Posture Flashcards
do patients often prent to the PT with postural problems?
no, usually the patient will consult for symptoms produced by the pathology that is at cause of the postural abnormality
why information should the PT be made aware of when assessing posture in the subjective exam?
- history of the injury?
- specific postures/positions that relieve or increase pain
- changes in footwear on symptoms
- age/growth spurt
- explain the type of pain, and scale
- hand dominance
how should posture be assessed
-natural relaxed postionwhen standed, seated and laying in both prone and supine positions
barefoot
what is used to assess the position of landmarks to ensure that they enable minimal effort and reduced strain?
line of gravity which should be located as close to the center of gravity as possible
when viewing posture from an anterior view the nose should be alligned with what other landmarks?
manubrium, sternum, xiphersternum and umbilicus
from an anterior view in a patient with proper posture, how should the traps be?
equally bulked on either side
in proper posture from an anterior view, which shoulder tends to be slightly more depressed?
the shoulder on the dominant side
in proper posture anteriorly, how should the arms be found?
at equidistance on either side of the body
what portions of the hips should be leveled in proprer anterior posture?
high points of iliac
ASIS
how are the knees in proper anterior posture?
straight with the patella facing forward
in proper anterior posture, how are the arches of the feet?
equal on either side
how are the angles of the feet in proper anterior posture?
equal on both side, with an angle ranging from 5-18 degrees
when viewing posture from a lateral view, the imaginary line going from head to toes should pass through which structures?
- earlobes
- bodies of the cervical vertebrae
- acromion process
- midway through the thorax
- through the bodies of the lumbar vertebrae
- PSIS slightly higher than ASIS
- slightly posterior to the hip joint
- slightly anterior to the axis of the knee
- anterior to the lateral malleolus
what happens to posture if laterally the neck is erect? is this an ideal posture?
chin and head are in balance directly above the shoulder the upper back will be normally rounded trunk will be erect abdomen will be flat lower back will be normally curved this represents a proper posture
what happens to posture if laterally the neck is forward? is this an ideal posture?
-the chin will be slightly out
-upperback will be more rounded
-trunk will be inclined more posteriorly
-abdomen will protrude
-lower back will be slightly hallow
improper posture
what happens to posture if laterally the neck is markedly forward? is this an ideal posture?
-chin advances
-upper back is rounded
-abdomen protudes and saggs
trunk inclined posteriorly
lower back hallow
in a musch more drastic fashion
how should the shoulders and head and scapulae be in proper posterior posture?
shoulders should be leveled and head in midline
scapulae should be leveled as well and equidistant from the spine
how should the spine be in proper posterior posture?
straight
what would be abnormal for the ribs in proper posterior posture?
ribs that protrude off to one side, should be symmetrical on either side
what should be leveled in proper posterior posture?
- waist angles
- PSIS
- gluteal folds
- Knee joints
how should the heels be in proper posterior psoture?
straight as opposed to angled in or out
is this proper or improper posture from a posterior view
- head is erect and gravity line passes through the center
- shoulders are levelled horizontally
- spine is straight
- hips are levelled horizontally
- feet point straight ahead
proper
is this proper or improper posture from a posterior view
-head is twisted or turned to one side
-shoulder is slightly higher than the other on twisted side
-spine is curved
-hip is higher than the other on contralateral side
horizontally
-feet point outwards
abnormal posture
what should a PT observe when a patient is in forward flexion?
- feet should be slightly apart
- knees straight
- if there is assymetry in the rib cafe?
- assymetry in the spinal musculature
- kyphosis present
- lumbar portion flexed or straight?
- any restrictions such as tight hamstrings or pain
when evaluating posture in a seated position, how is it initally viewed? and after?
initially observed in a chair and then seated but without support
why do we evaluate the patient in an unsupported seated position?
it requires more muscle activity to maintain posture
allows to study, front back and sides
what should be observed for posture in a supine position?
- head
- shoulders
- waist angle
- ASIS
- extension of the lumbar spine
- measure distal aspect of ASIS to tip of medial malleoli
what should be observed for posture in a proneposition?
head neck shoulders thoracic spine PSIS musculature of the buttocks, posterior thighs and calves for symmetry
what is the goal behind postural assessment?
- see if the patients habitual posture is contributing to the patient’s symptoms
- educated on the importance of proper posture
- identify aspects that may be at fault in the patients posture
- build an exercise program to correct any significant imbalances
in posture posture, what is the goal of the arrangement of the vertebrae?
provide proper shock absorption due to its anterior and posterior curves
what portions of the spine are bent anteriorly to form a lordotic curve?
cervical and lumbar spines
what portions of the spine are bent posteirorly to form kyphotic curves?
thoracic and sacral spines
what can”good” posture be defined as?
he optimal alignment of the pt’s body that allows the neuromuscular system to perform actions requiring the least amount of energy to achieve the desired effect
why is it important to have proper posture/skeletal alignment?
each joint has a direct effect on both its neighboring joint, and on the joints further away
what may be causes of faulty postureS?
