PosturalPosturalAnalysisAnalysis
Aila Nica J. Bandong, PTRPInstructorDepartment of Physical TherapyUP- College of Allied Medical Professions
PT 142: Assessment in Physical Therapy
LEARNING OBJECTIVES At the end of the session the learners
should be able to: • Review basic biomechanics of normal
posture. • Review abnormal postures in terms of
clinical picture and anatomic changes• Discuss the examination procedure and
related concepts• Describe the documentation format of results
of postural assessment• Discuss other postural assessment
procedures with technology and work applications
POSTURE
•Relative disposition of the body at any one moment
•Composite of the positions of the different parts of the body at the time
•Result of underlying processes or tensional relationship throughout the body
•Affected by the integrity of the inert and dynamic structures surrounding the body
POSTURE
BIOMECHANICS
Dorsiflexors Plantarflexors Tibialis anterior Peroneals
HamstringsGastrocs Popliteus
Quadriceps
SIRT G. Maximus Hamstrings Abductors
Adductors
Abductors
Adductors
BIOMECHANICS
External Rotators
Internal Rotators
External Rotators
Internal Rotators
Low back msAbdominalsLat. trunk ms.Lat. trunk ms.
ES, QLPost. back ms
Rectus abdominisExt. oblique
Gluteus max Hams
SIRT Anterior Pelvic Tilt Post. Pelvic TiltGmax & Gmed
Lat. trunk ms
Rotation
Lateral tilt
Hip adductors
STANDARD POSTURE
Posterior to apex of coronal suture
Through EAM& dens
Through VB of LV Through
sacral promontoryPosterior to the
center of the hip jt
Ant. To knee joint axis
Through calcaneocuboid jt
Through ear lobes
Through bodies CV
Through shouder jt.
Through trunk
Through GT
Anterior to midline knee
Anterior to lat malleolus
Plumb linealignmentLine of
Gravity
FAULTY POSTURE •Any deviation from the normal/proper posture
FAULTY POSTURE •Postural pain syndromes
▫Posture deviates from normalalignment but no structurallimitation
▫Mechanical stress but relievedby activity or change of position
▫No abnormalities in musculoskeletal structures
•Postural dysfunctions▫Adaptive shortening of soft tissues
and muscle weakness▫Imbalance in strength and flexibility
FAULTY POSTURE:Standing
•Head and neck•Shoulder and scapula•Head, neck, shoulder and scapula•Trunk•Feet and knees
Head and Neck
•Forward head▫Inc flexion of the
lower cervical and upper thoracic regions
▫Inc extension of the occiput on the upper cervical vertebrae
▫Pr0trusion of mandible
Head and Neck
•Flat neck▫Dec cervical
lordosis▫Inc flexion of the
occiput on the atlas
▫Retraction of the mandible
▫Exaggeratedmilitary posture
Head Posterior Tilt
Head Anterior Tilt
MarkedAnterior Tilt
Forward Head with Attempted Correction
Head and Neck
Shoulders and Scapula
Shoulders and scapula Good position
Scapula AbductedSlightly Elevated
Scapula Adducted Slightly Elevated
Shoulders and scapula
Shoulders and scapula Good position
Shoulders Elevated Scapula Adducted
Shoulder DepressedScapula Abducted
Shoulders and Scapula
Scapula depressed Winging of the Scapula
Shoulders and scapula Good position
Head, Neck, Shoulders and Scapula
•Upper crossed syndrome▫The occiput and C1/C2
will hyperextend with the head being pushed forward
▫The lower cervical to 4th Thoracic vertebrae will be posturally stressed
▫Rotation and abduction of the scapulae occurs
Head, Neck, Shoulders and Scapula
•Upper crossed syndrome▫Tight muscles:
Pectoralis major and minor, upper trapezius, Levator scapulae, SCM
▫ Weak muscles: Lower and middle trapezius, Serratus Anterior, Rhomboids (Chaitow, 2001)
Trunk •Kyphosis-LordosisForward head
Increased cervical lordosisScapula
AbductedIncreased thoracic kyphosisIncreased
lumbar lordosis
Anterior pelvic tilt
Knees slightly hyperextended
Ankles slightly plantarflexed
Short and Tight:• Neck extensors• Hip flexors• Low back
Lengthened and Weak:• Neck flexors• Hamstrings• Erector spinae• Possibly abdominals
Trunk •Sway-back Forward head
Increased cervical lordosis
Increased thoracic kyphosis
Decreased lumbar lordosis
Posterior pelvic tilt
Knees slightly hyperextended
Ankles neutral
Short and Tight:• Upper abdominals• Intercostals• Hamstrings
Lengthened and Weak:• Neck flexors• Hip flexors• Thoracic extensors• Lower abdominals
Trunk •Military type Normal-slightly
posteriorNormal
Normal kyphosisIncreased
lumbar lordosis
Anterior pelvic tilt
Knees slightly hyperextended
Ankles slightly plantarflexed
Short and Tight:• Lumbar extensors• Hip flexors
Lengthened and Weak:• Abdominals• Hamstrings
Trunk •Flat back Forward head
Increased cervical lordosis
Decreased kyphosis
Decreased lumbar lordosis
Posterior pelvic tilt
Knees slightly hyperextended
Ankles slightly plantarflexed
Short and Tight:• Neck extensors• Abdominals• Hamstrings
Lengthened and Weak:• Neck flexors • Back extensors• Hip flexors
Trunk
•Lower crossed syndrome▫Tight muscles:
Erector Spinae, Iliopsoas
▫ Weak muscles: Gluteus maximus, Abdominals
•Scoliosis▫Lateral deviation of the spine ▫Deformity
Structural Fixed deformity Apical vertebrae Vertebral body on convex Spinous process on concave
Non-structural Flexible deformity Positional, functional, postural
Trunk
How is scoliosis detected?
