Postural Symmetry & Asymmetry Flashcards
What do you do for the screening examination?
Static Postural Examination Regional Range of Motion Assessment
What is the structural examination composed of?
Screening, scanning, segmental definition
What do you do for the scanning examination?
Layer by layer palpation
What do you do for the segmental definition?
Segmental motion testing
Define TART.
T - tenderness A - asymmetry R - range of motion T - tissue texture (layer by layer)
Define posture.
The distribution of body mass in relation to gravity over a base of support.
What does the distribution of body mass in posture depend upon?
Energy requirements for homeostasis. Integrity of myoligamentous structures. Compensation that structures at or below the base of the skull have on the visual and/or balance functions of the body.
Define optimal posture.
Posture in which the postural muscles are at their resting tone and no additional energy beyond this basal level needs to be expended for the person to remain upright. It is a perfect distribution of the body mass around the center of gravity.
What is compensated posture a result of?
Homeostatic mechanisms working through the entire body unit to maximize function. Posture is dynamic (functional) because the alignment of body mass with respect to gravity requires constant adjustment to the individual’s changing postural demands.
Why does the body undergo postural compensation?
To keep the body balanced and the eyes level.
In what planes does compensated posture occur?
All 3
What type of input is the CNS most concerned with?
Visual and vestibular; spinal compensation involves CNS correlation of proprioceptive information from tendons and muscles as well as vestibular info from the semicircular canals.
What is proper structure?
Symmetry in the sagittal plane and normal alternating anteroposterior spinal curves.
How are transition zones defined?
Anatomically; they are affected by arthrodial, skeletal, and myofascial anatomy.
Where do transition zones occur?
At occipitocervical, cervicothoracic, thoracolumbar, and lumbosacral junctions.
Describe some transitional changes.
Bony changes in the vertebrae, changes in physiologic curves in the sagittal plane, other joints involved, muscular changes, and fascial changes.
Transition zones are commonly susceptible to what?
Somatic dysfunction
Where does the mid-gravity line fall?
Vertical line from top of head to midpoint between heels.
Name the symmetrical posterior landmarks.
Inion, mastoids, earlobe, neck, angle of shoulder, acromion, spine of scapula, inferior angle of scapula, spine, waist crease lines, iliac crest, PSIS, gluteal cleft, gluteal lines, fingertips, popliteal lines, lateral malleolus, medial malleolus, achilles tendon
Define antalgic.
Counteracting or avoiding pain, as in posture or gait assumed so as to lessen pain.
What is the probable cause of symmetric dysfunction in both feet?
Arch collapse
What is the probable cause of asymmetric dysfunction in one foot?
Trauma or dysfunction
What are landmarks of the feet?
Arches and achilles tendons
What can cause landmark asymmetry in the feet?
Unilateral arch collapse with valgus hindfoot or compensation for long leg
What are the pelvic dysfunctions that create a long leg?
Anterior innominate rotation or inferior innominate shear (move backwards, taking the joint with it)
What is landmark asymmetry of the gastrocnemius muscle, and what clinical manifestations might you find there?
Larger muscle mass - deep vein thrombophlebitis Smaller muscle mass - S1/S2 radiculopathy, sciatic nerve neuropathy
What is landmark asymmetry of the knee, and what clinical manifestations might you find there?
Popliteal crease - asymmetry can indicate presence of short tibia Popliteal fossa - flattened/bulging can be Baker cyst; if flattened with genu recurvatum (hyperextension), indicates laxity of PCL
Are genu varum/valgum/recurvatum congenital or developmental? Are they usually unilateral or bilateral?
They’re both; typically bilateral.
What does unilateral genu varum/valgum/recurvatum indicate?
One compartment arthritis - varum = medial compartment, valgum = lateral compartment.
What is landmark asymmetry of thigh muscle mass, and what clinical manifestations might you find there?
Enlarged - venous insufficiency/thrombosis, tumor Smaller - atrophy, spinal stenosis (L1/S1/S2), sciatic neuropathy
What is landmark asymmetry of the iliac crests, and what clinical manifestations might you find there?
Anatomic or functional leg length inequality. If the legs have been symmetric from the feet up to the gluteal folds and trochanters asymmetry can indicate pelvic obliquity or varus/valgus deformities of the femoral neck.
Define scoliosis.
An appreciable deviation of a group of vertebrae from the normal straight vertical line of the spine as viewed in the posterior plane.
What is the most common cause of scoliosis?
Idiopathic
What is most scoliosis a response to?
Body’s desire to achieve homeostasis, which is absent mostly because of a postural abnormality.
Name 3 postural abnormalities and what they cause.
Anatomically short leg - unlevel sacral base. Innominate shear - unlevel sacral base. Unlevel cranial base
What is the scoliotic curve named for?
Location - cranial, cervical, thoracic, lumbar Direction - convexity or “apex” of curve Pattern of curve - “C” (single major), “S” (double major), rotatory, etc.
How does the naming convention of the scoliotic curve compare to the osteopathic description of the sidebending component?
It’s opposite
How do you measure leg length inequality due to scoliosis?
Measure between fused bony landmarks - from the ASIS to the medial malleolus; measure from umbilicus for apparent leg length.
What are the 4 normal coronal curves of the adult spine?
Cervical - convex forward (lordotic) Thoracic - convex backward (kyphotic) Lumbar - convex forward (lordotic) Fused sacrum - convex forward
What are the points of the coronal plane mid-gravity line?
Just anterior to lateral malleolus Just behind patella Greater trochanter of femur Sacral promontory Middle of L3 vertebra Greater tuberosity of humerus Odontoid process of C2 External auditory meatus
What is a flat back, and what is a consequence of it?
No anteroposterior curves - shock from walking is not absorbed.
What does a sway-backed posture look like?
Most weight of the body is pitched forward.
Head-forward posture adds how much force to the cervical spine at neutral, 15 degrees, 30 degrees, 45 degrees, 60 degrees, 90 degrees?
10-12 lbs., 27 lbs., 40 lbs., 49 lbs., 60 lbs., not measurable.
What do anterior head carriage and the forces thus generated lead to?
Premature degenerative disc disease and osteoarthritis of the cervical spine
Can you also get tremendous increases in load on the posterior cervical musculature?
Yes
Name some anterior view points of reference?
Mid-gravitational line, lateral body line, position of feet, levelness of tibial tuberosities, levelness of patellae, ASIS, prominence of hips (lateral translation), iliac crests, fullness over iliac crest, relation of forearms to iliac crests, prominence of costal arches, thoracic symmetry or asymmetry, prominence of sternal angle, position of shoulders, prominence of sternal end of clavicle, prominence of sternocleidomastoid muscles, direction of symphysis menti, symmetry of face, nasal deviations, angles of mouth, level of eyes, level of supraciliary arches, head position relative to shoulders and body
Hip hike with slight pelvic sideshift is usually caused by what?
Quadratus lumborum (lower back pain)
