Components of Postural Eval - Class 7 Flashcards
what does a postural eval involve
identification of the location of the body segments in relation to the LOG
in relation to the LOG
what’s in front of/behind
what is medial or lateral
is it symmetrical
postural evaluation requires
great proficiency by the examiner
d/t many postural deviations being subtle
for a postural eval the pt must be
adequately undressed
how should the pt start
in a comfortable position
may not even want to tell them were checking their posture –> they’ll try and correct it
if a pt wears an orthotic device
assess w/ and w/o and note changes
components of a postural eval
postural history
observation and inspection
muscle length assessment
is poor posture usually what motivates a pt to seek tx
no
sxs produced by pathology caused by or causing the postural abnormality compels the pt to seek tx
if a child is being examined
obtain prenatal and postnatal history
what does prenatal history include
health of the mother during pregnancy
any complications during pregnancy or delivery
any meds taken by the mother during that period
–> esp first trimester
what should the postural history include
history of the problem
pt’s general condition and health
family history
what should be obtained to determine whether posture is contributing to the problem
MOI
type, location and severity of sxs
side dominance
ADLs
driving, sitting and sleeping patterns
level and intensity of exercise
medical history
MOI –> overuse injuries associated w/ postural faults
insidious onset
no specific cause of pain
what does a non specific mechanism or time of injury indicate
injury is possibly caused by poor posture
common responses to questioning that may point towards postural involvement
insidious onset of pain
pain worsening as the day progresses
pain w/ specific postures
complaints of intermittent pain
vague or generalized pain
initially starts as an ache
pain associated w/ specific postures
hurts when they sit/stand for too long
hurts when they twist
pain that initially starts as an ache
progressively worsened over time
many postural dysfxns are worse/produced more
in the evening
after the individuals has maintained the posture all day
what should we ask about the sxs
are they constant or intermittent
are they worse at a certain time of the day
which positions/postures increase/decrease sxs
what type of pain are you experiencing
side dominance –> if one side is for most tasts
bilateral limb imbalances are likely to occur
bilateral limb imbalances
exposing the pt to overuse injuries
what should we ask about ADLs
what is the pt’s usual day like
which type of activities does the pt perform and for waht duration and frequency
what is the pt’s usual day like
many people have a repetitive daily schedule
driving, sitting and sleeping postures
ask if anything has changed in the person’s daily routine
changes in a routine
provide info about the instigating factor
pt may not thing it is a big change, but it could be the root of their issue
level and intensity of exercise
does the pt exercise regularly or at all
has their exercise routine changed
medical history
family history
previous illnesses, operations or severe injuries
history of other conditions
previous tx
deformity
difficulty breathing
family history
of any back problems or special problems
-congenital problem
-spinal fusion
-scoliosis
previous illnesses, operations or severe injuries
ex: thoracic surgery
history of other conditions
connective tissue dzs
RA
marfans syndrome
previous tx
if they had PT
–> what helped/what didnt help
deformity
is it present
is it progressive
is it stationary
difficulty breathing
thoracic spine affects rib cage –> rib cage affects breathing
what should we ask about the medical history concerning a child
if/when had been a growth spurt
puberty
difficulty fitting into clothing
female puberty
when did their period begin
does their back pain tend to be associated w/ their period
when does female puberty occur
almost always occurs after their peak growth of height
usually around age 11
male puberty
voice change
usually around age 13
observation and inspection should be
systemic and thorough
observation and inspection should be performed
for standing, sitting, supine and in prone positions
observation and inspection –> standing
should note body type and emotional attitude
how should we observe a pt in standing
anterior, lateral, posterior view
forward flexion
what are we going to find during observation and inspection
things we will later go back and look at a little more closely
inspection of leg length discrepancy
2 categories of LLD
2 categories of LLD
structural (true)
fxnal (apparent)
structural LLD
actual difference in the length of the the tibia or femur of one leg compared to the other
what is structural LLD caused by
disruption of the growth plate of one of the bones
congenital anomaly
how are measurements of structural LLD taken
ASIS to medial malleolus
when is a discrepancy considered significant –> structural LLD
10-20mm
what happens if measurements are asymmetrical –> structural LLD
put pt in hooklying
–> observe from the front and from the side
observing from the front –> structural LLD
one knee appears higher than the other
tibia is longer on that side
observing from the side –> structural LLD
one knee appears more in front of the other
femur is longer on that side
fxnal LLD
attributed to something other than the length of the tibia +/or femur
what is fxnal LLD caused by
tightness of muscles or joint structures
muscular weakness in the LE or spine
how are measurements taken fxnal LLD
medial malleolus to the umbilicus
when is measurement of fxnal LLD meaningful
test for true LLD is negative
how do we determine LLD
block method
block method
most clinically reliable and valid way of determining an LLD
how does the block method work
pt stand on firm surface w/ feet shoulder width apart
palpate and note starting levels of iliac crest
if heights are uneven –> block method
blocks of known thickness (measured in mm) are placed under the shorter leg
until the iliac crests are of equal height
how is LLD calculated –> block method
totaling the sum of the heights of the individual blocks
what is the height where tx is frequently considered –> LLD
10-20 mm
radiographs and CT evals
most accurate methods of assessing LLD
muscle length assessment is apart of
physical (objective) exam
what does the muscle length assessment attempt to do
objectively measure if specific muscles are shortened or elongated
–> may contribute to postural abnormality
if muscles crossing a joint are abnormally shortened
abnormal stresses may be placed on the joint
or
necessary mobility required for normal fxning may be lacking
if muscle crossing a joint is abnormally elongated
joint maybe affected by abnormal stresses
or
may lack the stability required for normal fxning