Forward bending test
Skyline view
1. Named according to convexity
2. Major curve - most significant curve
3. Minor curve - compensatory curve
4. Double major curve-2 major curves that are both structural
5. Transitional vertebrae - neutral vertebra between 2 curves
6. Apex of the curve - greatest rotation, farthest from the midline
Description of the curve
•Angle of curvature
How is severity of scoliosis measured?
Risser-Ferguson method Cobb method
How is progression of scoliosis measured? •Nash-Moe Scale
Feet and Knees
• Ideal alignment ▫Patella faces
forward▫Feet are in good
alignment ▫Hips and feet
neutral
Feet and Knees•Genu Varum
▫Knee separation ▫Hyperextension of the
knee▫Axis of knee is oblique ▫Hindfoot Supination ▫Forefoot pronation
SquintingPatella
Feet and Knees•Genu valgum
▫Hip adducted; IR of the femur▫Patella tilted medial
Tracks lateral▫Hindfoot pronation▫Forefoot supination ▫Hyperextension ▫Knee is oblique
Frog eyes
Feet and Knees •Patella alta •Patella
baja
Ideal LordosisWeak supportfrom low back
FAULTY POSTURE:Sitting
POSTURE IN LYING DOWN
•Supine accentuates kyphosis •Prone position accentuates lordosis •Sidelying position straightens spine
POSTURAL ANALYSIS•System of detecting deviations from
the normal posture
• Principles ▫Faulty alignment results in
undue stress and strain on inert and dynamic structures
▫Detection of muscles that are in an elongated and shortenedposition
▫Correlation exist between alignment and muscle test findings
POSTURAL ANALYSIS
EVALUATION PROCEDURE History-taking
Past musculoskeletal condition / congenital problems
Respiratory problemsDominant handGrowth history
Neurologic signs and symptoms
OI/ Postural Evaluation
Ocular Inspection
•Done before assessment of posture •Assessment of physique
▫Ectomorph/ Asthenic ▫Mesomorph/ Athletic▫Endomorph/ Pyknic Well
* Ectomesomorphic * Endomesomorphic
Pediatric * Well nourished * Over nourished * Undernourished
Ambulatory using BAC Alert, coherent,cooperative Ectomorphic(+)Dysarthria (+) postural deviation(see postural
assessment(+) gait deviation (see gait analysis)
DOCUMENTATION
EVALUATION PROCEDURE Anterior view Posterior view Lateral view
HeadNoseShouldersClaviclesSternumCarrying angleWaist angleIliac crestsASISGreater trochanterPatellaKneesFibular headMalleoliMedial archForefoot
TrapeziusShouldersScapulaeSpinal alignmentPSISGluteal foldsPopliteal lineMalleoliAchille’s tendonCalcaneus
Earlobes and shoulder
ChinShoulderBreastThoracic curveLumbar curveKnees
DOCUMENTATION
All landmarks in the anterior, posterior, and lateral views are level and WNL except on lateral view:
▫Acromion process anterior to the earlobes▫Chin protruded anteriorly▫Increased cervical lordosis
Significance: Rounded shoulders posture probably 20 ms imbalance
EVALUATION TOOL
•Posture boards •Plumb line •Dermatograph•Tape measure •Posture grid •Appropriate clothing •Chart for recording
EVALUATION TOOLS
•video and photographs in orthogonal planes
• images, computer softwares to identify the alignment of the body
APPLICATION TO WORK
•used as a basis of controls and limits that are aimed at preventing work-related musculoskeletal conditions
▫Time study based methods Continuous description of posture and force
level which is applicable to routine work
▫Work sampling methods Random and fixed time intervals which is
applicable to non-routine work
APPLICATION TO WORK
•five dimensions relevant to the definition of a posture in relation to workloads:1.angular relationship between body parts2.distribution of the masses of the body parts3.forces exerted on the environment during the
posture4.length of time that the posture is held5.effects on the person of maintaining the
posture
APPLICATION TO WORK
•OWAS •RULA •PATH
OWAS•Ovako Work posture Analysing System•General principles
▫Balance▫Symmetry▫No twisting
•Individual scores for positions of body segments▫Trunk (4 codes)▫Arms (3 codes)▫Legs (7 codes)
•Potential for musculoskeletal discomfort is related to the amount of time in awkward postures
RULA•Rapid Upper Limb Assessment•Assessment of upper body parts
applicable to sedentary work•Severity of postural loading in the
following body parts▫Head▫Trunk▫Upper arm▫Lower arm▫Wrist
•Looks into static or repetitive muscle work and the force exertion
PATH•Postures, Activities, Tools, and Handling•Measure the frequency of exposure to
manual materials handling•For non-routine work•Real time observations concerning
▫Task▫Body postures▫Tools used▫Loads handled
•Manual materials handling activities are those involving at least 4.5 kg▫Lift▫Lower▫Carry▫Push/pull▫Move/place
REFERENCES
•Kendall,McCreary, Provance (1993), Muscles Testing and Function: Williams and Wilkins: Maryland USA
•Magee, DJ.(1997), Orthopedic Physical Assessment : WB Saunders Co: PA
•Lecture notes by Professor CMCapio and Professor MGBEncabo