Postural Assessment

Question 1

How do we assess posture?

Answer 1

Patient should be in adequate dress, in their “natural” state and in their habitual relaxed posture
Consider behaviour and affect of patient
Three Views: anterior, lateral X2, posterior

Question 2

Postural assessment anterior view checklist

Answer 2

Head (Jaw, Nose, Ears)
is head straight / tilted to one side / rotated
may be result of weak muscles, trauma, hearing loss
Nose is inline with manubrium Shoulders

Trapezius , AC joints
symmetrical with no deviation
deviation may be from dislocations of AC or SC joints or fractures
dominant shoulder may be slightly sloped downward Chest

Other
no protrusion, depression or lateralization Pelvis (Iliac crests, ASIS, Pubic bones)
waist angles are equal
arms equal distance from the waist
patella should point straight ahead
knees may be in genu varum or valgum Feet (Feet arches, Feet angle)
check for equal arches
Are toes pointed out or pigeon toed?

Question 3

Postural assessment checklist lateral view

Answer 3

Ear lobe
in line with the tip of the shoulder (acromion) and high point of the iliac crest
a forward poking chin may correspond with lumbar lordosis Spinal segments
spine has normal curvature
large glut max muscles or excessive fat may give the appearance of exaggerated lordosis
examine the spine in relation to the sacrum not

The Shoulders
look for rounded shoulders
possibly caused by tight pectoral

The Knees
normally slightly flexed 0 to 5 degrees
hyperextended knees likely with increased lumbar lordosis
increased flexion seen with tight hamstrings

Ideally the centre of Gravity/Plumb Line passes through the following
anatomical landmarks
External auditory meatus
Humeral head and acromion
Middle of the body of L3 vertebrae
Greater trochanter
Just behind the mid knee
Just anterior to the lateral malleolus

Question 4

Postural assessment: posterior view

Answer 4

Mastoid process AC joint
Inferior scapula
spines and inferior angles should be level
PSIS
should be level, one higher than the other may indicate a leg length discrepancy, or rotational problem
Assess the in forward flexion (skyline view):
Asymmetry of rib cage (rib humping)
Asymmetry in the spinal musculature
Kyphosis
Whether lumbar spine straightens or flexes
Any restrictions to forward bending
Just anterior to the lateral malleolus