Posture Flashcards
Definition
Alignment and positioning of the body in relation to gravity, center of mass, or base of support
Good Posture
State of musculoskeletal balance that protects the supporting structures of the body against injury or progressive deformity
Muscles function efficiently; optimum positioning for thoracic and abdominal organs
Poor Posture
Faulty relationships increase strain on supporting structures, less efficient balance over base of support
Principles of alignment
APTA - “optimizing movement”
Alignment is the foundation for optimal movement and musculoskeletal health requires optimal movement to prevent or minimize painful syndromes
Static vs. Dynamic
Recognize that orientation/organization relative to gravity is…
- continually changing
- always dynamic; only appears “static” during quiet standing (postural sway)
- organize for efficiency for readiness to move in any direction
Muscle Imbalances - Biomechanical Theory
Constant stress placed on the musculoskeletal system due to habitual postures or repetitive motions - leads to adaptive shortening (weakening?) or lengthening (strengthening?)
The length - tension curve
Muscle Imbalances - Joint motion is changed due to
changes of the tissue guiding the motion
Muscle Imbalances - Joint positions suggest
which muscles may be elongated or shortened
Muscle Imbalances - Habitual postures can lead to
adaptive changes in muscles (and other tissues)
Muscle Imbalances - Neurologic Paradigm (janda)
Motor systems are working to maintain homeostasis
Proprioceptive info is integral to motor regulation
Muscle recruitment patterns are established and centralized in the CNS
Tight muscles tend to be more readily activated
Structural faults
Trauma
Congenital issues
Disease
May need surgical correction
Structural faults
Biomechanical vs. Neurologic
Biomechanical model incorporates structural faults better than neuro
Upper crossed syndrome - Inhibited`
Deep cervical flexors
Lower trap
Serratus Anterior
Upper crossed syndrome - Facilitated
SCM
Pectoralis
Upper Trap
Levator Scap
Lower Crossed Syndrome - Inhibited
Abdominals
Glut Min Med Max
Lower crossed syndrome - facilitated
Rectus femoris
Iliopsoas
Thoraco lumbar extensors
Short muscles will
Activate quickly
They are set to be facilitated
Lengthened muscles will
not be quick to activate
Tend to be inhibited
Functional Faults
Habitual postural positions
Repetitive motions
Functional Faults
Biomechanical vs. Neurologic
More neurological
Steps to static standing posture analysis
- Minimal clothing (comfort but need to see structures)
- Barefoot - no socks either
- Solid standing surface
- Minimize background noise
- Observation must occur on all four sides - make sure you have space
More steps to static standing posture analysis
- Line of gravity passes through center of mass and falls within base of support
- A plump represents line of gravity
- Feet are fixed reference point (under hips) - in general 4 in apart and each foot should be toed out about 15 degrees (no more than 25)
- need a system
Setting up your plump line
Post/Ant - position midway between heels
Lateral - position at the calcaneocuboid joint (ant to the lateral malleolus)
Palpation
In order to establish skeletal landmarks
Inform patient
Start where patient can see (usually lateral)
Always use two hands or make sure the pt knows where your hands are
Plumb line falls
Just ant to knee jt center Just post to hip joint center Through lumbar bodies Mid shoulder (acromion) Ext auditory meatus
Observing from a post view
- R and L symmetry
- Calcaneal position neutral
- Feet with toes slightly out
- Muscle tone/definition
- Knees straight (popliteal line)
- Level pelvis
- Spinous processes in line
- Scapula parallel and 3 in from spine
- Shoulders level
- Head and neck on straight
Observing from an ant view
- Weight bearing
- Toe position - toed out
- Tibias should be straight (no bowing)
- Knee should be in slight valgus
- Patella equal height and forward facing
- Muscle definition
- Greater troch equal
- ASIS height equal
