Assessment of Posture

1
Chapter 3

• Assessment of Posture

2
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

3
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 patterns may
  cause compensatory postures
• Overtime can result in muscle imbalances and soft
  tissue dysfunction

4
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

5
Clinical Anatomy

• Musculoskeletal system is designed to function in
  a mechanically and physiologically efficient
  manner to use the least possible amount of energy
• Postural deviations or skeletal malalignment
  cause other joints in kinetic chain to undergo
  compensatory motions or postures to allow body to
  move as efficiently as possible

6
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

7
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

8
Muscular Function

• Muscles produce joint motion and provide dynamic
  joint stability
• Muscles must be of adequate length and function
  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

9
Muscular Length-Tension Relationships

• Describes how a muscle is capable of producing
  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

10
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

11
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

12
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

13
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

14
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

15
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

16
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

17
History

• Driving, sitting, and sleeping postures
• Table 3-8, page 62
• Specific postures causing discomfort
• Level and intensity of exercise
• Medical History

18
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

19
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

20
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

21
Views

• Lateral view
• Table 3-9, page 63
• Anterior view
• Table 3-10, page 66
• Posterior view
• Table 3-11, page 67

22
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

23
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

24
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

25
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

26
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

27
Foot and Ankle

• Hyperpronation
• Review chapter 4
• Figure 3-13, page 74
• Supination
• Review chapter 4

28
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

29
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

30
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 of
  correcting the factors involved
• Most soft tissue dysfunctions that have a
  gradual, insidious onset have, at least, a
  minimal postural component

31
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