Chapter 3 - Assessment of Posture

7/30/2019 Chapter 3 - Assessment of Posture

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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

Chapter 3 - Assessment of Posture

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