Posture Assessment Flashcards
When performing the posture exam the PT must be
- Accurate and thorough- abnormalities are subtle
- Able to separate parts of body from whole, THEN assess sum of parts in reference to their interaction within the entire body structure
Correct posture
- Alignment of body for max physiological and biomechanical efficiency
- Minimizes stress/strain imparted to the supporting system by effect of gravity
The gravity line is drawn through the body’s center of gravity - located where
2nd sacral vertebra
T/F gravity line generally passes through all the joint axes of the body
F
If forces acting about a joint are out of balance, _____
Faulty joint motion can occur
Most important segments to have muscular and mechanical balance
Head, trunk, shoulders and pelvic girdle
Examples of postural faults
Rounded shoulders
Lumbar lordosis
Rounded shoulders
Shortened pec major and minor
Lumbar lordosis
Tight hip flexors and elongated abs
When should posture analysis be performed
After the history and systems review
Usually start your observation (after patient is instructed to assume comfortable and relaxed posture)
Proximal lay and move dismally viewing the patient from anterior, lateral, and posterior
Head and neck plumb line laterally
Ear lobe to acromion process
Shoulder plum line laterally
Acromion process
Thoracic vertebra laterally
Bisects the chest symmetrically
Lumbar vertebrae laterally
Midway between abdomen, back, and slightly anterior to sacroiliac joint
Pelvis and hip plumb line laterally
Anterior to SI joint and posterior to hip joint through greater trochanter
Plumb line knee laterally
Slightly anterior to midline of jt
Plumb line laterally ankle
Just anterior to lateral malleolus
Post plum line head and neck
Bisects head through external occipital protuberance
Post plum line shoulder and scapula
Midway between shoulders
Post plum line trunk
Spinous processes of thoracic and lumbar vertebra
Post plum line pelvis and hip
Plumb line bisects gluteal cleft with the PSIS, iliac crests, and greater throchanters are level
Post plum line ankle and foot
Equidistant between medial malleoli
Anterior view assess carrying angle of elbow
Men -5 to 10 degrees
Women - 10-15 degrees
Anterior plumb line assess if
- ASIS are level
- Patellar alignment - straight, inward, outward
- Angle of toeing out - norm values 5 to 7 degrees for each foot
Causes of forward head
- Tight cervical extensor, upper trap, and lector scapulae
2. Elongated cervical flexors
Causes of rounded shoulders
- Tight pec major/minor, serratus anterior
2. Weakness of thoracic extensors, middle trap and rhomboids
Signs of rounded shoulders
Acromion process anterior to line
Scapulae abducted
Signs of kyphosis
Increased posterior convexity of vertebrae
Causes of kyphosis
- Lengthened thoracic extensors, middle and lower traps, posterior ligaments
- Tight anterior longitudinal ligament and anterior chest muscles
Barrel chest
Increased overall anteroposterior diameter of the rib cage
Anterior pelvic tilt
Lordosis
Causes of lordosis
- Tight hip flexors and low back extensors and posterior longitudinal ligament
- Lengthened and weak lower abdominal muscles
Posterior pelvic tilt
Flat back
Causes of flat back
- Tight hamstring
2. Weak hip flexors
When assessing laterally in the pelvis and hip, anterior pelvis drops and is called _____. This is caused by
Anterior pelvic tilt
- Increased lumbar lordosis and thoracic kyphosis
- Tight hip flexors
- Lengthened abdominals
Anterior pelvis is raised with minimal curvature in lumbar spine is called ____. And is caused by
Posterior pelvic tilt
- Tight hamstrings
- Lengthened hip flexors and lower abdominals
Hyper extension of the knee is called ____. And is caused by
Genu recurvatum
- Tight quads and calves
- Lengthened posterior capsule and hamstring muscles
Head tilt from posterior view
Patient’s head lies more to one side of plum line
Caused by tightness of lateral neck flexors on one side
Rotated head from posterior view caused by
Tightness of sternocleidomastoid, upper trap, and scalene
Posterior view shoulder and scap problems
- Dropped Shoulder
- Abducted scapula
- Winging of scapula
Dropped shoulder (one lower than other) caused by
- Tightness of rhomboid and latissimus Dorsi
2. Hand dominance (dominant side might be lower)
Abducted scap (too far away from midline of thoracic vertebra) caused by
- Tight serratus anterior muscles
2. Lengthened rhomboids and middle trap muscles
What is scap winging and what is it caused by
Medial border of scapula lifted off the ribs
Caused by weak serratus anterior
Problems assessing posterior thoracic and lumbar regions
Scoliosis
Lateral pelvic tilt or drop
Pelvic rotation
Causes of lateral pelvic drop
- Scoliosis
- Leg length discrepancy
- Shortening of contralateral quadratus lumborum
Causes of pelvic rotation
Tightness of the medial rotators and hip flexor muscles on the rotated side
Bow legs - name and causes
Genu Varum
Caused by coxa valga and structural changes in the alignment of femoral condyles/tibial plateau
Knock knees- name and causes
Genu Valgum
Caused by coxa varum and structural changes in the alignment of femoral condyles/tibial plateau
Pronated foot/ankle
(pes planus)
- Calcaneal eversion
- Midfoot width increase
- Lowering of medial longitudinal arch
Supinated foot/ankle
(Pes cavus)
Calcaneal inversion
Midfoot width decrease
Elevation of the medial longitudinal arch
Assessing posture at the beginning of the scanning exam allows PT to assess the entire body and not just the _____
Patient identified problem
