Assessment of Posture

1
Assessment of Posture

• Part 2

2
Patient History

• Neurologic symptoms?
• Nature, extent, type, and duration of pain?
• Exacerbating activities or positions?
• Difficulty breathing?
• Dominant hand?
• Previous treatment? Did it help?

3
Observation

• Body type
• Ectomorph
• Mesomorph
• Endomorph

4
Observation

• Anterior view
• Head straight on shoulders
• Shoulders level
• Clavicles/AC joints
• Sternum ribs
• Waist angles arm positions
• Carrying angles

5
Observation

• Anterior view
• Iliac crests
• ASIS
• Patellae
• Knees
• Fibular heads
• Malleoli level
• Arches
• Planus
• Cavus
• Feet angle
• Bony bowing

6
Observation

• Anterior view (cont.)
• Diastematomyelia (hairy patches)
• Pigmented lesions
• Café au lait spots
• neurofibromatosis

7
Observation

• Lateral view
• Alignment
• Lateral line of reference
• Forward head
• Curvatures normal?
• Rounded shoulders
• AC/ear relationship
• Muscle tonus

8
Observation

• Lateral view
• Chest deformities
• Pectus carinatum
• Pectus excavatum
• Pelvic angle normal (30)
• Knee position

9
Observation

• Posterior view
• Shoulders level
• Spines inferior angles of scapula congruent
• Spine alignment
• Rib symmetry
• Arms equidistant and equally rotated
• PSIS level
• Gluteal folds level

10
Observation

• Posterior view
• Knee joints level
• Achilles tendon angles
• Heels straight
• Tibia or femur bowed?

11
Observation

• Forward flexion
• Rib cage asymmetry?
• Spinal musculature asymmetry?
• Kyphosis?
• Lumbar spine movement normal?
• Restriction to movement?

12
Examination

• Leg length measurement
• Clear the hips first
• Structural
• ASIS to the medial malleolus
• Functional
• Umbilicus to medial malleolus
• Differences of 1-1.3 cm considered WNL
• Some studies indicate .5 cm may cause symptoms

13
Examination

• Slump test
• Patient flexes head and straightens the leg with
  foot dorsiflexed
• AT gently eases patient forward to increase the
  stretch on the sciatic nerve
• Back pain in flexion that is eased with head
  extension and/or plantarflexion may indicate a
  nerve root irritation

14
Lab Time!