Chapter 8 Assessment of Body Alignment Posture and Gait Flashcards
What are ectomorphs?
typical lean individual, light build with small joints and lean muscle – long thin limbs with stringy muscles, shoulders thin with little width
What are mesomorphs?
large bone structure, large muscles, naturally athletic physique, easy to gain or lose weight, naturally strong and build muscle mass quickly
What are endomorphs?
solid and generally soft, gain weight easily, shorter build with thick arms and legs, muscles are strong (upper legs)
What is a mixed body type?
A combination of any ectomorph, mesomorph and endomorph
What is the role of posture control?
Antigravity function – maintaining erect posture and keeping eyes level
Maintenance of equilibrium and balance
Providing mechanical support for motion
What is optimal posture?
Balanced dissemination of body mass around the center of gravity where the compression forces on spinal disks is balanced by ligamentous tension and with minimal energy expenditure from postural muscles
Joint ROM, muscle length and strength play a role
Body is in upright position – line of gravity passes anterior to the spinal column
Maintain body position – tension in spinal ligaments and muscles
Other forces: body weight, tension in spinal ligaments and paraspinal muscles, intra-abdominal pressure and any applied external loads
Major form of loading on spine is axial, l/s supports weight above it
Assess = alignment in standing, flexibility and muscle length tests, muscle strength
What are we looking for during an anterior view postural assessment?
Eyes, nose, zygomatic arch, mandible, ear lobes leveled
Head position: rotation, tilt, side bent (curve at the neck)
Shoulders: obvious muscle imbalance, atrophy, difference in shoulder height,
Hand position: internal, external rotation
Chest: developed, hollow chested, rib cage prominent, symmetrical, inspiration/expiration movement
Belly button off center, asymmetrical abdominal development
Elbow carrying angle from body (anatomical position)
Arm length: arms by side, arms same length, one side longer (consistent with shoulder)
What are we looking for during a posterior view postural assessment?
Head position: rotation (can I see one cheek more than another), tilt (look at the top of the head), side bent
Shoulder atrophy (deltoid and supraspinatus)
Shoulder elevation, depression (dominant side), rounding
Scapula: symmetry, winging, medially/laterally rotated
Spinous processes: C curve, S curve, straight
Para spinal muscle development: rigidity, muscle spasm, nerve injury, lumbar lateral shift
What are we looking for during a side view postural assessment?
Tip of ear aligned with shoulder, hip, malleoli
Head position: rotation, tilt, side bent
Shoulders: rounded
Thoracic spine increased/decreased kyphosis, cervical spine increased/ decreased lordosis (chin forward), lumbar spine increased/decreased (flat back)
Tightness in back extensors, weak abdominal muscles (leaning back)
Pelvis level
Knee hyperextension
What is lordosis, what are signs of lordosis and what are causes of it?
increased the anterior lumbar curve from neutral when compared to normal posture
Pelvis = anteriorly rotated
Weakened abdominals, tight hip flexors, TFL, deep lumbar extensors
Pelvic angle increases to 40 degrees
Causes: bilateral congenital hip dislocation, spondylolisthesis, hip flexor contractures, poor postural habits, overtraining with repeat lumbar extension
What is a swayback posture and what are signs of it?
Decrease anterior lumbar curve and increase in the posterior thoracic curve
Head and superior aspect of femur to shift anterior to compensate for posterior position
Increased lordosis and kyphosis
Weakness in lower abdominals, lower thoracic extensors, hip flexors, tight hip extensors, lower lumbar extensors and upper abdominals
Entire pelvis shifts anteriorly causing hips to move into extension
What is flat back, what are its causes, what is a common sign and how would you treat it?
decreased anterior lumbar curve
Pelvis rotates posteriorly
Decrease lumber curve to 20 degrees, shifts center of gravity anterior to the lumbar spine and hips
Causes: use of Harrington rods for scoliosis, degenerative disk disease, ankylosing spondylitis, post laminectomy syndrome, compression fractures, osteoporosis
Common sign – lean forward when walking/standing
low back, buttocks, posterior thigh muscles recruited to tilt pelvis
Treatment – strengthen gluteal, low back, abdominal, hamstring musculature
What is kyphosis, what does it cause and what are its causes?
increase posterior thoracic curve
Causes anterior head position, increase lordosis and anterior pelvic rotation
Cause = congenital, unknown, osteoporosis
Scheuermann disease – osteochondritis of the spine, rounded shoulders
What is scoliosis and what are its characteristics?
lateral curvature of the spine causing bilateral asymmetries of the shoulder and pelvic area
Lateral deformity coupled with rotational deformity
C-shape or S-shape
Structural – involves inflexible curvature that persists with lateral bending of the spine
Non-structural – flexible and corrected with lateral bending
Mild (curve less than 20 degrees) – asymptomatic and self-limiting
Moderate (20-45 degrees) – bracing necessary
Mild-to-moderate treated with flexibility, strength, general fitness activities
Severe – surgery
What are the characteristics of upper cross syndrome?
Tightness of upper trapezius, levator scapula, pectoralis major/minor
Weakness of deep cervical flexors, middle/lower trapezius
Joint dysfunction at AO joint, C4-C5 segment, cervicothoracic joint, GH joint, T4-T5 segment
Forward head posture, increased cervical lordosis and thoracic kyphosis, elevated and protracted shoulders, winging of scapula
What are the characteristics of lower cross syndrome?
Tightness of thoracolumbar extensors, iliopsoas, rectus femoris
Weakness of deep abdominals, gluteus maximus/medius
Joint dysfunction at L4-L5 and L5-S1 segments, SI joint, hip joint
Anterior pelvic tilt, increased lordosis, lateral lumbar shift, lateral leg rotation, knee hyperextension
What are the forces sustained by the lower leg, ankle and foot?
Tension, compression, bending and torsion
Running – foot sustains impact 2-3 fold body weight, magnitudes if forces increase with gait speed
Injuries in runners – cavus feet and leg length inequality
What is the foot deformation during gait?
50% BW distributed through subtalar joint, 50% transverse tarsal joint
Foot – deforms with each ground contact due to ligaments/tendons
Energy stored in tendons, ligaments, plantar fascia, gastrocnemius, soleus
Push-off phase – stored energy is released
What are the forces at the tibiofemoral joints?
Medial compartment – majority of load during stance
Sport participation – knee forces large
What are the forces at the patellofemoral joint?
Compressive forces – found to be half the body weight during walking gait, increases up to 8-fold during stair climbing – lateral force distribution, lateral patellar tilt
What are the forces at the hip when standing?
Subject to extremely high loads during sport
Weight supported at each hip is half the weight of the body segments above the hip
Tension is large, strong muscles add compression to the hip joint
What are the forces at the hip during gait?
Compression same as BW during swing phase – increase 3-6-fold BW during stance phase
Force ==> skeleton through foot muscle tension ==> compressive load
Walking/running increases forces on hip
Crutch/cane on opposite side to injured limb – more evenly distributes the load
What are the different support phases during a gait assessment?
Single support: initial swing, midswing, terminal swing
Double support: initial contact, loading response
Single support: midstance, terminal stance
Double support: preswing
