Posture Posture Evaluation Martha Macht Sliwinski PT PhD The alignment and positioning of the body in relation to gravity, center of mass and base of support The physical therapist uses posture tests and measures to assess structural abnormalities in addition to the ability to right the body against gravity Correct Posture Good Posture Maximal physiological and biomechanical efficiency Minimize stress and strains Segments aligned vertically with gravity line through axis of all joints Balanced strength and length of muscles Balance is based on a force couple A state of musculoskeletal balance that protects the supporting structures of the body against injury or progressive deformity Postural Analysis Endomorphs View from different positions Use dominant eye Identify bony landmarks Assess with and without orthotic devices and shoewear Assess in ideal and real-life postures Note relevant medical history The naturally large person characterized with a round face, wide hips, big bones, slow metabolism and high number of fat cells. 1
Mesomorphs Ectomorphs The naturally muscular person with wide shoulders, small waist, athletic build, low body fat percentage with an increased metabolism The skinny person with a linear appearance, small muscles, ultra fast metabolism, low body fat, narrow shoulders, hips and waist. Postural Tests & Measures Analysis of resting (static) posture or preferred in any position Analysis of dynamic posturing/functional movements Analysis of static and dynamic postures, using computer-assisted imaging, posture grids, plumb lines, still photography, videotape, visual analysis Clinical Indications for Postural Tests & Measures Abnormal bony alignment Impaired aerobic capacity Impaired joint integrity/mobility Impaired motor function Impaired muscle performance Impaired sensory integrity Pain Ideal Posture lateral view Ear lobe Dens Cervical vertebral bodies Tip of the acromion Mid trunk Lumbar bodies/sacral promontory Greater trochanter Slightly anterior to knee Slightly anterior to lateral malleolus 2
Ideal Posture Muscle Balance Cervical Spine Thoracic Spine Lumbar Spine Hips Knees Ankle Abdominals Hip Flexors Erector Spinae Hip Extensors Poor Posture (AAOS 1947) Poor Posture Increases strain on supporting structures (ie, ligaments, cartilage, bone-tendon interface, etc) Less efficient balance of body over its base of support Alteration of the normal arthokinematics/kinetics of affected joints irrespective of position (eg, standing erect, lying, squatting, etc) Anatomic impairments Physiologic impairments Psychosocial impairments Bony structure abnormalities Habitual Posturing Development of Posture Lordosis A marked anterior pelvic tilt A marked lordosis Marked anterior pelvic tilt and lordosis 3
Hyperlordotic and Kypholordotic Kypholordotic Posture : forward C-spine: hyperextended : abducted T spine: flexion L spine: hyperextended : anterior tilt Hips: flexed Knees: slightly hyperextended Ankles: slight plantar flexion Military Type Sway Back : neutral C-spine: normal, slightly anterior T spine:normal, slightly posterior L spine: hyperextended lordosis : anterior tilt Knees: slightly hyperextended Ankles: slightly plantar flexed : forward C-spine: slightly extended T spine: flexion L spine: flexion, flattening : posterior tilt Hips: hyperextended Knees: hyperextended Ankles: neutral Sway Back and Flat Back Flat Back : forward C-spine: slightly extended T spine: flexion upper part, lower part, straight L spine: flexed, straight : posterior tilt Hips: extended Knees: extended Ankles: slight plantar flexion 4
Ideal Alignment: Posterior View Faulty Alignment: Posterior View Cervical Spine Thoracic Spine Lumbar Spine Hips C spine T and L spine Hips joints Faulty Alignment: Posterior View Faulty Postures: Side & Back Views C spine T and L spine Hips joints Figure A; posture appears good from the posterior view but is faulty from the side Figure B faulty posture both front and side views Anterior View Measuring Leg Length Lower Extremity Torso Shoulder and Neck Structural Leg Length Test (or true ): measure from ASIS to medial malleolus Functional Leg Length Test (or apparent): measure from medial malleolus to umbilicus 5