- imbalances in muscles
- misaligned joints
how may muscle imbalances arise?
alteration in joint load distribution and non-neutral alignment
in a person with a faulty posture but with strong and flexible muscles, will be joints be more or less affected?
less since they have the ability to change position readily so that the stresses don’t become excessive
what happens if the joints are hypomobile or hypermobile and the patient presents with faulty posture?
the posture cannot be easily altered which can result in pathology
what can pathology resulting from faulty posture arise by?
- cumulative effect of repetitive small stresses (micro-trauma) over a prolonged period of time
- macro-trauma orver a shorter period of time
why is it important to have proper posture?
- reflects the body’s proper architecture
- supports the joints and tissues
- optimizes efficency and balance
how are the joints and ligments in a patient with proper posture?
ligaments and joint capsules can remain slac and will minimally contribute to postural support
what happens when a less optimal posture is maintaiend?
ligaments and jopint capsules get stretched and they weaken
postural muscles become supressed asking for larger mobility muscles to work and thus increasing fatigue and tension in the fascia
some muscles will shorten and contract, other wills lengthen and stretch
what are some anatomical factors which may affect proper posture?
bony contour laxity of ligamentous structures fasical and musculotendinous tightness mucles tone of the glutes, abs and erectors the pelvic angle joint position and mobility neurogenic inflow and outflow
what are some factors (positional) which may affect posture?
- poor postural habit
- muscle imbalances or contractures
- pain
- repsiratory conditions
- excess weight
- muscle spasms
how can we correct posture that is not due to structural issues?
- identify the problem
- strenghten the weakened muscle
strethc the tight muscle - educate the patient on the importance to maintain proper posture when sitting, standing and performing ADLs
how can posture be affected by pain?
patient may perform postural shiftds to minimize the effect of pain
what can structural factors causing improper posture result from?
congenital abnormalities
developemental problems
trauma
diseases
what generally happens if we have a deviation in one part of the body to the rest of the body? why?
generally deviation in one part will cause deviation in other as the body attempts to maintain the correct center of gravity and correct the visual plane
what is lordosis?
an excessive anterior curvature of the baclk, thus excessive cureves at the cervical and lumbar spines
what may be some causes of lordosis?
- lax muscles expecially in the abdomen and tight muscles such as hip[ flexors or lumbar extensors
- heavy abdomen in the case of pregnancy or excess weight
- compensation from kyphosis
- hip flexion contractiure
- spondylolisthesis
- wearing high heels
what are the properties associated with pathological lordosis?-
- sagging shoulders, ; protracted scapulae and medially rotated arms
- medial rotation of the legs
- forward head
- pelvis is tilter anteriorly
- knees are hyperextended
what is pathological lordosis generally associated with?
tight: hip flexors
weak: abs and deep lumbar extensors
what are some properties associed to swayback lordosis?
- thoractoloumbar spine kyphosis (excessive posterior curve)
- entire pelvis shifts anteriorly
- hips brought into extension
what is swayback lordosis generally associated with?
tight: hip extensors, low lumbar extensors and upper abs
weak: hip flexors, lower abs and low thoracic extensors
what are some properties of kyphosis round back?
-excessive posterior curvature of the thoracic spine
what is round back kyphosis associed with?
tight hip extensors and trunk flexors
weak hip flexors and lumbar extensors
what are some properties of flat back kypshosis
-mobile lumbar spine
posterior pelvic tilt
decreased lumbar lordosis
decreased thoracic kyphosis
whta is flat back kyphosis associated with?
tight: hamstrings, abs and hip extensors
weak: hip flexors and lumbar exxtensors
what can be affected bt pelvic movement?
lumbar curves
whta will cause in increase in lumbar lordosis?
anterior pelvic tilt
what type of condition is associated with a posterior pelvic tilt?
flat back kypohosis
a forward shifted pelvis results in what type of postural abnormality?
swayback lordosis
what is scolisosis?
lateral curvature of the spine
what does structral scolisosis arise from
bony deformity, congenital or acquires muscle weakness
idiotpathic scoliosis accounts for what % of all scoliosis?
75-85%
what does non-strutural scolosisarise from?
postural problems
nerve root irritation
inflammatoion of compensation caused by leg legth descrepency or contractiure of the lumbar spine
what is dextroscolisosis?
most common type of curve on the right side of the spine
generally in the thoracic region
whhat is levoscolisosis
spinal curve to the left, generally in the lumbar spine as a compensation from a curev in the thoracic region
what is the mostcommon location for a scoliosis
the thoracuic spine
vertebres from what regions of the spine are involved in throacolumbar scoliosis?
thoracis and lumbar spines
is posture meant to be dynamic or stiff/immobile?
dynamic
ewhy is it important to change posture regularly?
because the body is not meant to be held in a constant position as it will experience stresses on various structures
why is dynamic posture important?
it prevents mMSK fatigue
improves circulation in the body
minimizes the progressive strain on muscles, tendons and liugaments
it distributes the work among muscles and minimizes fatigue
it helps keep you more alert, leading to increased energy and productivity
