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Chapter 3Assessment of Posture
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Introduction
Posture is the position of the body at a given
point in time
Correct posture can: improve performance
decrease abnormal stresses
reduce the development of pathological
conditions
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Introduction
Faulty posture:
Deviates from ideal posture
Requires an increased amount of muscular
activity Places an increased amount of stress on the
joints and surrounding tissues
Restrictions in normal movement patternsmay cause compensatory postures
Overtime can result in muscle imbalances andsoft tissue dysfunction
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Introduction
Pain related to postural deviations is a
common clinical occurrence
Many do not seek help until pain is experienced
Postural assessment is used to determine if
postural deviations are contributing factors
in patients pain or dysfunction
Posture must be evaluated in functional and
nonfunctional positions
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Clinical Anatomy
Musculoskeletal system is designed tofunction in a mechanically andphysiologically efficient manner to use the
least possible amount of energy
Postural deviations or skeletal malalignment
cause other joints in kinetic chain to undergocompensatory motions or postures to allowbody to move as efficiently as possible
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The Kinetic Chain
Closed kinetic chain Weight-bearing
Lower extremity
Distal segment meets resistance or is fixated Interdependency of each joint = predictable changes in
position
Figure 3-1A, page 53
Open kinetic chain Non-weight-bearing
Upper extremity
Distal segment moves freely in space
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The Kinetic Chain
A dysfunction occurring in one area may
affect the proximal or distal associated joints
and soft tissue structures
Causing a specific postural deviation
The body compensates for these deviations
to maintain as much efficiency as possible in
movement and function
Table 3-1, page 54
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Muscular Function
Muscles produce joint motion and providedynamic joint stability
Muscles must be of adequate length andfunction in a proper manner If too short or too long
Adverse stress on joints
Work inefficiently Create need for compensatory motions
Table 3-2, page 55
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Muscular Length-Tension
Relationships
Describes how a muscle is capable ofproducing different amounts of tension(force), depending on its length
Active insufficiency Muscle is shortened and maximum tension
cannot be produced
Passive insufficiency Muscle is lengthened and cannot generate
sufficient tension to be effective
Figure 3-4, page 56
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Agonist and Antagonist
Relationships
Agonist
Muscle that contracts to perform the primary movement
of a joint
Antagonist Performs opposite movement of agonist and must relax
to allow agonists motion to occur
Reciprocal inhibition
Bicep/triceps example
Co-contraction
Used for dynamic stability of joint
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Muscular Imbalances
Impaired relationship between a muscle that
is overactivated, subsequently shortened
and tightened and another that is inhibited
and weakened
Table 3-3, page 57
Postural vs. phasic muscles
Table 3-4, page 57
Table 3-5, page 57
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Soft Tissue Imbalances
Joints capsule and surrounding ligaments
undergo adaptive changes from prolonged
overstressing or understressing of structure
Faulty posture can alter the position of
joints, causing an increase in stress on
different portions of the joint capsule and
surrounding ligaments
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Clinical Evaluation of Posture
Not an exact science
Radiographs, photographs, computer analysis
Clinical tools plumb lines, goniometers,
flexible rulers, inclinometers (fig. 3-5, page 58)
Subjective vs. objective methods
Normal, mild, moderate, severe posture
Quantifiable measurements can assess
treatment plan
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Clinical Evaluation of Posture
Commonly assessed in various positions
Standing and sitting
Sport-specific and ADLs
Orthoposition
Normal or properly aligned posture
4 movements to perform before assessment
Page 58
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History
To determine if a postural dysfunction is
contributing to the patients pathology
Identify any routine repetitive motions IF injury is chronic
Explore day to day tasks and posture
If injury is acute Determine factors that may have predisposed
athlete to the injury
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History
Mechanism of injury Common responses
Insidious onset
Pain worsening as day progresses
Posture-specific pain
Intermittent, vague , or generalized pain
Starting as an ache and progressing
Type, location, and severity of symptoms
Side of dominance Activities of daily living
Table 3-7, pages 60-61
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History
Driving, sitting, and sleeping postures
Table 3-8, page 62
Specific postures causing discomfort Level and intensity of exercise
Medical History
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Inspection
Considerations
Area being used is private, comfortable
Patient preparedness
Do not inform patient you are assessing posture
Use systematic approach
Start at feet and work superiorly or vice versa
Compare bilaterally for symmetry
Your eyes should be at level of region you are
observing
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Overall Impression
Determine patients general body type
Ectomorph, mesomorph, endomorph
Inherited
Can indicate a persons natural abilities and
disabilities
Does not necessarily dictate how they may
function
Box 3-1, page 64
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Views of Postural Inspection
Inspect from lateral, anterior, posterior views
Plumb line
Feet as permanent landmark Lateral view
Slightly anterior to lateral malleolus
Anterior and posterior view
Equidistant from both feet
Box 3-2, page 65
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Views
Lateral view
Table 3-9, page 63
Anterior view
Table 3-10, page 66
Posterior view
Table 3-11, page 67
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Inspection of Leg Length
Discrepancy
Three categories
Structural (true)
Functional (apparent)
Compensatory
Table 3-12, page 68
Block method (Box 3-3, page 69)
Figure 3-6, page 68 Figure 3-7, page 70
Figure 3-8, page 70
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Palpation
To determine specific positions (key
landmarks) not necessarily for point
tenderness
Lateral aspect
Pelvic position
ASIS and PSIS, 9-100
Box 3-4, page 71
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Palpation
Anterior aspect
Patellar position
Iliac crest heights Figure 3-9, page 70
ASIS heights Figure 3-10, page 70
Lateral malleolus and fibula head heights
Shoulder heights Figure 3-11, page 72
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Palpation
Posterior aspect
Many of same landmarks used for anterior view
PSIS position
Figure 3-12, page 72
Spinal alignment
Scapular position
Box 3-5, page 73
Not important at this time
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Common Postural Deviations
Not all postural deviations cause pathology
Clinicians must identify
Normal posture
Asymptomatic deviations
Deviations causing dysfunction and/or pain
Potential muscle imbalances can cause
poor posture OR be a result of poor posture Deviations also caused by skeletal
malalignment, anomalies, or combination
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Foot and Ankle
Hyperpronation
Review chapter 4
Figure 3-13, page 74
Supination
Review chapter 4
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The Knee
Genu Recurvatum
Knee axis of motion is posterior to plumb line
Box 3-6, page 75
Genu Valgum Occurs due to
structural anomalies or muscular weaknesses at the hip
Secondary to hyperpronation of the feet
Can lead to
Increased pronation
Internal tibial and femoral rotation
Medial patellar positioning
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The Knee
Genu Varum
Occurs due to
Structural anomalies at the hip
Excessive supination
Can lead to
Supination
External tibial and femoral rotation
Lateral patellar positioning
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Interrelationships Between Regions
Table 3-14, page 83
May be impossible to determine if posture is
the cause or the effect Understand relationships and importance ofcorrecting the factors involved
Most soft tissue dysfunctions that have a
gradual, insidious onset have, at least, a
minimal postural component
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Documentation of Postural
Assessment
Table 3-15, page 85
As part of a SOAP note
Figure 3-14, page 84 Standard postural assessment form
Guidelines for documenting posture
Pages 83, 85