- Equal iliac crest height
- Umbilicus should be midline
- Symm thoracic cage
- Shoulders horizontal and equal height
- Head and neck straight forward
Lordotic Posture Head Cervical Thoracic Lumbar Pelvis Knee Ankle Elongated and weak Short and strong
Head = neutral Cervical = normal (slightly ant) Thoracic = normal (slightly post) Lumbar = hyperextended (lordosis) Pelvis = ant tilt Knee = slightly hyperextended Ankle = slightly plantar flexed Elongated and weak = ant abdominals, hamstrings elongated and may or may may not be weak Short and strong = low back and hip flexors
Kyphotic Lordotic Posture
Short and tight
Weak and elongated
Short, tight = neck extensors and chest muscles, Hip flexors
Weak = neck flexors and upper back extensors and abdominals will be elongated and weak, hip extensors too
Flat back posture
Forward weight shift Head - forward Cervical - extended Thoracic - upper flexion, lower flat Lumbar - flat or extended Pelvis - post tilt Hp - extended Knee - extended Ankle - plantar flexed
Sway back posture
Strong
Weak
Strong (short, tight) - Neck extensors, chest muscles, upper IO, hip extensors
Weak = neck flexors, upper back extensors, EO, hip flexors
Knees are hyperextended
Upper trunk is shifted rearward
Headedness
For every inch of forward head posture, it can increase the weight of the head on the spine by an additional 10 pounds
Psoterior view - Scapulae
Flat against thorax
4-6 in btw medial borders equidistant from T spine
Sup angle and inf angle situation btw T2 and T7
Posterior view - shoulders and UEs
Neutral roation
Elbow (olecranon) oriented visibly
Forearm/hand neutral/against body (using both supination and pronation - not anatomical position)
Closer look - spine - primary curves
Kyphosis throughout in utero and early infancy
Persist in thoracic and sacrococcygeal regins
Closer look - spine - secondary curve
Lordotic curves develop with postural control (head control, sitting, standing)
Closer look - pelvis - Post view
PSISs and iliac crests on same horizontal plane
Closer look - pelvis - Ant view
ASISs and iliac crests on same horizontal plane
Closer look - pelvis - lateral view
ASISs and pubic symphysis on same frontal plane
PSIS and ASIS on same horizontal plane - normal posture has ASIS slightly below PSISs
Ant tilt inc lordosis
Pst tilt dec lordosis
Knee - typical development progression
Bowed (varus) - infancy, pre standing/walking
Straighten - upright, bipedal activities
Valgus - childhood
Less valgus (many females) or slight varus (many males) - 6 to 7 years
Closer Look - Feet Ant view
Medial longitudinal arch by 6 or 7 years
Toes flat on floor, in line with respective metatarsals
Closer look - feet post view
Vertical calcaneous and achilles tendon
Closer look - knees, feet, LEs
Hips in neutral rotation
Femoral condyles and patallae in frontal plane
Feet toed out
A line passes through center of hip joint center of knee joint - 2nd MTP joint
Closer look - knee variations
Postural - apparent in standing; not strucutral; usually not seen in supine
Varus
Postural bowlegs
Hips IR
Knees hyperextended
Feet pronated
Valgus
Postural knock-knees
Hips ER
Knees hyperextended
Feet supinated
Scoliosis
Affects more females than males
Onset is often peripubertal
Influenced by postural habits
Functional Scoliosis
Associated with handedness, back spasms
May not be apparent with forward bending
Strucutral Scoliosis
Persists with forward bending (screening) - further assessment with x-rays
Posture can be assessed
in other positions besides standing (sitting, working stations)
Dynamically and statically
With technological aids (still photos, video)
Handedness Head Cervical Shoulder Scapulae Thoracic and lumbar Pelvis Hip LE Feet
Head = erect, neither tilted nor rotated
Cervical = straight
Shoulder = right low
Scapulae = adducted, right slightly depressed
Thoracic and lumbar = curve is convex toward the left
Pelvis = lateral tilt, high on right
Hip = right adducted and slightly medially rotated, left abducted
LE= straight, neither valgus nor varus
Feet = right is slightly pronated
