KIN 191A

Assessment of Posture

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INTRODUCTION

• WHAT IS POSTURE

• CLINICAL ANATOMY

• CLINICAL EVALUATION OF POSTURE

• COMMON POSTURAL DEVIATIONS

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WHAT IS POSTURE

• The position of the body at a given point in time

• Ideal posture– Characterized by specific landmarks

being aligned with the force of gravity, keeping the body as close to physiological equilibrium as possible

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CLINICAL ANATOMY

• Kinetic chain

• Muscular function

• Muscular length-tension relationships

• Agonist and antagonist relationships

• Muscular imbalances

• Soft tissue imbalances

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Kinetic Chain

• Open kinetic chain (OKC)– Non-weight-bearing

– Movement occurs at predominantly at one joint (movement at one joint does not affect at other joints)

• Closed kinetic chain (CKC)– Weight-bearing

– Movement at one joint affects movement at other joints in a consistent and predictable fashion

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Muscular Function

• Produce joint motion

• Provide dynamic joint stability

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Muscular Length-Tension Relationships

• Describes how a muscle is capable of producing different amounts of tension (force) depending on its length

• Active insufficiency– Occurs when muscle is shortens and the actin

and myosin myofilaments are overlapped to the point where maximum tension cannot be produced

• Passive insufficiency– Occurs when the muscle is lengthened and the

actin and myosin myofilaments lack sufficient overlap to stretch enough to complete full ROM

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Agonist and Antagonist Relationships

• Agonist– A muscle that contracts to perform the primary

movements of the joint

• Antagonist– Performs the opposite movement of the agonist

muscle– Must reflexively relax to allow the agonist’s

motion to occur

• Co-contraction– Concurrent contraction of the agonist and

antagonist muscles

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Muscular Imbalances

• An impaired relationship between a muscle that is overactivated, subsequently shortened and tightened and another that is inhibited and weakened

• Nerve injury/Pain/Joint effusion/ Poor posture/Repetitive activity of one muscle group

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Soft Tissue Imbalances

• A joint capsule and surrounding ligaments adaptation due to abnormal compressive or shear forces being produced within the joint(s) crossed by those muscles

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CLINICAL EVALUATION OF POSTURE

• Views of Postural Inspection– Lateral view– Anterior view– Posterior view

• Inspection of Leg length Discrepancy• Palpation

– Lateral aspect– Anterior aspect– Posterior aspect

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Views of Postural Inspection

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Assessment of Ideal Posture

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Lateral View• Determinations of the anterior and

posterior alignment of the body relative to the frontal plane

• Alignment relative to plumb line (bisects)– Auditory meatus– Acromion process– Mid thoracic region– Greater trochanter– Lateral femoral condyle (slightly anterior)– Lateral malleolus (slight posterior)

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Anterior View• Bisects the midline of the body in

sagittal plane

• Alignment relative to plumb line (bisects)– Head– Chest– Umbilicus

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Posterior View

• Plumb line should be equal distance from both feet, bisecting spinal column or trunk and head

• Alignment relative to plumb line (bisects)– Occipital protuberance– Cervical spinous processes– Scapular borders– Thoracic spinous processes– Lumbar spinous processes– Median sacral crests

Classification of Body Types

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Palpation

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Lateral Aspect

• Pelvic position– Palpate ASIS and PSIS on the same side– Relationship between ASIS and PSIS,

normally 8-10°

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Anterior Aspect

• Patellar position

• Iliac crest heights

• ASIS heights

• Lateral malleolus and fibular head heights

• Shoulder heights

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Posterior Aspect

• PSIS positions

• Spinal alignments

• Scapular positions

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COMMON POSTURAL DEVIATIONS

• FOOT AND ANKLE– Hyperpronation– Hypersupination

• KNEE– Genu recurvatum– Genu varum– Genu valgum

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• SPINAL COLUMN– Hyperlordotic posture– Kypholordotic posture– Swayback posture– Flat back posture– Scoliosis

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• SHOULDER AND SCAPULAR– Forward shoulder posture– Scapular winging

• HEAD AND CERVICAL SPINE– Forward head posture

Lordosis / Good / Sway Back

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Hyperlordotic Posture

• Increase in the anterior curve of the lumbar spine

• Tighten or shortened hip flexor muscles

• Anterior pelvic tilt• General concavity viewed from behind

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Lordosis

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During Extension

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Kypholordotic Posture

• Increase in total lumbar lordosis

• Compensatory increase in thoracic kyphosis

• Tighten or shortened hip flexor muscles or back extensors

• Anterior pelvic tilt

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Swayback Posture

• Tightens or shortens hip extensors

• Posterior pelvic tilt

• Genu recurvatum

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Flat Back Posture

• Tightens or shortens hip extensors

• Posterior pelvic tilt

• Flexed lumbar spine (↓ lumbar lordosis)

• Extended thoracic spine (↓ thoracic kyphosis)

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Scoliosis

• Lateral curve of the vertebral column– Curve is named according to the convexity– If the curve is convex to the left: left

scoliotic curve– “C” curves or compound “S” curves

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Scoliosis Curve Patterns

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Adams’ Position

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Cobb’s Angle

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Forward Shoulder Posture

• Tightened, shortened, overdeveloped anterior shoulder girdle muscles

• Large breast development

• Humeral head displaced anteriorly

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Scapular Winging

• Weakness of serratus anterior muscle

• Weakness of middle and lower trapezius muscles

• Trauma to the long thoracic nerve

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Forward Head Posture

• Extension of upper cervical spine

• Flexion of lower cervical spine

• Forward shoulder