆ Foot/ankle: Heels are straight and parallel, not overly pronated
◆ Knees: Neutral position, neither adducted nor abducted
◆ LPHC: Pelvis level with both posterior superior iliac spines in the same transverse plane
◆ Shoulders/scapulae: Level, not elevated or protracted (medial borders
essentially parallel and approximately three to four inches apart)
◆ Head: Neutral position neither tilted nor rotated
Note: An imaginary line should begin midway between the heels, extending upward between the lower extremities, through the midline of the pelvis, and through the spine and skull.

Question 24

Chapter 5 Summary

Answer 24

A static postural assessment is a simple yet effective tool to quickly “size up” your client. Consider yourself a detective looking for structural deviations within a kinetic chain as well as for symmetry from the right to the left side of the body. Alterations in structure will lead to or could be caused by muscle imbalances. Many muscle imbalances can be inferred simply from the deviations noted in the static postural assessment. Using a static postural assessment upon an initial evaluation of your client will give you a “big picture” view of how that individual uses his or her body day in and day out. Consider the body as a road map. Movement patterns commonly used will be expressed in the alignment the body naturally assumes. Identifying these static deviations and asymmetries in conjunction with that identified in the dynamic postural assessment (See Chapter 6, Movement Assessments) will provide clues as to how an individual uses his or her body biomechanically. Knowing that and understanding how interconnected all the body systems are, the Health and Fitness Professional can begin to identify what other components have been affected by the altered alignment. How have these alterations distorted the feedback from the proprioceptors? How has the altered alignment affected the function of the soft tissue? Has the fascia been overloaded? Have compensatory muscle

Question 25

Chapter 5 Summary

(cont)

Answer 25

Have compensatory imbalances been generated creating altered length-tension relationships, altered force production, synergistic dominance, and reciprocal inhibition relationships? How have these changes affected the entire kinetic chain and overall coordination of movement within the limbs and between the limbs and the trunk? What further questions will you need to ask your client about day-to-day postural habits (How your client stands, sits, carries packages, briefcases, or babies)? Do you need to dig further into prior injuries, surgeries, or “minor” aches and pains that with time may have altered his or her freedom of movement? Does your client appear to fall neatly into one of the more common postural disorders or has your client combined compensations leading to further complexities in biomechanical and neuromuscular loading? The static postural assessment is the first step in assessing the biomechanical and neuromuscular pieces of the puzzle necessary to create a program for functional rebalancing for your client.